Journal of Health Sciences & Surveillance System

Investigating the Role of Short and Long Sleep Durations in Cardiovascular Diseases: Results from Kharameh PERSIAN Cohort Study in Iran

Document Type : Original Article

Authors

Alireza Dehghani 1
Mozhgan Seif 2
Abbas Rezaianzadeh 3

1 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/jhsss.2025.106961.2056
Abstract
Background: Cardiovascular Diseases (CVDs) are now among the most common chronic conditions and are the leading cause of disability, morbidity, and mortality worldwide. Also, sleep 
duration is considered a neglected modifiable risk factor for CVDs. Therefore, this study aimed to investigate the association between sleep duration and the prevalence of CVD in a large scale of the Iranian population.
Methods: In this cross-sectional study, baseline data from 9,632 participants aged 40 to 70 years were collected between 2014 and 2016 and analyzed. Sleep duration was categorized into five groups (<6, 6–6.9, 7–7.9, 8–8.9, and ≥9 hours). The association between categorized sleep duration and the prevalence of CVD was assessed using both crude and adjusted multiple logistic 
regression models. In addition, a sensitivity analysis was performed.
Results: In the crude analysis, both males and females who slept <6 hours showed similar odds ratios for CVD (males: OR=1.42, P=0.046; females: OR=1.44, P<0.001). In the adjusted model, both short (<6 hours) and long (≥9 hours) sleep durations were associated with increased odds of CVD for both genders, reaching statistical significance exclusively in females. A sensitivity analysis was then performed, which resulted in modest attenuation of the associations in both genders.
Conclusion: Overall, our findings indicate that both short and long sleep duration are associated with an increased risk of CVD, particularly among females. These results emphasize the importance of maintaining a balanced sleep duration for cardiovascular health and support the potential benefit of sleep related interventions in reducing CVD risk.

Highlights

Alireza Dehghani (Google Scholar)

Mozhgan Seif (Google Scholar)

Keywords

Cardiovascular Diseases
Sleep Duration
Sleep Disorders
Iran
Cohort Studies
  1. Nouravaran Feizabadi M, Kourosh Holakouie-Naieni K, Rahimi Foroushani A, Taghipour A. Assessment of Cardiovascular Diseases Risk Factors in the Staff of Mashhad University of Medical Sciences Using on a Multilevel Analysis Approach. Journal of School of Public Health and Institute of Public Health Research. 2022;19(4):423–32.
  2. Zhuang Z, Gao M, Yang R, Li N, Liu Z, Cao W, et al. Association of physical activity, sedentary behaviours and sleep duration with cardiovascular diseases and lipid profiles: a Mendelian randomization analysis. Lipids Health Dis. 2020;19(1):86. doi: 10.1186/s12944-020-01257-z. PubMed PMID: 32384904; PubMed Central PMCID: PMC7206776.
  3. Coronado F, Melvin SC, Bell RA, Zhao G. Global Responses to Prevent, Manage, and Control Cardiovascular Diseases. Prev Chronic Dis. 2022;19:E84. doi: 10.5888/pcd19.220347. PubMed PMID: 36480801; PubMed Central PMCID: PMC9746707.
  4. Zhao D. Epidemiological Features of Cardiovascular Disease in Asia. JACC Asia. 2021;1(1):1–13. doi: 10.1016/j.jacasi.2021.04.007. PubMed PMID: 36338365; PubMed Central PMCID: PMC9627928.
  5. Saki N, Karandish M, Cheraghian B, Heybar H, Hashemi SJ, Azhdari M. Prevalence of cardiovascular diseases and associated factors among adults from southwest Iran: Baseline data from Hoveyzeh Cohort Study. BMC Cardiovasc Disord. 2022;22(1):309. doi: 10.1186/s12872-022-02746-y. PubMed PMID: 35804295; PubMed Central PMC.ID: PMC9270737.
  6. Cheraghian B, Heybar H, Saki N, Raeisizadeh M, Hashemi SJ, Bitaraf S. Sleep duration and Framingham s cardiovascular risk score: results from the Hoveyzeh Cohort Study (HCS). BMC Cardiovasc Disord. 2023;23(1):570. doi: 10.1186/s12872-023-03611-2. PubMed PMID: 37986150; PubMed Central PMCID: PMC10662158.
  7. Hall MH, Brindle RC, Buysse DJ. Sleep and cardiovascular disease: Emerging opportunities for psychology. Am Psychol. 2018;73(8):994–1006. doi: 10.1037/amp0000362. PubMed PMID: 30394778; PubMed Central PMCID: PMC6220679.
  8. Ravichandran R, Gupta L, Singh M, Nag A, Thomas J, Panjiyar BK. The Interplay Between Sleep Disorders and Cardiovascular Diseases: A Systematic Review. Cureus. 2023;15(9):e45898.  doi: 10.7759/cureus.45898. PubMed PMID: 37885512; PubMed Central PMCID: PMC10598613.
  9. Ikehara S, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, et al. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep. 2009;32(3):295–301.  doi: 10.1093/sleep/32.3.295. PubMed PMID: 19294949; PubMed Central PMCID: PMC2647783.
  10. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep. 2011;34(11):1487–92. doi: 10.5665/sleep.1382. PubMed PMID: 22043119; PubMed Central PMCID: PMC3198203.
  11. Ferrie JE, Shipley MJ, Cappuccio FP, Brunner E, Miller MA, Kumari M, et al. A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. Sleep. 2007;30(12):1659–66. doi: 10.1093/sleep/30.12.1659. PubMed PMID: 18246975; PubMed Central PMCID: PMC2276139.
  12. Eguchi K, Pickering TG, Schwartz JE, Hoshide S, Ishikawa J, Ishikawa S, et al. Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. Arch Intern Med. 2008;168(20):2225–31. doi: 10.1001/archinte.168.20.2225. PubMed PMID: 19001199; PubMed Central PMCID: PMC3839087.
  13. Yazdanpanah MH, Homayounfar R, Khademi A, Zarei F, Shahidi A, Farjam M. Short sleep is associated with higher prevalence and increased predicted risk of cardiovascular diseases in an Iranian population: Fasa PERSIAN Cohort Study. Sci Rep. 2020;10(1):4608. doi: 10.1038/s41598-020-61506-0. PubMed PMID: 32165672; PubMed Central PMCID: PMC7067883.
  14. Collaborators GBDEMRCD. Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study. Int J Public Health. 2018;63(Suppl 1):137–49. PubMed PMID: 28776245; PubMed Central PMCID: PMC5973984.
  15. Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian population: the Isfahan Cohort Study. Arch Iran Med. 2013;16(3):138–44. PubMed PMID: 23432164.
  16. Miri L, Foroughan M, Vahedi M, Shahbazi A. The Relationships Between Daily Sleepiness and Cardiovascular Health Indicators in the Older Adults. Salmand: Iranian Journal of Ageing. 2021;16(3):452–67. doi: 10.1007/s00420-020-01641-3. PubMed PMID: 33426591.
  17. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, et al. Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design. Am J Epidemiol. 2018;187(4):647–55. doi: 10.1093/aje/kwx314. PubMed PMID: 29145581; PubMed Central PMCID: PMC6279089.
  18. Cakir H, Gunes A, Er F, Cakir H, Karagoz A, Yilmaz F, et al. Evaluating the relationship of sleep quality and sleep duration with Framingham coronary heart disease risk score. Chronobiol Int. 2022;39(5):636–43. doi: 10.1080/07420528.2021.2018453. PubMed PMID: 35016566.
  19. Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Soc Sci Med. 2010;71(5):1027–36. doi: 10.1016/j.socscimed.2010.05.041. PubMed PMID: 20621406.
  20. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484–92. doi: 10.1093/eurheartj/ehr007. PubMed PMID: 21300732.
  21. Im E, Kim GS. Relationship between sleep duration and Framingham cardiovascular risk score and prevalence of cardiovascular disease in Koreans. Medicine (Baltimore). 2017;96(37):e7744. doi: 10.1097/MD.0000000000007744. PubMed PMID: 28906359; PubMed Central PMCID: PMC5604628.
  22. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246–56. doi: 10.1016/j.sleep.2016.08.006. PubMed PMID: 27743803.
  23. Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev. 2008;12(3):197–210. doi: 10.1016/j.smrv.2007.07.007. PubMed PMID: 18222099.
  24. Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med. 1998;60(5):610–5. doi: 10.1097/00006842-199809000-00017. PubMed PMID: 9773766.
  25. Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK. Sleep restriction for 1 week reduces insulin sensitivity in healthy men. Diabetes. 2010;59(9):2126–33. doi: 10.2337/db09-0699. PubMed PMID: 20585000; PubMed Central PMCID: PMC2927933.
  26. Wheaton AG, Chapman DP, Croft JB. School Start Times, Sleep, Behavioral, Health, and Academic Outcomes: A Review of the Literature. J Sch Health. 2016;86(5):363–81. doi: 10.1111/josh.12388. PubMed PMID: 27040474; PubMed Central PMCID: PMC4824552.
  27. Sauvet F, Leftheriotis G, Gomez-Merino D, Langrume C, Drogou C, Van Beers P, et al. Effect of acute sleep deprivation on vascular function in healthy subjects. J Appl Physiol (1985). 2010;108(1):68–75. doi: 10.1152/japplphysiol.00851.2009. PubMed PMID: 19910332.
  28. Tasali E, Van Cauter E. Sleep-disordered breathing and the current epidemic of obesity: consequence or contributing factor? Am J Respir Crit Care Med. 2002;165(5):562–3. doi: 10.1164/ajrccm.165.5.2201001b. PubMed PMID: 11874803.
  29. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. doi: 10.1371/journal.pmed.0010062. PubMed PMID: 15602591; PubMed Central PMCID: PMC535701.
  30. Knutson KL. Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence. Best Pract Res Clin Endocrinol Metab. 2010;24(5):731–43. doi: 10.1016/j.beem.2010.07.001. PubMed PMID: 21112022; PubMed Central PMCID: PMC3011978.
  31. Writing Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):e38–360. doi: 10.1161/CIR.0000000000000350. PubMed PMID: 26673558.
  32. Shahrbabaki SS, Linz D, Hartmann S, Redline S, Baumert M. Sleep arousal burden is associated with long-term all-cause and cardiovascular mortality in 8001 community-dwelling older men and women. Eur Heart J. 2021;42(21):2088–99.  doi: 10.1093/eurheartj/ehab151. PubMed PMID: 33876221; PubMed Central PMCID: PMC8197565.
  33. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982–3021. doi: 10.1016/j.jacc.2020.11.010. PubMed PMID: 33309175; PubMed Central PMCID: PMC7755038.
  34. Rezaei F, Seif M, Gandomkar A, Fattahi MR, Hasanzadeh J. Agreement between laboratory-based and non-laboratory-based Framingham risk score in Southern Iran. Sci Rep. 2021;11(1):10767. doi: 10.1038/s41598-021-90188-5. PubMed PMID: 34031448; PubMed Central PMCID: PMC8144380.
Journal of Health Sciences & Surveillance System
Volume 14, Issue 3
Summer 2026
Pages 212-219

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