Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Sleep Med. 2021 Apr;80:265-272. doi: 10.1016/j.sleep.2021.01.057. Epub 2021 Feb 5.
This study aimed to examine the association of bedtime with mortality and major cardiovascular events.
Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as 'earlier' sleepers and those who reported a bedtime after midnight as 'later' sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers.
A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03-1.16]) and later sleepers (HR of 1.10 [1.02-1.20]).
Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes.
本研究旨在探讨就寝时间与死亡率和主要心血管事件的关系。
在 Prospective Urban Rural Epidemiology（PURE）研究中，来自 21 个国家的 112198 名参与者根据自我报告的习惯入睡时间记录就寝时间。参与者前瞻性随访 9.2 年。我们检查了就寝时间与全因死亡率、非致死性心肌梗死、卒中和心力衰竭的复合结局之间的关系。通常在晚上 10 点之前就寝的参与者被归类为“早睡”者，而报告午夜后就寝的参与者被归类为“晚睡”者。应用 Cox 脆弱性模型，使用随机截距来考虑中心内的聚类。
共报告了 5633 例死亡和 5346 例主要心血管事件。就寝时间与复合结局之间存在 U 形关系。与晚上 10 点至午夜之间就寝的人作为参考组相比，调整年龄和性别后，早睡和晚睡者发生复合结局的风险更高（HR 分别为 1.29 [1.22, 1.35]和 1.11 [1.03, 1.20]）。在充分调整的模型中，纳入了人口统计学因素、生活方式行为（包括总睡眠时间）和疾病史，结果大大减弱，但估计表明早睡者（HR 为 1.09 [1.03-1.16]）和晚睡者（HR 为 1.10 [1.02-1.20]）的风险略高。
早睡（晚上 10 点或更早）或晚睡（午夜或更晚）可能是不良健康结果的指标或危险因素。
