BACKGROUND: Cardio-renal-metabolic multimorbidity is defined as the coexistence of two or three cardio-renal-metabolic diseases, namely cardiovascular disease, type 2 diabetes mellitus, and chronic kidney disease. The association between sleep traits and cardio-renal-metabolic disease progression is often overlooked. Anxiety and depression may affect both sleep and cardio-renal-metabolic diseases, while their mediating role is unclear.
METHODS: We conducted a multistate analysis using data from 375,837 UK Biobank participants (42.16% men, mean age 55.77 years, 95.37% White) to investigate the associations between sleep traits and the longitudinal progression from healthy to first cardio-renal-metabolic disease, cardio-renal-metabolic multimorbidity, and death. Sleep traits, including sleep duration, ease of getting up in the morning, chronotype, napping during day, insomnia, and snoring, were self-reported at baseline, and an integrated sleep score was calculated, with higher scores indicating healthier sleep. Counterfactual mediation analysis assessed the role of anxiety and depression.
RESULTS: During a median follow-up of 13.68 years, 110,287 participants developed first cardio-renal-metabolic disease, 14,562 experienced cardio-renal-metabolic multimorbidity, and 2709 died. Healthy sleep traits were associated with a decreased risk of progressing from healthy to first cardio-renal-metabolic disease (HR=0.70, 95% CI: 0.67-0.72), healthy to death (HR=0.79, 95% CI: 0.70-0.88), and first cardio-renal-metabolic disease to cardio-renal-metabolic multimorbidity (HR=0.70, 95% CI: 0.64-0.76). Anxiety or depression mediated 16.48% of the first cardio-renal-metabolic disease risk, 14.48% of cardio-renal-metabolic multimorbidity risk, and 25.17% of mortality risk.
CONCLUSIONS: Healthy sleep traits were associated with a protective effect in early- to mid-stage cardio-renal-metabolic disease development, with anxiety and depression acting as mediators. Adhering to healthy sleep traits and addressing anxiety and depression may help prevent cardio-renal-metabolic diseases and their progression.
