Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis

Abstract

Abstract Background: There is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality. Methods and Results: We conducted a systematic review, meta-analysis and spline analysis of prospective cohort studies which evaluate the association between sleep duration and quality, and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We employed linear and non-linear dose-response meta-analysis models and used DerSimonian-Laird random-effects meta-analysis models of risk ratios, with inverse variance weighting, and the I2 statistic to quantify heterogeneity. 74 studies including 3,340,684 participants with 164,600 deaths among 1,447,093 participants who reported death events. Findings were broadly similar across both linear and non-linear dose response models in 30 studies with >1,000,000 participants, and we report results from the linear model. Self-reported duration of sleep beyond 8 hours was associated with a moderate increased risk of all-cause mortality, with RR 1.14(1.05-1.25) for 9 hours, RR 1.30(1.19-1.42) for 10 hours and RR 1.47(1.33-1.64) for 11 hours. No significant difference was identified for periods of self-reported sleep below 7 hours, while similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (RR 1.44 95%CI 1.09-1.90) but no difference in mortality and other outcomes. Conclusions: Divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.