Sleep Patterns and Frailty: Joint Impact on Major Adverse Cardiac Events

Sleep patterns and frailty phenotypes are becoming increasingly important metrics for assessing cardiovascular disease (CVD) risk; however, research investigating their synergistic effects on major adverse cardiac events (MACE) remains scarce.

This study aimed to investigate how sleep patterns and frailty phenotypes jointly influence MACE.

A total of 380,105 participants from the UK Biobank were included for the analysis. Frailty phenotypes and sleep patterns were defined based on the frailty scores and sleep scores, respectively. Cox proportional hazards models were used to evaluate the associations between combinations of frailty phenotypes and sleep patterns and MACE, including nonfatal myocardial infarction, stroke, or CVD-related death.

After a median follow-up period of 12.94 years (Q1-Q3: 12.23-13.64 years), 18,074 participants experienced incident MACE, with an incidence rate of 3.73 per 1,000 person-years (95% CI: 3.68-3.79). Compared with participants with frailty and poor sleep patterns, nonfrail participants with healthy sleep patterns have the lowest risk of MACE (HR: 0.560; 95% CI: 0.445-0.704; P < 0.001) and other secondary outcomes. Maintaining a healthy sleep pattern was associated with a reduced risk of MACE among the pre-frail participants (HR: 0.815; 95% CI: 0.732-0.853; P < 0.001). These findings remained robust across a series of sensitivity analyses and various subgroups.

Maintaining a healthy sleep pattern and a nonfrail status were jointly associated with a significantly decreased risk of MACE. These results emphasize the importance of promoting sleep health to mitigate CVD risk in prefrail participants.