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Integrating sleep and circadian health assessment into cardiac rehabilitation may enhance cardiac recovery, improve exercise tolerance and adherence, and support comprehensive secondary prevention.

This narrative review argues that systematic assessment and management of sleep and circadian health are underutilized in cardiac rehabilitation (CR) programs, despite evidence linking sleep disorders and circadian disruption to impaired cardiac recovery and increased adverse events. The authors propose practical strategies including sleep screening, sleep hygiene education, and chronotype-informed exercise scheduling, which may improve CR outcomes. No quantitative effect sizes are provided as this is a narrative review.

Last updated: Aug 13, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score32/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Integrating sleep and circadian health into cardiac rehabilitation: A narrative review and practical framework for implementation.

observational

Ghram A, Loureiro Diaz J, Laukkanen JA, Kunutsor SK, Lippi G, Terada T, Covassin N, Hautala AJ, Kaddoura R, Pescatello LS, Bonikowske AR, Somers VK, Weiss K, Knechtle B, Hedaya L, Akbar Z, Ozemek C, Niebauer J, Biondi-Zoccai G, Abuenjelh AMA, Elrayess MA, Chamari K, Natarajan S, Contiga Mahinay M, Contreras N, Aladab A, Papasavvas T, Moholdt T, Sandbakk Ø, BaHammam AS, Lavie CJ, Ben Saad H · Sleep medicine reviews (2026)

Participants: N/A
Duration: N/A
Intervention: Proposed integration of sleep and circadian health assessment and management into cardiac rehabilitation programs
Outcome: Cardiac recovery, exercise tolerance and adherence, secondary prevention comprehensiveness
Effect Size: N/A
Population: Patients undergoing cardiac rehabilitation

Result:

PubMed: 42551177DOI: 10.1016/j.smrv.2026.102349

Mechanism Graph

Sleep disorders (e.g., OSA, CSA, insomnia) are common in CR patients and may impair recovery
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Sleep screening and management are currently underutilized in CR
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Implementing sleep-circadian strategies (e.g., screening, education, chronotype-informed scheduling) addresses this gap
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Improved sleep health may enhance cardiac recovery, exercise adherence, and personalized prevention

Limitations

  • ⚠Narrative review without systematic search or quantitative synthesis
  • ⚠No empirical data presented; conclusions are based on existing literature and expert opinion
  • ⚠Practical implementation strategies are not tested in a clinical trial

Frequently Asked Questions

What sleep disorders are commonly seen in cardiac rehabilitation patients?▼

Obstructive sleep apnea, central sleep apnea, and insomnia are commonly encountered and may adversely affect CR participation and outcomes.

What practical strategies are suggested for integrating sleep health into CR?▼

Routine sleep screening with validated tools, selective use of objective sleep assessments, sleep hygiene education, chronotype-informed exercise scheduling, and referral pathways to sleep medicine specialists.

How might artificial intelligence help in this context?▼

AI may support early detection of sleep disturbances, individualized exercise prescription, remote monitoring, and precision CR approaches integrating sleep and circadian health.

Is this a systematic review or meta-analysis?▼

No, it is a narrative review, so it does not provide quantitative effect sizes or pooled data.

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References

  1. 1.Ghram A, Loureiro Diaz J, Laukkanen JA, Kunutsor SK, Lippi G, Terada T, Covassin N, Hautala AJ, Kaddoura R, Pescatello LS, Bonikowske AR, Somers VK, Weiss K, Knechtle B, Hedaya L, Akbar Z, Ozemek C, Niebauer J, Biondi-Zoccai G, Abuenjelh AMA, Elrayess MA, Chamari K, Natarajan S, Contiga Mahinay M, Contreras N, Aladab A, Papasavvas T, Moholdt T, Sandbakk Ø, BaHammam AS, Lavie CJ, Ben Saad H. "Integrating sleep and circadian health into cardiac rehabilitation: A narrative review and practical framework for implementation.." Sleep medicine reviews, 2026. PMID: 42551177 DOI: 10.1016/j.smrv.2026.102349
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.