Improved sleep efficiency is associated with reduced cardio-metabolic risk: Findings from the MODERN trial

Stephanie R. Yiallourou, Melinda J. Carrington

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11 Citations (Scopus)


Poor sleep increases cardio-metabolic risk, but limited information on the impact of sleep for the improvement of cardio-metabolic health exists. This analysis examined the impact of sleep on a health and lifestyle modification programme to reduce cardio-metabolic disease risk factors. Secondary analysis of the MODERN randomised controlled trial to reduce cardio-metabolic risk was undertaken at baseline and 24-month follow-up. Participants aged 40–70 years (n = 121) with three or more cardio-metabolic risk factors were randomised to a health and lifestyle modification intervention (n = 59) or usual care (n = 62), and underwent 7 day/night actigraphy to assess total sleep time, sleep efficiency (%), number of awakenings/night and physical activity levels. Blood pressure, blood lipid and glycaemic levels, anthropometric and diet measures were collected. The mean age was 59 ± 7 years and 37% were male. Baseline sleep measures were not different between groups. At the 24-month follow-up, both groups showed improvements in cardio-metabolic risk factors, albeit the change in blood pressure was greater in the intervention compared with the usual care group (systolic blood pressure: –11 versus –4 mmHg, p =.014). There were no differences between groups for diet, physical activity or sleep parameters. An increase in sleep efficiency was independently associated with lower systolic blood pressure (β = −2.117, p =.002) and higher high-density lipoprotein levels (β = 0.040, p =.033); an increase in total sleep time was associated with lower low-density lipoprotein levels (β = −0.003, p =.038) at 24 months. Overall, improvement in sleep quality over time was beneficial to reduce blood pressure and lipid levels. These findings highlight sleep as a potential target to reduce cardio-metabolic risk.

Original languageEnglish
Article numbere13389
Number of pages12
JournalJournal of Sleep Research
Issue number6
Publication statusPublished - Dec 2021
Externally publishedYes


  • cardiovascular disease
  • diabetes
  • prevention
  • regional
  • sleep duration
  • sleep quality

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