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Association of Estimated Sleep Duration and Naps With Mortality and Cardiovascular Events: A Study of 116 632 People From 21 Countries Publisher Pubmed



Wang C1, 2 ; Bangdiwala SI1 ; Rangarajan S1 ; Lear SA3 ; Alhabib KF4 ; Mohan V5 ; Teo K1 ; Poirier P6 ; Tse LAH7 ; Liu Z7 ; Rosengren A8 ; Kumar R9 ; Lopezjaramillo P10 ; Yusoff K11, 12 Show All Authors
Authors
  1. Wang C1, 2
  2. Bangdiwala SI1
  3. Rangarajan S1
  4. Lear SA3
  5. Alhabib KF4
  6. Mohan V5
  7. Teo K1
  8. Poirier P6
  9. Tse LAH7
  10. Liu Z7
  11. Rosengren A8
  12. Kumar R9
  13. Lopezjaramillo P10
  14. Yusoff K11, 12
  15. Monsef N13
  16. Krishnapillai V14
  17. Ismail N15
  18. Seron P16
  19. Dans AL17
  20. Kruger L18
  21. Yeates K19
  22. Leach L20
  23. Yusuf R21
  24. Orlandini A22
  25. Wolyniec M23
  26. Bahonar A24
  27. Mohan I25
  28. Khatib R26
  29. Temizhan A27
  30. Li W2
  31. Yusuf S1
Show Affiliations
Authors Affiliations
  1. 1. Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, L8L 2X2, ON, Canada
  2. 2. Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Shilong West Road, Mentougou District, Beijing, 102300, China
  3. 3. Department of Medicine, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, BC, Canada
  4. 4. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
  5. 5. Madras Diabetes Research Foundation, Dr Mohan’s Diabetes Specialities Centre, No. 6B, Conran Smith Road, Gopalapuram, Chennai, 600086, India
  6. 6. Department of Medicine, Faculte de pharmacie, Universite Laval, Institut universitaire de cardiologie et de pneumologie de Quebec, 2725 Chemin Sainte-Foy, Quebec City, G1V 4G5, QC, Canada
  7. 7. Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Ngan Shing Street, Sha Tin, SAR 96H2þ9X, Hong Kong
  8. 8. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Diagnosvagen 11, Gothenburg, 41650, Sweden
  9. 9. Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
  10. 10. Research Institute, FOSCAL, Department of Medicine, Medical School, UDES, Calle 158 #20-95, local 101–102, Floridablanca, Colombia
  11. 11. Department of Medicine, UiTM Selayang, Shah Alam, Selangor Darul Ehsan, 40450, Malaysia
  12. 12. UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
  13. 13. Dubai Health Authority, Al Maktoum Bridge Street, Bur Dubai Area 4545, Dubai, United Arab Emirates
  14. 14. Health Action by People, Thiruvananthapuram and Community Medicine, Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara P. O., Kochi, Kerala, 682041, India
  15. 15. Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Selangor, 43600, Malaysia
  16. 16. Department of Medicine, Universidad de La Frontera, Francisco Salazar 1145, Temuco, Regioen de la Araucania, Chile
  17. 17. Department of Medicine, UP College of Medicine, University of the Philippines Manila, Padre Faura Street, Ermita, Manila, 1000, Philippines
  18. 18. Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Private Bag X2046, Mmabatho, 2745, South Africa
  19. 19. Department of Medicine, Queen’s University, Office of Global Health Research, 99 University Avenue, Kingston, K7L 3N6, ON, Canada
  20. 20. Department of Medicine, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa
  21. 21. School of Life Sciences, Independent University, Academic Building, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka, 1229, Bangladesh
  22. 22. ECLA Foundation, Paraguay 160, Rosario, Santa Fe, Argentina
  23. 23. Department of Social Medicine, Medical University of Wroc?aw, Bujwida 44 Street, Wroc?aw, 50–345, Poland
  24. 24. Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Avenue, Isfahan, 81746 73461, Iran
  25. 25. Department of Clinical Research, EHCC, Jawahar Circle, Jaipur, 302017, India
  26. 26. Departments of Neurology, Northwestern University Feinberg School of Medicine, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, 60611, IL, United States
  27. 27. Department of Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, University of Saglik Bilimleri, T?bbiye Cd No. 38, Selimiye Mahallesi, Uskudar/_Istanbul, 34668, Turkey

Source: European Heart Journal Published:2019


Abstract

Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self- and results reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (<_6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6–8 h/day, those who slept <_6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99–1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99–1.12), 1.17 (1.09–1.25), and 1.41 (1.30–1.53) for 8–9 h/day, 9–10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (<_6 h). Conclusion Estimated total sleep duration of 6–8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping <_6 h/night. © The Author(s) 2019. Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2018.
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