Adherence to a Healthy Sleep Pattern and Incident Heart Failure

Emerging evidence has implicated various sleep problems in the development of heart failure.2 Sleep behaviors are multifaceted, and individual sleep behaviors usually correlate with each other in a compensatory fashion.3,4 However, the majority of previous studies did not consider the complex nature of the overall sleep pattern. We recently generated and validated a healthy sleep pattern that incorporated 5 different sleep behaviors, which was associated with a lower risk of coronary heart disease in 2 independent cohorts.5 In the current study, we prospectively investigated the relationship between this healthy sleep pattern and the risk of heart failure. The UK Biobank is a prospective cohort of 502 505 participants aged 37 to 73 years at the time of recruitment (2006–2010). We excluded participants with heart failure (N=2418) and those with missing information on the sleep behaviors (N=91 810) at baseline, leaving a total of 408 802 participants for the current analysis. All participants provided written informed consent. The study was approved by the National Health Service National Research Ethics Service and the Institutional Review Board of Tulane University. Sleep behaviors were collected through a touchscreen questionnaire. A healthy sleep score was created by combining chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness.5 Sleep duration was categorized into 3 groups: short (<7 h/d), recommended (7–8 h/d), and prolonged (>8 h/d). Healthy sleep factors were defined as early chronotype (“morning” person or “morning” than “evening” person); sleep 7 to 8 h/d; reported never/rarely or sometimes insomnia symptoms; no snoring; and no excessive daytime sleepiness (“never/rarely” or “sometimes”). Each sleep factor was coded 1 if meeting the healthy criterion and 0 if not. The healthy sleep score was obtained by summing up the 5 individual sleep factors. A higher score indicated a healthier sleep pattern. Incidence of heart failure was collected until April 1, 2019, and defined based on International Classification of Diseases, Tenth Edition (I11.0, I13.0, I13.2, I50.X), hospital procedure codes, and self-reported information confirmed by nurses. Among the 408 802 study participants, a total of 5221 cases of heart failure were recorded during a median follow-up of 10.1 years. The association between the healthy sleep score and heart failure incidence was estimated by Fine-Gray subdistribution hazard models, accounting for competing risk of mortality. The healthy sleep score was inversely associated with the incidence of heart failure across all 3 models. The hazard ratio (95% CI) for heart failure was 0.85 (95% CI, 0.83– 0.87) for a 1-point increase in the healthy sleep score (Table, model 2). The association did not appreciably change with additional adjustment for prevalent diabetes, hypertension, medication use, and genetic variations (Table, model 3; hazard ratio [95% CI], 0.87 [95% CI, 0.84–0.90]). Compared with participants with a healthy sleep score of 0 to 1, the hazard ratio (95% CI) for heart failure was 0.58 (95% CI, 0.49–0.70) for those Xiang Li, PhD Qiaochu Xue, MPH Mengying Wang, MPH Tao Zhou, PhD Hao Ma, PhD Yoriko Heianza, PhD Lu Qi , MD, PhD