Huang Tianyi, Kianersi Sina, Wang Heming, Potts Kaitlin S, Noordam Raymond, Sofer Tamar, Rutter Martin K, Redline Susan
Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA.
Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
medRxiv. 2024 Jul 27:2024.07.26.24311090. doi: 10.1101/2024.07.26.24311090.
Emerging evidence supports a link between circadian disruption as measured by higher night-to-night variation in sleep duration and increased risk of cardiovascular disease (CVD). It remains unclear whether this association varies by CVD types or may be modified by average sleep duration and genetic risk for CVD.
Our prospective analysis included 86,219 UK Biobank participants who were free from CVD when completing 7 days of accelerometer measurement in 2013-2016. Sleep irregularity was evaluated by the standard deviation (SD) of accelerometer-measured sleep duration over 7 days. Incident major CVD events, defined as fatal or nonfatal myocardial infarction (MI) and stroke, were identified through linkage to Hospital Episode Statistics data until May 31, 2022. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs for associations of sleep duration SD with risk for major CVD events overall and for MI and stroke separately.
We documented 2,310 incident cases of major CVD events (MI: 1,183, stroke: 1,175) over 636,258 person-years of follow-up. After adjusting for sociodemographic factors and family history of CVD, the HR (95% CI) associated with a 1-hour increase in sleep duration SD was 1.19 (1.10, 1.27) for CVD (p-trend<0.0001), 1.23 (1.11, 1.35) for MI (p-trend<0.0001), and 1.17 (1.05, 1.29) for stroke (p-trend=0.003). Additional adjustment for lifestyle factors, co-morbidities and sleep-related factors modestly attenuated these associations. Higher sleep irregularity was associated with higher CVD risk irrespective of genetic risk (p-interaction=0.43), but this association was stronger among individuals with longer average sleep duration >8 hours (p-interaction=0.006).
Higher night-to-night variation in accelerometer-measured sleep duration was associated with consistently higher risks for major CVD events. The association did not seem to be modified by genetic risk for CVD and was more pronounced in long sleepers.
越来越多的证据支持，以夜间睡眠时间变化较大衡量的昼夜节律紊乱与心血管疾病（CVD）风险增加之间存在关联。目前尚不清楚这种关联是否因CVD类型而异，或者是否会受到平均睡眠时间和CVD遗传风险的影响。
我们的前瞻性分析纳入了86219名英国生物银行参与者，他们在2013年至2016年完成7天的加速度计测量时无CVD。通过7天内加速度计测量的睡眠时间标准差（SD）评估睡眠不规律情况。通过与医院事件统计数据链接，确定直至2022年5月31日的重大CVD事件，定义为致命或非致命性心肌梗死（MI）和中风。使用多变量调整的Cox比例风险模型估计睡眠时间SD与总体重大CVD事件风险以及分别与MI和中风风险的关联的风险比（HR）和95%置信区间（CI）。
在636258人年的随访中，我们记录了2310例重大CVD事件（MI：1183例，中风：1175例）。在调整社会人口学因素和CVD家族史后，睡眠时间SD每增加1小时，CVD的HR（95%CI）为1.19（1.10，1.27）（p趋势<0.0001），MI为1.23（1.11，1.35）（p趋势<0.0001），中风为1.17（1.05，1.29）（p趋势=0.003）。对生活方式因素、合并症和睡眠相关因素进行额外调整后，这些关联略有减弱。无论遗传风险如何，较高的睡眠不规律与较高的CVD风险相关（p交互作用=0.43），但这种关联在平均睡眠时间>8小时的个体中更强（p交互作用=0.006）。
加速度计测量的夜间睡眠时间变化较大与重大CVD事件风险持续升高相关。这种关联似乎不受CVD遗传风险的影响，且在睡眠较长者中更为明显。
