Association of longitudinal patterns of the habitual sleeping time with the risk of cardiovascular events and overall mortality

reference

wang yh, wang j, chen sh, et al. Association of longitudinal patterns of the habitual sleeping time with the risk of cardiovascular events and overall mortality. Jama network open . 2020; 3 (5): E205246.

Study goal

to determine whether the courses of the long-term sleep time are associated with the later risk of CVES and the overall mortality

draft

prospective, population -based cohort study

participant

52,599 Chinese adults (76.2 % male, 23.8 % female) without atrial fibrillation, myocardial infarction, stroke or cancer. The mean value [SD] The starting age of all participants was 52.5 years [11.8] years.

study parameters evaluated

trajectories of the sleep duration from January 1, 2006 to December 31, 2010 were identified in order to examine the connection with the risk of CVES and the overall mortality from January 1, 2010 to December 31, 2017 in 2006, 2008 and 2010. Trajectories of the sleep duration for 4 years were identified by latent mixture modeling.

The subjective, habitual nightly sleeping time was given average every two years in personal conversations with the question "How many hours of sleep do you have on average in the last 12 months per night?" raised.

primary result measurements

Total mortality and first CVES (including fatal or non -fatal CVES, including atrial fibrillation, myocardial infarction and stroke).

Based on the output duration and the patterns over time, 4 sleeping processes were categorized as follows:

1. normal stable
2. Normally decreasing
3. slightly increasing
4. low stable

important knowledge

The course of the sleep duration was significantly associated with the risk of CVES and the overall mortality.

compared to the normal stable group, which maintained a sleeping time of 7.0 to 8.0 hours per night for 4 years, low -stable and low -rising patterns were significantly associated with a higher risk for the first CVEs after adaptation for potential confounder.

adapted Hazard Ratios (HRS) of CVES were for each pattern:

• low: 1.22 (95 % KI, 1.04-1.43)
• Normal-decreasing: 1.13 (95 % AI, 0.97-1.32)
• Low-stable: 1.47 (95 % AI, 1.05-2.05)

Compared to volunteers in the normal-stable group, the risk of total mortality was significantly higher in those with normal decreasing and less stable sleeping duration.

adapted HRS of death were for every pattern:

• Normal-decreasing: 1.34 (95 % KI, 1.15-1.57)
• Lowly increasing: 0.95 (95 % KI, 0.80-1.13)
• Low-stable: 1.50 (95 % AI, 1.07-2.10)

The results were consistent, even if potential disruptive variables were excluded, including the results that occurred in the first 2 years of follow -up, with shift workers, those who suffered from cancer during follow -up, with those with self -reported frequent snoring or in volunteers with atrial fibrillation.

For none of the medical comorbidities, a significant interaction was observed, and the results were similar if they were stratified after the starting weight and gender.

In the case of stratification according to age groups, however, the association with CVES was found for the groups with low stable (HR, 1.75; 95 % KI, 1.17–1.62) and low rising (HR, 1.28; 95 % KI, 1.04–1.56) found in the participants under the age of 65.

Participants with a sleeping time of 7.0 to 8.0 hours a night had the lowest risk of all endpoints. After cleaning up for potential confounders, short and long sleeping times were associated with Cves and death.

compared to sleeping from 7.0 to less than 8.0 hours per night, the adapted HRS for the combined endpoints were 1.24 (95 % KI, 1.10–1.39) for those who sleep less than 6.0 hours per night, 1.08 (95 % KI, 0.98–1.20). For those who slept 6.0 to less than 7.0 hours a night, 1.32 (95 % CI, 1.21–1.44) for those who slept 8.0 to less than 9.0 hours a night, and 1.45 (95 % CI, 1.13–1.87) for those who sleeped at least 9.0 hours per night. The results were similar for CVES and total mortality.

practice implications

Sleeping deprivation contributes significantly to chronic diseases and earlier mortality. It is estimated that 50 to 70 million Americans chronically suffer from sleeping and growing. The prevalence of insomnia in primary care patients is estimated at 69 %.

This study is the first to evaluate the connection between changes in the sleep pattern with cardiovascular events and mortality. The results indicate that the course curves of the duration of sleep are clinically important variables that are to be assessed when evaluating the risks for a first cardiovascular event and death. Since the results were obtained even after adaptation by a single extent of the output sleeping time, the current research builds on a number of earlier evidence that show that individual dimensions of the sleeping time are also associated with disadvantageous health consequences.

Earlier research has evaluated the comorbidities and mortality in connection with chronic sleep deprivation. Inadequate sleep is a correlate of practically all psychiatric disorders and indicates certain disorders such as depression and drug abuse. Insomnia is also associated with a reduced quality of life, the extent of which is similar to chronic diseases such as congestive heart failure and severe depressed disorders ^{3.4 and is considered an early symptom of Alzheimer's disease, Parkinson's disease and Huntington disease.}

Inadequate sleep is a correlate of practically all psychiatric disorders and indicates certain disorders such as depression and drug abuse.

less than 6 hours of sleep per night on average were associated with a risk of blood pressure, which is twice as high. Men who have a short sleep also had four times higher risk of dying early. Both short sleepers and late risers, i.e. people who sleep on average more than 9 hours a night, have an increased risk of metabolic syndrome and diabetes.

An earlier study published in 2010 in the magazine sleeping came to the conclusion that increased early mortality was associated with male short sleepers, but not with female. showed.

The current study provides clinically relevant data that can provide information about how clinicians assess their patients. In addition to the question of how many hours the patients sleep average per night, understanding the changes in sleep patterns can provide a more comprehensive picture of the risk of first cardiovascular events and death over time.

The implementation of additional research to confirm these results and the expansion of the end points to additional endpoints such as diabetes, high blood pressure and cancer would expand our knowledge of the health effects of sleep and changes in the sleep pattern over time.