Objective Assessment of Daytime Napping and Incident Heart Failure in 1140 Community‐Dwelling Older Adults: A Prospective, Observational Cohort Study

Abstract

Background Disrupted nighttime sleep has been associated with heart failure (HF). However, the relationship between daytime napping, an important aspect of sleep behavior commonly seen in older adults, and HF remains unclear. We sought to investigate the association of objectively assessed daytime napping and risk of incident HF during follow‐up. Methods and Results We studied 1140 older adults (age, 80.7±7.4 [SD] years; female sex, 867 [76.1%]) in the Rush Memory and Aging Project who had no HF at baseline and were followed annually for up to 14 years. Motor activity (ie, actigraphy) was recorded for ≈10 days at baseline. We assessed daytime napping episodes between 9 am and 7 pm objectively from actigraphy using a previously published algorithm for sleep detection. Cox proportional hazards models examined associations of daily napping duration and frequency with incident HF. Eighty‐six participants developed incident HF, and the mean onset time was 5.7 years (SD, 3.4; range, 1–14). Participants who napped longer than 44.4 minutes (ie, the median daily napping duration) showed a 1.73‐fold higher risk of developing incident HF than participants who napped <44.4 minutes. Consistently, participants who napped >1.7 times/day (ie, the median daily napping frequency) showed a 2.20‐fold increase compared with participants who napped <1.7 times/day. These associations persisted after adjustment for covariates, including nighttime sleep, comorbidities, and cardiovascular disease/risk factors. Conclusions Longer and more frequent objective napping predicted elevated future risk of developing incident HF. Future studies are needed to establish underlying mechanisms.

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…In the Rush Memory and Aging Project, daytime napping in older adults (81.4±7.5 years of age) was associated with higher risk of HF (per 1-SD increase in square root–transformed nap duration: HR, 1.38 [95% CI, 1.12–1.69]; frequency >1.7 times per day: HR, 2.20 [95% CI, 1.41–3.46]). 41…”

Association of longitudinal patterns of nighttime sleep duration and daytime napping duration with risk of multimorbidity

“…So far, there are few studies on daytime nap patterns and multimorbidity, but a recent study found that individuals with the high-concave daytime napping duration pattern had a higher risk of hypertension, compared with individuals with a low-stable napping duration pattern [20]. Past studies have found the association of baseline daytime napping duration with metabolic syndrome [31], stroke [32], heart failure [33]. In contrast, a meta-analysis of cohort studies only found an association between daytime napping duration and cardiovascular in women crowds [34].…”

Daytime napping and Alzheimer's dementia: A potential bidirectional relationship

“…Finally, there could be unmeasured comorbidities that affect both daytime sleep and cognition, for example, sleep apnea 44 . The MAP has started collecting sleep apnea risk scores (Berlin Questionnaire) since 2013, and only few MAP participants had this score available at the time of analysis (i.e., <300 participants) 45 . This can be further examined later when new data become available.…”