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Original research
Prospective study of sleep duration, snoring and risk of heart failure
  1. Sheng Zhuang1,
  2. Shue Huang2,
  3. Zhe Huang3,
  4. Shun Zhang4,
  5. Laila Al-Shaar5,
  6. Shuohua Chen3,
  7. Shouling Wu3,
  8. Xiang Gao6
  1. 1 Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  2. 2 Department of Epidemiology and Biostatistics, University of California Irvine, Irvine, California, USA
  3. 3 Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
  4. 4 Department of Psychiatry, Kailuan Mental Health Center, Tangshan, Hebei, China
  5. 5 Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
  6. 6 Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
  1. Correspondence to Dr Xiang Gao, Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai 200437, China; xiang_gao{at}; Dr Shouling Wu, Department of Cardiology, Kailuan General Hospital, Tangshan 063000, People's Republic of China; drwusl{at}


Objective To investigate whether nighttime sleep duration and snoring status were associated with incident heart failure (HF).

Methods A prospective study was conducted based on Kailuan cohort including 93 613 adults free of pre-existing cardiovascular diseases. Sleep duration and snoring status were assessed by self-reported questionnaire. Incident HF cases were ascertained by medical records. Cox proportional hazards model was applied to calculate the HR and 95% CI of risk of developing HF. Mediation analysis was used to understand whether hypertension and diabetes mediated the association between sleep duration, snoring and HF. Data analysis was performed from 1 June 2021 to 1 June 2022.

Results During a median follow-up of 8.8 years, we documented 1343 incident HF cases. Relative to sleep duration of 7.0–7.9 hour/night, short sleep duration was associated with higher risk of developing HF: adjusted HR was 1.24 (95% CI 1.01 to 1.55) for <6 hours/night and 1.29 (95% CI 1.06 to 1.57) for 6.0–6.9 hours/night, after adjustment for potential confounders such as age, sex, smoking, hypertension and diabetes. A similar 20%–30% higher risk of incident HF was found in individuals reporting occasional or frequent snoring relative to never/rare snorers: adjusted HR was 1.32 for occasional snoring (95% CI 1.14 to 1.52) and 1.24 (95% CI 1.06 to 1.46) for frequent snoring. Presence of diabetes significantly mediated the association between both short sleep duration and snoring and HF risk and hypertension significantly mediated the snoring–HF relationship.

Conclusion Short sleep duration and snoring were associated with high risk of HF.

  • Epidemiology
  • Heart Failure
  • Risk Factors

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • SZ and SH are joint first authors.

  • Contributors SW and XG conceptualised and designed the study. SZhu and SH drafted the manuscript. SH, ZH, SZha, SC and SW collected and analysed data. SZhu, SH, ZH, SZha, SC, LA-S, SW and XG interpreted the data and critically revised the manuscript for the intellectual content. XG is responsible for the overall content as guarantor.

  • Funding This research was supported by Natural Science Foundation of Hebei Province (H2018209318).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.