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Eur Heart J Acute Cardiovasc Care. 2017 Dec 1:2048872617741733. doi: 10.1177/2048872617741733. [Epub ahead of print]

Association between short and long sleep durations and cardiovascular outcomes: a systematic review and meta-analysis.

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1 Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, USA.
2 Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai St' Luke, Mount Sinai Heart, USA.
3 Division of Cardiovascular Diseases, Mayo Clinic, USA.
4 Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA.
5 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic. USA.
6 Mayo Clinic Libraries, Mayo Clinic, USA.
7 Division of Gastroenterology and Hepatology, Mayo Clinic, USA.
8 Division of Gastroenterology, Phramongkutklao Hospital and College of Medicine, Royal Thai Army, Bangkok, Thailand.
9 Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan.
10 Department of Cardiovascular Medicine, Cleveland Clinic, USA.



A shorter sleep duration has been identified as a risk factor for cardiovascular diseases and increased mortality. It has been hypothesized that a short sleep duration may be linked to changes in ghrelin and leptin production, leading to an alteration of stress hormone production. Here, we conducted a systematic review and meta-analysis to investigate the potential relationship between a sleep duration and cardiovascular disease mortality.


We conducted a comprehensive search of Ovid Medline In-Process and other non-indexed citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Scopus from database inception to March 2017. Observational studies were included if the studies reported hazard ratios or odds ratios of the associations between sleep durations (short and long) and cardiovascular disease mortality. Data were extracted by a reviewer and then reviewed by two separate reviewers. Conflicts were resolved through consensus. Using the DerSimonian and Laird random effects models, we calculated pooled hazard ratios and pooled odds ratios with 95% confidence intervals (CI). Subgroup analyses were performed to explore potential sources of heterogeneity. The quality of the included studies and publication bias were assessed.


In total, our meta-analysis included 19 studies (31 cohorts) with a total of 816,995 individuals with 42,870 cardiovascular disease mortality cases. In pooled analyses, both short (risk ratio 1.19; 95% CI 1.13 to 1.26, P<0.001, I2=30.7, Pheterogeneity=0.034), and long (risk ratio 1.37; 95% CI 1.23 to 1.52, P<0.001, I2=79.75, Pheterogeneity<0.001) sleep durations were associated with a greater risk of cardiovascular disease mortality.


Both short (<7 hours) and long sleep durations (>9 hours) can increase the risk of overall cardiovascular disease mortality, particularly in Asian populations and elderly individuals. Future epidemiological studies would ideally include objective sleep measurements, rather than self-report measures, and all potential confounders, such as genetic variants.


Sleep duration; cardiovascular disease; coronary heart disease; meta-analysis; metabolic syndrome; stroke; systematic review; type 2 diabetes


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