M SLEEP 7

Association of Estimated Sleep Duration and Naps With Mortality and Cardiovascular Events

European Heart Journal

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• This analysis used questionnaire data from the international PURE study to examine the association between sleeping patterns and cardiovascular events in 116,632 people from high-, middle-, and low-income countries. Based on analysis of self-reported data over a median follow-up of 7.8 years that was adjusted by age and gender, individuals with relatively long (>8 hours per day) and relatively short (≤6 hours per day) estimated total sleep durations had a higher risk of a composite outcome of major cardiovascular outcomes. However, an additional analysis that was adjusted for lifestyle behaviors, health status, and demographic characteristics found a significant trend for a greater risk of the composite outcome for those with sleep durations of more than 9 hours per day and a nonsignificant trend for greater risk for those who had 6 or fewer total hours of daily sleep.
• These findings suggest that there is a lower risk of major cardiovascular events and deaths in people who have 6 to 8 hours of total daily sleep.

Abstract

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AIMS

To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events.

METHODS AND RESULTS

We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6-8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99-1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99-1.12), 1.17 (1.09-1.25), and 1.41 (1.30-1.53) for 8-9 h/day, 9-10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h).

CONCLUSION

Estimated total sleep duration of 6-8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.