What is the Link Between Sleep and PAD?

How much sleep do you get each night? What about your patients? Although we know that sleep needs are not the same for all, 7–9 hours per night is a standard recommendation.¹ However, more than one-third of US adults do not meet even the minimum of this sleep goal, and almost half relate frequent daytime sleepiness.¹

A recent Swedish study has suggested that sleeping fewer than 5 hours each night is linked to a 74 percent increased risk of developing peripheral arterial disease (PAD) as compared to sleeping 7–8 hours.² The authors point out that insufficient nighttime sleep and daytime napping have previously been associated with a raised risk of coronary artery disease.²

This research was news to me. I never recall any mention of sleep issues as a contributing factor to arterial disease. I am curious if this emerging research has any bearing on the development of PAD specifically in people with diabetes?

Additional Risk Factors for PAD

People with diabetes are already at an increased risk for PAD. There's an even greater chance of developing PAD if one or more of these additional risk factors are present:³

• overweight/obesity
• physical inactivity
• smoking
• high blood pressure
• high low-density lipoprotein levels (LDL)
• family history of cardiovascular disease, stroke or PAD
• previous history of coronary artery disease (heart attack, angina, angioplasty, or bypass surgery) or stroke³

PAD and the Sleep Cycle

PAD can interrupt the normal sleep cycle in 3 ways. The first is pain or tingling in the feet. The antidote for this is to stand up or hang the feet over the side of the bed. Second, according to Lee Kirksey, MD, a vascular surgeon at the Cleveland Clinic, “There's a clear association between (PAD) and obstructive sleep apnea ....” The periods of apnea and resultant decreases in oxygen saturation can lead to inflammation and potential impact, including scarring, of the arteries throughout the body.⁴ And lastly, around 10–20% of people with PAD also have restless leg syndrome. The propensity leg movement may even wake one from sleep. Although PAD has not been implicated as a cause of restless leg syndrome, they are associated.⁴

The authors of the Swedish study concluded that this bidirectional link between sleep duration and PAD warrants further study.² There is potential for reciprocal impact between the two conditions, including incorporating pain management and physical activity.²

The Question to be Answered

The question to be answered here is to what extent does lack of sleep contribute to PAD or does PAD contribute to the lack of sleep in the patient with diabetes? Podiatrists should lead the way in researching this issue as they are well-trained to evaluate the circulatory condition of their patients with diabetes. The challenge will be to do the research to find out.

Dr. Hinkes is President and Chief Medical Officer of ePrevenir, Inc. He is board certified by the American Board of Foot and Ankle Surgery and is a Fellow of the American College of Foot and Ankle Surgeons and the American Professional Wound Care Association. He is the author of “Healthy Feet for People With Diabetes” and “Keep the Legs You Stand On,” available at www.amazon.com.

References

1. Barry L. Poor sleep may lead to clogged arteries. Audacy. Published March 20, 2023. Accessed March 27, 2023.
 
2. Yuan S, Levin MG, Titova OE, et al. Sleep duration, daytime napping, and risk of peripheral artery disease: multinational cohort and Mendelian randomization studies. Eur Heart J Open. 2023;3(2):oead008.
 
3. American Heart Association. Peripheral artery disease and diabetes. Last reviewed May 4, 2021. Accessed March 27, 2023.

4. Benisek A. Peripheral artery disease and sleep. WebMD. Accessed March 26, 2023.

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