Abstract 4146664: Sleep duration and risk of incident heart failure in a cohort of primarily low-income Black and White adults

Introduction: Short and long sleep durations have been associated with cardiovascular (CV) disease risk and mortality, but less is known about the relationship with heart failure (HF). Clinical guidelines recommend adults sleep at least 7 hours and less than 9 hours per night for optimal health. We prospectively investigated the association between sleep duration and incident HF in the Southern Community Cohort Study (SCCS), a large cohort of primarily low-income Black and White adults. Methods: The study included 26,669 Black and White SCCS participants without prevalent HF at enrollment (2002-2009) who were receiving Center for Medicare/Medicaid Services (CMS). Participants self-reported weekday and weekend sleep duration at enrollment; weighted average nightly sleep duration was calculated. Incident HF was ascertained using ICD-9/10 codes via CMS claims through December 31, 2016. Multivariable Cox models were conducted to test associations between sleep duration and incident HF. Results: Participants had a median age of 55 years, and were predominantly Black (69%), female (62%) and low-income (87% < $25,000/year). Approximately 27% of participants reported a habitual sleep duration of 8-9 hours per night, while 18%, 21%, 17% and 17% reported sleep durations <6, 6-7, 7-8 and >9 hours, respectively. Over median 10 years of follow-up, 7,375 participants (27.6%) developed HF. Compared to those who slept 8-9 hours a night, participants with a sleep duration <6 hours (HR 1.15; 95% CI 1.07-1.24) and between 6-7 (HR 1.07; 95% CI 1.00-1.15) were at greater risk for incident HF independent of demographics, socioeconomic indicators, employment, and health behaviors including smoking, alcohol consumption, physical activity, and diet ( Figure 1 ). The association for the shortest sleep duration (<6 hours) persisted after adjustment for CV risk factors and depressive symptoms (HR 1.10; 95% CI 1.02-1.18). Sleep durations ≥9 hours were not significantly associated with HF risk. Conclusions: Shorter sleep duration was associated with higher risk of developing HF in a cohort of middle aged Black and White adults. Strategies to promote optimal sleep duration may improve primary prevention of HF among individuals at high-risk.