Device-measured weekend catch-up sleep, mortality, and cardiovascular disease incidence in adults

Attempting to recover a sleep debt by extending sleep over the weekend is a common compensatory behavior in the population and is recommended by sleep-focused organizations. However, the purported benefits of catch-up sleep are based on a limited number of cross-sectional studies that relied on self-reported sleep. The objective of this study was to examine the association between accelerometer-derived weekend catch-up sleep and mortality and incident cardiovascular disease (CVD) in adults.

A prospective cohort study of UK adults who wore wrist-attached accelerometers was conducted. Weekend catch-up sleep was defined as a longer average sleep duration on weekends compared to weekdays. Participants were categorized into four groups: no weekend catch-up sleep (reference); > 0 to < 1 hour; ≥ 1 to < 2 hours; and ≥ 2 hours difference. Associations between weekend catch-up sleep and mortality and incident CVD were assessed using Cox proportional hazards regression, adjusted for potential confounders.

A total of 73 513 participants (sample for mortality) and 70 518 participants (sample for CVD incidence) were included, with an average (SD) follow-up period of 8.0 (0.9) years. In multivariable-adjusted models, weekend catch-up sleep was not associated with mortality (≥ 2 hours group: hazard ratio [HR], 1.17 [95% CI: 0.97 to 1.41]) or incident CVD (HR, 1.05 [95% CI, 0.94 to 1.18]). Dose-response analyses treating catch-up sleep as a continuous measure or analyses restricted to adults sleeping less than 6 hours on weekdays at baseline were in agreement with these findings.

Weekend catch-up sleep was not associated with mortality or CVD incidence. These findings do not align with previous evidence and recommendations by sleep authorities suggesting that extending sleep over the weekend may offer protective health benefits.