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American Journal of Epidemiology Advance Access originally published online on October 23, 2008
American Journal of Epidemiology 2008 168(12):1367-1373; doi:10.1093/aje/kwn281
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Sleep Duration and Coronary Heart Disease Mortality Among Chinese Adults in Singapore: A Population-based Cohort Study

Anoop Shankar, Woon-Puay Koh, Jian-Min Yuan, Hin-Peng Lee and Mimi C. Yu

Correspondence to Dr. Anoop Shankar, Department of Community Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, P.O. Box 9190, Morgantown, WV 26506-9190 (e-mail: ashankar{at}hsc.wvu.edu).

Received for publication January 9, 2008. Accepted for publication August 8, 2008.

While some studies have found a positive association between both short and long sleep durations and cardiovascular disease (CVD), others have found an association only with a long or short sleep duration. In addition, there are limited data from non-Western populations on this topic. The authors examined the association between sleep duration and coronary heart disease (CHD) mortality among Chinese adults in Singapore (1993–2006), performing a prospective cohort study among 58,044 participants aged ≥45 years (55.9% women) without preexisting CVD. The main outcome of interest was CHD mortality (n = 1,416). The authors found both short and long sleep durations to be positively associated with CHD mortality, independent of smoking, alcohol intake, and body mass index. Compared with persons with a sleep duration of 7 hours (referent), the multivariable relative risk of CHD mortality for a sleep duration of ≤5 hours was 1.57 (95% confidence interval: 1.32, 1.88); for a sleep duration of ≥9 hours, it was 1.79 (95% confidence interval: 1.48, 2.17). This association persisted in subgroup analyses by sex and body mass index. In a population-based cohort of Chinese adults from Singapore, sleep durations of ≤5 hours and ≥9 hours (versus 7 hours) were modestly associated with CHD mortality. These results suggest that sleep duration may be an important marker for CVD.

Asian continental ancestry group; cardiovascular diseases; coronary disease; mortality; Singapore; sleep

Abbreviations: BMI, body mass index; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease


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