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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
Open accessAbstract
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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Metadata
- 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 (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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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