Self-Reported Sleep Characteristics Associated with Cardiovascular Disease Among Older Adults Living in Rural Eastern China: A Population-Based Study

Purpose: To investigate the cross-sectional associations of self-reported sleep characteristics with cardiovascular diseases (CVDs) and cardiovascular multimorbidity in older adults living in rural Eastern China.

Patients and methods: This population-based study included 4618 participants (age ≥65 years; 56.5% women) living in rural Eastern China. In March-September 2018, data were collected through interviews, clinical examinations, neuropsychological testing, and laboratory tests. Sleep parameters were assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Score, and Berlin questionnaire. Coronary heart disease (CHD), heart failure (HF), and stroke were defined according to in-person interviews, clinical and neurological examinations, and electrocardiogram examination. Data were analyzed using logistic regression and restricted cubic spline regression.

Results: CHD was diagnosed in 991 participants, HF in 135 participants, and stroke in 696 participants. The multivariable-adjusted odds ratio (OR) of CHD was 1.27 (95% CI, 1.09-1.49) for sleep duration ≤6 hours/night (vs >6-8 hours/night), 1.40 (1.20-1.62) for poor sleep quality, and 1.22 (1.04-1.43) for high risk for obstructive sleep apnea (OSA). The OR of HF was 2.16 (1.38-3.39) for sleep duration >8 hours/night, and 1.76 (1.22-2.54) for high risk for OSA. In addition, the OR of stroke was 1.23 (1.04-1.46) for poor sleep quality, 1.32 (1.01-1.72) for excessive daytime sleepiness, and 1.42 (1.19-1.70) for high risk for OSA. The associations of poor sleep with cardiovascular multimorbidity (≥2 CVDs) were stronger than that of sleep problems with a single CVD.

Conclusion: Extreme sleep duration, high risk for OSA, and other sleep problems were associated with CVDs, especially cardiovascular multimorbidity.