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A groundbreaking study involving over 6,000 individuals has demonstrated significant associations between sleep patterns—specifically rapid eye movement (REM) sleep, deep sleep, and sleep irregularity—and the risk of various chronic diseases. The study, published in Nature Medicine, leveraged data from commercial wearable devices and the All of Us Research Program to draw its conclusions.
“Most of what we think we know about sleep patterns in adults comes from either self-report surveys, which are widely used but have all sorts of problems with over- and under-estimating sleep duration and quality, or single-night sleep studies,” explained Dr. Evan L. Brittain, the study’s corresponding author from Vanderbilt University, Nashville, Tennessee. “In our study, we had a unique opportunity to understand sleep using a large cohort of individuals with wearable devices measuring sleep duration, quality, and variability. The All of Us Research Program is the first to link wearables data to the electronic health record at scale, allowing us to study long-term, real-world sleep behavior.”
The American Heart Association’s recognition of sleep as a crucial component of heart health highlights the timeliness and importance of this study, Dr. Brittain added.
Study Insights
The study analyzed objectively measured sleep data from 6,785 adults using Fitbit devices, with data linked to electronic health records. The median age of participants was 50.2 years; 71% were women, and 84% identified as White. Sleep monitoring spanned a median period of 4.5 years.
Key findings include:
- REM Sleep: Each percent increase in REM sleep was associated with a reduced incidence of atrial fibrillation (odds ratio [OR], 0.86), atrial flutter (OR, 0.78), and sinoatrial node dysfunction/bradycardia (OR, 0.72).
- Deep Sleep: Higher percentages of deep sleep were linked to reduced odds of atrial fibrillation (OR, 0.87), major depressive disorder (OR, 0.93), and anxiety disorder (OR, 0.94).
- Sleep Irregularity: Increased irregular sleep was significantly associated with higher odds of obesity (OR, 1.49), hyperlipidemia (OR, 1.39), hypertension (OR, 1.56), major depressive disorder (OR, 1.75), anxiety disorder (OR, 1.55), and bipolar disorder (OR, 2.27).
The researchers also noted J-shaped associations between average daily sleep duration and hypertension, as well as major depressive disorder and generalized anxiety disorder.
Clinical Implications
“The biggest surprise for me was the impact of sleep variability on health,” Dr. Brittain told Medscape Medical News. “The more your sleep duration varies, the higher your risk of numerous chronic diseases across the entire spectrum of organ systems. Sleep duration and quality were also important but less surprising.”
Dr. Brittain emphasized the importance of consistent sleep patterns for reducing chronic disease risk. “For patients, that means going to sleep and waking up at roughly the same time each night,” he said. He also noted the value of commercial wearable devices in clinical settings for providing objective insights into patient behavior.
Limitations and Future Directions
Despite its strengths, the study had limitations, including its relatively young, White, and female cohort. Dr. Brittain acknowledged the need for validation in a more diverse population.
Dr. Arianne K. Baldomero, a pulmonologist and assistant professor of medicine at the University of Minnesota, emphasized the importance of this study in understanding the impact of sleep patterns on chronic disease. “This study reinforces the importance of adequate sleep, typically around 7 hours per night,” she said. However, she also noted the ongoing need to determine whether abnormal sleep patterns cause or result from chronic diseases.
The study was partially funded by an unrestricted gift from Google and supported by the National Institutes of Health. Dr. Brittain disclosed receiving research funds unrelated to this work from United Therapeutics, while Dr. Baldomero had no financial conflicts to disclose.
This research underscores the critical role of consistent and quality sleep in maintaining overall health and preventing chronic diseases, paving the way for future interventions using wearable technology.
