Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Eugeniahemmet T2, 171 76 Stockholm, Sweden.
Eur J Epidemiol. 2013 Jun;28(6):463-73. doi: 10.1007/s10654-013-9802-2. Epub 2013 Apr 4.
Limited evidence suggests that the association between sleep duration and cardiovascular events is strongest in individuals who also report sleep disturbances. We investigated sleep duration and insomnia symptoms in relation to incident cardiovascular events in the Swedish National March Cohort comprising 41,192 adults. Habitual sleep duration and difficulty falling asleep, difficulty maintaining sleep, early morning awakening, and nonrestorative sleep were self-reported in 1997. During 13.2 years of follow-up, we identified 4,031 events (myocardial infarction, stroke, heart failure, or death from cardiovascular disease) in the Swedish National Patient Register and the Cause of Death Register. After adjustment for potential confounders, short sleep duration (≤5 h) was associated with slightly increased risks of overall cardiovascular events and, specifically, myocardial infarction: hazard ratio, HR (95% confidence interval) 1.24 (1.06-1.44) and 1.42 (1.15-1.76), respectively. These HRs were attenuated as we included BMI, depressive symptoms and other relevant covariates in our analysis. Insomnia symptoms per se were unrelated to risk. However, in a joint analysis, there was some evidence that short sleepers who reported frequent insomnia symptoms had the highest HRs (1.26-1.39) of overall cardiovascular events. Short sleep or insomnia symptoms without the other conferred no increased risk. Our results suggest that symptoms of sleep disturbance should be taken into account when assessing the association between short sleep and cardiovascular disease.
有限的证据表明，在同时报告睡眠障碍的个体中，睡眠持续时间与心血管事件之间的关联最强。我们研究了睡眠时间和失眠症状与瑞典国家三月队列中 41192 名成年人发生心血管事件的关系。习惯性睡眠时间和入睡困难、睡眠维持困难、清晨早醒和睡眠质量差等情况于 1997 年进行了自我报告。在 13.2 年的随访期间，我们在瑞典国家患者登记处和死因登记处确定了 4031 例事件（心肌梗死、中风、心力衰竭或心血管疾病死亡）。在调整了潜在混杂因素后，短睡眠时间（≤5 小时）与整体心血管事件的风险略有增加相关，特别是与心肌梗死相关：风险比（HR）（95%置信区间）分别为 1.24（1.06-1.44）和 1.42（1.15-1.76）。当我们在分析中纳入 BMI、抑郁症状和其他相关协变量时，这些 HR 会减弱。失眠症状本身与风险无关。然而，在联合分析中，有一些证据表明，经常报告失眠症状的短睡者的整体心血管事件的 HR 最高（1.26-1.39）。没有其他症状的短睡眠时间或失眠症状不会增加风险。我们的研究结果表明，在评估短睡眠与心血管疾病之间的关联时，应考虑睡眠障碍的症状。
