International Journal of Epidemiology 2001;30:183
© International Epidemiological Association 2001
Letter to the Editor |
Siesta and coronary artery disease
Sir—I read with interest the article from Costa Rica which suggested that the practice of siesta is associated with increased risk of myocardial infarction.1 This is the second such provocative article in recent years linking siesta with increased mortality, the first being from Israel.2
These two reports are most controversial, because they are contrary to studies from China3 and Greece,4,5 all of which showed a protective action of siesta against coronary artery disease. Sleep is an important part of life. One feature of populations with a low incidence of coronary artery disease, as in China, is the afternoon nap or siesta as they call it in Spain and Latin American countries. It has been an age-old custom for Chinese of all ages, especially the elderly population, to take an afternoon nap. As a matter of fact, it is almost impossible to reach anyone in the Chinese Embassy in Washington DC between noon and 2 p.m. because everybody is supposed to be napping.6 The afternoon nap represents an important stress-coping mechanism that can provide protection against coronary artery disease.6
It should be noted that all the subjects in the Costa Rican study were survivors of myocardial infarction rather than healthy normal subjects. Perhaps these myocardial infarction survivors had other confounding factors, such as sleep apnoea syndrome,1,2 that may play a role. It is also possible that a genetic predisposition to siesta7 may be another confounding factor.
Therefore, until the authors from Costa Rica can produce their findings in healthy subjects, an afternoon nap should continue to be viewed as a ‘healthy and natural activity’8 that should be encouraged. As Noel Coward remarked, in hot climates, only ‘mad dogs and Englishmen go out in the midday sun’, while the locals ‘seemed hardwired to take an afternoon siesta’.7
Notes
George Washington University, Washington DC, 20037, USA.
References
1
Campos H, Siles X. Siesta and the risk of coronary heart disease: results from a population-based, case-control study in Costa Rica. Int J Epidemiol 2000;29:429–37.
2
Bursztyn M, Ginsburg G, Hammerman-Rozenberg R, Stessman J. The siesta in the elderly: risk factor for mortality? Arch Intern Med 1999; 159:1582–86.
3 Liu RX. A pathway analysis of risk factors in relation to coronary heart disease. Chin J Prev Med 1993;27:165–68.
4 Trichopoulos D, Tzonou A, Christopoulos C, Havatzoglou S, Trichopoulos A. Does a siesta protect from coronary heart disease? Lancet 1987;2:269–70.
5
Kalandidi A, Tzonou A, Toupadaki N et al. A case-control study of coronary heart disease in Athens, Greece. Int J Epidemiol 1992;21: 1074–80.
6
Cheng TO. Afternoon nap is good for the elderly. Arch Intern Med 2000;160:711.
7 Blau J, Rothenfluh A. Siesta-time is in the genes. Neuron 1999; 24:4–5.[ISI][Medline]
8 Mulcahy D, Wright C, Sparrow J et al. Heart rate and blood pressure consequences of an afternoon SIESTA (Snooze-Induced Excitation of Sympathetic Triggered Activity). Am J Cardiol 1993;71:611–14.[ISI][Medline]
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