Association between sleep duration and CVD mortality: a prospective cohort study based on middle-aged and elderly chest pain patients

Previous studies have yielded varying conclusions about the relationship between sleep duration and cardiovascular disease (CVD) mortality across different populations. Therefore, it is crucial to examine this relationship specifically within the U.S. chest pain population. This study aims to evaluate the association between sleep duration and cardiovascular disease (CVD) mortality among a U.S. population presenting with chest pain. This prospective cohort study included 70,190 participants from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). Participants who reported ever experiencing chest pain or discomfort, with severe chest pain lasting more than half an hour, were categorized as having chest pain. Mortality data were obtained by linking the cohort database with the National Death Index as of December 31, 2018. Cardiovascular disease (CVD) mortality was classified according to the 10th revision of the International Classification of Diseases (ICD-10) and included the following codes: I00-I09 (acute rheumatic fever, chronic rheumatic heart disease), I11 (hypertensive heart disease), I13 (hypertensive heart and kidney disease), I20-I25 (ischemic heart disease), I26-I28 (pulmonary embolism and other acute pulmonary heart disease), I29, I30-I51 (other forms of heart disease), and I60-I69 (cerebrovascular disease). Data were analyzed between June and July 2024. Among 2,952 US patients with chest pain, the mean age was 57.92 ± 11.63 years, with 1,424 males (49.01%). A total of 1,439 participants (48.74%) reported sleeping ≤ 6 h, while 376 participants (12.73%) reported sleeping > 9 h. After a median follow-up of 85.92 months, there were 164 CVD-related deaths. Compared with patients who had normal sleep duration, those with insufficient sleep had an adjusted hazard ratio (HR) of 1.99 (95% confidence interval [CI], 1.36–2.89; P < 0.001) for CVD mortality, while those with excessive sleep had an adjusted HR of 2.39 (95% CI, 1.37–4.16; P = 0.002). Sensitivity analyses, which excluded patients who died within 2 years of follow-up (sleep duration ≤ 6 h: HR, 1.94; 95% CI, 1.31–2.87; sleep duration > 9 h: HR, 2.40; 95% CI, 1.29–4.44) or those with a baseline history of cancer (sleep duration ≤ 6 h: HR, 1.98; 95% CI, 1.27–3.07; sleep duration > 9 h: HR, 2.86; 95% CI, 1.51–5.41), demonstrated that the association between sleep duration and CVD mortality remained robust. Further exclusion of patients with incomplete data (sleep duration ≤ 6 h: HR, 2.23; 95% CI, 1.51–3.30; sleep duration > 9 h: HR, 2.47; 95% CI, 1.35–4.53) also supported these findings, indicating a consistent relationship between sleep duration and CVD mortality among US chest pain patients. Both longer and shorter sleep durations are associated with increased cardiovascular disease mortality in the U.S. chest pain population.