title: The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: a prospective study from the Whitehall II cohort.
abstract: OBJECTIVE
  Short sleep duration is associated with increased CHD (coronary heart disease) mortality and morbidity, although some evidence suggests that sleep disturbance is just as important. We investigated whether a combination of short sleep duration and sleep disturbance is associated with a higher risk of CHD than their additive effects.
  
  
  METHODS
  The Whitehall II study.
  
  
  METHODS
  The Whitehall II study recruited 10,308 participants from 20 civil service departments in London, England. Participants were between the ages of 35 and 55 years at baseline (1985-1988) and were followed up for an average of 15 years.
  
  
  METHODS
  N/A.
  
  
  METHODS
  Sleep hours and sleep disturbance (from the General Heath Questionnaire-30) were obtained from the baseline survey. CHD events included fatal CHD deaths or incident nonfatal myocardial infarction or angina (ICD-9 codes 410-414 or ICD-10 120-25).
  
  
  RESULTS
  Short sleep duration and sleep disturbance were both associated with increased hazards for CHD in women as well as in men, although, after we adjusted for confounders, only those reporting sleep disturbance had a raised risk. There was some evidence for an interaction between sleep duration and sleep disturbance. Participants with short sleep duration and restless disturbed nights had the highest hazard ratios (HR) of CHD (relative risk:1.55, 95% confidence interval:1.33-1.81). Among participants who did not report any sleep disturbance, there was little evidence that short sleep hours increased CHD risk.
  
  
  CONCLUSIONS
  The effect of short sleep (< or = 6 hours) on increasing CHD risk is greatest among those who reported some sleep disturbance. However, among participants who did not report any sleep disturbance, there was little evidence that short sleep hours increased CHD risk.
authors.affiliation: International Center for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, UK. t.chandola@ucl.ac.uk
authors.forename: Tarani
authors.initials: T
authors.lastname: Chandola
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Aleksander
authors.initials: A
authors.lastname: Perski
authors.forename: Tasnime
authors.initials: T
authors.lastname: Akbaraly
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012892:Sleep Deprivation / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors