Healthy Sleep Patterns, Mortality, and Life Expectancy in Adults With and Without Atherosclerotic Cardiovascular Disease

Background: Healthy sleep is a multidimensional behavior critical for chronic disease prevention, yet its long-term impact on mortality and life expectancy—particularly among individuals with atherosclerotic cardiovascular disease (ASCVD)—remains unclear. Objectives: The purpose of this study was to evaluate the associations between sleep patterns and mortality and life expectancy among adults with and without ASCVD. Methods: We analyzed data from 148,622 U.S. adults (mean age 48.4 years, 50.6% female) in the National Health Interview Survey (2013-2018), with mortality follow-up through December 31, 2019. A composite sleep score based on 5 self-reported behaviors was constructed to categorize participants as having poor, intermediate, or healthy sleep patterns. Multivariable Cox models estimated hazard ratios (HRs) for all-cause mortality, and life expectancy was calculated using a flexible parametric survival model. Results: Over a median 4.3 years of follow-up (IQR: 2.8-5.5), 5,643 deaths occurred. Compared with those with poor sleep patterns, participants with healthy sleep patterns had significantly lower all-cause mortality, both among individuals with ASCVD (HR 0.74, 95% CI: 0.62-0.89) and those without ASCVD (HR 0.82, 95% CI: 0.70-0.95; P for additive interaction = 0.03). At age 45, a healthy sleep pattern was associated with an estimated life expectancy gain of 3.0 years (95% CI: 1.1-4.8) among individuals with ASCVD, and 1.5 years (95% CI: 0.3-2.6) among those without. Conclusions: Multidimensional healthy sleep patterns are associated with lower mortality and increased life expectancy in adults, with greater absolute benefits observed in individuals with ASCVD.