Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults
Open accessAbstract
Study objectives There is limited information on the relationship between risk of cardiovascular disease and the joint effects of sleep quality and sleep duration, especially from large, prospective, cohort studies. This study is to prospectively investigate the joint effects of sleep quality and sleep duration on the development of coronary heart disease.Methods This study examined 60,586 adults aged 40 years or older. A self-administered questionnaire was used to collect information on sleep quality and sleep duration as well as a wide range of potential confounders. Events of coronary heart disease were self-reported in subsequent medical examinations. Two types of Sleep Score (multiplicative and additive) were constructed to reflect the participants' sleep profiles, considering both sleep quality and sleep duration. The Cox regression model was used to estimate the hazard ratio (HR) and the 95% confidence interval (CI).Results A total of 2,740 participants (4.5%) reported new events of coronary heart disease at follow-up. For sleep duration, participants in the group of < 6 h/d was significantly associated with an increased risk of coronary heart disease (HR: 1.13, 95% CI: 1.04-1.23). However, the association in the participants with long sleep duration (> 8 h/d) did not reach statistical significance (HR: 1.11, 95% CI: 0.98-1.26). For sleep quality, both dreamy sleep (HR: 1.21, 95% CI: 1.10-1.32) and difficult to fall asleep/use of sleeping pills or drugs (HR: 1.40, 95% CI: 1.25-1.56) were associated with an increased risk of the disease. Participants in the lowest quartile of multiplicative Sleep Score (HR: 1.31, 95% CI: 1.16-1.47) and of additive sleep score (HR: 1.31, 95% CI: 1.16-1.47) were associated with increased risk of coronary heart disease compared with those in the highest quartile.Conclusions Both short sleep duration and poor sleep quality are associated with the risk of coronary heart disease. The association for long sleep duration does not reach statistical significance. Lower Sleep Score (poorer sleep profile) increases the risk of coronary heart disease, suggesting the importance of considering sleep duration and sleep quality together when developing strategies to improve sleep for cardiovascular disease prevention.
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Poor sleep may have similar bidirectional relationships with other causes of dementia, including poor cerebrovascular health.
“Poor sleep may have similar bidirectional relationships with other causes of dementia, including poor cerebrovascular health.”
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The Discussion (page unavailable) links poor sleep with higher coronary heart disease risk and acknowledges uncertainty about whether poor sleep contributes to cardiometabolic disease or reflects existing illness. It does not examine dementia or cerebrovascular health, or establish a bidirectional relationship with either. (LLM, conf=0.85)
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Relationship between sleep disorders and the prognosis of neurological function after stroke
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Cardiovascular inflammaging: Mechanisms, consequences, and therapeutic perspectives
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Sleep Deficiency and Cardiometabolic Disease
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Associations Between Sleep Duration and Sensory Impairments Among Older Adults in China
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Effects of sleep deprivation on coronary heart disease
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Sleep moderates the association between arterial stiffness and 24-hour blood pressure variability
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Self-citationSleep Health Disparity and Race/Ethnicity, Socioeconomic Status, and Gender: A Systematic Review
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Healthy Sleep Every Day Keeps the Doctor Away
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Sleep Status and the Associated Factors: A Large Cross-Sectional Study in Shaanxi Province, China
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Sleep and Cardiovascular Health
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How can light be used to optimize sleep and health in older adults?
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Sleep Deficiency and Cardiometabolic Disease
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Is insufficient sleep duration a risk indicator for periodontal disease? A systematic review
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Association Between Excess Sleep Duration and Risk of Stroke: A Population-Based Study
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- Authors
- Lao, X. Q., Liu, X., Deng, H.-B., Chan, T.-C., Ho, K. F., Wang, F., Vermeulen, R., Tam, T., Wong, M. C. S., Tse, L. A., Chang, L.-Y., & Yeoh, E.-K.
- Affiliations
- Chinese University of Hong Kong (HK)
- Sun Yat-sen University (CN)
- Research Center for Humanities and Social Sciences, Academia Sinica (TW)
- Utrecht University (NL)
- Institute of Sociology, Academia Sinica (TW)
- Corresponding author
- Lao, Xiang Qian
- ORCID
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2018-01-15
- Volume
- 14
- Issue
- 1
- Pages
- 109-117
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC5734879
- OpenAlex
- W2783195034
- Cited by
- 317
- References
- 43
- Citations by year
- 2026: 30 · 2025: 56 · 2024: 57 · 2023: 54 · 2022: 60 · 2021: 33 · 2020: 13 · 2019: 7 · 2018: 7
- FWCI
- 19.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- 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 quality, sleep duration, coronary artery disease, cardiovascular risk, short sleep duration, long sleep, difficulty falling asleep, hypnotics, sleep profiles, middle-aged and older adults
- MeSH terms
- Coronary Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Sleep, Sleep Wake Disorders, Taiwan, Time Factors, Cohort Studies, Comorbidity
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