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Abstract
Objective Sleep deprivation has been associated with risk of autoimmune diseases. We investigated whether it was associated with risk of developing SLE using the Nurses’ Health Study (NHS) (1986-2016) and NHSII (1989-2017) cohorts.
Methods Average sleep duration in a 24-hour period was reported in the NHS (1986-2014) and in NHSII in (1989-2009). Lifestyle, exposure and medical information was collected on biennial questionnaires. Adjusted Cox regression analyses modeled associations between cumulative average sleep duration (categorical variables) and incident SLE (figure 1). Interactions between sleep duration and shiftwork, bodily pain (Short-Form 36 questionnaire) and depression were examined.
Results We included 186,072 women with 187 incident SLE cases during 4,246,094 person- years of follow-up (table 1). Chronic low sleep duration (≤5 hours/night vs reference >7-8 hours) was associated with increased SLE risk (adjusted HR 2.47, 95%CI:1.29-4.75) (table 2), which persisted after the analysis was lagged (4 years, adjusted HR 3.14, 95%CI1.57-6.29) and adjustment for shiftwork, bodily pain, and depression (adjusted HR 2.13, 95%CI:1.11-4.10) (table 3). We detected additive interactions between low sleep duration and high bodily pain (SF-36 <75) with an attributable proportion (AP) of 64% (95%CI:40%-87%) and HR for SLE of
2.97 (95%CI:1.86-4.75) for those with both risk factors compared to those with neither. Similarly, there was an interaction between low sleep duration and depression with an AP of 68% (95%CI:49%-88%) and an HR for SLE of 2.82 (95%CI:1.64-4.85).
Conclusion Chronic low sleep duration was associated with higher SLE risk, with stronger effects among those with bodily pain and depression, highlighting the potential role of adequate sleep in disease prevention.
Age-standardized baseline characteristics in the Nurses’ Health Study (NHS) in 1986 and the NHSII in 1989 by sleep duration (n=186,072)
Hazard ratios (95% confidence intervals) for risk of incident SLE in Nurses’ Health Study NHS (1986-2016) and NHSII (1989-2017) by sleep duration (n=186,072)
Hazard ratios (95% confidence intervals) for risk of incident SLE in Nurses’ Health Study and NHSII by sleep duration (n=180,359) with lag (at least 4 years between sleep measurement and SLE risk window)
Study schematic illustrating the prospective cohort design for NHSII. The primary exposure was cumulative average sleep duration and the outcome was SLE onset at least 2 years after last sleep duration assessment. The primary analysis was conducted so that there was always at least 2 years between the last sleep duration exposure assessment and the outcome date of SLE diagnosis that occurred in the SLE risk window. The analysis for NHS was similar except for the years of sleep duration assessment (1986-2014). The sensitivity analysis was lagged by another follow-up cycle of two years so that there was at least 4 years between the last sleep duration exposure assessment and the outcomes dates of SLE diagnosis. NHS, Nurses’ Health Study, NHSII, Nurses’ Health Study II, SD, sleep duration, SLE, systemic lupus erythematosus.
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