Enhancing the Utility of Sleep-Related Symptoms as Predictors of Poor Cardiovascular Health: A Population Study in Middle-Aged and Older Adults Residing Near the Equator

BACKGROUND: Sleep-related symptoms are known to influence cardiovascular health (CVH), but the relative importance of sleep duration versus quality remains uncertain. This study evaluates whether a combined measure - "satisfactory sleep health," incorporating both adequate sleep duration and good sleep quality - better correlates with CVH status in middle-aged and older adults living near the Equator. METHODS: In this population-based, cross-sectional study, 1781 middle-aged and older adults living in rural villages of coastal Ecuador were assessed for sleep duration and quality using structured interviews and the Pittsburgh Sleep Quality Index (PSQI). Satisfactory sleep health was defined as 7- to 8 h of sleep plus a PSQI score ≤5 points. CVH status was evaluated using the American Heart Association's Life's Simple 7 construct. Multivariate logistic regression models were used to determine the investigated associations, after adjustment for relevant confounders. RESULTS: While adequate sleep duration alone showed no significant association with CVH, good sleep quality, and satisfactory sleep health were inversely associated with poor CVH in unadjusted models. After adjustment for demographics, level of education, and symptoms of depression, satisfactory sleep health was associated with a 21% reduction in the odds of poor CVH status (OR = 0.79; 95% CI = 0.64-0.99; P < 0.05). CONCLUSIONS: A combined assessment of sleep duration and quality provides a more robust predictor of CVH than either component alone. These findings support the inclusion of multidimensional sleep metrics in public health frameworks evaluating cardiovascular risk and highlight their potential utility in guiding targeted prevention strategies.