Abstract
BACKGROUND: Sleep is an important determinant of cardiovascular health. We sought to investigate the longitudinal association between sleep duration and incident carotid plaque in a rural Chinese population. METHODS: This population-based prospective cohort study included 1004 rural residents (age ≥40 years) who were free of carotid plaque and had no history of clinical stroke and transient ischemic attack at baseline (2017). Incident carotid plaques were detected by carotid ultrasound images at follow-up (2021). Multivariable Cox regression was used to associate sleep duration with the presence and severity of incident carotid plaques. Restricted cubic splines analyses were conducted to assess dose-response association between sleep duration and incident carotid plaques. RESULTS: During the mean follow-up of 3.95 (SD=0.14) years, 214 (21.3%) of the 1004 participants were found to have incident carotid plaques. A short sleep duration (<7 versus 7-9 hours) was associated with multivariable-adjusted hazard ratio (95% CI) of 1.58 (1.10-2.28) for carotid plaques, 2.96 (1.38-6.36) for greater carotid plaque thickness, and 2.57 (1.33-4.97) for multiple carotid plaques; those associations remained significant in participants with low-to-intermediate traditional cardiovascular disease risk. Long sleep duration (>9 versus 7-9 hours) was not significantly associated with carotid plaques. Restricted cubic splines supported the association of short, but not long, sleep duration with increased risk of incident carotid plaques. CONCLUSIONS: A short sleep duration is a risk factor for carotid plaques, even among individuals with low-to-intermediate cardiovascular disease risk. This suggests that short sleep duration may be a potential target for early interventions to delay carotid atherosclerosis. REGISTRATION: URL: https://www.chictr.org.cn; Unique Identifier: ChiCTR1800017197.