Nonrestorative sleep: a simple question with major consequences—a call to integrate sleep health in preventive medicine

Nonrestorative sleep (NRS) is a deceptively simple question: "Do you get adequate rest during sleep?"(Yes/No) -yet it carries profound implications for both individual health and public health.While often overlooked in clinical practice, NRS is increasingly recognized as a marker of vulnerability, linking sleep physiology, mental health, and cardiometabolic outcomes (Figure 1).The article by Takahashi et al. (SLEEP 2025, in press) represents an important contribution to the growing literature linking sleep disorders with adverse cardiometabolic outcomes [1].Using a very large and representative dataset of 86,009 participants drawn from national health check-ups and followed for a mean of 5.7 years, the authors demonstrate that NRS is independently associated with the incidence of major adverse cardiac and cerebrovascular events (MACCEs), even after adjustment for conventional risk factors.MACCEs were defined as ischemic heart disease (IHD), heart failure (HF), cerebral hemorrhage (CH), and cerebral infarction (CI) requiring hospitalization.Importantly, nearly one-third of the general population (32.9%) reported NRS at baseline, and NRS status was associated with a greater risk of MACCE development in individuals under 60 years of age, a subgroup often exposed to higher mental and physical stress, and more irregular lifestyles [1].By framing NRS as a "red flag" symptom, this compelling work echoes previous observations that disturbed or insufficiently restorative sleep is strongly associated with psychiatric disorders, daytime dysfunction, and elevated risk of suicide [2-5].However, despite its apparent simplicity, the construct of NRS is far from homogeneous [6].It can encompass non-refreshing, non-recovering, or nonsatisfying sleep experiences.Dimensions that only partially overlap and are variably captured by existing measures.Some individuals may describe NRS as non-restful, others as non-refreshing or even paradoxically "stimulating" or "emotionally charged."This diversity of experience highlights that NRS may reflect multiple underlying physiological or psychological mechanisms rather than a single entity