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

TY - JOUR

T1 - Self-Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality

T2 - A Dose-Response Meta-Analysis

AU - Kwok, Chun Shing

AU - Kontopantelis, Evangelos

AU - Kuligowski, George

AU - Gray, Matthew

AU - Muhyaldeen, Alan

AU - Gale, Christopher P.

AU - Peat, George M.

AU - Cleator, Jacqueline

AU - Chew-Graham, Carolyn

AU - Loke, Yoon Kong

AU - Mamas, Mamas Andreas

PY - 2018/8/7

Y1 - 2018/8/7

N2 - Background: There is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality.Methods and Results: We conducted a systematic review, meta-analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We utilized linear and nonlinear dose-response meta-analysis models and used DerSimonian-Laird random-effects meta-analysis models of risk ratios, with inverse variance weighting, and the I 2 statistic to quantify heterogeneity. Seventy-four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose-response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self-reported duration of sleep >8 hours was associated with a moderate increased risk of all-cause mortality, with risk ratio, 1.14 (1.05-1.25) for 9 hours, risk ratio, 1.30 (1.19-1.42) for 10 hours, and risk ratio, 1.47 (1.33-1.64) for 11 hours. No significant difference was identified for periods of selfreported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09-1.90), but no difference in mortality and other outcomes.Conclusions: Divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.

AB - Background: There is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality.Methods and Results: We conducted a systematic review, meta-analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We utilized linear and nonlinear dose-response meta-analysis models and used DerSimonian-Laird random-effects meta-analysis models of risk ratios, with inverse variance weighting, and the I 2 statistic to quantify heterogeneity. Seventy-four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose-response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self-reported duration of sleep >8 hours was associated with a moderate increased risk of all-cause mortality, with risk ratio, 1.14 (1.05-1.25) for 9 hours, risk ratio, 1.30 (1.19-1.42) for 10 hours, and risk ratio, 1.47 (1.33-1.64) for 11 hours. No significant difference was identified for periods of selfreported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09-1.90), but no difference in mortality and other outcomes.Conclusions: Divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.

KW - Cardiac risk factors

KW - Coronary artery disease

KW - Meta-analysis

KW - Prevention

UR - https://www.scopus.com/pages/publications/85051439177

U2 - 10.1161/JAHA.118.008552

DO - 10.1161/JAHA.118.008552

M3 - Article

C2 - 30371228

SN - 2047-9980

VL - 7

SP - 1

EP - 26

JO - Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease (JAHA)

JF - Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease (JAHA)

IS - 15

M1 - e008552

ER -