The Relationship Between Sleep Duration and Cardiovascular Disease: A Prospective Cohort Study Based on Charls

Background

The association between sleep disturbances and chronic diseases has attracted growing scholarly interest. Nevertheless, comprehensive national data on the longitudinal relationship between sleep duration and cardiovascular disease (CVD), along with its regional distribution characteristics, remain scarce. particularly for the Chinese population. Given the substantial burden of CVD and pronounced regional health disparities among middle-aged and older adults in China, a deeper investigation into the role of sleep is warranted.

Objectives

This research sought to systematically examine the dynamic relationship between sleep duration and cardiovascular disease (CVD) in individuals aged 45 years and older, employing multiple waves of data from the China Health and Retirement Longitudinal Study (CHARLS). The study also evaluated nonlinear associations and subgroup heterogeneity.

Methods

This prospective cohort study comprised participants with complete data across 3 waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011 (N = 13,078), 2013 (N = 9,075), and 2015 (N = 12,397). Data on sleep duration and cardiovascular disease (CVD) diagnoses were obtained through structured questionnaires. To evaluate the association between sleep duration and CVD, multivariable logistic regression models were utilized, with adjustments sequential adjustments for demographic characteristics, lifestyle factors, and comorbidities. Restricted cubic spline (RCS) models were employed to investigate potential nonlinear associations, and subgroup analyses were conducted to identify heterogeneity.

Results

Individuals diagnosed with cardiovascular disease (CVD) consistently reported shorter average sleep duration compared to their counterparts without CVD, exemplified by an average of 6.00 hours versus 6.41 hours in 2011 (p < 0.001). A short sleep duration, defined as less than 5 hours, was significantly associated with an elevated risk of CVD, whereas a sleep duration of 6 to 8 hours was correlated with the lowest risk. After full adjustment, each additional hour of sleep was associated with an approximate 9% reduction in the odds of CVD. Restricted cubic spline (RCS) analyses indicated a nonlinear inverse relationship, with the risk of CVD decreasing as sleep duration increased. The protective effects of adequate sleep were more pronounced among older adults, individuals with higher educational attainment, and nonsmokers. Predictive models incorporating sleep duration exhibited enhanced accuracy and sensitivity across all study waves, with the area under the curve (AUC) consistently improving.

Conclusions

This study provides strong longitudinal evidence of an inverse relationship between sleep duration and cardiovascular disease (CVD) risk among middle-aged and older Chinese adults. Specifically, sleep duration of less than 5 hours were associated with an elevated risk of CVD, whereas sleeping between 6 and 8 hours was correlated with the lowest risk. These findings underscore the importance of incorporating sleep health into clinical and public health strategies aimed at preventing cardiovascular disease.