Insomnia With Objective Short Sleep Duration Is Associated With Incident Cardiovascular and Cerebrovascular Disease: Evidence from the UK Biobank Data.
Pejovic S, Shang Y, et al. • Journal of the American Heart Association • 2026
Insomnia with objective short sleep duration, but not insomnia with normal sleep duration or short sleep duration alone, is significantly associated with incident cardiovascular and cerebrovascular disease in the UK Biobank.
Key Findings
Results
Insomnia with short sleep duration was significantly associated with incident cardiovascular disease (CVD).
Hazard ratio for insomnia with short sleep duration and incident CVD: HR=1.39, 95% CI=1.11–1.74
Sample size for incident CVD analysis: 6,959 participants with an average follow-up of 3.6 years
Short sleep duration was defined as nightly sleep below the sample median (<7.3 hours); insomnia was defined as self-reported difficulty falling or staying asleep 'Usually'
Multivariable Cox proportional hazards models were used, adjusting for major confounders
Results
Insomnia with normal sleep duration was not significantly associated with incident CVD.
HR=1.13, 95% CI=0.89–1.43 for insomnia with normal sleep duration versus normal sleepers with normal sleep duration
This association did not reach statistical significance
Reference group was normal sleepers with normal sleep duration
Results
Short sleep duration alone (without insomnia) was not significantly associated with incident CVD.
HR=1.03, 95% CI=0.86–1.23 for normal sleepers with short sleep duration versus normal sleepers with normal sleep duration
This association did not reach statistical significance
Participants were classified into 4 mutually exclusive sleep groups based on presence or absence of short sleep duration and insomnia symptoms
Results
Insomnia with short sleep duration was significantly associated with incident cerebrovascular disease (CBVD).
Hazard ratio for insomnia with short sleep duration and incident CBVD: HR=1.76, 95% CI=1.29–2.39
Sample size for incident CBVD analysis: 7,690 participants with an average follow-up of 3.4 years
The association was stronger for CBVD than for CVD (HR=1.76 vs. HR=1.39)
Results
Insomnia with normal sleep duration was not significantly associated with incident CBVD.
HR=1.04, 95% CI=0.72–1.49 for insomnia with normal sleep duration versus normal sleepers with normal sleep duration
This association did not reach statistical significance
Results
Short sleep duration alone (without insomnia) was not significantly associated with incident CBVD.
HR=1.13, 95% CI=0.87–1.48 for normal sleepers with short sleep duration versus normal sleepers with normal sleep duration
This association did not reach statistical significance
Methods
The study used accelerometer-measured habitual sleep duration to objectively assess the insomnia with short sleep duration phenotype in a large population cohort.
Sleep duration was measured via accelerometer, distinguishing this study from prior work relying solely on self-report
Insomnia was assessed via self-report of difficulty falling or staying asleep 'Usually' versus Never/Rarely/Sometimes
The sample median of accelerometer-measured sleep duration was 7.3 hours, used as the threshold for short sleep
The study used UK Biobank data, extending previous findings to a large prospective population sample
What This Means
This research suggests that people who have both insomnia symptoms (difficulty falling or staying asleep most nights) and objectively short sleep duration (less than about 7.3 hours per night, measured by a wrist-worn device) face a meaningfully higher risk of developing heart disease and stroke compared to people who sleep well. Specifically, this combination was associated with a 39% higher risk of cardiovascular disease and a 76% higher risk of cerebrovascular disease (such as stroke) over approximately 3–4 years of follow-up. Importantly, neither insomnia alone nor short sleep alone was significantly linked to these outcomes — it was specifically the combination of the two that stood out.
This research matters because it helps clarify why previous studies on sleep and heart health have sometimes produced mixed results. Simply sleeping fewer hours, or simply having trouble sleeping, may not be enough to substantially raise cardiovascular risk on its own. It is the pairing of both problems — struggling to sleep and actually getting less sleep as a result — that appears to be the more dangerous combination. The study is notable for using accelerometers (wrist-worn activity trackers) rather than self-reported sleep duration, which provides a more objective measure of how much people actually slept.
The findings reinforce the idea that the 'insomnia with short sleep duration' phenotype may represent a biologically distinct and more severe form of insomnia that warrants particular clinical attention. This research suggests that screening for both sleep complaints and actual sleep duration together, rather than separately, could help identify people at higher cardiovascular and cerebrovascular risk.
Pejovic S, Shang Y, Kong L, He F, Fernandez-Mendoza J, Lenker K, et al.. (2026). Insomnia With Objective Short Sleep Duration Is Associated With Incident Cardiovascular and Cerebrovascular Disease: Evidence from the UK Biobank Data.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.045898