Integrating Sleep and Life’s Essential 8 Into Cardiometabolic Care, With Michael Grandner, PhD

Sleep health earned a formal place in cardiovascular risk assessment when the American Heart Association expanded Life's Simple 7 to Life's Essential 8, elevating sleep alongside blood pressure and cholesterol as a core metric of cardiometabolic health. The change reflects data linking common sleep disorders, including obstructive sleep apnea, restless legs syndrome, insomnia, and narcolepsy, to elevated cardiovascular and metabolic risk. Insomnia specifically is associated with new-onset hypertension, weight gain, disrupted glucose metabolism, elevated A1c, type 2 diabetes, and increased risk of myocardial infarction and stroke, effects that appear to operate independently of total sleep time through pathways including sympathetic activation and systemic inflammation.

Despite this burden, the majority of sleep disorders go undiagnosed in primary care settings, in part because sleep is rarely emphasized in medical training. Screening tools can help close that gap: the STOP-BANG questionnaire flags typical risk factors for sleep apnea, though women with the condition often present atypically with daytime fatigue or nighttime awakenings rather than classic symptoms. Validated multi-disorder screeners, such as SleepHealthScreen.com, allow patients to complete an assessment in the waiting room and share results with clinicians without requiring providers to memorize which symptoms map to which conditions.

"Sleep issues are common. They're something that lots of people can relate to, and addressing sleep issues can help address other problems as well," said Michael Grandner, PhD, director of the Sleep and Health Research Program and the Behavioral Sleep Medicine Clinic, and assistant professor of psychiatry, psychology, and medicine at the University of Arizona.

For referrals, Grandner points primary care clinicians toward the American Academy of Sleep Medicine's directory for accredited sleep centers, and the Society of Behavioral Sleep Medicine or CBTI directory for insomnia-focused behavioral providers. In the following interview, recorded at SLEEP 2026 in Baltimore, Grandner discusses how primary care physicians can better identify and triage sleep disorders in everyday visits.

References:

1. 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