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% CI s. 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 .