0819 Does Sleep Health Modify the Relationship Between Hypertensive Disorders of Pregnancy and Incident Cardiovascular Disease?

Abstract

Abstract Introduction With pregnancy considered a cardiovascular “stress test”, adverse pregnancy outcomes (APOs), such as gestational hypertension, have been associated with higher risk of poor cardiometabolic health later in life. Sleep has been identified as a contributor to cardiometabolic health; however, few studies have considered how sleep may affect APO-associated cardiovascular disease risk. Methods To investigate sleep health during middle-to-older adulthood as a potential modifier of longitudinal associations between hypertensive disorders of pregnancy (HDP) and CVD incidence, we used data collected from 32,313 parous women (mean±SD age 55±8.9 years) without prior CVD in the Sister Study (enrollment: 2003-2009; n=1,407 Hispanic/Latina, n=2,411 non-Hispanic (NH)-Black, n=27,683 NH-White, and n=812 another race/ethnicity). Report of physician-diagnosed CVD or death from CVD (i.e., heart failure, myocardial infarction, stroke) was collected over follow-up until October 2020. At enrollment, participants reported a history of HDP (i.e., gestational hypertension, preeclampsia, eclampsia) and current sleep health characteristics (i.e., short (< 7 hours) habitual sleep duration, frequent napping, insomnia symptoms; all yes vs. no). Adjusting for sociodemographic, health behavior, and clinical characteristics, Cox proportional hazards regressions estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD among participants with vs. without history of HDP. Wald tests assessed HDP*sleep characteristics interactions. Results Overall, 11% of women reported a history of HDP, and prevalence varied by racial/ethnic group (14% among NH-Black and Latina, 12% another race/ethnicity, 11% NH-White). Poor sleep characteristics were prevalent and more frequent among participants with a history of HDP (e.g., insomnia symptoms: 46% vs. 43% [no HDP]). Over a mean±SD 12±3.0 years of follow-up, there were 1,658 new cases of CVD. After adjustment, the association between HDP and higher risk of CVD (HR=1.40 [95% CI:1.22-1.60]) did not differ between participants with poor vs. non-poor sleep (all p-interactions > 0.05; e.g., short sleep: HRyes=1.41 [1.11-1.79] and HRno=1.34 [1.13-1.59]). Conclusion Using subjective measures, poor sleep during middle-to-older age did not appear to exacerbate risk of CVD associated with HDP. Future studies that include multiple dimensions of objective sleep measured over the life course are warranted to better elucidate how sleep health among parous women may impact CVD risk. Support (if any) NIEHS (Z1AES103325[CLJ] and Z01ES044005 [DPS])