Sleep and Cardiometabolic Disease: A Wearable-Electronic Health Record Study in the US All of Us Research Program
Authors' conclusion
Night-to-night irregularity in sleep duration and timing was associated with the CVD composite, heart failure, hypertension, and type 2 diabetes; mean duration was not associated with the CVD composite. More wearable-estimated sleep cycles were associated with lower atrial arrhythmia risk beyond conventional sleep metrics, a novel finding requiring confirmation.
Study context
- Population
- US adults in the All of Us Research Program with linked Fitbit and electronic health records (2009–2023)n = 10,362, median age, 53 years, 70% female, Exploratory analyses of wearable-estimated sleep cycles (1,017,812 sleep-stage nights) 7,199 participants
- Outcome
- Prespecified endpoints, including a CVD composite (myocardial infarction, heart failure, cardiomyopathy, or ischemic stroke), heart failure, hypertension, and type 2 diabetes
- Follow-up
- Median , 3.7 years
Methodological detailslinked Fitbit and electronic health records, 180-day baseline (≥90 valid nights), 180-day washout to limit reverse causation, Cox models adjusted for demographic, socioeconomic, lifestyle, and comorbidity factors
- Linked Fitbit and electronic health records
- 180-day baseline (≥90 valid nights)
- 180-day washout to limit reverse causation
- Cox models adjusted for demographic, socioeconomic, lifestyle, and comorbidity factors
Main finding
As reported in the abstract
Hazard ratio (95% CI)
Each 1-SD (29-minute) higher night-to-night variability in sleep durationCVD composite
1.24(1.09–1.41)
Higher variability in bedtimeCVD composite
1.23(1.10–1.37)
Higher variability in waketimeCVD composite
1.20(1.09–1.32)
Higher variability in midpointCVD composite
1.21(1.09–1.35)
Mean sleep durationCVD composite; not associated
0.96(0.85–1.08)
Variability in sleep durationheart failure
1.32(1.13–1.55)
Variability in sleep durationhypertension
1.16(1.08–1.25)
Variability in sleep durationtype 2 diabetes
1.20(1.07–1.35)
Each 1-SD, as printed
- Participants who developed the CVD composite
- 230
Observational data: associations, not effects.
Further findings
Atrial arrhythmia, by wearable-estimated sleep cycles (exploratory)
| Hazard ratio (95% CI) | ||
|---|---|---|
| More sleep cyclesLower atrial arrhythmia risk | 0.72 (0.58–0.89) | |
| More sleep cyclesIndependent of sleep duration, regularity, and timing | 0.58 (0.44–0.77) | |
| 0.512Hazard ratio (log scale) |
Original publication
Sleep and Cardiometabolic Disease: A Wearable-Electronic Health Record Study in the US All of Us Research Program. Circ Popul Health Outcomes. Published 2 November 2026. doi:10.
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