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Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries

Wang C 1 , Bangdiwala SI 1 , Rangarajan S 1 , Lear SA 2 , AlHabib KF 3 , Mohan V 4 Show all authors , Teo K 1 , Poirier P 5 , Tse LA 6 , Liu Z 6 , Rosengren A 7 , Kumar R 8 , Lopez-Jaramillo P 9 , Yusoff K 10 , Monsef N 11 , Krishnapillai V 12 , Ismail N 13 , Seron P 14 , Dans AL 15 , Kruger L 16 , Yeates K 17 , Leach L 18 , Yusuf R 19 , Orlandini A 20 , Wolyniec M 21 , Bahonar A 22 , Mohan I 23 , Khatib R 24 , Temizhan A 25 , Li W 26 , Yusuf S 1

Affiliations 

  • 1 Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada
  • 2 Department of Medicine, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
  • 3 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 4 Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, No. 6B, Conran Smith Road, Gopalapuram, Chennai, India
  • 5 Department of Medicine, Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, Québec, Canada
  • 6 Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing Street, Sha Tin, Hong Kong SAR 96H2+9X, China
  • 7 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Diagnosvägen 11, Gothenburg, Sweden
  • 8 Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
  • 9 Research Institute, FOSCAL, Department of Medicine, Medical School, UDES, Calle 158 #20-95, local 101-102, Floridablanca, Colombia
  • 10 Department of Medicine, UiTM Selayang, 40450 Shah Alam, Selangor Darul Ehsan, Malaysia, and UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
  • 11 Dubai Health Authority, Al Maktoum Bridge Street, Bur Dubai Area 4545, Dubai, United Arab Emirates
  • 12 Health Action by People, Thiruvananthapuram and Community Medicine, Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara P. O., Kochi, Kerala, India
  • 13 Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Selangor, Malaysia
  • 14 Department of Medicine, Universidad de La Frontera, Francisco Salazar 1145, Temuco, Regiæn de la Araucanía, Chile
  • 15 Department of Medicine, UP College of Medicine, University of the Philippines Manila, Padre Faura Street, Ermita, Manila, Metro Manila, Philippines
  • 16 Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Private Bag X2046 Mmabatho, South Africa
  • 17 Department of Medicine, Queen's University, Office of Global Health Research, 99 University Avenue, Kingston, Ontario, Canada
  • 18 Department of Medicine, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, South Africa
  • 19 School of Life Sciences, Independent University, Academic Building, Room 10002, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka-1229, Bangladesh
  • 20 ECLA Foundation, Paraguay 160, Rosario, Santa Fe, Argentina
  • 21 Department of Social Medicine, Medical University of Wrocław, Bujwida 44 Street, 50-345 Wrocław, Poland
  • 22 Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Avenue, Isfahan 81746 73461, Iran
  • 23 Department of Clinical Research, EHCC, Jawahar Circle, Jaipur, India
  • 24 Departments of Neurology, Northwestern University Feinberg School of Medicine, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL, USA
  • 25 Department of Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, University of Saglik Bilimleri, Tıbbiye Cd No. 38, Selimiye Mahallesi, 34668 Üsküdar/İstanbul, Turkey
  • 26 Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Room 101-106, Block A, Shilong West Road, Mentougou District, Beijing, China
Eur Heart J, 2019 05 21;40(20):1620-1629.
PMID: 30517670 DOI: 10.1093/eurheartj/ehy695

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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