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Background <p>Sleep irregularity, defined by night-to-night variability in sleep duration and timing, has emerged as an important dimension of sleep health beyond average sleep duration. Evidence suggests that irregular sleep patterns may be associated with cardiovascular risk, but no systematic synthesis has comprehensively examined their relationship with major adverse cardiovascular events (MACE).</p> Objectives <p>To systematically review the association between sleep irregularity and incident major cardiovascular events in adults, and to quantitatively synthesise evidence from studies using objectively measured sleep irregularity where appropriate.</p> Methods <p>We conducted a systematic review in accordance with PRISMA 2020. Prospective cohort studies published from 2010 onwards were identified through PubMed, Scopus, and Web of Science. Risk of bias was assessed using the Newcastle–Ottawa Scale. Narrative synthesis was undertaken for all eligible studies, and a random-effects meta-analysis was performed for studies reporting objectively measured sleep irregularity and comparable cardiovascular outcomes.</p> Results <p>Fifteen studies were included in the qualitative synthesis. Three studies comprising over 150,000 participants were included in the meta-analysis. Greater objectively measured sleep irregularity was associated with a higher risk of incident cardiovascular events (pooled hazard ratio 1.25, 95% CI 1.12–1.39; I² = 61%). Narrative synthesis suggested that insomnia symptoms and circadian misalignment were also associated with adverse cardiovascular or related risk outcomes. Studies of obstructive sleep apnoea were retained only as contextual evidence and were not treated as the primary sleep-irregularity exposure.</p> Conclusions <p>Objectively measured sleep irregularity was associated with a higher risk of major cardiovascular events in adults. Complementary narrative evidence suggests that other disturbed or misaligned sleep patterns may also be linked to adverse cardiovascular outcomes. As all included evidence was observational, these findings should be interpreted cautiously.</p>

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Sleep Irregularity and Major Adverse Cardiovascular Events in Adults: A Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2026年6月3日

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  • Arqam Mibsaam Ahmad,
  • Faaiza Kazi,
  • Shifan Arif,
  • Gauri Krishnaswamy

摘要

Background

Sleep irregularity, defined by night-to-night variability in sleep duration and timing, has emerged as an important dimension of sleep health beyond average sleep duration. Evidence suggests that irregular sleep patterns may be associated with cardiovascular risk, but no systematic synthesis has comprehensively examined their relationship with major adverse cardiovascular events (MACE).

Objectives

To systematically review the association between sleep irregularity and incident major cardiovascular events in adults, and to quantitatively synthesise evidence from studies using objectively measured sleep irregularity where appropriate.

Methods

We conducted a systematic review in accordance with PRISMA 2020. Prospective cohort studies published from 2010 onwards were identified through PubMed, Scopus, and Web of Science. Risk of bias was assessed using the Newcastle–Ottawa Scale. Narrative synthesis was undertaken for all eligible studies, and a random-effects meta-analysis was performed for studies reporting objectively measured sleep irregularity and comparable cardiovascular outcomes.

Results

Fifteen studies were included in the qualitative synthesis. Three studies comprising over 150,000 participants were included in the meta-analysis. Greater objectively measured sleep irregularity was associated with a higher risk of incident cardiovascular events (pooled hazard ratio 1.25, 95% CI 1.12–1.39; I² = 61%). Narrative synthesis suggested that insomnia symptoms and circadian misalignment were also associated with adverse cardiovascular or related risk outcomes. Studies of obstructive sleep apnoea were retained only as contextual evidence and were not treated as the primary sleep-irregularity exposure.

Conclusions

Objectively measured sleep irregularity was associated with a higher risk of major cardiovascular events in adults. Complementary narrative evidence suggests that other disturbed or misaligned sleep patterns may also be linked to adverse cardiovascular outcomes. As all included evidence was observational, these findings should be interpreted cautiously.