From Life’s Simple 7 to Life’s Essential 8: How Sleep Disorders Shape Cardiovascular Risk

Cardiovascular disease remains the leading cause of death in the US, and in 2022, the American Heart Association unveiled the “Life's Essential 8” framework that introduced sleep as a core metric alongside blood pressure, cholesterol, glucose, weight, diet, physical activity, and nicotine exposure.^1,2 The addition reflected a growing body of evidence that sleep quality and duration independently influence cardiovascular risk, not merely through their effects on traditional risk factors but as a distinct contributor to heart disease.

Obstructive sleep apnea has long been recognized by primary care physicians as a cardiovascular risk factor. Less established in clinical practice is the relationship between heart disease and other sleep disorders, including insomnia, restless leg syndrome, and narcolepsy. Epidemiologic data link narcolepsy and insomnia with documented short sleep duration to poorer cardiovascular outcomes, with emerging evidence implicating restless leg syndrome as well, though much of this evidence remains retrospective.

"All of those traditional cardiovascular risk factors are significantly influenced by sleep quality and sleep duration, and sleep itself can be an independent risk factor for heart disease," Virend Somers, MD, PhD, the Alice Sheets Marriott Professor of Cardiovascular Medicine at Mayo Clinic, said to Patient Care Online in an interview at SLEEP 2026 in Baltimore. Somers noted that prospective studies are still needed to confirm these associations, along with trials demonstrating that treating sleep disorders improves cardiovascular outcomes rather than simply correlating with them.

At SLEEP 2026, Somers presented a session connecting Life's Essential 8 to sleep disorders beyond obstructive sleep apnea, outlining what primary care clinicians should understand about this evolving evidence base. In the above interview, Somers discusses the cardiovascular implications of insomnia, restless leg syndrome, and narcolepsy, and where sleep medicine research is headed next.

References:

1. Centers for Disease Control and Prevention. Heart Disease Facts. CDC. Updated October 24, 2024. Accessed June 19, 2026. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
2. Lloyd-Jones DM, Allen NB, Anderson CAM, et al, on behalf of the American Heart Association. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146:e18-e43. doi:10.1161/CIRCULATIONAHA.122.060911