Multidimensional healthy sleep characteristics and pneumonia risk: a large-scale, population-based prospective cohort study

Background Sleep disturbances are hypothesized to increase susceptibility to pneumonia; however, most evidence arises from studies examining isolated sleep characteristics. The relationship between a multidimensional healthy sleep score and pneumonia risk remains unclear. Herein, the association between a multidimensional healthy sleep score and risk of pneumonia was evaluated. Methods This prospective analysis encompassed 361,589 participants from the United Kingdom (UK) Biobank (mean age: 56.1 years; 46.1% male). Five sleep characteristics—sleep duration, chronotype, insomnia symptoms, snoring, and daytime sleepiness—were used to construct a healthy sleep score (range: 0–5). Participants were categorized into poor (0–1), intermediate (2–3), and healthy (4–5) sleep score categories. Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for pneumonia incidence. Results Over a median follow-up period of 13.2 years, there were 20,116 new cases of pneumonia. A healthy sleep score was associated with a 26% lower risk of pneumonia (adjusted HR: 0.74, 95% CI: 0.69–0.80). This association exhibited a graded pattern, with higher sleep scores associated with progressively lower risk. The absence of frequent daytime sleepiness (HR: 0.79, 95% CI: 0.74–0.85) and insomnia symptoms (HR: 0.88, 95% CI: 0.86–0.91) exhibited the strongest component-specific inverse associations. Associations were stronger among participants younger than 60 years and females (P for interaction <0.001 for both). Conclusions A multidimensional healthy sleep score is associated with a lower risk of pneumonia. These findings support the potential relevance of multidimensional sleep assessment to respiratory infection susceptibility and warrant further investigation.