Association of Changes in Sleep Patterns with Cardiometabolic Disease and All-Cause Mortality: A Prospective Cohort Study Among Chinese Adults

Abstract

Cardiometabolic diseases (CMDs) represent critical health burdens for middle-aged and elderly populations. Nevertheless, the mechanism by which alterations in sleep patterns affect CMD risk and all-cause mortality remain unclear. This research aimed to explore the relationships between dynamic sleep pattern shifts and both CMDs as well as all-cause mortality among adult residents in China. We performed a prospective cohort investigation based on datasets obtained from the China Health and Retirement Longitudinal Study (CHARLS) (2011–2020). A total of 8,106 individuals aged 50–70 years who were free of CMDs at study entry were enrolled for baseline-related analyses, whereas 6,374 participants were selected for transition-oriented analyses. Sleep patterns were evaluated through three self-reported sleep phenotypes (sleep duration, napping duration, and insomnia) and summarized into a composite sleep score. Incident CMDs (heart disease, stroke, or diabetes) together with all-cause mortality constituted the main study outcomes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Over a median follow-up period of 7.01 years for CMDs and 9.01 years for all-cause mortality, varying changes in sleep patterns corresponded to differing risks of CMDs and death from any cause. Compared with those whose sleep duration remained consistently unfavourable, participants who shifted from unfavourable to favourable sleep duration demonstrated lower risks of CMDs (HR = 0.86, 95% CI 0.75–0.98) and all-cause mortality (HR = 0.78, 95% CI 0.61–0.99). Furthermore, participants who progressed from low-risk to moderate-risk or high-risk sleep patterns were associated with increased risks of CMDs (low-risk to moderate-risk: HR = 1.24, 95% CI 1.00–1.55; low-risk to high-risk: HR = 1.66, 95% CI 1.17–2.36) compared with those with stable low-risk sleep patterns. In contrast, compared with those whose high-risk sleep patterns remained stable, participants who transitioned from high-risk back to low-risk or moderate-risk patterns demonstrated lower CMD risks (high-risk to low-risk: HR = 0.63, 95% CI 0.48–0.82; high-risk to moderate-risk: HR = 0.73, 95% CI 0.58–0.92). Sleep pattern deterioration is linked to increased risks of CMDs and death from any cause, whereas sleep pattern improvement is associated with decreased risks of both outcomes. Our findings underscore the notion that preserving low-risk sleep patterns may play a key role in preventing CMDs and all-cause mortality.