Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries
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Aims: To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods and results: We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-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, P trend < 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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- Authors
- Wang, C., Bangdiwala, S. I., Rangarajan, S., Lear, S. A., AlHabib, K. F., Mohan, V., Teo, K., Poirier, P., TSE, L. A., Liu, Z., Rosengren, A., Kumar, R., Lopez-Jaramillo, P., Yusoff, K., Monsef, N., Krishnapillai, V., Ismail, N., Seron, P., Dans, A. L., Kruger, L., Yeates, K., Leach, L., Yusuf, R., Orlandini, A., Wolyniec, M., Bahonar, A., Mohan, I., Khatib, R., Temizhan, A., Li, W., & Yusuf, S.
- Affiliations
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Population Health Research Institute (CA)
- Simon Fraser University (CA)
- King Saud University (SA)
- Madras Diabetes Research Foundation (IN)
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Chinese University of Hong Kong (HK)
- Sahlgrenska University Hospital (SE)
- Post Graduate Institute of Medical Education and Research (IN)
- Research Institute, FOSCAL, Department of Medicine, Medical School, UDES, Calle 158 #20-95, local 101–102, Floridablanca, Colombia
- UCSI University (MY)
- Dubai Health Authority (AE)
- Health Action by People, Thiruvananthapuram and Community Medicine, Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara P. O., Kochi, Kerala, India
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Selangor, Malaysia
- Department of Medicine, Universidad de La Frontera, Francisco Salazar 1145, Temuco, Regiæn de la Araucanía, Chile
- University of the Philippines Manila (PH)
- Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Private Bag X2046 Mmabatho, South Africa
- Queen's University (CA)
- University of the Western Cape (ZA)
- Independent University, Bangladesh (BD)
- ECLA Foundation, Paraguay 160, Rosario, Santa Fe, Argentina
- Department of Social Medicine, Medical University of Wrocław, Bujwida 44 Street, 50–345 Wrocław, Poland
- Isfahan University of Medical Sciences (IR)
- Department of Clinical Research, EHCC, Jawahar Circle, Jaipur, India
- Northwestern University (US)
- Sağlık Bilimleri Üniversitesi (TR)
- Corresponding author
- Li, Wei
- Yusuf, Salim
- ORCID
- 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
- Yusoff, Khalid
- Yeates, Karen
- Leach, Lloyd
- Yusuf, Rita
- Bahonar, Ahmad
- Mohan, Indu
- Khatib, Rasha
- Temizhan, Ahmet
- Li, Wei
- Yusuf, Salim
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-12-05
- Volume
- 40
- Issue
- 20
- Pages
- 1620-1629
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC6528160
- OpenAlex
- W2903066159
- Cited by
- 385
- References
- 51
- Citations by year
- 2026: 26 · 2025: 66 · 2024: 67 · 2023: 87 · 2022: 57 · 2021: 39 · 2020: 28 · 2019: 14 · 2018: 1
- FWCI
- 26.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
- Funders
- Heart and Stroke Foundation of Ontario
- Population Health Research Institute
- Canadian Institutes of Health Research
- CIHR
- CIHR’s Strategy for Patient Oriented Research
- SPOR
- Ontario SPOR Support Unit
- Ontario Ministry of Health and Long-Term Care
- AstraZeneca
- National Center for Cardiovascular Diseases (6566-04-18062)
- Indian Council of Medical Research
- Ministry of Science, Technology and Innovation of Malaysia (100-IRDC/BIOTEK, 07-05-IFN-BPH 010)
- Ministry of Higher Education of Malaysia (600—RMI/LRGS/5/3)
- Universiti Teknologi MARA
- Universiti Kebangsaan Malaysia
- United Nations Relief and Works Agency for Palestine Refugees in the Near East
- UNRWA
- International Development Research Centre
- IDRC
- Philippine Council for Health Research & Development
- PCHRD
- Polish Ministry of Science and Higher Education (290/W-PURE/2008/0)
- Wroclaw Medical University
- Saudi Heart Association
- Deanship of Scientific Research at King Saud University
- National Research Foundation
- Medical Research Council of SA
- SA Sugar Association
- SASA
- Faculty of Community and Health Sciences
- UWC
- Swedish Heart and Lung Foundation
- Swedish Research Council
- Swedish Council for Health
- Working Life and Welfare
- King Gustaf V’s and Queen Victoria Freemasons Foundation
- Metabolic Syndrome Society
- Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority
- McMaster University
- China Scholarship Council
- CSC
- Medical College of Georgia
- Augusta University
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- sleep duration, daytime napping, all-cause mortality, cardiovascular events, J-shaped association, nocturnal sleep, time in bed
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Female, Health Status, Humans, Life Style, Male, Middle Aged, Prospective Studies, Risk Factors, Sleep, Time Factors, Self Report
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