{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:41:18Z","timestamp":1786466478335,"version":"build-2736575974"},"posted":{"date-parts":[[2026,8,10]]},"group-title":"Epidemiology","reference-count":88,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,8,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>In characterizing sleep and circadian health, the day\u2013to\u2013day regularity of sleep-wake timing strongly predicts health outcomes, outperforming short sleep duration in prospective associations with mortality and new-onset disease (1, 2). It is unknown whether biological (e.g., sleep and circadian physiology) and sociocultural (e.g., exposures that affect sleep-wake timing) sex differences lead to differences in day\u2013to\u2013day sleep-wake regularity or modify its prospective associations with health outcomes. Here, we present findings from a UK Biobank study of 506,582 person-days of accelerometer recordings across 73,647 middle-aged adults preceding 549,009 person-years of follow-up. We compared SRI scores between males and females and evaluated whether all\u2013cause, cardiovascular, and cancer mortality differed across SRI groups by sex. Custom contrasts were used to compare estimated marginal means across specific SRI-sex combinations. Females were overrepresented among very high (SRI \u226590) and underrepresented among very low (SRI &lt;60) groups. After adjustment for demographic, health, and behavioral covariates, males still had higher odds than females of exhibiting SRI &lt;60. Low SRI and male sex were synergistically associated with higher mortality rate. Demographic, health, and behavioral covariate-adjusted models showed stronger and more dose\u2013dependent associations between low SRI and mortality among males than females. Although the omnibus SRI \u00d7 sex interaction terms were not statistically significant, the interaction contrast for SRI &lt;60 versus \u226590 differed by sex, suggesting a possible sex difference in mortality rates at very low SRI. Together, our findings suggest that males may be more vulnerable than females to the mortality risk associated with highly irregular sleep-wake schedules.<\/jats:p>","DOI":"10.64898\/2026.08.06.26359893","type":"posted-content","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:35:20Z","timestamp":1786368920000},"source":"Crossref","is-referenced-by-count":0,"title":["Sex differences in sleep regularity and its associations with mortality"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3100-7347","authenticated-orcid":false,"given":"Mark \u00c9.","family":"Czeisler","sequence":"first","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, United States"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States"},{"name":"School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7714-4630","authenticated-orcid":false,"given":"Josh","family":"Leota","sequence":"additional","affiliation":[{"name":"School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Research, Algorithms, and Data Science, WHOOP, Inc., Boston, MA, United States"},{"name":"Division of Sleep and Circadian Medicine, Department of Medicine, Mass General Brigham, Boston, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0089-8167","authenticated-orcid":false,"given":"Flora","family":"Le","sequence":"additional","affiliation":[{"name":"School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5396-4677","authenticated-orcid":false,"given":"Prashant","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States"},{"name":"Division of Cardiovascular Medicine and CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5999-5459","authenticated-orcid":false,"given":"Andreas G.","family":"Kontopidis","sequence":"additional","affiliation":[{"name":"Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, United States"},{"name":"Boston Scientific, Marlborough, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3581-8078","authenticated-orcid":false,"given":"Nicholas S.","family":"Peters","sequence":"additional","affiliation":[{"name":"National Heart Lung Institute & Centre for Cardiac Engineering, Imperial College London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4143-8485","authenticated-orcid":false,"given":"Matthew P.","family":"Pase","sequence":"additional","affiliation":[{"name":"School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7527-8558","authenticated-orcid":false,"given":"Shantha M.W.","family":"Rajaratnam","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States"},{"name":"School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia"},{"name":"Division of Sleep and Circadian Medicine, Department of Medicine, Mass General Brigham, Boston, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-3586","authenticated-orcid":false,"given":"Daniel B.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States"},{"name":"Division of Cardiovascular Medicine and CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States"},{"name":"Richard A and Susan F Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026081108451275000_2026.08.06.26359893v1.1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsad253"},{"key":"2026081108451275000_2026.08.06.26359893v1.2","doi-asserted-by":"crossref","unstructured":"D. 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