Multidimensional Healthy Sleep Characteristics and Pneumonia Risk: A Large-scale, Population-based Prospective Cohort Study.

Background: Sleep disturbances are hypothesized to increase susceptibility to pneumonia; however, most evidence arises from studies examining isolated sleep characteristics. The relationship between a multidimensional healthy sleep score and pneumonia risk remains unclear. Herein, the association between a multidimensional healthy sleep score and risk of pneumonia was evaluated. Methods: This prospective analysis encompassed 361 589 participants from the United Kingdom (UK) Biobank (mean age: 56.1 years; 46.1% male). Five sleep characteristics-sleep duration, chronotype, insomnia symptoms, snoring, and daytime sleepiness-were used to construct a healthy sleep score (range: 0-5). Participants were categorized into poor (0-1), intermediate (2-3), and healthy (4-5) sleep score categories. Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for pneumonia incidence. Results: Over a median follow-up period of 13.2 years, there were 20 116 new cases of pneumonia. A healthy sleep score was associated with a 26% lower risk of pneumonia (adjusted HR: 0.74, 95% CI: 0.69-0.80). This association exhibited a graded pattern, with higher sleep scores associated with progressively lower risk. The absence of frequent daytime sleepiness (HR: 0.79, 95% CI: 0.74-0.85) and insomnia symptoms (HR: 0.88, 95% CI: 0.86-0.91) exhibited the strongest component-specific inverse associations. Associations were stronger among participants younger than 60 years and females ( Conclusions: A multidimensional healthy sleep score is associated with a lower risk of pneumonia. These findings support the potential relevance of multidimensional sleep assessment to respiratory infection susceptibility and warrant further investigation.