Association of sleep patterns with the trajectory of multimorbidity: A large community-based longitudinal study.

Objective: This study aimed to investigate whether sleep patterns are associated with the accumulation of multiple chronic diseases and multimorbidity-free survival, and to explore the role of C-reactive protein in these associations.

Methods: The study included 247,751 chronic disease--free participants from the UK Biobank (mean age: 55.20 ± 8.09, 54.69% females) who were followed for up to 16 years to detect incident chronic diseases. A total of 59 chronic diseases were ascertained through information on medical records. Multimorbidity was defined as the presence of two or more chronic diseases. Sleep patterns were assessed based on duration, chronotype, insomnia, snoring, and daytime sleepiness and categorized as healthy, intermediate, or poor. Plasma C-reactive protein concentration was measured through blood samples. Data were analyzed using the linear mixed-effects models, Cox regression, Laplace regression, and mediation analysis.

Results: During the follow-up (median: 10.34 years), 108,764 (43.90%) participants developed multimorbidity. Having a poor compared with healthy sleep pattern was related to significantly faster accumulation of chronic diseases (β_mix = 0.081, 95% confidence interval [CI]: 0.075, 0.086). Among people with a poor sleep pattern, the hazard ratio (95% CI) of multimorbidity was 1.347 (1.304, 1.392). Further, having poor sleep pattern shortened the median multimorbidity-free survival time by 1.747 (95% CI: -1.949, -1.546) years. In mediation analysis, C-reactive protein mediated 5.24% of sleep-multimorbidity association.

Conclusions: Poor sleep pattern is associated with accelerated accumulation of chronic disease, increased risk of developing multimorbidity, and shortened multimorbidity-free survival time. C-reactive protein partially mediates the sleep-multimorbidity association. Our findings underscore the connection between sleep and the development of chronic disease.