Association Between Sleep Patterns and the Risk of Cardiometabolic Diseases or Cardiometabolic Multimorbidity and the Mediating Role of Metabolic Biomarkers: A Prospective Study of the UK Biobank Cohort

Abstract

Aim: To identify the relationship between joint sleep patterns and the incidence of cardiometabolic diseases (CMDs) and multimorbidity (CMM) as well as the mediating effects of plasma metabolites. Methods: This prospective study included 190,827 participants from the UK Biobank. The joint sleep pattern was evaluated by the healthy sleep score according to five sleep factors (chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness). Cox proportional hazards models were utilized to evaluate the relationship between sleep-related metabolites and the incidence of CMM and CMDs. Mediation analyses were conducted to quantify the potential mediating effects of circulating metabolites. Results: After a median follow-up of 13.5 years, 24,602 incident cases of CMDs and 2740 incident cases of CMM were identified. Per 1-decrement of sleep score was associated with 10.5% and 15.1% increased risks of CMDs and CMM, respectively. However, sleep was not associated with the progression from the first disease to CMM. A total of 152 metabolites were identified to be associated with sleep patterns, among which lipoproteins emerged as the predominant class. Most of the metabolites showed mediation effects on the association between sleep and outcomes. Conclusions: Poor sleep pattern was associated with increased risk of CMDs and CMM. Differences in metabolites, especially lipoproteins, might partially explain the association between sleep pattern and cardiometabolic health.