Sleep and Overnight Cardiovascular Outcomes During the First Week on a Temperature-Controlled Sleep Surface: Stratified by Baseline Performance
- 1Dartmouth College
Abstract
ObjectivesTemperature-controlled sleep surfaces are used nightly by hundreds of thousands of people, yet cohort analyses show improved perceived sleep quality without matching objective change. Cohort means may mask benefits concentrated in those with the greatest baseline deficit. We asked whether objective changes in sleep and overnight cardiovascular function differ by baseline sleep performance.
MethodsIn this exploratory, retrospective, open-label study of 171 adults, wearable-derived sleep and overnight cardiovascular endpoints were compared between seven baseline nights and the first seven nights on a temperature-controlled sleep surface (Orion Sleep System). Participants were stratified by baseline performance separately for each endpoint.
ResultsAt the cohort level, total sleep time rose 7.3 minutes (p = 0.01, not significant), average heart rate fell 1.79 bpm (95% CI -2.25 to -1.34) and minimum heart rate 1.75 bpm (95% CI -2.18 to -1.33; both p < 0.001), and HRV rose 3.25 ms (95% CI 1.33 to 5.17, p = 0.001). Effects were baseline-dependent. In the most-deficient quartile for each endpoint, total sleep time rose 33.5 minutes (9.6%; 95% CI 21.5 to 45.5), REM 13.6 minutes (19.4%; 95% CI 8.6 to 18.6), deep sleep 4.4 minutes (13.1%; 95% CI 2.0 to 6.9), and HRV 4.7 ms (15.6%; 95% CI 2.2 to 7.2); wake after sleep onset fell 16.3 minutes (26.0%; 95% CI -23.0 to -9.6) in the most fragmented quartile (all p < 0.001).
ConclusionObjective gains were largest where the baseline deficit was greatest.
What Was KnownUsers of temperature-controlled sleep surfaces report clear improvements in sleep quality, but objective measurement has not confirmed them. Existing evaluations analyze participants as one group, even though sleep deficiency takes distinct forms: short sleep, fragmented sleep, and reduced deep or REM sleep. No study has asked whether these devices affect people differently depending on which deficit they carry.
What This Study AddsUse of a temperature-controlled sleep surface is associated with measurable overnight cardiovascular change: heart rate fell across the cohort and in nearly every baseline quartile, and heart rate variability rose across the cohort and in those with the lowest baseline. Objective sleep benefits are not absent from these devices but are concentrated by deficit, with gains in deep sleep, REM sleep, total sleep time, and sleep continuity appearing in the participants who lacked each specific measure at baseline, while remaining near zero cohort-wide. These findings show that the long-reported gap between subjective and objective results reflects, at least in part, the averaging of heterogeneous sleepers rather than the absence of an effect.
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BibTeX
@misc{tucker2026sleep,
title = {{Sleep and Overnight Cardiovascular Outcomes During the First Week on a Temperature-Controlled Sleep Surface: Stratified by Baseline Performance}},
author = {L. Tucker and J. Zwiebel and E. Costantino},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.31.26361834},
url = {https://www.medrxiv.org/content/10.64898/2026.08.31.26361834v1},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - Sleep and Overnight Cardiovascular Outcomes During the First Week on a Temperature-Controlled Sleep Surface: Stratified by Baseline Performance
AU - L. Tucker
AU - J. Zwiebel
AU - E. Costantino
PY - 2026
DA - 2026/08/31
PB - medRxiv
DO - 10.64898/2026.08.31.26361834
UR - https://www.medrxiv.org/content/10.64898/2026.08.31.26361834v1
AB - ObjectivesTemperature-controlled sleep surfaces are used nightly by hundreds of thousands of people, yet cohort analyses show improved perceived sleep quality without matching objective change. Cohort means may mask benefits concentrated in those with the greatest baseline deficit. We asked whether objective changes in sleep and overnight cardiovascular function differ by baseline sleep performance. MethodsIn this exploratory, retrospective, open-label study of 171 adults, wearable-derived sleep and overnight cardiovascular endpoints were compared between seven baseline nights and the first seven nights on a temperature-controlled sleep surface (Orion Sleep System). Participants were stratified by baseline performance separately for each endpoint. ResultsAt the cohort level, total sleep time rose 7.3 minutes (p = 0.01, not significant), average heart rate fell 1.79 bpm (95% CI -2.25 to -1.34) and minimum heart rate 1.75 bpm (95% CI -2.18 to -1.33; both p < 0.001), and HRV rose 3.25 ms (95% CI 1.33 to 5.17, p = 0.001). Effects were baseline-dependent. In the most-deficient quartile for each endpoint, total sleep time rose 33.5 minutes (9.6%; 95% CI 21.5 to 45.5), REM 13.6 minutes (19.4%; 95% CI 8.6 to 18.6), deep sleep 4.4 minutes (13.1%; 95% CI 2.0 to 6.9), and HRV 4.7 ms (15.6%; 95% CI 2.2 to 7.2); wake after sleep onset fell 16.3 minutes (26.0%; 95% CI -23.0 to -9.6) in the most fragmented quartile (all p < 0.001). ConclusionObjective gains were largest where the baseline deficit was greatest. What Was KnownUsers of temperature-controlled sleep surfaces report clear improvements in sleep quality, but objective measurement has not confirmed them. Existing evaluations analyze participants as one group, even though sleep deficiency takes distinct forms: short sleep, fragmented sleep, and reduced deep or REM sleep. No study has asked whether these devices affect people differently depending on which deficit they carry. What This Study AddsUse of a temperature-controlled sleep surface is associated with measurable overnight cardiovascular change: heart rate fell across the cohort and in nearly every baseline quartile, and heart rate variability rose across the cohort and in those with the lowest baseline. Objective sleep benefits are not absent from these devices but are concentrated by deficit, with gains in deep sleep, REM sleep, total sleep time, and sleep continuity appearing in the participants who lacked each specific measure at baseline, while remaining near zero cohort-wide. These findings show that the long-reported gap between subjective and objective results reflects, at least in part, the averaging of heterogeneous sleepers rather than the absence of an effect.
ER -