Healthy Sleep Patterns Linked to 26% Lower Pneumonia Risk in Major UK Cohort Study

A study published in *Open Forum Infectious Diseases* on June 20, 2024, analyzed data from more than 360,000 adults in the United Kingdom and found that healthy sleep patterns were linked to a 26% lower risk of developing pneumonia over a median follow-up of 13 years. According to the researchers, a higher sleep quality score—based on factors such as sleep duration, insomnia symptoms, and daytime sleepiness—was associated with progressively reduced pneumonia risk.

The study, conducted by Chinese researchers using data from the UK Biobank, evaluated 361,589 adults with a mean age of 56.1 years, nearly half of whom were male, over a median follow-up period of 13.2 years. During this time, 20,116 participants developed pneumonia, representing 5.6% of the cohort, according to the published findings in *Open Forum Infectious Diseases* on June 20, 2024.

Participants in the healthiest sleep category experienced a 26% lower risk of pneumonia compared to those with the poorest sleep scores (adjusted hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.69–0.80), according to a study published in *Open Forum Infectious Diseases*.

Researchers assessed sleep patterns using a composite healthy sleep score ranging from 0 to 5, which incorporated five factors: sleep duration, chronotype (morning versus evening preference), symptoms of insomnia, snoring, and daytime sleepiness. Participants were categorized as having poor (scores 0–1), intermediate (2–3), or healthy (4–5) sleep profiles. The analysis showed a graded inverse association between the sleep score and pneumonia risk, with those in the healthiest sleep category experiencing a 26% lower risk compared to those with the poorest sleep scores (adjusted hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.69–0.80), according to the study authors.

Among the individual sleep characteristics, the absence of frequent daytime sleepiness was linked to the strongest reduction in pneumonia risk (HR 0.79; 95% CI, 0.74–0.85), followed by the absence of insomnia symptoms (HR 0.88; 95% CI, 0.86–0.91). Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals, adjusting for potential confounders, the researchers reported.

The study also identified variations in the strength of these associations by demographic factors. The protective effect of healthy sleep patterns was more pronounced in participants younger than 60 years and among females, with statistically significant interactions (P for interaction <0.001) noted by the investigators. These findings suggest that age and sex may modify the relationship between sleep quality and pneumonia risk, according to the authors.

The researchers noted that intermediate sleep scores were associated with moderately lower pneumonia risk compared to poor sleep profiles, indicating a dose-response relationship. This graded pattern supports the utility of a multidimensional sleep assessment rather than relying on single sleep factors, the study said.

This research aligns with previous studies linking poor sleep to increased susceptibility to infections. For example, the Nurses’ Health Study II, which followed 56,953 women aged 37 to 57 years, found that both short sleep duration (five hours or less) and long sleep duration (nine hours or more) were associated with increased risk of pneumonia, with relative risks of 1.39 (95% CI, 1.06–1.82) and 1.38 (95% CI, 1.04–1.84), respectively. Additionally, perceived inadequate sleep was linked to a 50% increased risk of pneumonia after adjustment for confounders, according to prior published data.

Further supporting evidence from UK Biobank analyses showed that poor sleep regularity, as measured by actigraphy in 88,461 adults over a median of 6.8 years, was associated with elevated risks of several diseases, including respiratory infections. Another UK Biobank study reported that healthy sleep profiles were linked to lower risk of infection-related hospitalizations, particularly among individuals younger than 65 years.

The authors of the current study emphasized the importance of comprehensive sleep quality evaluation in understanding respiratory infection susceptibility. They called for further research to elucidate the mechanisms linking sleep patterns to pneumonia risk and to explore potential preventive strategies.

The study was published as an advance article with the digital object identifier 10.1093/ofid/ofag233. Full details and the accepted manuscript are available through the Center for Infectious Disease Research & Policy at the University of Minnesota.