Sleep duration and cause-specific mortality among US adults with heart disease: A NHIS-NDI linkage cohort study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Established heart disease (coronary heart disease, heart condition/disease, or myocardial infarction) (n=3287). Intervention: Long self-reported sleep duration (≥9 hours per 24-hour period) vs. 7–8 hours of sleep per 24-hour period. Primary outcome: All-cause mortality (HR 1.51, 95% CI 1.32-1.73).

Q: What does this research mean for the field?

Among adults with established heart disease, long sleep duration (≥9 hours) is associated with an increased risk of all-cause, heart-related, and non-heart-related mortality compared to 7–8 hours of sleep. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tolulope V. Adebile; Tobi Faith Oloyede; Emmanuel U. Azu; Mobolaji Timothy Olagunju; Olamide Asifat; Temitayo Mary Paul; Oluwaseun Ipede; Wandoo Abwa; Purbasha Biswas; Lili Yu¹

doi:10.1371/journal.pone.0362657

November 13, 2026PLoS ONEOpen Access

Sleep duration and cause-specific mortality among US adults with heart disease: A NHIS-NDI linkage cohort study

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Key result

Long sleep duration is linked to ~51% higher all-cause mortality in adults with heart disease.

HR 1.51
95% CI 1.32-1.73
n=3,287

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Why the study?

Sleep duration is increasingly recognized as a component of cardiovascular health, yet its prognostic significance for mortality among adults with established heart disease remained unclear.

Is self-reported sleep duration associated with all-cause, heart-related, and non-heart-related mortality among US adults with established heart disease?

Key Points

To examine the association between self-reported sleep duration and all-cause, heart-related, and non-heart-related mortality among adults with pre-existing heart disease.
Analyzed 3,287 adults aged 18 years or older with heart disease from the 2004 National Health Interview Survey linked to the National Death Index through December 31, 2019.
Categorized self-reported sleep duration as short (≤6 hours), reference (7–8 hours), and long (≥9 hours) per 24-hour period.
Employed stratified Cox proportional hazards models and restricted cubic splines adjusted for demographic, behavioral, and clinical covariates across 15 years of follow-up.
Over 15 years of follow-up, 49.4% of participants died (n=1,623), including 16.7% from heart-related causes (n=550) and 32.6% from non-heart-related causes (n=1,073).
Compared with 7–8 hours of sleep, long sleep (≥9 hours) was associated with higher risks of all-cause mortality (HR: 1.51 [95% CI: 1.32–1.73]), heart-related mortality (HR: 1.53 [95% CI: 1.22–1.92]), and non-heart-related mortality (HR: 1.50 [95% CI: 1.27–1.77]).
Restricted cubic spline analyses showed a nonlinear relationship between sleep duration and mortality, identifying the lowest predicted mortality risk at 6–7 hours of sleep.

Study Design

Type

Cohort (n=3,287)

Structured PICO

Is self-reported sleep duration associated with all-cause, heart-related, and non-heart-related mortality among US adults with established heart disease?

P

Population

3,287 US adults aged ≥18 years with self-reported heart disease from the 2004 National Health Interview Survey followed for 15 years via National Death Index linkage.

E

Exposure

Self-reported sleep duration categorized as short (≤6 hours per 24-hour period) or long (≥9 hours per 24-hour period), as well as continuous sleep duration.

C

Comparator

Reference self-reported sleep duration of 7–8 hours per 24-hour period.

O

Outcome

All-cause mortality, heart disease-related mortality (ICD-10 codes I00–I09, I11, I13, I20–I51), and non-heart disease-related mortality over 15 years of follow-up (through December 31, 2019).hard clinical

Main Result

Hazard Ratio: 1.51 (95% CI 1.32–1.73)

Long sleep duration (≥9 hours) is independently associated with a >50% higher risk of all-cause, heart-related, and non-heart-related mortality among US adults with heart disease, serving as a simple clinical marker of elevated residual risk.

Limitations

Sleep duration was self-reported and measured at a single time point, which may introduce misclassification and not reflect long-term patterns.
Residual confounding from factors such as depression, obstructive sleep apnea severity, medication use, and cardiovascular disease severity remains possible.
Angina was not used as part of the primary heart disease case definition.
Findings are generalizable only to the non-institutionalized US adult population.
Observational study design prevents inference of causality; long sleep duration may represent a consequence rather than a cause of poor health.
Self-reported sleep duration measured at a single time point
Potential residual confounding by depression, obstructive sleep apnea severity, medication use, and cardiovascular disease severity
Self-reported history of heart disease without angina in the primary case definition
Generalizable only to non-institutionalized US adults
Observational design precludes causal inference

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Answers are grounded in this paper and cite their sources.

Implication

Long sleep may mark higher mortality risk in heart disease; leaves open whether modification improves outcomes.

Abstract

Background Sleep duration is increasingly recognized as a component of cardiovascular health, yet its prognostic significance among adults with established heart disease remains unclear. We examined associations between sleep duration and mortality among US adults with heart disease. Methods We analyzed data from 3,287 adults with heart disease participating in the 2004 National Health Interview Survey linked to the National Death Index through December 31, 2019. Sleep duration was categorized as ≤6 hours, 7–8 hours, and ≥9 hours. Cox proportional hazards models stratified by variables violating the proportional hazards assumption estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, heart-related, and non-heart-related mortality. Restricted cubic splines evaluated nonlinear dose-response relationships. Results During 15 years of follow-up, 49.4% of participants died, including 16.7% from heart-related causes and 32.6% from non-heart-related causes. Compared with 7–8 hours of sleep, long sleep duration (≥9 hours) was associated with higher risks of all-cause mortality (HR:1.51 [95% CI:1.32–1.73]), heart-related mortality (HR:1.53 [95% CI:1.22–1.92]), and non-heart-related mortality (HR:1.50 [95% CI:1.27–1.77]). Restricted cubic spline analyses demonstrated nonlinear associations, with the lowest predicted mortality risk occurring at 6–7 hours. Findings remained robust across multiple sensitivity analyses and age and sex subgroups. Conclusions Among US adults with heart disease, long sleep duration was consistently associated with higher risks of all-cause, heart-related, and non-heart-related mortality. Sleep duration may represent a simple marker of residual risk that could enhance risk stratification among adults living with heart disease.

Discussion

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Cite This Study

Adebile et al. (2026) conducted a cohort in Established heart disease (coronary heart disease, heart condition/disease, or myocardial infarction) (n=3,287). Long self-reported sleep duration (≥9 hours per 24-hour period) vs. 7–8 hours of sleep per 24-hour period was evaluated on All-cause mortality (HR 1.51, 95% CI 1.32-1.73). Long sleep duration (≥9 hours) was associated with a 51% higher risk of all-cause mortality compared with 7–8 hours among US adults with heart disease.

synapsesocial.com/papers/6af88c410e4d8f4b089c1b16 https://doi.org/10.1371/journal.pone.0362657

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Sleep duration and cause-specific mortality among US adults with heart disease: A NHIS-NDI linkage cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sleep duration and cause-specific mortality among US adults with heart disease: A NHIS-NDI linkage cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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