Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis
Open accessAbstract
Background There is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality. Methods and Results We conducted a systematic review, meta‐analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We utilized linear and nonlinear dose‐response meta‐analysis models and used DerSimonian–Laird random‐effects meta‐analysis models of risk ratios, with inverse variance weighting, and the I 2 statistic to quantify heterogeneity. Seventy‐four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose‐response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self‐reported duration of sleep >8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio , 1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio , 1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes. Conclusions Divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.
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Long sleep duration is associated with an increased risk of mortality of coronary heart disease.
“We also found suggestive evidence that long sleep duration is associated with an increased risk of mortality of coronary heart disease (28).”
From Sleep Duration/Quality with Health Outcomes: An Umbrella Review of Meta-Analyses of Prospective Studies (2022) · cites this paper as [28]
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- Authors
- Kwok, C. S., Kontopantelis, E., Kuligowski, G., Gray, M., Muhyaldeen, A., Gale, C. P., Peat, G. M., Cleator, J., Chew‐Graham, C., Loke, Y. K., & Mamas, M. A.
- Affiliations
- Keele University (GB)
- University of Manchester (GB)
- University of Dundee (GB)
- Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
- Research Institute for Primary Care & Health Sciences Keele University Stoke‐on‐Trent United Kingdom
- University of East Anglia (GB)
- Corresponding author
- Kwok, Chun Shing
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2018-08-07
- Volume
- 7
- Issue
- 15
- Pages
- e008552-e008552
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC6201443
- OpenAlex
- W2885117088
- Cited by
- 506
- References
- 99
- Citations by year
- 2026: 49 · 2025: 96 · 2024: 84 · 2023: 88 · 2022: 77 · 2021: 59 · 2020: 37 · 2019: 14 · 2018: 1 · 2014: 1
- FWCI
- 4.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of the American Heart Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (ACF-2013-06-001)
- 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, sleep quality, cardiovascular disease, mortality, all-cause mortality, stroke, coronary artery disease, long sleep, short sleep duration, dose-response relationship
- MeSH terms
- Cardiovascular Diseases, Coronary Disease, Humans, Mortality, 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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