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Sleep characteristics and cardiovascular events in a large Swedish cohort

  • CARDIOVASCULAR DISEASE
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Abstract

Limited evidence suggests that the association between sleep duration and cardiovascular events is strongest in individuals who also report sleep disturbances. We investigated sleep duration and insomnia symptoms in relation to incident cardiovascular events in the Swedish National March Cohort comprising 41,192 adults. Habitual sleep duration and difficulty falling asleep, difficulty maintaining sleep, early morning awakening, and nonrestorative sleep were self-reported in 1997. During 13.2 years of follow-up, we identified 4,031 events (myocardial infarction, stroke, heart failure, or death from cardiovascular disease) in the Swedish National Patient Register and the Cause of Death Register. After adjustment for potential confounders, short sleep duration (≤5 h) was associated with slightly increased risks of overall cardiovascular events and, specifically, myocardial infarction: hazard ratio, HR (95 % confidence interval) 1.24 (1.06–1.44) and 1.42 (1.15–1.76), respectively. These HRs were attenuated as we included BMI, depressive symptoms and other relevant covariates in our analysis. Insomnia symptoms per se were unrelated to risk. However, in a joint analysis, there was some evidence that short sleepers who reported frequent insomnia symptoms had the highest HRs (1.26–1.39) of overall cardiovascular events. Short sleep or insomnia symptoms without the other conferred no increased risk. Our results suggest that symptoms of sleep disturbance should be taken into account when assessing the association between short sleep and cardiovascular disease.

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Acknowledgments

Preliminary data from this study were presented in abstract form at the 2011 World Association of Sleep Medicine & Canadian Sleep Society Congress, Québec City, Canada. The ICA Group and Ericsson provided financial support for the data collection in this study. Financial support from the National Research School in Healthcare Sciences at the Karolinska Institutet enabled the data analysis, interpretation of results, and preparation of the manuscript. The funding sources had no role in the design, conduct, or analysis of this study or the decision to submit the manuscript for publication. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Eugeniahemmet T2, 171 76, Stockholm, Sweden

    Anna Westerlund & Ylva Trolle Lagerros

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Rino Bellocco & Hans-Olov Adami

  3. Department of Statistics, University of Milano-Bicocca, Milan, Italy

    Rino Bellocco

  4. Department of Medical Sciences, Division of Acute and Internal Medicine, Uppsala University, Uppsala, Sweden

    Johan Sundström

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Hans-Olov Adami

  6. Stress Research Institute, Stockholm University, Stockholm, Sweden

    Torbjörn Åkerstedt

  7. Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden

    Torbjörn Åkerstedt

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  1. Anna Westerlund
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  2. Rino Bellocco
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  3. Johan Sundström
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  4. Hans-Olov Adami
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  5. Torbjörn Åkerstedt
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  6. Ylva Trolle Lagerros
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Correspondence to Anna Westerlund.

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Westerlund, A., Bellocco, R., Sundström, J. et al. Sleep characteristics and cardiovascular events in a large Swedish cohort. Eur J Epidemiol 28, 463–473 (2013). https://doi.org/10.1007/s10654-013-9802-2

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  • DOI: https://doi.org/10.1007/s10654-013-9802-2

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