Subsequent hypertension mediates the association between sleep duration trajectories and new-onset cardiovascular disease: a population-based cohort
ABSTRACT
Background:
Prior research has rarely explored the link between sleep duration trajectories and cardiovascular disease (CVD), either in cross-sectional or longitudinal data. We aimed to analyze the relationship between sleep duration trajectories and the incidence of CVD.
Objective:
We aimed to analyze the relationship between sleep duration trajectories and the incidence of CVD.
Methods:
Data from 5,602 participants in the China Health and Retirement Longitudinal Study (CHARLS) were used in the analysis. Sleep duration was self-reported at multiple time points, and group-based trajectory modeling identified distinct patterns of total and nocturnal sleep duration over time. To investigate the link between sleep duration trajectories and CVD, Cox proportional hazards models, restricted cubic splines, and mediation analyses were employed, with sensitivity analyses ensuring the results' robustness.
Results:
Four sleep duration trajectories were identified: steady high, inverted U-shaped, steady low, and U-shaped. Compared to the steady high group, those with an inverted U-shaped pattern had a 29% higher risk of hypertension (total sleep: adjusted HR=1.29, 95%CI: 1.04-1.61, p=0.020; nocturnal sleep: HR=1.29, 95%CI: 1.04-1.59, p=0.018). Persistently short sleepers showed a 30-34% increased risk of CVD (total sleep: HR=1.30, 95%CI: 1.07-1.58, p=0.010; nocturnal sleep: HR=1.34, 95%CI: 1.10-1.64, p=0.003). Notably, steady low sleepers showed a 97% increased stroke risk during nocturnal periods compared to the steady high group (HR=1.97, 95%CI 1.25-3.10, p=0.004). Mediation analysis demonstrated that hypertension served as a partial mediator in the association between sleep instability and stroke risk.
Conclusions:
Findings identify inverted U-shaped and steady low sleep trajectories as cardiovascular risk factors, with partial mediation by hypertension, suggesting sleep pattern stability as a preventive strategy.
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