Sleep health · 2026
Associations of concurrent insomnia symptoms and excessive daytime sleepiness with mortality and incident cardiovascular disease.
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Wang Ruhan, Li Tingting, Zheng Chenchen, Liu Buyun, Bao Wei, Rong Shuang
Аннотация
OBJECTIVES: Excessive daytime sleepiness commonly co-occurs with insomnia symptoms, yet their joint association with long-term outcomes is unclear. To examine the joint associations of insomnia symptoms and excessive daytime sleepiness with all-cause mortality, cardiovascular disease mortality, and incident cardiovascular disease (defined as coronary heart disease, stroke, myocardial infarction, and heart failure).
METHODS: We analyzed 495,398 UK Biobank participants with valid baseline sleep data. Insomnia symptoms and excessive daytime sleepiness were self-reported and combined into 4 phenotypes: neither insomnia symptoms nor excessive daytime sleepiness, insomnia symptoms only, excessive daytime sleepiness only, and insomnia symptoms+excessive daytime sleepiness. Outcomes were ascertained via linkage to national registries. Cox models estimated adjusted hazard ratios (HRs), and both additive (RERI, AP) and multiplicative (product-term) interactions were assessed.
RESULTS: Over a mean follow-up of 14.9 years, totaling 7.46 million person-years, there were 51,926 deaths (10,854 cardiovascular disease deaths) and 51,299 incident cardiovascular disease events. In multivariable models, insomnia symptoms+excessive daytime sleepiness was associated with higher risks of all-cause mortality (HR 1.32, 95% CI 1.25-1.40), cardiovascular disease mortality (1.28, 1.14-1.43), and incident cardiovascular disease (1.40, 1.32-1.49) versus the reference. Insomnia symptoms only and excessive daytime sleepiness only showed modest risk elevations, whereas additive interaction between insomnia symptoms and excessive daytime sleepiness was evident for all-cause mortality (RERI 0.19, 95% CI 0.09-0.30; AP 0.14, 0.07-0.20) and cardiovascular disease incidence (RERI 0.20, 0.08-0.31; AP 0.14, 0.01-0.28).
CONCLUSIONS: The co-occurrence of insomnia symptoms and excessive daytime sleepiness was associated with higher risks of all-cause, cardiovascular disease mortality and incident cardiovascular disease than either symptom alone. These findings support considering combined sleep-symptom profiles in risk assessment, while further studies are needed to clarify underlying mechanisms and determine clinical implications.
METHODS: We analyzed 495,398 UK Biobank participants with valid baseline sleep data. Insomnia symptoms and excessive daytime sleepiness were self-reported and combined into 4 phenotypes: neither insomnia symptoms nor excessive daytime sleepiness, insomnia symptoms only, excessive daytime sleepiness only, and insomnia symptoms+excessive daytime sleepiness. Outcomes were ascertained via linkage to national registries. Cox models estimated adjusted hazard ratios (HRs), and both additive (RERI, AP) and multiplicative (product-term) interactions were assessed.
RESULTS: Over a mean follow-up of 14.9 years, totaling 7.46 million person-years, there were 51,926 deaths (10,854 cardiovascular disease deaths) and 51,299 incident cardiovascular disease events. In multivariable models, insomnia symptoms+excessive daytime sleepiness was associated with higher risks of all-cause mortality (HR 1.32, 95% CI 1.25-1.40), cardiovascular disease mortality (1.28, 1.14-1.43), and incident cardiovascular disease (1.40, 1.32-1.49) versus the reference. Insomnia symptoms only and excessive daytime sleepiness only showed modest risk elevations, whereas additive interaction between insomnia symptoms and excessive daytime sleepiness was evident for all-cause mortality (RERI 0.19, 95% CI 0.09-0.30; AP 0.14, 0.07-0.20) and cardiovascular disease incidence (RERI 0.20, 0.08-0.31; AP 0.14, 0.01-0.28).
CONCLUSIONS: The co-occurrence of insomnia symptoms and excessive daytime sleepiness was associated with higher risks of all-cause, cardiovascular disease mortality and incident cardiovascular disease than either symptom alone. These findings support considering combined sleep-symptom profiles in risk assessment, while further studies are needed to clarify underlying mechanisms and determine clinical implications.