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. 2022 Aug 2;11(15):e025969.
doi: 10.1161/JAHA.122.025969. Epub 2022 Jul 26.

Association of Sleep Duration, Napping, and Sleep Patterns With Risk of Cardiovascular Diseases: A Nationwide Twin Study

Zhiyu Wang  1   2   3 , Wenzhe Yang  1   2   3 , Xuerui Li  1   2   3 , Xiuying Qi  1   2   3 , Kuan-Yu Pan  4 , Weili Xu  1   2   3   5
Affiliations

Association of Sleep Duration, Napping, and Sleep Patterns With Risk of Cardiovascular Diseases: A Nationwide Twin Study

Zhiyu Wang et al. J Am Heart Assoc. .

Abstract

Background Although sleep disorders have been linked to cardiovascular diseases (CVDs), the association between sleep characteristics and CVDs remains inconclusive. We aimed to examine the association of nighttime sleep duration, daytime napping, and sleep patterns with CVDs and explore whether genetic and early-life environmental factors account for this association. Methods and Results In the Swedish Twin Registry, 12 268 CVD-free twin individuals (mean age=70.3 years) at baseline were followed up to 18 years to detect incident CVDs. Sleep duration, napping, and sleep patterns (assessed by sleep duration, chronotype, insomnia, snoring, and daytime sleepiness) were self-reported at baseline. CVDs were ascertained through the Swedish National Patient Registry and the Cause of Death Register. Data were analyzed using a Cox model. In the multiadjusted Cox model, compared with 7 to 9 hours/night, the hazard ratios (HRs) of CVDs were 1.14 (95% CI, 1.01-1.28) for <7 hours/night and 1.10 (95% CI, 1.00-1.21) for ≥10 hours/night, respectively. Compared with no napping, napping 1 to 30 minutes (HR, 1.11 [95% CI, 1.03-1.18]) and >30 minutes (HR, 1.23 [95% CI, 1.14-1.33]) were related to CVDs. Furthermore, a poor sleep pattern was associated with CVDs (HR, 1.22 [95% CI, 1.05-1.41]). The co-twin matched control analyses showed similar results as the unmatched analyses, and there was no significant interaction between sleep characteristics and zygosity (P values >0.05). Conclusions Short or long sleep (<7 or ≥10 hours/night), napping, and poor sleep patterns are associated with an increased CVD risk. Genetic and early-life environmental factors may not account for the sleep-CVD association.

Keywords: cardiovascular diseases; cohort study; sleep; twin study.

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Figures

Figure 1
Figure 1. Flowchart of the study population.
CHD indicates coronary heart disease; CVDs, cardiovascular disease; and SALT, Screening Across the Lifespan Twin.
Figure 2
Figure 2. Restricted spline curve for the association of nighttime sleep duration with cardiovascular diseases (CVDs).
Adjusted for age, sex, education, marital status, body mass index, smoking status, alcohol consumption, physical activity, type 2 diabetes, hypertension, and depression. P values for nonlinear associations were <0.05.
Figure 3
Figure 3. Sleep characteristics and risks of cardiovascular diseases.
Forest plot illustrating the estimated hazard ratios (HRs) and 95% CIs of cardiovascular diseases in relation to sleep characteristics. Adjusted for age, sex, education, marital status, body mass index, smoking status, alcohol consumption, physical activity, type 2 diabetes, hypertension, and depression. *P<0.05.
See this image and copyright information in PMC

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