Artículo de revista
Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study
Fecha
2021-04-05Autor
Wang, Chuangshi
Hu, Bo
Rangarajan, Sumathy
Bangdiwala, Shrikant I.
Lear, Scott A.
Mohan, Viswanathan
Gupta, Rajeev
Alhabib, Khalid F.
Soman, Biju
Abat, Marc Evans M.
Rosengren, Annika
Lanas, Fernando
Avezum, Alvaro
Lopez-Jaramillo, Patricio
Diaz, Rafael
Yusoff, Khalid
Iqbal, Romaina
Chifamba, Jephat
Yeates, Karen
Zatońska, Katarzyna
Kruger, Iolanthe M.
Bahonar, Ahmad
Yusufali, AfzalHussein
Li, Wei
Yusuf, Salim
The Prospective Urban Rural Epidemiology (PURE) study investigators
Institución
Resumen
Objectives
This study aimed to examine the association of bedtime with mortality and major cardiovascular events.
Methods
Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as ‘earlier’ sleepers and those who reported a bedtime after midnight as ‘later’ sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers.
Results
A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03–1.16]) and later sleepers (HR of 1.10 [1.02–1.20]).
Conclusion
Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes.