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Effects of Sleep Patterns on Risk of Chronic Disease
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This large analysis of electronic health record data from the All of Us Research Program evaluated whether sleep duration and quality (measured with wearable commercial devices such as Fitbit, Apple Watch, etc) are associated with chronic disease incidence. Poor sleep, particularly poor rapid eye movement and poor deep sleep, was associated with incident atrial fibrillation. Irregular sleep patterns were associated with obesity, hypertension, hyperlipidemia, depression, and anxiety.
- Poor sleep duration and quality are associated with a number of chronic health conditions. Furthermore, poor rapid eye movement and deep sleep may be associated with serious health conditions as well. Commercial wearable devices may be a viable means for patients to measure sleep duration and quality.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPoor sleep health is associated with increased all-cause mortality and incidence of many chronic conditions. Previous studies have relied on cross-sectional and self-reported survey data or polysomnograms, which have limitations with respect to data granularity, sample size and longitudinal information. Here, using objectively measured, longitudinal sleep data from commercial wearable devices linked to electronic health record data from the All of Us Research Program, we show that sleep patterns, including sleep stages, duration and regularity, are associated with chronic disease incidence. Of the 6,785 participants included in this study, 71% were female, 84% self-identified as white and 71% had a college degree; the median age was 50.2 years (interquartile range = 35.7, 61.5) and the median sleep monitoring period was 4.5 years (2.5, 6.5). We found that rapid eye movement sleep and deep sleep were inversely associated with the odds of incident atrial fibrillation and that increased sleep irregularity was associated with increased odds of incident obesity, hyperlipidemia, hypertension, major depressive disorder and generalized anxiety disorder. Moreover, J-shaped associations were observed between average daily sleep duration and hypertension, major depressive disorder and generalized anxiety disorder. These findings show that sleep stages, duration and regularity are all important factors associated with chronic disease development and may inform evidence-based recommendations on healthy sleeping habits.
Additional Info
Disclosure statements are available on the authors' profiles:
Sleep patterns and risk of chronic disease as measured by long-term monitoring with commercial wearable devices in the All of Us Research Program
Nat. Med. 2024 Jul 19;[EPub Ahead of Print], NS Zheng, J Annis, H Master, L Han, K Gleichauf, JH Ching, M Nasser, P Coleman, S Desine, DM Ruderfer, J Hernandez, LD Schneider, EL BrittainFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Sleep and chronic diseases
There have been many studies that examined sleep and its association with chronic diseases. Most of these studies relied on the participants to quantify how much sleep they received, a method that does not accurately measure sleep parameters. Some studies have used proper sleep monitors, but these monitors can’t be used over a long period, so they are only good for getting short-term data.
Thankfully, there are Fitbits that can record a variety of data even during sleep. The authors of this study, who are part of the All of Us Research Program initiative, used Fitbit to examine different sleep parameters and their connection to chronic diseases. The main study enrolled 1 million individuals; however, the sleep aspect of the study enrolled 6785 Fitbit users with linked electronic medical record data, and in this way, the authors could determine which chronic diseases were linked to sleep.
The study lasted 4.5 years and collected 6.47 million person-nights of data. The average age of the participants was 50 years, and 71% were females.
Most people went to sleep by 11:10 PM and stayed asleep for 6.7 hours. Individuals with just 1 more hour of sleep were 38% less likely to be obese. Obstructive sleep apnea incidence decreased by 23% with just that extra 1 hour of extra sleep. On the flip side, 1 hour less sleep was associated with an increase in the risk of hypothyroidism and shortness of breath.
For the different stages of sleep, the authors reported that rapid eye movement (REM) sleep, light sleep, and deep sleep made up approximately 21%, 64%, and 15% of the total sleep time, respectively. Interestingly, every 1% increase in REM sleep or deep sleep was associated with a 13% reduction in the incidence of atrial fibrillation. However, a 1% increase in light sleep increased atrial fibrillation.
The researchers suggest that this might be related to the sympathetic–parasympathetic system. This makes sense for deep sleep, where the parasympathetic nervous system dominates, so there is a lower chance of arrhythmia. Light sleep is associated with an increased sympathetic tone (just in case you are attacked and need to defend yourself quickly). Increased sympathetic tone means a potentially higher chance of atrial fibrillation. The one that does not make sense is the REM sleep. In REM sleep, the sympathetic tone is increased, yet there was a reduced incidence of atrial fibrillation. Perhaps it is the balance between the sympathetic and parasympathetic nervous systems that is driving everything.
The most surprising finding of this study was regarding sleep irregularity, which means going to sleep at different times and for different durations. The authors found that sleep irregularity was associated with 24 different chronic diseases, including hypertension (56%), high cholesterol (39%), obesity (49%), depression (75%), anxiety (55%), and even bipolar disease (127%). I guess all body systems like regularity and predictability. Variability and surprises put the system into battle mode, which is not good. Therefore, fixing sleep irregularity is the key.