Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2017; 9(5): 396-406
Published online May 26, 2017. doi: 10.4330/wjc.v9.i5.396
Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults
Jill L Kaar, Christina M Luberto, Kirsti A Campbell, Jeff C Huffman
Jill L Kaar, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, United States
Christina M Luberto, Kirsti A Campbell, Jeff C Huffman, Department of Psychiatry, Harvard Medical School, Boston, MA 02115, United States
Christina M Luberto, Kirsti A Campbell, Jeff C Huffman, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: Authors do not have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jeff C Huffman, MD, Department of Psychiatry, Massachusetts General Hospital, Blake 11, 55 Fruit Street, Boston, MA 02114, United States.
Telephone: +1-617-7242910 Fax: +1-617-7249150
Received: January 7, 2017
Peer-review started: January 10, 2017
First decision: February 17, 2017
Revised: March 4, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: May 26, 2017

Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.

Keywords: Sleep, Diet, Physical activity, Cardiovascular disease, Care management

Core tip: This manuscript discusses the link between modifiable health behaviors; including sleep, diet, activity, and their relationship to adult risk for cardiovascular disease. Despite knowing that these behaviors are often interrelated, interventions to date have primarily focused on changing one health behavior vs intervening on multiple behaviors simultaneously. Population health level care management approaches are outlined to aide providers in counseling their patients.