Sleep Patterns May Influence Cardiovascular Health and All-Cause Mortality

A recent study has noted significant associations between poor sleep health, such as prolonged or irregular sleep patterns, and major adverse cardiovascular events and all-cause mortality.

Sleep quality has been emerging over the last few years as a strong indicator of long-term health outcomes. Sleep regularity, which is the consistency of sleep-wake timing, has become a possibly stronger predictor of cardiometabolic risk than sleep duration. Additionally, sleep quality is varied between men and women.1

“Given the known sex-based differences in sleep and cardiovascular risk profiles, it is important to assess whether associations between sleep patterns and outcomes differ by sex to inform personalized prevention strategies,” wrote Soo Jung Park, division of cardiology, department of internal medicine, Hanyang University Medical Center, and colleagues. “However, studies examining the combined effects of sleep duration and quality, along with their sex-specific associations with clinical outcomes, such as mortality and cardiovascular diseases, remain limited.”1

Conducted at the Hanyang University Medical Center in Korea, investigators utilized data from the Korean Genome Epidemiology Study (KoGES), which took place from 2001-2003. Investigators in the KoGES aimed to develop a comprehensive set of health care guidelines for common complex diseases in Korea. To that end, they investigated possible contributing factors such as smoking, drinking, and diet.2

Investigators for this study initially gathered 10,030 patients from the Ansung-Ansan cohort of the KoGES. Among these, participants with a history of myocardial infarction or stroke at baseline, as well as those without data on sleep duration, regularity, or perceived sufficiency were excluded, which resulted in a final total of 9641 participants. These were then categorized into 3 subgroups based on self-reported sleep duration: <7 hours (n = 4050), 7-8 hours (n = 4811), and >8 hours (n = 780).1

Participants with longer sleep duration were older, with a mean age of 55.68 +/- 9.1 years, and were more likely to reside in rural areas. There was a lower proportion of men in the short (44.1%) and long (46.7%) sleep groups than in the 7-8 hour group (50.3%, P <.001 for all). Collectively, men reported a slightly longer sleep duration and a higher prevalence of sufficient sleep on average.1

During a median follow-up of 186 months, investigators observed 1095 deaths and 811 MACEs. Cumulative incidence curves indicated a higher risk of all-cause mortality and MACE in the long sleep group comparatively (P <.001). After adjusting for clinically relevant variables, the long sleep group displayed a significantly higher risk of all-cause mortality compared to those with 7-8 hours (adjusted hazard ratio [HR] 1.27; 95% CI, 1.04-1.54; P = .017). The short sleep group saw a non-significant trend towards increased mortality (adjusted HR 1.11; 95% CI, 0.97-1.27; P = .121). Those with irregular sleep also showed a modest but non-significant increase in mortality compared with regular sleepers (adjusted HR 1.1; 95% CI, 0.96-1.27; P = .164). Notably, insufficient sleep was not associated with an increased all-cause mortality risk (adjusted HR 0.98; 95% CI, 0.85-1.13; P = .757).1

A sex-stratified analysis did not display a significant interaction between sex and sleep patterns, but investigators found some differences between men and women. Men in the long and short sleep groups saw a higher risk of all-cause mortality compared to those with 7-8 hours of sleep, and women saw a higher association for mortality in the long sleep group and with irregular sleep patterns.1

“Although the interaction between sex and sleep patterns was not statistically significant, stratified analyses suggested potential sex-specific trends,” Park and colleagues wrote. “These patterns may help inform tailored sleep health strategies that consider both sleep characteristics and sex.”1

References

1. Park, S.J., Park, J., Kim, B.S. et al. The impact of sleep health on cardiovascular and all-cause mortality in the general population. Sci Rep 15, 30034 (2025). https://doi.org/10.1038/s41598-025-15828-6

2. Kim Y, Han BG; KoGES group. Cohort Profile: The Korean Genome and Epidemiology Study (KoGES) Consortium. Int J Epidemiol. 2017;46(2):e20. doi:10.1093/ije/dyv316