Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: The Multiethnic Cohort Study

Abstract

Objective To explore an independent association between self-reported sleep duration and cause-specific mortality. Methods Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii. Results Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9 year follow-up. Shorter (≤5 h/day) and longer (≥9 h/day) sleepers of both sexes (vs. 7 h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00-1.28) for ≤5 h/day and 1.22 (95% CI 1.09-1.35) for ≥9 h/day among men; and 1.20 (95% CI 1.05-1.36) for ≤5 h/day and 1.29 (95% CI 1.13-1.47) for ≥9 h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (Phetero 0.53) or among women (Phetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index. Conclusion Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.

Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

“…A total of 74 studies met the inclusion criteria; the process of study selection is shown in Figure 1 8, 9, 11, 12, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89,...…”

“…For the meta‐analysis, there were 7 studies37, 47, 49, 51, 61, 75, 78 (Data S11) and 15 studies**** (Data S12) for CHD mortality and CHD, respectively. Although there were fewer studies, a similar J‐shaped pattern was observed where there was greater risk of CHD mortality and events with incremental deviation from the reference 7 to 8 hours of self‐reported sleep (a modest increase for 6 hours and greater increase for ≤5 hours; Data S10).…”

“…Meta‐analysis of 5 studies27, 47, 49, 51, 65 were included in the analysis of stroke mortality (Data S10). For stroke events, there were 13 studies †.…”

“…** References 11, 21, 23, 25, 26, 27, 29, 32, 33, 34, 36, 39, 40, 41, 44, 46, 47, 48, 49, 51, 52, 53, 54, 56, 57, 61, 64, 66, 68, 70, 71, 72, 77, 79, 80, 84, 86, 87, 88.…”

Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts

“…In a study of US adults (N = 135,685) followed for almost 13 years, shorter (≤5 h/day) and longer (≥9 h/day) sleepers of both sexes had an increased risk (vs. 7 h/day) of all-cause and CVD mortality (Kim et al, 2013). In a prospective study of Dutch adults (N = 20,432) followed for 10-15 years, those reporting short sleep (≤6 h) at baseline were at 15 % greater risk of developing CVD and 23 % greater risk of coronary heart disease (CHD) relative to those sleeping 7 h (Hoevenaar-Blom et al, 2011).…”