Sleep Medicine · Jun 8, 2026

Associations of sleep duration and insomnia with cardiometabolic disease onset, multimorbidity, and mortality: A prospective study in 461,046 Chinese adults

By Chen Y, Zou Y, Su Y et al.

AIMS: To investigate the independent and joint associations of sleep duration and insomnia with the incidence of first cardiometabolic disease (FCMD), cardiometabolic multimorbidity (CMM), and all-cause mortality among Chinese adults. METHODS: We conducted a prospective cohort study among 461,046 adults at baseline from the China Kadoorie Biobank. Participants were followed for incident FCMD, CMM (defined as the occurrence of two or more CMDs), and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the independent and joint associations of sleep duration and insomnia with each outcome. RESULTS: Over a median follow-up of approximately 10 years, 73,159 participants (15.9%) developed FCMD, 12,183 (2.6%) developed CMM, and 33,259 (7.2%) died. Compared with normal sleep duration (7-9 h/day), abnormal sleep duration (<7 or >9 h/day) was associated with higher risks of FCMD (HR = 1.04, 95% CI: 1.02-1.06), CMM (HR = 1.10, 95% CI: 1.05-1.14), and all-cause mortality (HR = 1.07, 95% CI: 1.04-1.09). Insomnia was similarly associated with higher risks of FCMD (HR = 1.08, 95% CI: 1.06-1.11), CMM (HR = 1.10, 95% CI: 1.05-1.16), and all-cause mortality (HR = 1.07, 95% CI: 1.04-1.11). Joint analyses showed a graded pattern, with the highest risks consistently observed among participants with both abnormal sleep duration and insomnia. Associations were broadly consistent across population subgroups. CONCLUSION: Abnormal sleep duration and insomnia were independently and jointly associated with higher incidence risks of FCMD, CMM, and all-cause mortality.

doi.org/10.1016/j.sleep.2026.109073 PubMed 42269188 Populations