Cited by 388Sleep and related disordersSleep and Work-Related FatigueObstructive Sleep Apnea Research

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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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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, Noorhassim, 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·2019·European Heart Journal

DOI 10.1093/eurheartj/ehy695PMC PMC6528160

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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 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
DOI: 10.1093/eurheartj/ehy695
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 (medical) › 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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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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