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Association of Bedtime With Mortality and Major Cardiovascular Events: An Analysis of 112,198 Individuals From 21 Countries in the Pure Study Publisher Pubmed



Wang C1 ; Hu B1 ; Rangarajan S2 ; Bangdiwala SI2 ; Lear SA3 ; Mohan V4 ; Gupta R5 ; Alhabib KF6 ; Soman B7, 8 ; Abat MEM9 ; Rosengren A10 ; Lanas F11 ; Avezum A12 ; Lopezjaramillo P13 Show All Authors
Authors
  1. Wang C1
  2. Hu B1
  3. Rangarajan S2
  4. Bangdiwala SI2
  5. Lear SA3
  6. Mohan V4
  7. Gupta R5
  8. Alhabib KF6
  9. Soman B7, 8
  10. Abat MEM9
  11. Rosengren A10
  12. Lanas F11
  13. Avezum A12
  14. Lopezjaramillo P13
  15. Diaz R14
  16. Yusoff K15, 16
  17. Iqbal R17
  18. Chifamba J18
  19. Yeates K19
  20. Zatonska K20
  21. Kruger IM21
  22. Bahonar A22
  23. Yusufali A23
  24. Li W1
  25. Yusuf S2
Show Affiliations
Authors Affiliations
  1. 1. Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  2. 2. Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  3. 3. Faculty of Health Sciences, Simon Fraser University, Canada
  4. 4. Dr.Mohan's Diabetes Specialities Centre, No. 6, Conran Smith Road, Gopalapuram, Chennai, 600086, India
  5. 5. Eternal Heart Care Centre & Research Institute, Jawahar Circle, Jaipur, 302017, India
  6. 6. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, 11472, Saudi Arabia
  7. 7. Health Action By People, Medical College, Navarangam Lane, Opp. Men's Hostel-3, Trivandrum, 695011, Kerala, India
  8. 8. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
  9. 9. Division of Adult Medicine, Department of Medicine, Philippine General Hospital, Philippines
  10. 10. Sahlgrenska University Hospital/Ostra Hospital, Diagnosvagen 11, Goteborg, SE 416 85, Sweden
  11. 11. Universidad de La Frontera, M Montt 112, Temuco, Chile
  12. 12. Hospital Alemao Oswaldo Cruz and UNISA, Rua 13 de Maio, Sao Paulo, 1975, SP, Brazil
  13. 13. Masira Research Institute, Universidad de Santander (UDES), Colombia
  14. 14. Instituto Cardiovascular de Rosario, ECLA, Paraguay 160, Rosario, 2000, Argentina
  15. 15. Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves, 68100, Selangor, Malaysia
  16. 16. UCSI University, 1 Jalan Menara Gading, Taman Connaught, Cheras, 56000, Kuala Lumpur, Malaysia
  17. 17. Department of Community Health Sciences, The Aga Khan University, P.O. Box 3500 Stadium Road, Karachi, 74800, Pakistan
  18. 18. University of Zimbabwe, Department of Physiology, P.O.Box MP167, Harare, Zimbabwe
  19. 19. Queen's University, Department of Medicine, Kingston, ON, Canada
  20. 20. Faculty of Medicine, Head of Social Medicine Department, Wroclaw Medical University, Bujwida 44 St, Wroclaw, 50-345, EU, Poland
  21. 21. Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom, 2520, South Africa
  22. 22. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  23. 23. Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates

Source: Sleep Medicine Published:2021


Abstract

Objectives: This study aimed to examine the association of bedtime with mortality and major cardiovascular events. Methods: Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as ‘earlier’ sleepers and those who reported a bedtime after midnight as ‘later’ sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers. Results: A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03–1.16]) and later sleepers (HR of 1.10 [1.02–1.20]). Conclusion: Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes. © 2021
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