The mix of sleep problems, not one habit, tracked with death risk

This is not another study of daytime naps. On 23 October 2026 the Journal of Global Health published an analysis of 257,509 UK Biobank participants, a UK cohort that enrolled people aged 37 to 73 between 2006 and 2010. Their median age at the start was 57, and about 54% were women. The team, from the Affiliated Hospital of Qingdao University and the Chinese PLA General Hospital with a co-author at Johns Hopkins Hospital, did not look at hours of sleep alone. They scored seven self-reported features, one point each: sleeping 7–8 hours, no frequent insomnia, waking refreshed, no snoring, no habitual daytime napping, no habitual dozing off during the day, and an intermediate chronotype, neither a strong morning nor a strong evening type. The score ran from 0 to 7.

Each extra point was associated with 5% lower all-cause mortality (hazard ratio 0.95, 95% CI 0.94–0.96), 4% lower cardiovascular mortality, 8% lower risk of coronary heart disease and 9% lower risk of heart failure. The models were adjusted for age, sex, ethnicity, deprivation, education, employment, body mass index, smoking, alcohol, physical activity and family history of heart disease and stroke. People who scored 0–2 had a 61% higher risk of heart failure and a 48% higher risk of coronary heart disease than those who scored 6–7. For death from any cause and for stroke, a score of 5 looked almost the same as 6–7; risk rose clearly only below 5.

Which combinations stood out?

A few days ago we wrote about long daytime naps and mortality in older adults. This paper treats napping as one piece of seven, and asks which problems tend to come together. A clustering algorithm sorted participants into five patterns and compared four of them with a group of 55,664 people who had few sleep problems of any kind.

• Mixed disturbance, 53,868 people: 73% slept less than 7 hours and 81% reported insomnia, along with other problems. All-cause mortality was 8% higher (HR 1.08, 1.04–1.12), coronary heart disease 27% higher and heart failure 28% higher.

• Non-restorative sleep, 22,146 people, all of whom said they usually did not wake refreshed. All-cause mortality was 16% higher (HR 1.16, 1.09–1.23), cardiovascular death 21% higher and heart failure 28% higher.

• Snoring-dominated, 85,046 people: coronary heart disease was 14% higher, yet all-cause mortality was 6% lower (HR 0.94, 0.90–0.97).

• Morning type, 40,785 people: largely no link with the outcomes, apart from a 7% higher risk of coronary heart disease.

The snoring result runs against intuition, and that is useful in itself: in observational data a single pattern can point in an unexpected direction, which is why none of these figures should be read as a cause on its own. The authors' own reading is that risk followed the accumulation of several problems rather than any one of them.

What did the blood samples add?

In 26,984 participants, 2,911 plasma proteins had been measured at the start. After strict correction for multiple testing, 188 were linked to the sleep score, mostly proteins linked in enrichment analyses to inflammatory, immune and chemotactic pathways. In exploratory analyses, 34 proteins showed a statistical mediation signal. The strongest for mortality was hepatocyte growth factor, HGF, with the largest exploratory estimated mediation proportion for overall mortality: 49%, but the 95% confidence interval stretched from 16% to 73%. The authors call these results hypothesis-generating. A protein-only model had lower discrimination than the demographic and lifestyle model, which included age, body mass index, smoking and physical activity.

How far does this evidence go?

This was a prospective observational analysis, not a randomised trial. It linked a baseline questionnaire to health and death records; the paper does not state a median follow-up time in its main text. Nobody was asked to change how they slept, so it cannot show that improving the score lowers anyone's risk. The authors state that residual confounding and reverse causation cannot be excluded: poor sleep can be an early sign of an illness that has not yet been diagnosed. Sleep was reported once, by questionnaire, at the start, and was never measured with a device. Of 501,936 UK Biobank participants, 244,427 were left out because of missing sleep or covariate data. The cohort is about 95% white and, as the authors note, healthier and better off than the general British population. The authors gave all seven features equal weight as a simple, non-outcome-driven way to construct the score. The work was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Shandong Province, and the authors disclose no relevant interests.

What changes for someone without a diagnosis?

In 2022 the American Heart Association added sleep health to its Life's Essential 8 measures of cardiovascular health. This study's score included features beyond duration. It cannot determine whether any one person who sleeps seven hours belongs to a particular higher-risk pattern.

The practical reading is to look at the whole set rather than one number on a tracker. If several of these features come together, for example insomnia most nights, waking unrefreshed, or loud snoring with dozing off in the day, discuss it with your doctor.

This article is for information only and does not replace a consultation with a doctor.

Sources

• Wei Z, Xiao Q, Wang S, et al. Multidimensional sleep health: risk of cardiovascular disease and mortality, and mediation by plasma proteins. Journal of Global Health, 2026;16:04349. PMID 42924631 · DOI 10.7189/jogh.16.04349 · full text, PMC13693298

• Lloyd-Jones DM, et al. Life's Essential 8: updating and enhancing the American Heart Association's construct of cardiovascular health. Circulation, 2022. PMID 35766027