Journal
EUROPEAN HEART JOURNAL
Volume 40, Issue 20, Pages 1620-1629Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehy695
Keywords
Sleep duration; Naps; Cardiovascular diseases; Mortality
Categories
Funding
- Heart and Stroke Foundation of Ontario
- Population Health Research Institute
- Canadian Institutes of Health Research (CIHR)
- CIHR's Strategy for Patient Oriented Research (SPOR), through Ontario SPOR Support Unit
- Ontario Ministry of Health and Long-Term Care
- AstraZeneca (Canada)
- SanofiAventis (France)
- SanofiAventis (Canada)
- Boehringer Ingelheim (Germany)
- Boehringer Ingelheim (Canada)
- Servier
- GlaxoSmithKline
- Novartis
- King Pharma
- Argentina: Fundacion ECLA (Estudios Clinicos Latino America)
- Bangladesh: Independent University, Bangladesh
- Brazil: Unilever Health Institute, Brazil
- Canada: Public Health Agency of Canada
- Canada: Champlain Cardiovascular Disease Prevention Network
- Chile: Universidad de la Frontera
- China: National Center for Cardiovascular Diseases
- Colombia: Colciencias [6566-04-18062]
- India: Indian Council of Medical Research
- Malaysia: Ministry of Science, Technology and Innovation of Malaysia [100-IRDC/BIOTEK 16/6/21 (13/2007), 07-05-IFN-BPH 010]
- Malaysia: Ministry of Higher Education of Malaysia [600-RMI/LRGS/5/3 (2/2011)]
- Malaysia: Universiti Teknologi MARA
- Malaysia: Universiti Kebangsaan Malaysia [UKM-Hejim-Komuniti-15-2010]
- United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)
- International Development Research Centre (IDRC), Canada
- Philippines: Philippine Council for Health Research & Development (PCHRD)
- Poland: Polish Ministry of Science and Higher Education [290/W-PURE/2008/0]
- Poland: Wroclaw Medical University
- Saudi Arabia: Saudi Heart Association
- Saudi Arabia: King Saud University, Riyadh, Saudi Arabia [RG-1436-013]
- South Africa: The North-West University, SANPAD (SA and Netherlands Programme for Alternative Development)
- South Africa: National Research Foundation
- South Africa: Medical Research Council of SA
- South Africa: SA Sugar Association (SASA)
- South Africa: Faculty of Community and Health Sciences (UWC)
- Swedish Heart and Lung Foundation
- Swedish Research Council
- Swedish Council for Health, Working Life and Welfare
- King Gustaf V's and Queen Victoria Freemasons Foundation
- AFA Insurance
- Turkey: Metabolic Syndrome Society
- Turkey: AstraZeneca, Turkey
- Turkey: Sanofi Aventis, Turkey
- United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences
- United Arab Emirates: Dubai Health Authority, Dubai UAE
- China Scholarship Council (CSC)
- Bangladesh: Mitra and Associates
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Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods and results We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-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 nonsignificant 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, P-trend < 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.
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