Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 10;79(4):257-264.
doi: 10.1136/jech-2024-222795.

Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults

Jean-Philippe Chaput  1   2 , Raaj Kishore Biswas  3 , Matthew Ahmadi  3 , Peter A Cistulli  4   5 , Shantha M W Rajaratnam  6 , Wenxin Bian  3 , Marie-Pierre St-Onge  7 , Emmanuel Stamatakis  3
Affiliations

Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults

Jean-Philippe Chaput et al. J Epidemiol Community Health. .

Abstract

Background: This study examines the associations between device-measured sleep regularity and the risk of major adverse cardiovascular events (MACE), and aims to determine whether sufficient sleep duration attenuates or eliminates the effects of irregular sleep on MACE risk.

Methods: A prospective cohort study of adults aged 40-79 years from the UK Biobank who wore wrist-attached accelerometers for 7 days was conducted. Sleep Regularity Index (SRI) scores were calculated for each participant using a validated algorithm, and categorised as irregular (SRI <71.6), moderately irregular (SRI between 71.6 and 87.3), and regular (SRI >87.3 (reference group)). Information on MACE and its subtypes (myocardial infarction, heart failure, stroke) was obtained from inpatient hospitalisation and death records.

Results: We analysed data from 72 269 individuals followed for 8 years, without a previous history of MACE and without an event in the first year of follow-up. Irregular (HR 1.26, 95% CI 1.16 to 1.37) and moderately irregular sleepers (HR 1.08, 95% CI 1.01 to 1.70) were at higher risk of MACE compared with regular sleepers. Dose-response analyses treating SRI as a continuous measure showed that SRI was associated with MACE risk in a near-linear fashion, with a steeper MACE risk reduction at higher (better) SRI scores. Joint SRI and sleep duration analyses showed that meeting the age-specific sleep duration recommendation offsets MACE risk for moderately irregular sleepers (HR 1.07, 95% CI 0.96 to 1.18), but not for irregular sleepers (HR 1.19, 95% CI 1.06 to 1.35).

Conclusions: Irregular sleep was strongly associated with higher MACE risk. Adequate sleep duration was not sufficient to offset these adverse effects among irregular sleepers. This study supports the inclusion of sleep regularity in public health guidelines and clinical practice as a risk factor for cardiovascular disease.

Keywords: CARDIOVASCULAR DISEASES; PUBLIC HEALTH; SLEEP.

PubMed Disclaimer

Conflict of interest statement

Competing interests: PAC has an appointment as an endowed Academic Chair at the University of Sydney that was created from ResMed funding; he receives no personal fees, and this relationship is managed by an Oversight Committee of the University. Additionally, he has received research support from ResMed, SomnoMed, and Bayer, and is a consultant/adviser to SomnoMed, ResMed, and Sunrise Medical. SMWR declared grants or contracts from Vanda Pharmaceuticals, WA Police and the Centers for Disease Control and Prevention, consulting fees from Roche and Circadian Therapeutics, honoraria from Roche, a patent for a digital application for sleep in shift workers (application no. 17/799206), and acts as Chair of the Sleep Health Foundation and the International Association of Circadian Health Clinics. The other authors declared no competing interests.

References

    1. Chaput J-P, Dutil C, Featherstone R, et al. Sleep duration and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab 2020;45:S218–31. - PubMed
    1. Chaput J-P, Dutil C, Featherstone R, et al. Sleep timing, sleep consistency, and health in adults: a systematic review. Appl Physiol Nutr Metab 2020;45:S232–47. - PubMed
    1. Sletten TL, Weaver MD, Foster RG, et al. The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel. Sleep Health 2023;9:801–20. - PubMed
    1. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42:3227–337. - PubMed
    1. Windred DP, Burns AC, Lane JM, et al. Sleep regularity is a stronger predictor of mortality risk than sleep duration: a prospective cohort study. Sleep 2024;47:zsad253. - PMC - PubMed

LinkOut - more resources