Integrated 24-Hour Time Use Patterns to Mediate Depression and Cardiovascular Disease Comorbidity: A Shared Lifestyle Pathway

AI Summary

Integrated 24-hour sleep, work, and activity patterns significantly associate with cardiometabolic and mental health outcomes.
Favourable patterns halve all-cause mortality and depression risk and reduce cardiovascular risk compared with moderate patterns.
Unfavourable patterns double mortality and depression risk; integrated time use mediates approximately 44% of depression-CVD comorbidity, supporting personalised prevention.

AI Summary

OBJECTIVE: To investigate how integrated patterns of time use behaviors (sleep, work, and physical activity) within a fixed limited time frame associate with health outcomes related to cardiovascular disease (CVD) and depression, as well as their potential mediating role in the relationship between depression and CVD. RESULTS: Among 23,625 participants, 6 favorable patterns (eg, stable work with protected sleep/activity) were associated with half the risk of all-cause mortality (hazard ratio, 0.52; 95% CI, 0.40 to 0.67) and depression (odds ratio, 0.50; 95% CI, 0.39 to 0.64) vs moderate patterns, alongside reduced cardiovascular risks. CONCLUSION: Within the 24-hour time constraint, integrated sleep-work-activity patterns are strongly associated with cardiometabolic/mental health and mediate nearly half of depression-CVD comorbidity.

Basic summary

Mayo Clin Proc. 2026 Jun 4:S0025-6196(26)18393-1. doi: 10.1016/j.mayocp.2026.01.036. Online ahead of print.

ABSTRACT

PARTICIPANTS AND METHODS: Using the National Health and Nutrition Examination Survey (NHANES 2005-2018), we analyzed cross-sectional (n≈37,939 to 42,395) and prospective cohort (n≈23,625 to 29,698) data. Outcomes included all-cause/cardiovascular mortality, major adverse cardiovascular events, CVD risk factors, and depression. A novel time use optimization algorithm defined 27 distinct behavioral patterns (classified as favorable, moderate, or unfavorable) based on joint sleep-work-activity ranges. Associations were assessed via Cox regression and generalized linear models; mediation analysis quantified behavioral contributions to depression-CVD comorbidity.

RESULTS: Among 23,625 participants, 6 favorable patterns (eg, stable work with protected sleep/activity) were associated with half the risk of all-cause mortality (hazard ratio, 0.52; 95% CI, 0.40 to 0.67) and depression (odds ratio, 0.50; 95% CI, 0.39 to 0.64) vs moderate patterns, alongside reduced cardiovascular risks. Three unfavorable patterns (eg, unemployment with sleep dysregulation) doubled mortality (hazard ratio, 2.06; 95% CI, 1.83 to 2.31) and depression risk (odds ratio, 2.47; 95% CI, 2.11 to 2.89). Crucially, these patterns mediated 44.4% (0.0023 of 0.0052) of the depression-major adverse cardiovascular events association and 44.6% (0.5521 of 1.2383) of the reverse association.

CONCLUSION: Within the 24-hour time constraint, integrated sleep-work-activity patterns are strongly associated with cardiometabolic/mental health and mediate nearly half of depression-CVD comorbidity. This finding supports a paradigm shift toward personalized time use recommendations for joint disease prevention.

PMID:42246916 | DOI:10.1016/j.mayocp.2026.01.036

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