Multidimensional sleep health: risk of cardiovascular disease and mortality, and mediation by plasma proteins

Figures

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  Figure 1. Associations of the SHS with risks of cardiovascular events and mortality. Blue squares represent estimated HRs and horizontal error bars indicate 95% CI. The vertical dashed line denotes the null value (HR = 1.0). Associations are shown both per one-point increase in the SHS and across sleep health score categories, with scores of 6–7 (best sleep) as the reference group. The HRs were estimated using multivariable Cox proportional hazards regression models adjusted for age, sex, ethnicity, TDI, BMI, employment status, educational level, smoking status, alcohol consumption, physical activity, and family history of heart disease and stroke. BMI – body mass index, CI – confidence interval, CVD – cardiovascular disease, FDR – false discovery rate, HR – hazard ratio, SHS – sleep health score, TDI – Townsend deprivation index. *P-values were based on two-sided tests and were adjusted for multiple comparisons using the FDR method.

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  Figure 2. Sleep health patterns characteristics and effects on cardiovascular events and mortality. Points represent HR estimates, while vertical error bars denote 95% CIs. The horizontal dashed line indicates the null value (HR = 1.0), with the reference group serving as the comparator. Statistical significance was assessed using two-sided Wald tests. Panel A. Radar plots illustrate the characteristics of clusters identified through K-prototypes clustering. Each axis represents the relative value of a distinct sleep-related characteristic within each pattern. Panel B. Associations between co-exposure patterns and cardiovascular outcomes and mortality were estimated using multivariable Cox proportional hazards regression, adjusted for age, sex, ethnicity, TDI, BMI, employment status, educational level, smoking status, alcohol consumption, physical activity, and family history of heart disease and stroke. BMI – body mass index, CI – confidence interval, TDI – Townsend deprivation index, HR – hazard ratio.

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  Figure 3. Exploratory mediation signals of proteins in the associations between the SHS and adverse health outcomes. This figure shows the estimated mediation proportions for 27 proteins showing exploratory mediation signals in at least two associations between the SHS and adverse health outcomes. The circular bar plot displays estimated mediation proportions derived from exploratory difference-in-coefficients analyses. Mediation analyses were adjusted for age, sex, ethnicity, TDI, BMI, employment status, educational level, smoking status, alcohol consumption, physical activity, and family history of heart disease and stroke. Two-sided P-values were FDR-corrected. ACE2 – angiotensin-converting enzyme 2, ALDH3A1 – aldehyde dehydrogenase, dimeric NADP-preferring, AMBP – alpha-1-microglobulin/bikunin precursor, BMI – body mass index, C3 – complement C3, CA14 – carbonic anhydrase 14, CCDC80 – coiled-coil domain-containing protein 80, CCL15 – C-C motif chemokine 15, CCL16 – C-C motif chemokine 16, CCL20 – C-C motif chemokine 20, CHD – coronary heart disease, COLEC12 – collectin-12, CPM – carboxypeptidase M, CRHBP – corticotropin-releasing factor-binding protein, EFNA4 – ephrin-A4, FABP4 – fatty…