Cited by 350Sleep and related disordersSleep and Work-Related FatigueObstructive Sleep Apnea Research

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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

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Chien, Kuo-Liong, Chen, Pei-Chung, Hsu, Hsiu-Ching, Su, Ta-Chen, Sung, Fung-Chang, Chen, Ming-Fong, Lee, Yuan-Teh·2010·SLEEP

DOI 10.1093/sleep/33.2.177PMC PMC2817905

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Abstract

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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Study Protocol for a Randomized Controlled Trial Assessing the Effectiveness of Personalized Computerized Cognitive Training for Individuals With Insomnia
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Sleep patterns and cardiovascular disease risk in US participants: a comprehensive analysis
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Pharmacopuncture Effects on Insomnia Disorder: Protocol for a Multi-Site, Randomized, Acupuncture-Controlled, Clinical Trial
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Association between Wakeup Frequency at Night and Atherogenic Dyslipidemia: Evidence for Sex Differences
Yao, C., Chen, I., Chen, C. O., Torng, P., & Su, T. (2022) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.63254 · Cited by 6
Sex differences in the association between social relationships and insomnia symptoms
Park, K., Cho, D., Lee, E. M., Kim, J., Shim, J., Youm, Y., An, S. K., Namkoong, K., & Kim, H. C. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8710 · Cited by 5
“The questionnaire used in this study has been peer-reviewed by psychiatrists and is in accordance with those used in previous large-scale cohort studies measuring insomnia with selfquestionnaires.(43,44,70) Still, the presence of insomnia symptoms identified in this study cannot be regarded as a confirmed diagnosis of…”
The Association Between Sleep Quality, Fatigue and Periodontal Status: a Pilot Study
Eroğlu, Z. T., Şen, D. Ö., Yarkaç, F. U., & Altıparmak, F. (2023) · Odovtos - International Journal of Dental Sciences · doi:10.15517/ijds.2023.54866 · Cited by 6
Association between energy-adjusted dietary inflammatory index and sleep quality disorders: a cross-sectional study on fasa adult cohort
Bazmi, S., Pourmontaseri, H., Shahraki, S. F. M., Pourmontaseri, A. R., Askari, A., Bagheri, P., Homayounfar, R., Farjam, M., Dehghan, A., Fakhraei, B., et al. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-00998-w · Cited by 4
Long sleep duration pattern is associated with increased cardiovascular recurrence: Effect of long‐term Mediterranean diet from the CORDIOPREV study
García‐Ríos, A., Romero‐Cabrera, J. L., Alcala-Diaz, J. F., Quintana‐Navarro, G. M., Martín‐Piedra, L., Larriva, A. P. A.-D., Torres-Peña, J. D., Rodríguez-Cantalejo, F., Kales, S. N., Ordovás, J. M., et al. (2025) · Journal of Internal Medicine · doi:10.1111/joim.20119 · Cited by 4
“Previous literature has shown similar relationships between long sleep duration and cardiometabolic risk [23, 27, 28].”
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“Sleep deprivation correlates with increased risks of cardiovascular disease, Alzheimer’s, diabetes, obesity, and chronic diseases, often leading to higher mortality in the elderly (Chien et al., 2010; Tsapanou et al., 2016; Pandi-Perumal et al., 2009).”
Bachelor Status and the Sleep Quality Among Chinese Men: A Moderated Mediation Model
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“Sleep is a vitally important health indicator that is associated with various other health outcomes, such as chronic diseases, cardiovascular disease, obesity, diabetes, psychiatric disorders, and even death (Bernert et al., 2014; Chien et al., 2010; Troxel et al., 2010).”
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Sleep and Stroke
Bassetti, C. L. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00093-3 · Cited by 4
Sleeping Difficulty and Subjective Short Sleep Duration are Associated with Serum N-terminal Pro-brain Natriuretic Peptide Levels in the Elderly Population
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“A large number of studies have revealed that the sleep duration and quality evaluated using a self-reported questionnaire were associated with cardiovascular morbidity and mortality (42, 43).”
Sleep Disturbances in Neurological Disease: A Target for Intervention
Khambadkone, S. G., & Benjamin, S. E. (2022) · Seminars in Neurology · doi:10.1055/a-1958-0710 · Cited by 5
Association of income relative deprivation and sleep duration in China
Peng, Z., & Wu, L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1008259 · Cited by 4
“, 2020); cognitive decline and dementia risk is greatly increased (Cappuccio et al., 2010; Chien et al., 2010).”
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Associations between sleep-related disorders and cardiovascular disease risk in hypertensive patients: Insights from the National Health and Nutrition Examination Survey (NHANES): A cross-sectional study
Liu, C., Chen, L., Zhang, S., Wang, H., Liu, X., Ma, J., Qiu, W., & Ye, Z. (2024) · Medicine · doi:10.1097/md.0000000000039341 · Cited by 4
Sleep disorders in individuals without sleep apnea increase the risk of peripheral arterial disorder: a nationwide population-based retrospective cohort study
Li, C.-H., Huang, K., Chen, W., Chen, C., Tu, C., Lin, C., Hsu, W., Chung, C., & Wu, C.-C. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.02.538 · Cited by 4
Impact of obstructive sleep apnea and comorbid insomnia on all-cause mortality: a prospective cohort study of 2401 patients with 6-year follow-up
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Schlafstörungen
Pollmächer, T. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_76 · Cited by 3
The Effect of Sleep Quality and Anxiety Level on Blood Pressure Variability
Köklü, M., Yagci, A. F., Coskun, P. M., Taşkan, H., Yaşar, S., Görmel, S., Asıl, S., & Çeli̇k, M. (2022) · Sleep and Vigilance · doi:10.1007/s41782-022-00219-y · Cited by 3
“Short sleep duration and poor sleep quality cause increased activity in the sympathetic nervous system, increased blood pressure, impaired glucose tolerance, increased hemoglobin A1C level, total cholesterol and triglyceride levels, and accelerated inflammatory processes [10, 11].”
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Gourineni, R. (2016) · Springer eBooks · doi:10.1007/978-3-319-41400-3_5 · Cited by 3
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Sleep duration and possible cardiovascular risk
Викторович, А. М., Orlova, A. A., & Drapkina, O. M. (2022) · Russian Journal of Preventive Medicine · doi:10.17116/profmed20222507194 · Cited by 2
Development and validation of the Japanese version of the Hyperarousal Scale
Ayabe, N., Nakajima, S., Okajima, I., Inada, K., Yamadera, W., Yamashita, H., Tachimori, H., Kamei, Y., Takeshima, M., Inoue, Y., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04243-0 · Cited by 2
“as cardiovascular disease [7, 8], and an increased risk of type 2 diabetes [9, 10], as well as deteriorated healthrelated quality of life [11–13].”
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Stroke and Sleep Disorders
Sümer, M. M. (2018) · Examines in Physical Medicine & Rehabilitation · doi:10.31031/epmr.2018.02.000526 · Cited by 2
“Insomnia was found to be a risk factor for cardiovascular events and death [55].”
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Modern understanding of the consequences of lack of sleep
Gavrilov, Y. V. (2022) · Medical academic journal · doi:10.17816/maj81192 · Cited by 2
Chronobiological types, duration of sleeping and psycho-emotional condition of teenagers
Petronytė, L., & Praninskienė, R. (2017) · Acta medica Lituanica · doi:10.6001/actamedica.v23i4.3425 · Cited by 2
“Short sleeping time correlates with poor learning results (8) and various addictions (9–10), an increasing risk of obesity and diabetes (11–13), and more frequent signs of anxiety and depression (14).”
Background
Eye acupuncture therapy for insomnia: a systematic review and network meta-analysis
Shi, Z., Wang, S., Sun, D., Liu, H., Wang, Y., & Xu, C. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1720073 · Cited by 1
Behavioral Differences Leading to Disparities in Energy Balance and Cancer
Spruijt‐Metz, D., Cook, L. T., Wen, C. K. F., García, R., O’Reilly, G. A., Hsu, Y., Unger, J. B., & Nguyen‐Rodriguez, S. T. (2014) · Springer eBooks · doi:10.1007/978-3-319-06103-0_3 · Cited by 1
“Inadequate sleep is a risk factor for not only obesity, diabetes, and CVD [109, 110], but also to some types of cancer.”
Background
The Future Treatment of Insomnia: Exploring the Mechanisms of Action of Current and Emerging Therapies
Ancoli‐Israel, S., & Neubauer, D. N. (2015) · Cited by 1
Insomnia and the risk of incident heart failure: ap opulation study
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Assessment of sleep disorders and proposed percentiles for adolescents
Gómez‐Campos, R., de Lázari, E. C., de Arruda, M., Carrillo, J. P., Urra-Albornoz, C., & Cossio‐Bolaños, M. (2019) · Archivos Argentinos de Pediatria · doi:10.5546/aap.2019.eng.73 · Cited by 1
Schlafstörungen
Pollmächer, T. (2011) · Springer eBooks · doi:10.1007/978-3-642-03637-8_63 · Cited by 1
Genetic study of the causal effect of lipid profiles on insomnia risk: a Mendelian randomization trial
Gong, Q., & Guo, C. (2023) · BMC Medical Genomics · doi:10.1186/s12920-023-01761-y · Cited by 1
“This is in line with Chien’s findings [23].”
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Effects of Sleep Deprivation
Toscanini, A. C., & Hasan, R. (2024) · Springer eBooks · doi:10.1007/978-3-031-50710-6_3 · Cited by 1
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“The symptoms of lack of sleep and insomnia are related to the decrease in operating efficiency [11], the increases in the risks of mental disorders including depression [12], risk of death [13] [14], risk of falling [15] and a decrease in cognitive function [8] [16].”
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Evaluación de los trastornos del sueño y propuesta de percentiles para los adolescentes
(2019) · Archivos Argentinos de Pediatria · doi:10.5546/aap.2019.73 · Cited by 1
Association of sleep disorder with cardiovascular risk in the Chilean adult population
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The Treatment of Insomnia
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Assessment of Health Perception Predictors: An Application of Grossman's Model to the Portuguese Population
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Investigating the causal interplay between sleep traits and risk of acute myocardial infarction: a Mendelian randomization studyPreprint
Arora, N., Bhatta, L., Skarpsno, E. S., Dalen, H., Åsvold, B. O., Brumpton, B. M., Richmond, R. C., & Strand, L. B. (2023) · medRxiv · doi:10.1101/2023.04.17.23288680 · Cited by 2
Sleep and Well-Being
Hamilton, N. A., Lillis, T. A., & Pressman, M. (2023) · Springer eBooks · doi:10.1007/978-3-031-17299-1_3743 · Cited by 1
INSOMNIA, ILL HEALTH AND WORK DISABILITY A LONGITUDINAL STUDY AMONG EMPLOYEES
Haaramo, P., Rahkonen, O., & Kouvonen, A. M. (2014) · Työväentutkimus Vuosikirja

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
ORCID: Chien, Kuo-Liong
Su, Ta-Chen
Sung, Fung-Chang
Venue: SLEEP
Publisher: Oxford University Press (OUP)
Published: 2010-02
Volume: 33
Issue: 2
Pages: 177-184
ISSN: 0161-8105 (ISSN-L)
1550-9109
DOI: 10.1093/sleep/33.2.177
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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Habitual Sleep Duration and Insomnia and the Risk of Cardiovascular Events and All-cause Death: Report from a Community-Based Cohort

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