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Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries.

Journal article
Authors Chuangshi Wang
Shrikant I Bangdiwala
Sumathy Rangarajan
Scott A Lear
Khalid F AlHabib
Viswanathan Mohan
Koon Teo
Paul Poirier
Lap Ah Tse
Zhiguang Liu
Annika Rosengren
Rajesh Kumar
Patricio Lopez-Jaramillo
Khalid Yusoff
Nahed Monsef
Vijayakumar Krishnapillai
Noorhassim Ismail
Pamela Seron
Antonio L Dans
Lanthé Kruger
Karen Yeates
Lloyd Leach
Rita Yusuf
Andres Orlandini
Maria Wolyniec
Ahmad Bahonar
Indu Mohan
Rasha Khatib
Ahmet Temizhan
Wei Li
Salim Yusuf
Published in European heart journal
Volume 40
Issue 20
Pages 1620–1629
ISSN 1522-9645
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1620–1629
Language en
Subject categories Clinical Medicine


To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events.We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6-8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99-1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99-1.12), 1.17 (1.09-1.25), and 1.41 (1.30-1.53) for 8-9 h/day, 9-10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h).Estimated total sleep duration of 6-8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.

Page Manager: Webmaster|Last update: 9/11/2012

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