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Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: Sleep Heart Health Study

  • Bertisch, Suzanne M1, 2
  • Pollock, Benjamin D3, 4, 5
  • Mittleman, Murray A1, 2, 6
  • Buysse, Daniel J7
  • Bazzano, Lydia A3
  • Gottlieb, Daniel J2, 8, 9
  • Redline, Susan1, 2, 9
  • 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
  • 2 Division of Sleep Medicine, Harvard Medical School, Boston, MA
  • 3 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
  • 4 & White Health, Dallas, TX
  • 5 Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX
  • 6 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
  • 7 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
  • 8 VA Boston Healthcare System, Boston, MA
  • 9 Department of Medicine, Brigham and Women’s Hospital, Boston, MA
Published Article
Oxford University Press
Publication Date
Mar 07, 2018
DOI: 10.1093/sleep/zsy047
PMID: 29522193
PMCID: PMC5995202
PubMed Central


Study Objectives To quantify the association between insomnia or poor sleep with objective short sleep duration and incident cardiovascular disease (CVD) and mortality in the general population. Methods We conducted a time-to-event analysis of Sleep Heart Health Study data. Questionnaires and at-home polysomnography (PSG) were performed between 1994 and 1998. Participants were followed for a median of 11.4 years (Q1-Q3, 8.8–12.4 years) until death or last contact. The primary exposure was insomnia or poor sleep with short sleep defined as follows: difficulty falling asleep, difficulty returning to sleep, early morning awakenings, or sleeping pill use, 16–30 nights per month; and total sleep of <6 hr on PSG. We used proportional hazard models to estimate the association between insomnia or poor sleep with short sleep and CVD, as well as all-cause mortality. Results Among 4994 participants (mean age: 64.0 ± 11.1 years), 14.1 per cent reported insomnia or poor sleep, of which 50.3 per cent slept <6 hr. Among 4437 CVD-free participants at baseline, we observed 818 incident CVD events. After propensity adjustment, there was a 29 per cent higher risk of incident CVD in the insomnia or poor sleep with short sleep group compared with the reference group (HR: 1.29, 95% CI: 1.00, 1.66), but neither the insomnia or poor sleep only nor short sleep only groups were associated with higher incident CVD. Insomnia or poor sleep with objective short sleep was not associated with all-cause mortality (HR: 1.07, 95% CI: 0.86, 1.33). Conclusions Insomnia or poor sleep with PSG-short sleep was associated with higher risk of incident CVD. Future studies should evaluate the impact of interventions to improve insomnia with PSG-short sleep on CVD.

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