Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults

Jean-Philippe Chaput; Raaj Kishore Biswas; Matthew Ahmadi; Peter A Cistulli; Shantha M W Rajaratnam; Wenxin Bian; Marie-Pierre St-Onge; Emmanuel Stamatakis

doi:10.1136/jech-2024-222795

Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults

J Epidemiol Community Health. 2024 Nov 27:jech-2024-222795. doi: 10.1136/jech-2024-222795. Online ahead of print.

Authors

Jean-Philippe Chaput^{1

2}, Raaj Kishore Biswas³, Matthew Ahmadi³, Peter A Cistulli^{4

5}, Shantha M W Rajaratnam⁶, Wenxin Bian³, Marie-Pierre St-Onge⁷, Emmanuel Stamatakis³

Affiliations

¹ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada jpchaput@cheo.on.ca.
² Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
³ The University of Sydney, Sydney, New South Wales, Australia.
⁴ Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁶ School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
⁷ Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.

PMID: 39603689
DOI: 10.1136/jech-2024-222795

Abstract

Background: This study examines the associations between device-measured sleep regularity and the risk of major adverse cardiovascular events (MACE), and aims to determine whether sufficient sleep duration attenuates or eliminates the effects of irregular sleep on MACE risk.

Methods: A prospective cohort study of adults aged 40-79 years from the UK Biobank who wore wrist-attached accelerometers for 7 days was conducted. Sleep Regularity Index (SRI) scores were calculated for each participant using a validated algorithm, and categorised as irregular (SRI <71.6), moderately irregular (SRI between 71.6 and 87.3), and regular (SRI >87.3 (reference group)). Information on MACE and its subtypes (myocardial infarction, heart failure, stroke) was obtained from inpatient hospitalisation and death records.

Results: We analysed data from 72 269 individuals followed for 8 years, without a previous history of MACE and without an event in the first year of follow-up. Irregular (HR 1.26, 95% CI 1.16 to 1.37) and moderately irregular sleepers (HR 1.08, 95% CI 1.01 to 1.70) were at higher risk of MACE compared with regular sleepers. Dose-response analyses treating SRI as a continuous measure showed that SRI was associated with MACE risk in a near-linear fashion, with a steeper MACE risk reduction at higher (better) SRI scores. Joint SRI and sleep duration analyses showed that meeting the age-specific sleep duration recommendation offsets MACE risk for moderately irregular sleepers (HR 1.07, 95% CI 0.96 to 1.18), but not for irregular sleepers (HR 1.19, 95% CI 1.06 to 1.35).

Conclusions: Irregular sleep was strongly associated with higher MACE risk. Adequate sleep duration was not sufficient to offset these adverse effects among irregular sleepers. This study supports the inclusion of sleep regularity in public health guidelines and clinical practice as a risk factor for cardiovascular disease.

Keywords: CARDIOVASCULAR DISEASES; PUBLIC HEALTH; SLEEP.