Research Paper Advance Articles

Sleep quality and risk of coronary heart disease—a prospective cohort study from the English longitudinal study of ageing

Chenxi Song1, *, , Rui Zhang1, *, , Jiaqiang Liao2, , Rui Fu1, , Chunyue Wang1, , Qianqian Liu1, , Weihua Song1, , Hongjian Wang1, , Kefei Dou1, ,

  • 1 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 2 Department of Environmental and Occupational Health, West China School of Public Health, Sichuan University, Chengdu, China
* Equal contribution

Received: May 30, 2020       Accepted: July 21, 2020       Published: November 16, 2020
How to Cite

Copyright: © 2020 Song et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: The association between sleep quality and risk of coronary heart disease (CHD) remains unclear in the elderly.

Results: At eight-year follow up, a total of 411 (4.29%) participants developed CHD. Compared with good quality group, the multivariable hazard ratio [HR] (95% confidence interval [CI]) for CHD was 1.393 (1.005, 1.931) for intermediate quality group and 1.913 (1.206, 3.035) for poor quality group. Consistent results were observed in participants with normal sleep duration.

Conclusions: Poor sleep quality may be a novel modifiable risk factor for CHD in the elderly independent of conventional cardiovascular risk factors, even when sleep duration was normal.

Methods: The current study included 9570 CHD-free participants in the English Longitudinal Study of Ageing (ELSA) from wave 4 (2008 to 2009). Incident CHD included new onset angina or myocardial infarction. Sleep quality was measured by a four-item questionnaire. Score ranged from 1 (best) to 4 (poorest). Participants were divided into three groups: good quality (1 ≤ score <2), intermediate quality (2 ≤ score <3) and poor quality (3 ≤ score ≤4). Cox regression model was used to calculate HR for CHD risk according to sleep quality, adjusted for conventional CHD risk factors and sleep duration.


CHD: coronary heart disease; HR: hazard ratio; CI: confidence interval; ELSA: English longitudinal study of ageing; BMI: body mass index; NS-SEC: National Statistics-Socio Economic Classification; CES-D: Centre for Epidemiological Studies Depression scale.