Association between short and long sleep durations and cardiovascular outcomes: a systematic review and meta-analysis

Krittanawong, Chayakrit; Tunhasiriwet, Anusith; Wang, Zhen; Zhang, Hongju; Farrell, Ann; Chirapongsathorn, Sakkarin; Sun, Tao; Kitai, Takeshi; Argulian, Edgar

doi:10.1177/2048872617741733

Cited by 94 publications

(86 citation statements)

References 36 publications

(34 reference statements)

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“…With CVD mortality, we also observed a similar nonsignificant positive association (27% increased CVD mortality) with long sleep. Our findings somewhat disagree with previous studies [ 18 , 22 , 30 , 38 , 39 ] which reported an increased CVD mortality associated with both short and long sleep. As a previous meta-analysis found a positive association with short sleep when specific CVD type (stroke, coronary heart disease) was examined but not when total CVD was examined [ 40 ], the association with short sleep may be specific to certain CVD type.…”

Section: Discussioncontrasting

confidence: 99%

Sleep duration and mortality in Korean adults: a population-based prospective cohort study

Kwon

Lee

et al. 2020

BMC Public Health

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Background Increasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer. However, the relationship with mortality is not clear, particularly in non-European populations. In this study, we investigated the association between sleep duration and mortality in a population-based prospective cohort of Korean adults. Methods This analysis included 34,264 participants (14,704 men and 19,560 women) of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2013 who agreed to mortality follow-up through December 31, 2016. Sleep duration was self-reported at baseline and was categorized into four groups: ≤4, 5–6, 7–8, and ≥ 9 h/day. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations with mortality (all-cause as well as CVD- and cancer-specific), adjusting for potential confounders. Results During up to 9.5 years of follow-up, we identified a total of 1028 deaths. We observed the lowest mortality at 5–6 h/day sleep. Compared with 7–8 h/day of sleep, short (≤4 h/day) and long (≥9 h/day) sleep were associated with a 1.05-fold (95% CI = 0.79–1.39) and 1.47-fold (95% CI = 1.15–1.87) higher all-cause mortality, respectively. After additional adjustment for self-rated health, the positive association with short sleep disappeared (HR = 0.99, 95% CI = 0.75–1.32) and the association with long sleep was slightly attenuated (HR = 1.38, 95% CI = 1.08–1.76). Long sleep was also nonsignificantly positively associated with both cancer-mortality (HR = 1.30, 95% CI = 0.86–1.98) and CVD-mortality (HR = 1.27, 95% CI = 0.73–2.21). There was no statistically significant evidence for nonlinearity in the relationships between sleep duration and mortality (all-cause as well as CVD- and cancer-specific). Effect modification by age, sex, education, and occupation were not statistically significant. Conclusions Our findings suggest that long sleep duration is associated with an increased all-cause mortality in Korean adults.

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Section: Discussioncontrasting

confidence: 99%

Sleep duration and mortality in Korean adults: a population-based prospective cohort study

Kwon

Lee

et al. 2020

BMC Public Health

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“…Wang et al [ 8 ] also did not find an association between anaemia, diabetes, and short and/or long sleep. This study did not confirm findings from previous studies on the association between hypertension, diabetes mellitus, ischemic heart disease, COPD, multimorbidity, and short sleep [ 5 , 6 , 7 , 8 , 9 , 10 ], and the association between hypertension, diabetes, cardiovascular disease, hyperlipidaemia, cerebrovascular diseases, multi-morbidity, and long sleep [ 4 , 8 , 9 , 11 , 12 , 13 ]. The lack of associations found in this study may be attributed to the low prevalence of short sleep and very high prevalence of long sleep.…”

Section: Discussioncontrasting

confidence: 99%

“…Regarding specific chronic conditions, this study only found an association between myocardial infarction and long sleep and in an unadjusted analysis, cataracts and short sleep, while there no associations for anaemia, angina, chronic bronchitis, diabetes, dyslipidaemia, heart failure, hypertension, kidney disease, stroke, HIV, and TB. Various studies have confirmed the relationship between cardiovascular conditions such as myocardial infarction with long sleep [ 4 , 8 , 9 , 10 , 11 , 12 , 13 ]. In a study in Ghana, sleep duration was also not associated with the prevalence of cardiovascular disorders [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Short sleep duration (≤6 h) has been linked with negative health outcomes, including cardiovascular diseases, ischemic heart disease, hypertension, diabetes mellitus, poor mental health, chronic obstructive pulmonary disease (COPD), chronic gastroenteritis/peptic ulcer, multimorbidity, and mortality [ 5 , 6 , 7 , 8 , 9 , 10 ]. There has also been evidence that links a long sleep duration (≥9 h over a 24 h period) in adults and older adults with morbidity (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular diseases, stroke, atrial fibrillation, poor general health, poor mental health, hyperlipidemia, urolithiasis, multi-morbidity) and mortality [ 4 , 8 , 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Self-Reported Sleep Duration and Its Correlates with Sociodemographics, Health Behaviours, Poor Mental Health, and Chronic Conditions in Rural Persons 40 Years and Older in South Africa

Peltzer

Pengpid

2018

IJERPH

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This study aims to investigate sleep duration and its association with sociodemographic, health behaviour, mental health, and chronic disease factors among rural individuals 40 years and older in South Africa. Cross-sectional data from the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa” (HAALSI) baseline survey were analysed. Socio-demographic, clinical, health, and sleep duration data were collected. The total sample included 4725 persons 40 years and older (mean age 61.5 years, SD = 13.0, age range of 40–111 years) in one sub-district in rural South Africa. The mean sleep duration was 8.28 ± 1.93 h. Short (<7 h) and long (≥9 h) sleepers accounted for 13.1% and 40.0% of the sample, respectively. In adjusted multinomial logistic regression, greater wealth status (p < 0.05), inadequate fruit and vegetable consumption (p < 0.001), and depressive symptoms (p < 0.05) were associated with a higher odds and physical inactivity (p < 0.05) with a lower odds of short sleep duration. Being male (p < 0.001) and depressive symptoms (p < 0.001) were associated with a higher odds and being 50 to 69 years old (p < 0.01), having Grade 1 to 11 education (p < 0.05), and greater wealth status (p < 0.001) were associated with a lower odds of long sleep duration. In adjusted multinomial logistic regression, compared to normal sleepers, long sleepers were more likely to have myocardial infarction (p < 0.05). In unadjusted analysis, compared to normal sleepers, short sleepers were more likely to have cataracts (p < 0.05). This study found that a significant proportion of rural dwellers 40 years and older in South Africa had a short sleep duration and a high proportion had a long sleep duration. Some associations, such as depression and myocardial infarction, with short and/or long sleep duration were confirmed, while no associations were found for many chronic conditions.

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“…However, the evidence supporting this association is not consistent. Some studies have found a link between long or short sleep duration and an increased risk of stroke (6)(7)(8)(9), whereas other studies have claimed no significant association (10,11). These conflicting findings from observational epidemiological studies may be due to differences in the study population, sample size, sleep duration assessment methods, or covariates adjusted in the statistical models.…”

Section: Introductionmentioning

confidence: 98%

Sleep Duration and Stroke: A Mendelian Randomization Study

et al. 2020

Front. Neurol.

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Study Objectives: To clarify the effects of sleep duration on stroke and stroke subtypes, we adopted a Mendelian randomization (MR) approach to evaluate their causal relationship. Methods: A genome-wide association study including 446,118 participants from UK biobank was used to identify instruments for short sleep, long sleep and sleep duration. Summary-level data for all stroke, ischemic stroke, intracerebral hemorrhage, and their subtypes were obtained from meta-analyses conducted by the MEGASTROKE consortium. MR analyses were performed using the inverse-variance-weighted method, weighted median estimator, MR pleiotropy residual sum and outlier (MR-PRESSO) test, and MR-Egger regression. Sensitivity analyses were further performed using leave-one-out analysis, MR-PRESSO global test and Cochran's Q test to verify the robustness of our findings. Results: By two-sample MR, we didn't find causal associations between sleep duration and risk of stroke. However, in the subgroup analysis, we found weak evidence for short sleep in increasing risk of cardio-embolic stroke (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.11-1.60; P = 0.02) and long sleep in increasing risk of large artery stroke [OR, 1.41; 95% CI, 1.02-1.95; P = 0.04]. But the associations were not significant after Bonferroni correction for multiple comparisons. Conclusions: Our study suggests that sleep duration is not causally associated with risk of stroke and its subtypes.

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Association between short and long sleep durations and cardiovascular outcomes: a systematic review and meta-analysis

Cited by 94 publications

References 36 publications

Sleep duration and mortality in Korean adults: a population-based prospective cohort study

Sleep duration and mortality in Korean adults: a population-based prospective cohort study

Self-Reported Sleep Duration and Its Correlates with Sociodemographics, Health Behaviours, Poor Mental Health, and Chronic Conditions in Rural Persons 40 Years and Older in South Africa

Sleep Duration and Stroke: A Mendelian Randomization Study

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