REM and deep sleep, not just total sleep time, associated with disease risk
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Greater amounts of REM and deep sleep were associated with lower risks of dozens of diseases, and less than 5 hours of total sleep was associated with high disease risks, according to a new study published Sept. 17 in the journal PLOS Medicine by Shengzhi Sun of Capital Medical University, China, and colleagues.
Sleep quantity and quality are priorities of China's National Health Commission and a focus in China more broadly. The most recent 2026 China Sleep Health White Paper finds that while the average Chinese person surveyed sleeps 6.97 hours per night, 23% sleep less than 6 hours per night. The same report notes that only 26% of respondents reported a consistent sleep schedule and that sleep disturbances have increased over time. Understanding how sleep patterns are linked to disease risk is therefore highly relevant to Chinese citizens.
There remains limited understanding of how sleep stages and other real-world sleep patterns relate to health outcomes. In part, that is because self-reported sleep measures often show poor correlation with objective assessments, making it difficult to capture real-world sleep patterns.
Sleep stages and disease risk
In the new study, researchers analyzed data from 95,559 UK Biobank participants who wore wrist accelerometers for seven consecutive days and nights. The researchers used a deep-learning algorithm to calculate sleep stages (REM, deep and light sleep), total sleep duration, wakefulness after sleep onset and night-to-night sleep irregularity. Participants were followed for a median of 8.9 years, and health records were available to test associations with more than 1,000 disease outcomes.
Greater REM sleep (per interquartile range, 47.6 minutes) was associated with a lower risk of 83 diseases, including heart failure (hazard ratio 0.74), dementia (hazard ratio 0.54) and Parkinson's disease (hazard ratio 0.20), while greater deep sleep was linked to a lower risk of seven conditions, including type 2 diabetes and major depressive disorder. Greater sleep irregularity and wakefulness after sleep onset were each linked to a higher risk of several conditions, including anxiety and substance use disorders.
Total sleep duration showed a nonlinear relationship with disease risk for many conditions, with the lowest risk concentrated in a 6- to 8-hour window; people sleeping less than 5 hours faced the greatest clinical vulnerability, with an increased risk of 37 conditions. However, as an observational study, this research cannot establish that sleep patterns directly cause disease risk.
A six- to eight-hour window
"The findings provide additional evidence supporting the role of a 6- to 8-hour sleep duration as a health safeguard for middle-aged and older adults, likely attributable to more favorable distributions of sleep stages," the authors say. "Maintaining a sleep duration of 6 to 8 hours can effectively reduce the risk of multiple diseases, providing new insights for health promotion and preventive practice."
The authors add, "Phenome-wide association analysis identified 156 significant associations between sleep patterns and incident diseases after Bonferroni correction.
"Sleep duration exhibited significant nonlinear associations with 86 disease phenotypes, with the minimum-risk duration for the majority of these conditions (69 phenotypes) precisely concentrated within a 6- to 8-hour window."
Publication details
Accelerometer-derived real-world sleep stages and risk of incident diseases: A UK Biobank cohort study and phenome-wide association analysis, PLOS Medicine (2026). DOI: 10.1371/journal.pmed.1005213
Journal information: PLoS Medicine
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