Sleep timing may predict congestive heart failure: A community-based cohort study

BACKGROUND: Previous studies have suggested that sleep timing is associated with cardiovascular risk factors. However, there is no evidence on the relationship between sleep timing and congestive heart failure (CHF). We aimed to examine this relationship in this study. METHODS AND RESULTS: We recruited 4765 participants (2207 men; mean age, 63.6±11.0 years) from the SHHS (Sleep Heart Health Study) database in this multicenter prospective cohort study. Follow-up was conducted until the first CHF diagnosis between baseline and the final censoring date. Sleep timing (bedtimes and wake-up times on weekdays and weekends) was based on a self-reported questionnaire. Cox proportional hazard models were constructed to investigate the association between sleep timing and CHF. During the mean follow-up period of 11 years, 519 cases of CHF (10.9%) were reported. The multivariable Cox proportional hazards models revealed that participants with weekday bedtimes >12:00 am (hazard ratio [HR], 1.56; 95% CI, 1.15–2.11; P=0.004) and from 11:01 pm to 12:00 am (HR, 1.25; 95% CI, 1.00–1.56; P=0.047) had an increased risk of CHF compared with those with bedtimes from 10:01 pm to 11:00 pm. After stratified analysis, the association was intensified in participants with a self-reported sleep duration of 6 to 8 hours. Furthermore, wake-up times >8:00 am on weekdays (HR, 1.53; 95% CI, 1.07–2.17; P=0.018) were associated with a higher risk of incident CHF than wake-up times ≤6:00 am. CONCLUSIONS: Delayed bedtimes (>11:00 pm) and wake-up times (>8:00 am) on weekdays were associated with an increased risk of CHF.