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Longitudinal associations of sleep duration and sleep quality with coronary heart disease risk among adult population: classical meta-analysis and Bayesian network meta-analysis

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Abstract

To examine the longitudinal associations of sleep duration and sleep quality with coronary heart disease (CHD) risk among individuals aged ≥ 20 years. A systematic review and meta-analysis of observational cohort studies were performed to evaluate the association between sleep quality and duration, and the risk of CHD. We searched three databases including PUBMED, the Cochrane Library and EMBASE, selected relevant studies and used the classical and Net-work models to establish the hazard ratio (HRs) of the results. Data extracted from 11 studies including 769,452 participants and 14,769 patients with CHD events were reviewed. In the classical meta-analysis, night sleep duration of < 7 h and/or > 8 h showed an increased risk of CHD (HR = 1.13, and 1.13, respectively) compared with reference sleep (7–8 h). However, the net-work model stratified sleep quality into good and poor subgroups, and there was no change in CHD risk in each subgroup despite different sleep hours. Furthermore, individuals with poor-quality sleep were at a greater risk of CHD than those with good-quality sleep (HR = 1.4, 1.3, and 1.4 for < 7, 7–8, and > 8 h, respectively). Moreover, individuals with reference time sleep but that of poor quality were associated with an increased risk of CHD compared with good sleepers having short/long sleep duration (HR = 1.3 and 1.2, respectively). Poor-quality sleep was associated with great morbidity and mortality of CHD, independent of sleep duration. Sleep quality rather than sleep duration might be crucial for increased CHD risk, suggesting the potential importance of poor-quality sleep as a possible CHD risk factor.

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References

  1. Luyster FS, Strollo PJ Jr, Zee PC, et al. Sleep: a health imperative. Sleep. 2012;35:727–34.

    Article  PubMed  PubMed Central  Google Scholar 

  2. National Sleep Foundation. National sleep foundation recommends new sleep times 2018. http://sleepfoundation.org/press-release/nationalsleep-foundation-rrecommend-new-sleep-times/page/0/1. Accessed 27 June 2018.

  3. Li M, Zhang XW, Hou WS, et al. Insomnia and risk of cardiovascular disease: a meta-analysis of cohort studies. Int J Cardiol. 2014;176:1044–7.

    Article  PubMed  Google Scholar 

  4. Sofi F, Cesari F, Casini A, et al. Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol. 2014;21(1):57–64.

    Article  PubMed  Google Scholar 

  5. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, et al. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep. 2011;34(11):1487–92.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kwok CS, Kontopantelis E, Kuligowski G, et al. Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis. J Am Heart Assoc. 2018;7:e008552.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ekstedt M, Söderström M, Åkerstedt T, et al. Disturbed sleep and fatigue in occupational burnout. Scand J Work Environ Health. 2006;32:121–31.

    Article  PubMed  Google Scholar 

  8. Ekstedt M, Åkerstedt T, Söderström M. Microarousals during sleep are associated with increased levels of lipids, cortisol, and blood pressure. Psychosom Med. 2004;66:925–31.

    Article  CAS  PubMed  Google Scholar 

  9. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.

    Article  PubMed  Google Scholar 

  10. Patel SR, Ayas NT, Malhotra MR, et al. A prospective study of sleep duration and mortality risk in women. Sleep. 2004;27:440–4.

    Article  PubMed  Google Scholar 

  11. Amagai Y, Ishikawa S, Gotoh T, et al. Sleep duration and mortality in Japan: the Jichi Medical School Cohort Study. J Epidemiol. 2004;14:124–8.

    Article  PubMed  Google Scholar 

  12. Ferrie JE, Shipley MJ, Cappuccio FP, et al. A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. Sleep. 2007;30:1614–5.

    Article  Google Scholar 

  13. Empana JP, Dauvilliers Y, Dartigues JF, et al. Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three-city study. Stroke. 2009;40:1219–24.

    Article  PubMed  Google Scholar 

  14. Hale L, Parente V, Dowd JB, et al. Fibrinogen may mediate the association between long sleep duration and coronary heart disease. J Sleep Res. 2013;22(3):305–14.

    Article  PubMed  Google Scholar 

  15. Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002;251:207–16.

    Article  CAS  PubMed  Google Scholar 

  16. Cappuccio FP, D’Elia L, Strazzullo P, et al. Sleep duration and all-cause mortality: a systematic review and metaanalysis of prospective studies. Sleep. 2010;33(5):585–92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ikehara S, Iso H, Date C, et al. Association of sleep duration and mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep. 2009;32:259–301.

    Article  Google Scholar 

  18. Sands-Lincoln M, Loucks EB, Lu B, et al. Sleep duration, insomnia, and coronary heart disease among postmenopausal women in the Women’s Health Initiative. J Womens Health (Larchmt). 2013;22(6):477–86.

    Article  Google Scholar 

  19. Gianfagna F, Veronesi G, Bertù L, et al. Influence of sleep disturbances on age at onset and long-term incidence of major cardiovascular events: the MONICA-Brianza and PAMELA cohort studies. Sleep Med. 2016;21:126–32.

    Article  PubMed  Google Scholar 

  20. Chien KL, Chen PC, Hsu HC, et al. Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. Sleep. 2010;33:177–84.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Heslop P, Smith GD, Metcalfe C, et al. Sleep duration and mortality: the effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Med. 2002;3:305–14.

    Article  PubMed  Google Scholar 

  22. Meisinger C, Heier M, Löwel H, et al. Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study. Sleep. 2007;30:1121–7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38:843–4.

    PubMed  PubMed Central  Google Scholar 

  24. Viale L, Allotey J, Cheong-See F, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015;386:1845–52.

    Article  PubMed  Google Scholar 

  25. Cochrane (2018) Cochrane handbook for systematic reviews of interventions. http://handbook.cochrane.org/. Accessed 27 June 2018.

  26. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making. 2013;33:607–17.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Palmerini T, Benedetto U, Bacchi-Reggiani L, et al. Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. Lancet. 2015;385:2371–82.

    Article  CAS  PubMed  Google Scholar 

  29. Neupane B, Richer D, Bonner AJ, Kibret T, Beyene J. Network meta-analysis using R: a review of currently available automated packages. PLoS ONE. 2014;9:e115065.

    Article  PubMed  PubMed Central  Google Scholar 

  30. van Valkenhoef G, Dias S, Ades AE, Welton NJ. Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis. Res Synth Methods. 2016;7(1):80–93.

    Article  PubMed  Google Scholar 

  31. Sedgwick P. Confidence intervals, P values, and statistical significance. BMJ. 2015;350:h1113.

    Article  PubMed  Google Scholar 

  32. Sedgwick P. How to read a forest plot in a meta-analysis. BMJ. 2015;351:h4028.

    Article  PubMed  Google Scholar 

  33. Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29(7–8):932–44.

    Article  CAS  PubMed  Google Scholar 

  34. Yang L, Yang H, He M, et al. Longer sleep duration and midday napping are associated with a higher risk of CHD incidence in middle-aged and older Chinese: the Dongfeng-Tongji cohort study. Sleep. 2016;39:645–52.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Strand LB, Tsai MK, Gunnell D, et al. Self-reported sleep duration and coronary heart disease mortality: a large cohort study of 400,000 Taiwanese adults. Int J Cardiol. 2016;207:246–51.

    Article  PubMed  Google Scholar 

  36. Chandola T, Ferrie JE, Perski A, Akbaraly T, Marmot MG. The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: a prospective study from the Whitehall II cohort. Sleep. 2010;33(6):739–44.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Shankar A, Koh WP, Yuan JM, et al. Sleep duration and coronary heart disease mortality among Chinese adults in Singapore: a population-based cohort study. Am J Epidemiol. 2008;168(12):1367–73.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Liu J, Yuen J, Kang S. Sleep duration, C-reactive protein and risk of incident coronary heart disease–results from the Framingham Offspring Study. Nutr Metab Cardiovasc Dis. 2014;24(6):600–5.

    Article  CAS  PubMed  Google Scholar 

  39. Cappuccio FP, Cooper D, D’Elia L, et al. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32:1484–92.

    Article  PubMed  Google Scholar 

  40. Buysse DJ. Insomnia JAMA. 2013;309(7):706–16.

    Article  CAS  PubMed  Google Scholar 

  41. Liu H, Chen A. Roles of sleep deprivation in cardiovascular dysfunctions. Life Sci. 2019;219:231–7.

    Article  CAS  PubMed  Google Scholar 

  42. Fatima Y, Doi SA, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2015;16(2):137–49.

    Article  CAS  PubMed  Google Scholar 

  43. Buman MP, Phillips BA, Youngstedt SD, et al. Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll. Sleep Med. 2014;15:755–61.

    Article  PubMed  Google Scholar 

  44. Suzuki E, Yorifuji T, Ueshima K, et al. Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study. Prev Med. 2009;49(2–3):135–41.

    Article  PubMed  Google Scholar 

  45. Ohayon M, Wickwire EM, Hirshkowitz M, et al. National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health. 2017;3:6–19.

    Article  PubMed  Google Scholar 

  46. Clark AJ, Salo P, Lange T, et al. Onset of impaired sleep and cardiovascular disease risk factors: a longitudinal study. Sleep. 2016;39:1709–18.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Budhiraja R, Quan SF. Sleep-disordered breathing and cardiovascular health. Curr Opin Pulm Med. 2005;1:501–6.

    Article  Google Scholar 

  48. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829–36.

    Article  CAS  PubMed  Google Scholar 

  49. Newman AB, Nieto FJ, Guidry U, et al. Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol. 2001;154:50–9.

    Article  CAS  PubMed  Google Scholar 

  50. Lutsey PL, McClelland RL, Duprez D, et al. Objectively measured sleep characteristics and prevalence of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis Sleep study. Thorax. 2015;70:880–7.

    Article  PubMed  Google Scholar 

  51. Carreras A, Zhang SX, Peris E, et al. Chronic sleep fragmentation induces endothelial dysfunction and structural vascular changes in mice. Sleep. 2014;37:1817–24.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Behl M, Bliwise D, Veledar E, et al. Vascular endothelial function and self-reported sleep. Am J Med Sci. 2014;347:425–8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Lavie L, Kraiczi H, Hefetz A, et al. Plasma vascular endothelial growth factor in sleep apnea syndrome: effects of nasal continuous positive air pressure treatment. Am J Respir Crit Care Med. 2002;165:1624–8.

    Article  PubMed  Google Scholar 

  54. Glantz H, Thunström E, Johansson MC, et al. Obstructive sleep apnea is independently associated with worse diastolic function in coronary artery disease. Sleep Med. 2015;16:160–7.

    Article  PubMed  Google Scholar 

  55. Tuleta I, França CN, Wenzel D, et al. Intermittent hypoxia impairs endothelial function in early preatherosclerosis. Adv Exp Med Biol. 2015;858:1–7.

    Article  CAS  PubMed  Google Scholar 

  56. Mullington JM, Haack M, Toth M, Serrador JM, Meier-Ewert HK. Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009;51:294–302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Hamer M, Endrighi R, Venuraju SM, Lahiri A, Steptoe A. Cortisol responses to mental stress and the progression of coronary artery calcification in healthy men and women. PLoS ONE. 2012;7:e31356.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Ashley NT, Sams DW, Brown AC, Dumaine JE. Novel environment influences the effect of paradoxical sleep deprivation upon brain and peripheral cytokine gene expression. Neurosci Lett. 2016;615:55–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Larsson SC, Burgess S, Michaëlsson K. Association of genetic variants related to serum calcium levels with coronary artery disease and myocardial infarction. JAMA. 2017;318:371–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Martin JL, Hakim AD. Wrist actigraphy. Chest. 2011;139:1514–27.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Marino M, Li Y, Rueschman MN, et al. Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep. 2013;36:1747–55.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Tal A, Shinar Z, Shaki D, Codish S, Goldbart A. Validation of graphy. J Clin Sleep Med. 2017;13:517–22.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was supported by the Research Grant of the National Natural Science Foundation of China (81801674).

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Author notes

  1. Rui Zeng and Yu-ting Jiang are equal contributors.

Authors and Affiliations

  1. Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Rd, Shunqing District, Nanchong, 637000, Sichuan, China

    Rui Zeng, Yu-ting Jiang, Tian-wu Chen, Dan-dan Guo & Rui Li

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  1. Rui Zeng
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  2. Yu-ting Jiang
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  3. Tian-wu Chen
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  4. Dan-dan Guo
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  5. Rui Li
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Contributions

ZR participated in the study design, contributed to data analysis and interpretation, and drafted the manuscript. JYT contributed to the preparation, editing and review of the manuscript. GDD carried out data acquisition, performed data analysis and interpretation and edited the manuscript. CTW carried out data acquisition and performed data analysis and interpretation. LR contributed to quality control of data and algorithm, and editing and review of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Rui Li.

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Zeng, R., Jiang, Yt., Chen, Tw. et al. Longitudinal associations of sleep duration and sleep quality with coronary heart disease risk among adult population: classical meta-analysis and Bayesian network meta-analysis. Sleep Biol. Rhythms 19, 265–276 (2021). https://doi.org/10.1007/s41105-021-00312-1

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