Interplay of Objective Sleep Duration and Cardiovascular and Cerebrovascular Diseases on Cause-Specific Mortality

Abstract

Background: Cardiovascular and cerebrovascular diseases (CBVDs) and cancer are leading causes of death. Short sleep is a potential contributor to health; however, its role in predicting mortality associated with cardiometabolic risk factors (CMRs) and CBVD remains poorly understood. We tested whether objective short sleep duration increases the risk of mortality associated with CMRs and CBVD. Methods and Results: A total of 1654 adults (aged 20–74 years) from the Penn State Adult Cohort (47.5 years, 52.5% women, and 89.8% white) whose cause of death was determined after 19.2 years (5.2 years). CMR was defined as stage 2 hypertension and/or type 2 diabetes mellitus on the basis of blood pressure and glucose levels or a report of diagnosis or treatment for these conditions. CBVD was defined as a report of diagnosis or treatment for heart disease and/or stroke. Objective short sleep duration was defined as polysomnographic total sleep time <6 hours. Cox proportional hazard models estimated multivariable-adjusted hazard ratios (HRs) and 95% CIs. Risk of all-cause mortality associated with CMR or CBVD was significantly modified by objective sleep duration (P<0.05), and it was significantly higher in subjects who slept <6 hours (HR, 2.14 [95% CI, 1.52–3.02] and HR, 3.17 [95% CI=2.16–4.65], respectively). In subjects who slept <6 hours, CMR was associated with a 1.83 higher (95% CI, 1.07–3.13) risk of CBVD mortality and CBVD with a 2.92 higher (95% CI, 1.28–6.65) risk of cancer mortality. In subjects who slept ≥6 hours, CMR was not significantly associated with CBVD mortality (HR, 1.35; 95% CI, 0.70–2.63) nor was CBVD significantly associated with cancer mortality (HR, 0.55; 95% CI, 0.18–1.64). Conclusions: Objective short sleep duration predicts the all-cause mortality prognosis of middle-aged adults with CMR and the cancer-specific mortality prognosis of those with CBVD.