The association of sleep duration and physical activity with cardiovascular diseases: a cohort study from the China health and nutrition survey

BACKGROUND: Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. This study investigated the independent and joint associations of sleep duration and moderate-to-vigorous physical activity (MVPA) with incident CVD. METHODS: Data were obtained from 5873 participants aged ≥40 years from the China Health and Nutrition Survey (CHNS) between 2009 and 2015. Sleep duration was categorised as healthy, short, or long, based on age-specific criteria. MVPA was quantified using the Compendium of Physical Activities and classified as inactive or active. The primary outcome was medically verified incident CVD during follow-up. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using adjusted Cox proportional hazards models. RESULTS: Over a mean follow-up of 5 years, 142 incident CVD events occurred. Compared with healthy sleep duration, age-specific short sleep duration was associated with a 58 % higher risk of CVD (HR = 1.58, 95 % CI: 1.03-2.45), while long sleep duration showed no significant association. Within the ≤8 h/day range, each additional hour of sleep reduction was associated with a 20 % increase in CVD risk (HR = 1.20, 95 % CI: 1.01-1.42). Active MVPA did not significantly attenuate the increased CVD risk associated with short sleep duration. Notably, these findings remained consistent even after accounting for all-cause mortality as a competing risk event. CONCLUSIONS: In this Chinese population, age-specific short sleep duration was associated with increased CVD risk, which was not attenuated by active MVPA. Maintaining healthy sleep duration across the lifespan may be an important component for the primary prevention of CVD.