Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: the Multiethnic Cohort Study

Prev Med. 2013 Oct;57(4):377-85. doi: 10.1016/j.ypmed.2013.06.017. Epub 2013 Jun 27.


Objective: To explore an independent association between self-reported sleep duration and cause-specific mortality.

Methods: Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii.

Results: Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9year follow-up. Shorter (≤5h/day) and longer (≥9h/day) sleepers of both sexes (vs. 7h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00-1.28) for ≤5h/day and 1.22 (95% CI 1.09-1.35) for ≥9h/day among men; and 1.20 (95% CI 1.05-1.36) for ≤5h/day and 1.29 (95% CI 1.13-1.47) for ≥9h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (Phetero 0.53) or among women (Phetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index.

Conclusion: Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.

Keywords: Cardiovascular disease; Ethnic groups; Mortality; Prospective studies; Sleep.

MeSH terms

  • Age Factors
  • Aged
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality, Premature
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Sex Factors
  • Sleep*
  • Socioeconomic Factors
  • Time Factors