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Habitual Sleep Duration and Insomnia and the Risk of Cardiovascular Events and All-cause Death: Report from a Community-Based Cohort
Open accessAbstract
STUDY OBJECTIVES: To investigate the relationship between sleep duration and insomnia severity and the risk of all-cause death and cardiovascular disease (CVD) events. DESIGN: Prospective cohort study. SETTING: Community-based. PARTICIPANTS: A total of 3,430 adults aged 35 years or older. INTERVENTION: None. MEASUREMENTS AND RESULTS: During a median 15.9 year (interquartile range, 13.1 to 16.9) follow-up period, 420 cases developed cardiovascular disease and 901 cases died. A U-shape association between sleep duration and all-cause death was found: the age and gender-adjusted relative risks (95% confidence interval [CI]) of all-cause death (with 7 h of daily sleep being considered for the reference group) for individuals reporting < or = 5 h, 6 h, 8 h, and > or = 9 h were 1.15 (0.91-1.45), 1.02 (0.85-1.25), 1.05 (0.88-1.27), and 1.43 (1.16-1.75); P for trend, 0.019. However, the relationship between sleep duration and risk of CVD were linear. The multivariate-adjusted relative risk (95% CI) for all-cause death (using individuals without insomnia) were 1.02 (0.86-1.20) for occasional insomnia, 1.15 (0.92-1.42) for frequent insomnia, and 1.70 (1.16-2.49) for nearly everyday insomnia (P for trend, 0.028). The multivariate adjusted relative risk (95% CI) was 2.53 (1.71-3.76) for all-cause death and 2.07 (1.11-3.85) for CVD rate in participants sleeping > or = 9 h and for those with frequent insomnia. CONCLUSIONS: Sleep duration and insomnia severity were associated with all-cause death and CVD events among ethnic Chinese in Taiwan. Our data indicate that an optimal sleep duration (7-8 h) predicted fewer deaths.
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“A study in the US of over 3,400 men and women 35 years of age or older reported a significant increase of cardiovascular disease events in those who complained of insomnia every day compared to those without any insomnia complaint (RR: 1.78, 95%CI 1.03–3.08) [214].”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [214]
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“A few studies have examined cardiovascular disease mortality in relation to self-reported sleep duration, but none found a significant association in fully adjusted models [212–214].”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [214]
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“Introduction A number of prospective studies have shown that longer or shorter sleep times are positively associated with all-cause mortality (Chien et al., 2010; Ferrie et al., 2007; Gangwisch et al., 2008; Hammond, 1964; Heslop et al., 2002; Hublin et al., 2007; Ikehara et al., 2009; Kripke et al., 2002; Kripke et a…”
BackgroundRod, N. H., Meena Kumari, B., Lange, T., Mika Kivimaki, B., Shipley, M. J., & Ferrie, J. E. (2014) · PLoS ONE · doi:10.1371/journal.pone.0091965 · Cited by 116
“those sleeping more than 9 hours per night, but not among those with shorter sleep duration [9].”
BackgroundThe Association Between Insomnia and Increased Future Cardiovascular Events
Hsu, C., Chen, Y., Chen, M., Huang, C., Chiang, C.-H., Huang, P., Chen, J., Chen, T., Lin, S., Leu, H., et al. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000199 · Cited by 111
Hublin, C., Partinen, M., Koskenvuo, M. J., & Kaprio, J. A. (2011) · SLEEP · doi:10.5665/sleep.1136 · Cited by 117
Sleep duration and risk of stroke: a dose–response meta-analysis of prospective cohort studies
He, Q., Sun, H., Wu, X., Zhang, P., Dai, H., Ai, C., & Shi, J. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.12.012 · Cited by 101
“Finally, se veral studies have reported that sleep quality was associated with the risk of stroke [3], but only three studies in our meta-analysis included presence of snoring or sleep disorders as confounders [10,13,15].”
Chen, H., Su, T., & Chou, P. (2013) · SLEEP · doi:10.5665/sleep.2884 · Cited by 91
Hasler, B. P., Martin, C. S., Wood, D. S., Rosario, B., & Clark, D. B. (2014) · Alcoholism: Clinical and Experimental Research · doi:10.1111/acer.12474 · Cited by 91
“Regardless of the mechanism, however, persistent sleep problems are a significant concern given that both insomnia and hypersomnia are well-documented risk factors for a growing list of physical and mental health problems (e.g., Baglioni et al., 2011; Breslau et al., 1996; Chien et al., 2010; McCall, 2011; Rosekind an…”
BackgroundZhi, T., Sun, X., Li, S., Wang, Q., Cai, J., Li, L., Li, Y., Xu, M., Wang, Y., Chu, X., et al. (2016) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2016.03.023 · Cited by 91
Zhong, G., Wang, Y., Tao, T., Ying, J., & Zhao, Y. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.01.025 · Cited by 89
The natural history of insomnia: acute insomnia and first-onset depression.
Ellis, J. G., Perlis, M. L., Bastien, C. H., Gardani, M., & Espie, C. A. (2014) · Sleep · doi:10.5665/sleep.3316 · Cited by 81
“15-21 The primary limitations of these seminal studies pertain to (1) the clear delineation of what constitutes acute insomnia, (2) whether the index episode represents a first-onset or recurrence of insomnia, (3) the mode of assessment used (in most cases non-standard instruments and often single-item questions), (4)…”
BackgroundAssociation between sleep duration and bone mineral density in Chinese women
Fu, X., Zhao, X., Lu, H., Jiang, F., Ma, X., & Zhu, S. (2011) · Bone · doi:10.1016/j.bone.2011.08.008 · Cited by 82
“Insufficient sleep can increase the risk of obesity, diabetes and cardiovascular diseases through elevating insulin resistance and proinflammatory responses while reducing leptin levels [9–12].”
BackgroundSleep duration pattern and chronic diseases in Brazilian adults (ISACAMP, 2008/09)
Lima, M. G., Francisco, P. M. S. B., & Barros, M. B. D. A. (2011) · Sleep Medicine · doi:10.1016/j.sleep.2011.07.011 · Cited by 79
Hayley, A. C., Williams, L. J., Venugopal, K., Kennedy, G. A., Berk, M., & Pasco, J. A. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414546700 · Cited by 79
Sleep duration and risk of all-cause mortality: a systematic review and meta-analysis
García‐Perdomo, H. A., Zapata-Copete, J. A., & Cerón, C. A. R. (2018) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000379 · Cited by 79
Mims, K. N., & Kirsch, D. B. (2016) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2015.10.009 · Cited by 81
“Insomnia is associated with all-cause mortality and cardiovascular death, including stroke.(36) Insomnia incidence in patients who have had a stroke approaches 57%, with 38% reporting insomnia as a preceding symptom to the stroke.”
BackgroundThe association between periodontitis and sleep duration
Romandini, M., Gioco, G., Perfetti, G., Deli, G., Staderini, E., & Laforí, A. (2017) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.12713 · Cited by 81
Aggarwal, B., Makarem, N., Shah, R., Emin, M. T., Wei, Y., St‐Onge, M., & Jelić, S. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.008590 · Cited by 79
Kravitz, H. M., Janssen, İ., Bromberger, J. T., Matthews, K. A., Hall, M. H., Ruppert, K. M., & Joffe, H. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0084-1 · Cited by 80
Sleep-Related Behaviors and Beliefs Associated With Race/Ethnicity in Women
Grandner, M. A., Patel, N. P., Jean‐Louis, G., JACKSON, N. J., Gehrman, P., Perlis, M. L., & Gooneratne, N. S. (2013) · Journal of the National Medical Association · doi:10.1016/s0027-9684(15)30080-8 · Cited by 73
Sleep Deprivation and Chronic Health Conditions Among Sexual Minority Adults
Dai, H. D., & Hao, J. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2017.1342166 · Cited by 74
“…cardiovascular disease, and other chronic health conditions (Ayas et al., 2003; Buxton &Marcelli, 2010; Cappuccio, D’Elia, Strazzullo, &Miller, 2010; Chien et al., 2010; Gallicchio &Kalesan, 2009; Gottlieb et al., 2005; Grandner, Chakravorty, Perlis, Oliver, & Gurubhagavatula, 2014; Grandner,…”
BackgroundInfluentialNambiema, A., Lisan, Q., Vaucher, J., Perier, M., Boutouyrie, P., Danchin, N., Thomas, F., Guibout, C., Solelhac, G., Heinzer, R. C., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad657 · Cited by 67
“The few prior studies examining several sleep patterns in the individuals and their association with CVD events have mostly studied dyads of sleep patterns, mainly insomnia and short 13,14,17 or long sleep duration 15 as well as snoring with EDS.”
BackgroundThe end of sleep: ‘Sleep debt’ versus biological adaptation of human sleep to waking needs
Horne, J. (2010) · Biological Psychology · doi:10.1016/j.biopsycho.2010.10.004 · Cited by 62
Cooper, D. C., Ziegler, M. G., Milic, M. S., Ancoli‐Israel, S., Mills, P. J., Loredo, J. S., von Känel, R., & Dimsdale, J. E. (2013) · Journal of Sleep Research · doi:10.1111/jsr.12083 · Cited by 61
“Diminished endothelial function could be a mechanism underlying the observed associations between poor sleep quality and adverse cardiovascular health (Chien et al., 2010; Wolk et al., 2005; Young et al., 2008).”
BackgroundSleep and allostatic load: A systematic review and meta-analysis
Christensen, D. S., Zachariae, R. H., Amidi, A., & Wu, L. M. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101650 · Cited by 71
Nakajima, S., Okajima, I., Sasai, T., Kobayashi, M., Furudate, N., Drake, C. L., Roth, T. G., & Inoue, Y. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.09.022 · Cited by 58
“Insomnia also is known to be highly associated with increased risk for depression [4–8] and physical diseases such as cardiovascular disease [9,10] and type 2 diabetes mellitus [11,12], possibly engendering deterioration of health-related quality of life [13–16].”
The Role of Trauma Type in the Risk for Insomnia
Brown, T. S. H., Akeeb, A., & Mellman, T. A. (2015) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4846 · Cited by 64
Rico-Rosillo, M. G., & Vega-Robledo, G. B. (2018) · Revista Alergia México · doi:10.29262/ram.v65i2.359 · Cited by 63
Ara, T., Rahman, M. M., Hossain, M. A., & Ahmed, A. I. A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.580268 · Cited by 53
Nocturnal cardiac autonomic profile in young primary insomniacs and good sleepers
de Zambotti, M., Cellini, N., Baker, F. C., Colrain, I. M., Sarlo, M., & Stegagno, L. (2014) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2014.06.014 · Cited by 53
“A growing body of evidence supports the association between insomnia and adverse CV events (Chien et al., 2010; Lanfranchi et al., 2009; Laugsand et al., 2011; Rosekind and Gregory, 2010) and it is well known that overstress of the CV system, i.e. elevated resting blood pressure (Vasan et al.,…”
BackgroundLi, L.-J., Yang, Y., Guan, B., Chen, Q., Wang, A.-X., Wang, Y., Zhang, N., & Wang, C. (2018) · Stroke and Vascular Neurology · doi:10.1136/svn-2017-000136 · Cited by 54
“However, few studies have explored the effects of insomnia on stroke mortality.(4) Insomnia, affecting approximately 12%–57% of stroke survivors, plays an essential role in the prognosis after stroke.”
BackgroundYazdanpanah, M. H., Homayounfar, R., Khademi, A., Zarei, F., Shahidi, A., & Farjam, M. (2020) · Scientific Reports · doi:10.1038/s41598-020-61506-0 · Cited by 58
The impact of daily arthritis pain on spouse sleep
Martire, L. M., Keefe, F. J., Schulz, R., Stephens, M. A. P., & Mogle, J. A. (2013) · Pain · doi:10.1016/j.pain.2013.05.020 · Cited by 53
“The self-reported sleep indicators that we measured each day have been linked with important health outcomes [12,22,30,45], and our findings add to this literature by demonstrating the implications of chronic arthritis pain for partners’ sleep.”
BackgroundResultLai, Y., Lin, C., Lin, M., Lee, S.-T., Sung, F.-C., Chang, Y.-J., & Kao, C. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.03.024 · Cited by 51
“Previous studies have reported that insomnia with objective short sleep duration was associated with the increased risks for hypertension, obesity, dyslipidemia, stroke and CVD events, and all-cause mortality [22–29].”
BackgroundEllis, J. G., Cushing, T., & Germain, A. (2015) · SLEEP · doi:10.5665/sleep.4752 · Cited by 130
Integrative Medicine for Insomnia
Zhou, E. S., Gardiner, P. M., & Bertisch, S. M. (2017) · Medical Clinics of North America · doi:10.1016/j.mcna.2017.04.005 · Cited by 49
Metadata
- Authors
- Chien, K.-L., Chen, P.-C., Hsu, H.-C., Su, T.-C., Sung, F.-C., Chen, M.-F., & Lee, Y.-T.
- Affiliations
- National Taiwan University (TW)
- National Taiwan University Hospital (TW)
- China Medical University (TW)
- China Medical University Hospital (TW)
- Corresponding author
- Lee, Yuan-Teh
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-02
- Volume
- 33
- Issue
- 2
- Pages
- 177-184
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2817905
- OpenAlex
- W2190946050
- Cited by
- 350
- References
- 46
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 23 · 2023: 24 · 2022: 31 · 2021: 16 · 2020: 21 · 2019: 17 · 2018: 27 · 2017: 20 · 2016: 27 · 2015: 25 · 2014: 28 · 2013: 35 · 2012: 18
- FWCI
- 30.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science Council
- National Taiwan University Hospital
- 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, insomnia, all-cause mortality, cardiovascular disease, cardiovascular events, U-shaped relationship, ethnic Chinese, optimal sleep duration, long sleep
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Habits, Health Surveys, Humans, Disorders of Excessive Somnolence, Sleep Initiation and Maintenance Disorders, Life Style, Male, Middle Aged, Prospective Studies, Risk, Sleep, Sleep Deprivation, Statistics as Topic, Taiwan, Cohort Studies, Health Behavior, Multivariate Analysis
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