Association of healthy sleep patterns with incident sepsis: a large population-based prospective cohort study

Abstract

Background: The role that sleep patterns play in sepsis risk remains poorly understood.

Objectives: The objective was to evaluate the association between various sleep behaviours and the incidence of sepsis.

Methods: In this prospective cohort study, we analysed data from the UK Biobank (UKB). A total of 409,570 participants who were free of sepsis at baseline were included. We used a composite sleep score that considered the following five sleep behaviours: sleep chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. Cox proportional hazards regression analysis was used to estimate the associations between healthy sleep scores and incident sepsis.

Results: During a mean follow-up of 13.54 years, 13,357 (3.26%) incident sepsis cases were recorded. Among the 409,570 participants with a mean age of 56.47 years, 184,124 (44.96%) were male; 9942 (2.43%) reported 0 to 1 of the five healthy sleep behaviours; 46,270 (11.30%) reported 2 behaviours; 115,272 (28.14%) reported 3 behaviours; 150,522 (36.75%) reported 4 behaviours; and 87,564 (21.38%) reported 5 behaviours at baseline. Each one-point increase in the sleep score was associated with a 5% lower risk of developing sepsis (hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.93-0.97). Compared with a healthy sleep score of 0-1, for a sleep score of 5, the multivariate-adjusted HR (95% CI) for sepsis was 0.76 (0.69-0.83). In addition, we found that the negative correlation was stronger in participants who were aged < 60 years than in their older counterparts (p for interaction < 0.001). However, healthy sleep pattern was not associated with sepsis-related death and critical care admission.

Conclusions: Findings from this cohort study suggest that a healthy sleep pattern may reduce the risk of developing sepsis, particularly among younger individuals.

Keywords: Cohort study; Sepsis; Sleep pattern; UK Biobank.

Fig. 1

Associations of each healthy sleep behaviours with the risk of sepsis. Hazard ratios were adjusted for age, sex, ethnicity, household income, educational level, Townsend deprivation index, body mass index, smoking status, alcohol frequency, diet score, physical activity level, cholesterol, blood pressure, medication use, lung disease, kidney disease, HIV infection, cancer, diabetes, cardiovascular disease, history of surgery, history of injuries, catheter use, and breathing tube use. PAR, population attributable fraction; HR, hazard ratio; CI, confidence interval

Fig. 2

Subgroup analysis for the association between per-1 point increment of healthy sleep score and incident sepsis. A Cox proportional hazard model was conducted. All hazard ratios (HRs) were calculated by adjusting the following: age, sex, ethnicity, household income, educational level, Townsend deprivation index, body mass index, smoking status, alcohol frequency, diet score, physical activity level, cholesterol, blood pressure, medication use, lung disease, kidney disease, HIV infection, cancer, diabetes, cardiovascular disease, history of surgery, history of injuries, catheter use, and breathing tube use. BMI, body mass index; HR, hazard ratio; CI, confidence interval. *P for interaction < 0.008 was considered statistically significant after corrected by multiple testing