title: Sleep duration, insomnia, and coronary heart disease among postmenopausal women in the Women's Health Initiative.
abstract: BACKGROUND
  Long and short sleep duration are associated with increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD); however, evidence is inconsistent. We sought to identify whether self-reported sleep duration and insomnia, based on a validated questionnaire, are associated with increased incident CHD and CVD among postmenopausal women.
  
  
  METHODS
  Women's Health Initiative Observational Study Participants (N=86,329; 50-79 years) who reported on sleep at baseline were followed for incident CVD events. Associations of sleep duration and insomnia with incident CHD and CVD were evaluated using Cox proportional hazards models over 10.3 years.
  
  
  RESULTS
  Women with high insomnia scores had elevated risk of CHD (38%) and CVD (27%) after adjustment for age and race, and in fully adjusted models (hazard ratio [HR]=1.19, 95% confidence interval [CI] 1.09-1.30; 1.11 95% CI 1.03-2.00). Shorter (≤5 hours) and longer (≥10 hours) sleep duration demonstrated significantly higher incident CHD (25%) and CVD (19%) in age- and race-adjusted models, but this was not significant in fully adjusted models. Formal tests for interaction indicated significant interactions between sleep duration and insomnia for risk of CHD (p<0.01) and CVD (p=0.02). Women with high insomnia scores and long sleep demonstrated the greatest risk of incident CHD compared to midrange sleep duration (HR=1.93, 95% CI 1.06-3.51) in fully adjusted models.
  
  
  CONCLUSIONS
  Sleep duration and insomnia are associated with CHD and CVD risk, and may interact to cause almost double the risk of CHD and CVD. Additional research is needed to understand how sleep quality modifies the association between prolonged sleep and cardiovascular outcomes.
authors: Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA. Megsands@mail.med.upenn.edu
authors: Megan
authors: M
authors: Sands-Lincoln
authors: Eric B
authors: EB
authors: Loucks
authors: Bing
authors: B
authors: Lu
authors: Mary A
authors: MA
authors: Carskadon
authors: Katherine
authors: K
authors: Sharkey
authors: Marcia L
authors: ML
authors: Stefanick
authors: Judith
authors: J
authors: Ockene
authors: Neomi
authors: N
authors: Shah
authors: Kristen G
authors: KG
authors: Hairston
authors: Jennifer G
authors: JG
authors: Robinson
authors: Marian
authors: M
authors: Limacher
authors: Lauren
authors: L
authors: Hale
authors: Charles B
authors: CB
authors: Eaton
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000503:physiopathology*; D013997:Time Factors; D016387:Women's Health
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