Sleep Quality and Outcomes in Preclinical Heart Failure: A Prospective UK Biobank Cohort Study

Prevention is crucial in reducing heart failure (HF) morbidity and mortality. The American Heart Association guideline emphasizes the progression from preclinical to clinical HF, yet the association between sleep and outcomes in preclinical HF remains unexplored. Our objective was to examine sleep quality in a large cohort of preclinical HF, and assess its association with clinical HF and mortality risk.

Using UK Biobank data from 2006-2010, we identified individuals with preclinical HF (Stage A/B). We examined self-reported sleep characteristics (duration, chronotype, insomnia, snoring, daytime sleepiness) individually and combined into a sleep quality score. Participants were followed until 2021 for clinical HF (Stage C/D) or death. Cox proportional hazard models assessed the relationship between sleep quality and clinical HF or mortality, accounting for competing risks. Interaction effects among sleep, sex, and deprivation were explored.

Among 311,446 preclinical HF participants (mean age 57.5 years, 49% men), sleep quality was categorized as healthy (35%), intermediate (60%), and poor (5%). Over a median 12-year follow-up, 10,780 clinical HF events and 24,996 deaths occurred. Poor sleep quality was associated with a higher risk of clinical HF (hazard ratio 2.03; 95% confidence interval, 1.79-2.31 in women; hazard ratio 1.55; 95% confidence interval, 1.41-1.71 in men). Deprivation was associated with higher HF risk across all sleep categories (P < .01).

Low-quality sleep was prevalent and associated with a higher risk of clinical HF and death, especially in women. Deprivation was linked to worse outcomes in both sexes. These findings highlight an opportunity to improve preclinical HF outcomes by addressing sleep quality.