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Najib T. Ayas, MD; David P. White, MD; JoAnn E. Manson, MD, DrPH; Meir J. Stampfer, MD, DrPH; Frank E. Speizer, MD; Atul Malhotra, MD; Frank B. Hu, MD, PhD

Arch Intern Med. 2003;163:205-209.

Background  Long-term sleep deprivation is common in today's society. Recent experiments have demonstrated that short-term sleep deprivation in healthy subjects results in adverse physiologic changes, including a decreased glucose tolerance and an increased blood pressure. However, the long-term health consequences of long-term sleep deprivation are unclear. The objective of this study was to determine whether decreased sleep duration (from self-reports) is associated with an increased risk of coronary events.

Methods  We studied a cohort of 71 617 US female health professionals (aged 45-65 years), without reported coronary heart disease (CHD) at baseline, who were enrolled in the Nurses' Health Study. Subjects were mailed a questionnaire in 1986 asking about daily sleep duration. Subjects were followed up until June 30, 1996, for the occurrence of CHD-related events. We assessed the relationship between self-reported sleep duration and incident CHD.

Results  A total of 934 coronary events were documented (271 fatal and 663 nonfatal) during the 10 years of follow up. Age-adjusted relative risks (95% confidence intervals) of CHD (with 8 hours of daily sleep being considered the reference group) for individuals reporting 5 or fewer, 6, and 7 hours of sleep were 1.82 (1.34-2.41), 1.30 (1.08-1.57), and 1.06 (0.89-1.26), respectively. The relative risk (95% confidence interval) for 9 or more hours of sleep was 1.57 (1.18-2.11). After adjusting for various potential confounders, including snoring, body mass index, and smoking, the relative risks of CHD (95% confidence intervals) for individuals reporting 5 or fewer, 6, and 7 hours of sleep were 1.45 (1.10-1.92), 1.18 (0.98-1.42), and 1.09 (0.91-1.30), respectively. The relative risk (95% confidence interval) for 9 or more hours of sleep was 1.38 (1.03-1.86).

Conclusion  Short and long self-reported sleep durations are independently associated with a modestly increased risk of coronary events.

From the Divisions of Sleep Medicine (Drs Ayas, White, and Malhotra) and Preventive Medicine (Dr Manson), Department of Medicine, Brigham and Women's Hospital, Boston, Mass; the Departments of Epidemiology (Drs Manson and Stampfer) and Nutrition (Drs Stampfer and Hu), Harvard School of Public Health, Boston; the Channing Laboratory, Brigham and Women's Hospital/Harvard Medical School (Drs Manson, Stampfer, and Speizer), Boston; and Harvard Medical School (Drs Ayas, White, Manson, Stampfer, Speizer, and Malhotra). Dr Ayas is now with the Division of Pulmonary Medicine, Vancouver General Hospital, Vancouver, British Columbia.

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