Abstract
Objective
To prospectively assess whether sleep patterns modified lifestyle-associated cardiovascular
disease (CVD) risk.
Patients and Methods
This study included 393,690 participants without CVD at baseline measurements between
March 13, 2006, and October 1, 2010, from UK Biobank. A lifestyle score was calculated
on the basis of the 4 lifestyle factors (smoking, alcohol consumption, physical activity,
and diet), and sleep patterns were constructed based on sleep duration, chronotype,
insomnia, snoring, and daytime dozing.
Results
During a median follow-up of 8.93 years, we observed 10,218 incident CVD events, including
6595 myocardial infarctions (MIs) and 3906 strokes. We found that sleep patterns significantly
modified the relations of the lifestyle score with incident CVD (P for interaction =.007) and MI (P for interaction =.004). Among participants with a poor sleep pattern, unfavorable
lifestyle (per score increase) was associated with 25% (95% CI, 13% to 39%) and 29%
(95% CI, 13% to 47%) increased risks for CVD and MI, while among participants with
a healthy sleep pattern, unfavorable lifestyle was associated with 18% (95% CI, 15%
to 21%) and 17% (95% CI, 13% to 21%) increased risks for CVD and MI.
Conclusion
Our results indicate that adherence to a healthy sleep pattern may attenuate the CVD
risk associated with an unfavorable lifestyle.
Abbreviations and Acronyms:
BMI (body mass index), CVD (cardiovascular disease), HR (hazard ratio), ICD-10(9) (International Classification of Diseases, Tenth (Ninth) Revision), MI (myocardial infarction), PRS (polygenic risk score), PRS-DUR (polygenic risk score of sleep duration), SNP (single-nucleotide polymorphism)To read this article in full you will need to make a payment
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References
- Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1736-1788
- Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study.Lancet. 2020; 395: 795-808
- Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond.Circulation. 2010; 121: 586-613
- Seven modifiable lifestyle factors predict reduced risk for ischemic cardiovascular disease and all-cause mortality regardless of body mass index: a cohort study.Int J Cardiol. 2013; 168: 946-952
- Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study.BMJ. 2009; 338: b349
- Sleep duration and risk-taking in adolescents: a systematic review and meta-analysis.Sleep Med Rev. 2018; 41: 185-196
- Sleep duration and sleep quality are associated with physical activity in elderly people living in nursing homes.Int J Environ Res Public Health. 2018; 15: 2512
- Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals.Am J Clin Nutr. 2011; 94: 410-416
- Current alcohol use is associated with sleep patterns in first-year college students.Sleep. 2016; 39: 1321-1326
- Relationships between smoking and sleep problems in black and white adolescents.Sleep. 2017; 40: zsw031
- Sleep patterns, genetic susceptibility, and incident cardiovascular disease: a prospective study of 385 292 UK biobank participants.Eur Heart J. 2020; 41: 1182-1189
- Baseline vitamin D status, sleep patterns, and the risk of incident type 2 diabetes in data from the UK Biobank Study.Diabetes Care. 2020; 43: 2776-2784
- Adherence to a healthy sleep pattern and incident heart failure: a prospective study of 408 802 UK Biobank Participants.Circulation. 2021; 143: 97-99
- Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population.Am J Epidemiol. 2017; 186: 1026-1034
- UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.PLoS Med. 2015; 12: e1001779
- UK Biobank data: come and get it.Sci Transl Med. 2014; 6: 224ed4
- Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies.Lancet. 2011; 378: 1297-1305
- Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis.BMJ. 2011; 342: d671
- Cardiovascular risks and benefits of moderate and heavy alcohol consumption.Nat Rev Cardiol. 2015; 12: 576-587
- The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study.Lancet. 2017; 390: 2643-2654
- Protocol for a Large-scale Prospective Epidemiological Resource. Protocol No: UKBB-PROT-09-06 (Main Phase). (AMENDMENT ONE FINAL).UK Biobank Coordinating Centre, March 21, 2007
- Genome-wide genetic data on ∼500,000 UK Biobank participants.(bioRxiv. Published online January 1, 2017)
- Genome-wide association study identifies genetic loci for self-reported habitual sleep duration supported by accelerometer-derived estimates.Nat Commun. 2019; 10: 1100
- Genome-wide association analyses of chronotype in 697,828 individuals provides insights into circadian rhythms.Nat Commun. 2019; 10: 343
- Genome-wide analysis of insomnia in 1,331,010 individuals identifies new risk loci and functional pathways.Nat Genet. 2019; 51: 394-403
- Risk of cardiovascular disease related to smoking is greater among women with sleep-disordered breathing.J Clin Sleep Med. 2018; 14: 1929-1935
- Smoking interacts with sleep apnea to increase cardiovascular risk.Sleep Med. 2008; 9: 247-253
- Sleep duration and total and cause-specific mortality in a large US cohort: interrelationships with physical activity, sedentary behavior, and body mass index.Am J Epidemiol. 2014; 180: 997-1006
- Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial.JAMA. 1997; 277: 32-37
- Physically active elderly women sleep more and better than sedentary women.Sleep Med. 2008; 9: 488-493
- Diet quality, dietary patterns and short sleep duration: a cross-sectional population-based study.Eur J Nutr. 2019; 58: 641-651
- Shorter sleep duration is associated with higher energy intake and an increase in BMI z-score in young children predisposed to overweight.Int J Obes (Lond). 2018; 42: 59-64
- Smoking, screen-based sedentary behavior, and diet associated with habitual sleep duration and chronotype: data from the UK Biobank.Ann Behav Med. 2016; 50: 715-726
- Mediterranean diet pattern and sleep duration and insomnia symptoms in the Multi-Ethnic Study of Atherosclerosis.Sleep. 2018; 41: zsy158
- The pathophysiology of cigarette smoking and cardiovascular disease: an update.J Am Coll Cardiol. 2004; 43: 1731-1737
- An update on alcohol and atherosclerosis.Curr Opin Lipidol. 2004; 15: 673-680
- Metabolic and endocrine response to exercise: sympathoadrenal integration with skeletal muscle.J Endocrinol. 2015; 224: R79-R95
- Does regular physical exercise preserve artery dilation by lowering Nox2-related oxidative stress?.Antioxid Redox Signal. 2018; 28: 1576-1581
- Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction.Am J Clin Nutr. 2004; 80: 1029-1035
- Relationship of sleep duration with all-cause mortality and cardiovascular events: a systematic review and dose-response meta-analysis of prospective cohort studies.J Am Heart Assoc. 2017; 6: e005947
- Circadian misalignment increases cardiovascular disease risk factors in humans.Proc Natl Acad Sci U S A. 2016; 113: E1402-E1411
- Insomnia and risk of cardiovascular disease.Chest. 2017; 152: 435-444
- Tissue vibration induces carotid artery endothelial dysfunction: a mechanism linking snoring and carotid atherosclerosis?.Sleep. 2011; 34: 751-757
- Similarities and differences in estimates of sleep duration by polysomnography, actigraphy, diary, and self-reported habitual sleep in a community sample.Sleep Health. 2018; 4: 96-103
- Self-reported and measured sleep duration: how similar are they?.Epidemiology. 2008; 19: 838-845
Article Info
Publication History
Published online: February 09, 2022
Footnotes
Grant Support: This work was supported by grants from the National Heart, Lung, and Blood Institute ( HL071981 , HL034594 , and HL126024 ) and the National Institute of Diabetes and Digestive and Kidney Diseases ( DK091718 , DK100383 , and DK078616 ). LQ is also supported by National Institute of General Medical Sciences ( P20GM109036 ). Q.S. is a recipient of a scholarship under the China Scholarship Council to pursue her study in the United States (201806010383).
Potential Competing Interests: The authors report no competing interests.
Identification
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