Elsevier

International Journal of Cardiology

Volume 219, 15 September 2016, Pages 231-239
International Journal of Cardiology

Sleep duration and risk of coronary heart disease: A systematic review and meta-analysis of prospective cohort studies

https://doi.org/10.1016/j.ijcard.2016.06.027Get rights and content

Abstract

Background

Epidemiological studies suggest an association between sleep duration and risk of coronary heart disease, however, the results are controversial. We conducted this systematic review and meta-analysis to summarize the potential dose-response relationship between sleep duration and risk of coronary heart disease.

Methods

The electronic reference databases (PubMed and Embase) were searched through January 2016 with selection criteria for relevant studies. Both semiparametric and parametric methods were used to calculate the pooled risk estimates.

Results

Seventeen articles with 22 independent reports involving 17,841 incident cases of coronary heart disease among 517,440 participants were included in our meta-analysis. A U-shaped relationship was detected between sleep duration and risk of coronary heart disease, with the lowest risk at 7–8 h per day. Compared with 7 h sleep duration per day, the combined relative risk of coronary heart disease were 1.11 (95% CI = 1.05–1.16) for an reduction of 1 h and 1.07 (95% CI = 1.00–1.15) for an increment of 1 h. And the results almost did not change in the subgroup analysis of gender and fatal cases. Exclusion of any single study did not alter the combined relative risk. In addition, visual inspection of funnel plots, Begg's and Egger's tests failed to identify publication bias.

Conclusions

Both short and long sleep durations are significantly associated with increased risk of coronary heart disease. Compared with 7 h sleep duration per day, the risk of coronary heart disease increases 11% for an hour decrease and increases 7% for an hour increase.

Introduction

Coronary heart disease (CHD), one of the commonest cardiovascular disease, is affecting millions of people in both developed and developing countries [1], [2]. Although the mortality rate of CHD has slightly decreased in developed countries in recently years, it is still the leading cause of death and extorts a heavy social burden in the worldwide [3], [4], [5]. Studies reveal that it may account for about seven million deaths and 129 million loss of disability-adjusted life years (DALYs) annually [6], [7].

A variety of risk factors are identified to be associated with CHD, including genetic and lifestyle factors [8], [9], [10]. In recent years, sleep habit and duration of sleep were reported to play an important role in the onset and progression of CHD [11]. It is estimated that nearly 30% of adults report sleeping less than 6 h per night in western countries [12]. Lack of sleep exerts deleterious effects on metabolic and endocrine systems [13]. Too much or too little sleep are related with several adverse outcomes, including hypertension, type 2 diabetes and poor health [14], [15]. However, as a modifiable lifestyle, sleep could decrease the risk as long as it has been revised.

Several epidemiology studies have found a U-shaped association between sleep duration and CHD [16], [17], [18], but other studies have not report a uniform relationship [19], [20], [21]. For instance, only short sleep duration were found to affect CHD in some studies [22]. A previous meta-analysis also indicated different results for short and long sleep duration [23]. In addition, the study just simply pooled the relative risks of short or long sleep duration group. It remains unknown the exact relationship of sleep duration and CHD. Therefore, we conducted a dose-response meta-analysis of prospective studies to quantify the association between sleep duration and risk of CHD.

Section snippets

Literature search

In accordance with the meta-analysis of observational studies in epidemiology (MOOSE) guidelines [24], we conducted a literature search of PubMed (Medline) and Embase for prospective studies through January 2016 by using the following search terms without restrictions: (“coronary heart diseases”, “CHD”, “cardiovascular disease”, “CVD” “ischemic heart disease”, “myocardial infarction”, “MI”, “angina pectoris”, “angina”, “chest pain”) and (“sleep”). In addition, we also reviewed references from

Literature search

The process of study identification and inclusion was shown in Fig. 1. The search identified 15,897 citations from PubMed and 10,018 citations from Embase prior to 6 January 2016. After 6871 duplicates were excluded, 19,044 citations were remaining for screening through title, abstract, of which 19,023 were excluded because they were cross-sectional studies, case-control studies, or irrelevant studies. After reviewing the full text of these 21 articles, 4 articles [19], [20], [36], [37] were

Discussion

To date, the results of prospective studies on the relationship between sleep duration and risk of CHD have been inconsistent [42], [46], [50]. Several possible reasons are contributed to it, for example, the categories of sleep duration differed across studies [46], [47]. A meta-analysis in 2011 showed both short and long sleep duration were associated with an increased risk of CHD [18], but another one in 2015 just found association between long sleep duration and mortality of CHD, not

Conclusion

In summary, both short and long sleep duration are significantly associated with increased risk of coronary heart disease. Compared with 7 h sleep duration per day, the risk of coronary heart disease increases 11% for an hour decrease and increases 7% for an hour increase. Randomized controlled trials with larger sample sizes and longer follow-up times are warranted to probe the potential mechanisms and to establish causality.

The following are the supplementary data related to this article.

Author contributions

DMW and WHC proposed the study. DMW and WZL performed the searching, data extraction, and quality assessment. XQC, YDM and WHC helped to develop search strategies. DMW, WZL, MZ, and LLX analyzed the data. JXM and GLY provided critical advice. DMW wrote the first manuscript. All authors contributed to reviewing or revising the paper and read and approved the final version.

Funding

The study was supported by the National 111 Project in China (No.B12004) and Innovative Research Team in University of Ministry of Education of China (No. IRT1246). The funder did not play any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the preparation, review, or approval of the manuscript.

Conflicts of interest

No conflicts of interest were reported.

Acknowledgements

None.

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