Accelerometer-derived real-world sleep stages and risk of incident diseases: A UK Biobank cohort study and phenome-wide association analysis
4 affiliations
- 1School of Public Health, Peking University, Beijing, China
- 2School of Public Health, Capital Medical University, Beijing, China
- 3Beijing Key Laboratory of Environment and Aging, Capital Medical University, Beijing, China
- 4Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission, Beijing, China
Abstract
Background: Previous studies utilizing self-reported data or polysomnography have found that poor sleep quality is associated with increased risk of morbidity and mortality. However, the association between real-world sleep patterns, including sleep stages, duration, and fragmentation, measured objectively with physiological data and the risk of incident disease among middle-aged and older adults has not yet been systematically evaluated. Methods and findings: In this cohort study, we analyzed wrist-worn accelerometer data from 95,559 Biobank participants and derived key metrics of real-world sleep patterns: rapid eye movement [REM], N1, N2, and N3; total sleep duration; sleep irregularity; and wakefulness after sleep onset using the SleepNet algorithm. Participants were followed up from the date of accelerometer wear until the first occurrence of disease, death, or April 1, 2024 with median follow-up length of 8.9 years. Phenome-wide association analysis and restricted cubic spline (RCS) analyses were performed using Cox proportional hazard regression, with adjustment for demographic characteristics, lifestyle factors, and environmental exposures, to map an atlas of associations between real-world sleep patterns and the incidence of 1,049 health outcomes. We found that variations in sleep patterns were associated with 156 incidences of diseases. Specifically, higher amount of REM sleep and deep sleep were associated with lower risks of 83 and 7 diseases, respectively, while greater sleep irregularity and increased WASO were linked to elevated risks of 3 and 6 diseases, respectively. RCS analyses revealed significant non-linear relationships between sleep duration and 86 disease phenotypes (P for nonlinear <0.05), with the minimum-risk hours for 69 phenotypes predominantly concentrated within the 6–8 hours window. In the category-specific analysis, individuals with extreme short sleep (<5 hours) exhibited the most widespread clinical vulnerabilities, accounting for 37 of the 41 identified significant adverse associations compared to the 6–8 hours reference group. The main limitation of this study was its observational design, which remains susceptible to residual confounding and precludes causal inference. Conclusion: In summary, this study characterizes real-world sleep patterns and their links to disease risk across multiple systems, highlighting the differential contributions of sleep stages and sleep duration. The findings underscore that maintaining 6–8 hours of sleep is associated with a more favorable sleep architecture and lower disease risk, offering insights for prevention and health promotion. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In this observational study, Shengzhi Sun and colleagues examine accelerometer-derived sleep patterns in 95,559 participants from the UK Biobank and find that differences in sleep stages, duration, regularity, and fragmentation are associated with the future incidence of a wide range of diseases. The analysis suggests that sleep characterized by higher proportions of REM and deep sleep, along with a typical duration of 6–8 hours, is generally linked to a more favorable health profile, but the observational design does not support causal conclusions.
Related
- Association of edentulism with incident non-communicable diseases among middle-aged and older adults: a population-based cohort study.
- Wrist-worn accelerometer-derived activity fragmentation and cause-specific mortality in US adults: a population-based prospective cohort study
- Physical activity and metabolic syndrome in relation to incident dementia in UK biobank.
- Circulating osteocalcin and incident dementia in the UK Biobank: a prospective cohort and exploratory multi-omics analysis
- Domestic Water Mineral Composition and Incident Glaucoma Risk: A Prospective Cohort Study From the UK Biobank
BibTeX
@article{luo2026accelerometerderived,
title = {{Accelerometer-derived real-world sleep stages and risk of incident diseases: A UK Biobank cohort study and phenome-wide association analysis}},
author = {Jingsong Luo and Ruiyi Liu and Jie Yin and Wangnan Cao and Shengzhi Sun and Rui Chen},
journal = {PLOS Medicine},
year = {2026},
month = sep,
doi = {10.1371/journal.pmed.1005213},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005213},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Accelerometer-derived real-world sleep stages and risk of incident diseases: A UK Biobank cohort study and phenome-wide association analysis
AU - Jingsong Luo
AU - Ruiyi Liu
AU - Jie Yin
AU - Wangnan Cao
AU - Shengzhi Sun
AU - Rui Chen
PY - 2026
DA - 2026/09/17
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1005213
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005213
AB - Background: Previous studies utilizing self-reported data or polysomnography have found that poor sleep quality is associated with increased risk of morbidity and mortality. However, the association between real-world sleep patterns, including sleep stages, duration, and fragmentation, measured objectively with physiological data and the risk of incident disease among middle-aged and older adults has not yet been systematically evaluated. Methods and findings: In this cohort study, we analyzed wrist-worn accelerometer data from 95,559 Biobank participants and derived key metrics of real-world sleep patterns: rapid eye movement [REM], N1, N2, and N3; total sleep duration; sleep irregularity; and wakefulness after sleep onset using the SleepNet algorithm. Participants were followed up from the date of accelerometer wear until the first occurrence of disease, death, or April 1, 2024 with median follow-up length of 8.9 years. Phenome-wide association analysis and restricted cubic spline (RCS) analyses were performed using Cox proportional hazard regression, with adjustment for demographic characteristics, lifestyle factors, and environmental exposures, to map an atlas of associations between real-world sleep patterns and the incidence of 1,049 health outcomes. We found that variations in sleep patterns were associated with 156 incidences of diseases. Specifically, higher amount of REM sleep and deep sleep were associated with lower risks of 83 and 7 diseases, respectively, while greater sleep irregularity and increased WASO were linked to elevated risks of 3 and 6 diseases, respectively. RCS analyses revealed significant non-linear relationships between sleep duration and 86 disease phenotypes (P for nonlinear <0.05), with the minimum-risk hours for 69 phenotypes predominantly concentrated within the 6–8 hours window. In the category-specific analysis, individuals with extreme short sleep (<5 hours) exhibited the most widespread clinical vulnerabilities, accounting for 37 of the 41 identified significant adverse associations compared to the 6–8 hours reference group. The main limitation of this study was its observational design, which remains susceptible to residual confounding and precludes causal inference. Conclusion: In summary, this study characterizes real-world sleep patterns and their links to disease risk across multiple systems, highlighting the differential contributions of sleep stages and sleep duration. The findings underscore that maintaining 6–8 hours of sleep is associated with a more favorable sleep architecture and lower disease risk, offering insights for prevention and health promotion. Why was this study done?: What did the researchers do and find?: What do these findings mean?: In this observational study, Shengzhi Sun and colleagues examine accelerometer-derived sleep patterns in 95,559 participants from the UK Biobank and find that differences in sleep stages, duration, regularity, and fragmentation are associated with the future incidence of a wide range of diseases. The analysis suggests that sleep characterized by higher proportions of REM and deep sleep, along with a typical duration of 6–8 hours, is generally linked to a more favorable health profile, but the observational design does not support causal conclusions.
SN - 1549-1676
ER -