Key result
Short sleep under 6 hours is linked to ~20% higher risk of incident MI.
Why the study?
The causal contribution of sleep duration to myocardial infarction and its potential to mitigate genetic predisposition to coronary disease was unclear.
Does short or long sleep duration increase the risk of incident myocardial infarction in individuals free of relevant cardiovascular disease?
Observational (n=461,347)
Yes
Does short or long sleep duration increase the risk of incident myocardial infarction in individuals free of relevant cardiovascular disease?
Hazard Ratio: 1.2 (95% CI 1.07–1.33)
Short and long sleep durations are associated with increased risk of myocardial infarction, with Mendelian randomization supporting a causal role for short sleep duration.
Should not yet change practice on sleep for MI prevention; leaves open causality and intervention benefit despite supportive MR data.
BACKGROUND: Observational studies suggest associations between extremes of sleep duration and myocardial infarction (MI), but the causal contribution of sleep to MI and its potential to mitigate genetic predisposition to coronary disease is unclear. OBJECTIVES: This study sought to investigate associations between sleep duration and incident MI, accounting for joint effects with other sleep traits and genetic risk of coronary artery disease, and to assess causality using Mendelian randomization (MR). METHODS: In 461,347 UK Biobank (UKB) participants free of relevant cardiovascular disease, the authors estimated multivariable adjusted hazard ratios (HR) for MI (5,128 incident cases) across habitual self-reported short (<6 h) and long (>9 h) sleep duration, and examined joint effects with sleep disturbance traits and a coronary artery disease genetic risk score. The authors conducted 2-sample MR for short (24 single nucleotide polymorphisms) and continuous (71 single nucleotide polymorphisms) sleep duration with MI (n = 43,676 cases/128,199 controls), and replicated results in UKB (n = 12,111/325,421). RESULTS: Compared with sleeping 6 to 9 h/night, short sleepers had a 20% higher multivariable-adjusted risk of incident MI (HR: 1.20; 95% confidence interval [CI]: 1.07 to 1.33), and long sleepers had a 34% higher risk (HR: 1.34; 95% CI: 1.13 to 1.58); associations were independent of other sleep traits. Healthy sleep duration mitigated MI risk even among individuals with high genetic liability (HR: 0.82; 95% CI: 0.68 to 0.998). MR was consistent with a causal effect of short sleep duration on MI in CARDIoGRAMplusC4D (Coronary ARtery DIsease Genome wide Replication and Meta-analysis plus Coronary Artery Disease Genetics Consortium) (HR: 1.19; 95% CI: 1.09 to 1.29) and UKB (HR: 1.21; 95% CI: 1.08 to 1.37). CONCLUSIONS: Prospective observational and MR analyses support short sleep duration as a potentially causal risk factor for MI. Investigation of sleep extension to prevent MI may be warranted.
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Daghlas et al. (2019) conducted an observational in Myocardial Infarction (n=461,347). Short (<6 h) and long (>9 h) sleep duration vs. Sleeping 6 to 9 h/night was evaluated on Incident myocardial infarction (HR 1.20, 95% CI 1.07 to 1.33). Short sleep duration (<6 hours) was associated with a 20% higher risk of incident myocardial infarction compared with 6-9 hours of sleep (HR 1.20; 95% CI 1.07-1.33), supported by causal MR analyses.
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