Sleep Duration and Mortality in Patients With Coronary Artery Disease

Abstract

Extremes in sleep duration are associated with higher cardiovascular risk in the general population, but their impact in patients with documented coronary artery disease (CAD) remains unknown and potentially of clinical significance. We hypothesized that both short and long sleep duration are associated with higher mortality in CAD. We inquired about sleep durations in 2,846 patients enrolled in the Emory Cardiovascular Biobank (mean age 64 years, 38% female, 23% Black, and 82% with obstructive CAD, defined by positive coronary angiography), who were then followed for all-cause and cardiovascular mortality. Multivariate Cox proportional hazard models were calculated to examine the association of sleep duration and mortality. Sleep durations of <6.5 hours (short), ≥6.5 to <7.5 hours (normal), and ≥ 7.5 hours (long), were reported by 39%, 26% and 35% of the cohort, respectively. On follow-up (median 2.8 years), mortality rates were 15%, 11%, and 17%, respectively. After adjusting for demographics and risk factors, both short and long sleep duration were associated with higher all-cause mortality (HR 1.44, 95% CI [1.10-1.89] and 1.41 [1.08-1.85], respectively). A similar pattern was demonstrated for cardiovascular mortality only for short (HR 1.48 [1.05-2.09]), but not long sleep duration. In conclusion, in patients with frank CAD, both short and long sleep duration were independently associated with higher all-cause mortality, and short sleep was independently associated with higher cardiovascular mortality. In conclusion, our study is the first to extend the observations of sleep duration and mortality from population-based studies to patients with documented cardiac disease.

Diagnostic and Therapeutic Approach to Sleep Disorders, High Blood Pressure and Cardiovascular Diseases: A Consensus Document by the Italian Society of Hypertension (SIIA)

“…Very little data is available regarding the relationship between sleep duration and cardiovascular events in patients with confirmed cardiovascular disease. Kim et al recently analysed the relationship between sleep duration and risk of events in about three thousand patients with confirmed coronary artery disease included in the “Emory Cardiovascular Biobank” [ 9 ]. Short or long sleep duration has been associated with a significant increase in the risk of death from all causes during an average follow-up of 2.8 years.…”

“…In addition, the expression of more than 700 genes involved in multiple functions, including metabolic control and redox status, is modified by sleep deprivation [4,8]. In parallel, a U-shaped association between sleep duration and all-cause mortality as well as increased cardiovascular risk has been described [9][10][11].…”

Racial disparities in sleep disturbances among patients with and without coronary artery disease: The role of clinical and socioeconomic factors

“…Our group has recently shown that both short and long sleep duration is associated with higher all-cause mortality in both Blacks and non-Blacks with CAD. 60 Future studies are needed to investigate whether higher rates of sleep disturbances among Black adults with MI translate into worse future outcomes. Strengths of this study include the comprehensive phenotyping of both cases and controls across multiple levels, including sociodemographic, medical and psychosocial data, which allowed us to investigate the role of all these factors on racial disparities in sleep.…”

Sleep duration and risk of cardio-cerebrovascular disease: A dose-response meta-analysis of cohort studies comprising 3.8 million participants

“…A limited number of studies examined the overlapping sleep duration for a lower risk of acquiring them. While new papers have been published on this subject in the past 5 years, the findings were inconsistent (4)(5)(6)(7)(8)(9)(10)(11)(12). Thus, through meta-analysis, this research seeks to revise the association of sleep duration with CCDs and unveil the sleep duration range valuable to preventing these diseases.…”