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

Chuangshi Wang, Shrikant I. Bangdiwala, Sumathy Rangarajan, Scott A. Lear, Khalid F. AlHabib, Viswanathan Mohan, Koon Teo, Paul Poirier, Lap Ah Tse, Zhiguang Liu, Annika Rosengren, Rajesh Kumar, Patricio Lopez-Jaramillo, Khalid Yusoff, Nahed Monsef, Vijayakumar Krishnapillai, Noor Hassim Ismail, Pamela Seron, Antonio L. Dans, Lanthé KrugerKaren Yeates, Lloyd Leach, Rita Yusuf, Andres Orlandini, Maria Wolyniec, Ahmad Bahonar, Indu Mohan, Rasha Khatib, Ahmet Temizhan, Wei Li, Salim Yusuf

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self- and results 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.

Original languageEnglish
Pages (from-to)1620-1629
Number of pages10
JournalEuropean Heart Journal
Volume40
Issue number20
DOIs
Publication statusPublished - 1 May 2019

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Sleep
Mortality
Health Status
Life Style
Demography

Keywords

  • Cardiovascular diseases
  • Mortality
  • Naps
  • Sleep duration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of estimated sleep duration and naps with mortality and cardiovascular events : A study of 116 632 people from 21 countries. / Wang, Chuangshi; Bangdiwala, Shrikant I.; Rangarajan, Sumathy; Lear, Scott A.; AlHabib, Khalid F.; Mohan, Viswanathan; Teo, Koon; Poirier, Paul; Tse, Lap Ah; Liu, Zhiguang; Rosengren, Annika; Kumar, Rajesh; Lopez-Jaramillo, Patricio; Yusoff, Khalid; Monsef, Nahed; Krishnapillai, Vijayakumar; Ismail, Noor Hassim; Seron, Pamela; Dans, Antonio L.; Kruger, Lanthé; Yeates, Karen; Leach, Lloyd; Yusuf, Rita; Orlandini, Andres; Wolyniec, Maria; Bahonar, Ahmad; Mohan, Indu; Khatib, Rasha; Temizhan, Ahmet; Li, Wei; Yusuf, Salim.

In: European Heart Journal, Vol. 40, No. 20, 01.05.2019, p. 1620-1629.

Research output: Contribution to journalArticle

Wang, C, Bangdiwala, SI, Rangarajan, S, Lear, SA, AlHabib, KF, Mohan, V, Teo, K, Poirier, P, Tse, LA, Liu, Z, Rosengren, A, Kumar, R, Lopez-Jaramillo, P, Yusoff, K, Monsef, N, Krishnapillai, V, Ismail, NH, Seron, P, Dans, AL, Kruger, L, Yeates, K, Leach, L, Yusuf, R, Orlandini, A, Wolyniec, M, Bahonar, A, Mohan, I, Khatib, R, Temizhan, A, Li, W & Yusuf, S 2019, 'Association of estimated sleep duration and naps with mortality and cardiovascular events: A study of 116 632 people from 21 countries', European Heart Journal, vol. 40, no. 20, pp. 1620-1629. https://doi.org/10.1093/eurheartj/ehy695
Wang, Chuangshi ; Bangdiwala, Shrikant I. ; Rangarajan, Sumathy ; Lear, Scott A. ; AlHabib, Khalid F. ; Mohan, Viswanathan ; Teo, Koon ; Poirier, Paul ; Tse, Lap Ah ; Liu, Zhiguang ; Rosengren, Annika ; Kumar, Rajesh ; Lopez-Jaramillo, Patricio ; Yusoff, Khalid ; Monsef, Nahed ; Krishnapillai, Vijayakumar ; Ismail, Noor Hassim ; Seron, Pamela ; Dans, Antonio L. ; Kruger, Lanthé ; Yeates, Karen ; Leach, Lloyd ; Yusuf, Rita ; Orlandini, Andres ; Wolyniec, Maria ; Bahonar, Ahmad ; Mohan, Indu ; Khatib, Rasha ; Temizhan, Ahmet ; Li, Wei ; Yusuf, Salim. / Association of estimated sleep duration and naps with mortality and cardiovascular events : A study of 116 632 people from 21 countries. In: European Heart Journal. 2019 ; Vol. 40, No. 20. pp. 1620-1629.
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abstract = "Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self- and results 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.",
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T1 - Association of estimated sleep duration and naps with mortality and cardiovascular events

T2 - A study of 116 632 people from 21 countries

AU - Wang, Chuangshi

AU - Bangdiwala, Shrikant I.

AU - Rangarajan, Sumathy

AU - Lear, Scott A.

AU - AlHabib, Khalid F.

AU - Mohan, Viswanathan

AU - Teo, Koon

AU - Poirier, Paul

AU - Tse, Lap Ah

AU - Liu, Zhiguang

AU - Rosengren, Annika

AU - Kumar, Rajesh

AU - Lopez-Jaramillo, Patricio

AU - Yusoff, Khalid

AU - Monsef, Nahed

AU - Krishnapillai, Vijayakumar

AU - Ismail, Noor Hassim

AU - Seron, Pamela

AU - Dans, Antonio L.

AU - Kruger, Lanthé

AU - Yeates, Karen

AU - Leach, Lloyd

AU - Yusuf, Rita

AU - Orlandini, Andres

AU - Wolyniec, Maria

AU - Bahonar, Ahmad

AU - Mohan, Indu

AU - Khatib, Rasha

AU - Temizhan, Ahmet

AU - Li, Wei

AU - Yusuf, Salim

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self- and results 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.

AB - Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self- and results 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.

KW - Cardiovascular diseases

KW - Mortality

KW - Naps

KW - Sleep duration

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