Abstract MP94: Short Sleep Duration Modifies the Relationship Between Cognitive Impairment Associated with Cardiovascular Disease and All-cause Mortality

Introduction: Epidemiological and experimental studies have shown that short sleep duration is associated with cognitive impairment as well as cardiovascular (CVD) and cerebrovascular (CBV) diseases. However, its role in predicting CVD/CBV mortality is still not well-established, particularly using objective sleep measures. Hypothesis: Polysomnography (PSG)-measured short sleep duration modifies the increased risk of CVD/CBV mortality associated with cognitive impairment in middle-age. Methods: We addressed this hypothesis in the Penn State Adult Cohort, a random, population-based sample studied in the sleep laboratory (N=1,524, 48.9±13.4y, 54% women) and followed-up after 20.5 ± 5.7 years to ascertain their cause of death. Cognitive impairment (n=155) was ascertained using a comprehensive neuropsychological battery including Mini-Mental State Examination, Symbol Digit Modalities Test, Trail Making Test parts A and B, Benton Visual Retention Test and Thurstone Word Fluency Test. PSG total sleep time classified subjects as normal (≥6 h) and short (<6 h) sleepers. Out of the 563 subjects who were deceased as of December 31, 2018, 244 died of CVD/CBV. Cox proportional hazards regression controlling for age, sex, race, education, obesity, sleep apnea, mental health problems and physical health problems, including hypertension, diabetes, heart disease and stroke at baseline, was used to assess the association between cognitive impairment and mortality. Results: Cognitive impairment was associated with an increased risk of all-cause mortality [(HR: 1.72 (1.35-2.06)], which was significantly modified by objective sleep duration (p-interaction=0.01). The association between cognitive impairment and all-cause mortality was significantly stronger among subjects who slept < 6 hours [HR: 2.00 (1.54-2.59)] than among those who slept ≥ 6 hours [HR: 1.00 (0.59-1.67)]. Despite the smaller sample size, we observed a similar pattern (p-interaction=0.18) that the association between cognitive impairment and CVD/CBV mortality was stronger among subjects who slept < 6 hours [HR: 2.09 (1.43-3.05)] than among those who slept ≥ 6 hours [HR: 1.24 (0.60-2.57)]. Conclusions: The risk of mortality associated with cognitive impairment in middle-age is significantly increased in adults with objective short sleep duration. Middle-aged adults who sleep objectively short may be more vulnerable to the effect of clinical and subclinical cerebrovascular morbidity on cognitive impairment and, thus, early death from CVD/CBV.

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The relationship between sleep duration and all-cause mortality in the older people: an updated and dose-response meta-analysis

10.21203/rs.2.22427/v2 ◽

2020 ◽

Author(s):

Mengyang He ◽

Xiangling Deng ◽

Yuqing Zhu ◽

Luyao Huan ◽

Wenquan Niu

Keyword(s):

Older People ◽

Sleep Duration ◽

Dose Response ◽

Data Extraction ◽

Meta Analysis ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk ◽

Long Sleep ◽

All Cause Mortality

Abstract Background: Short or long sleep duration is proposed as a potential risk factor for all-cause mortality in the older people, yet the results of published studies are not often reproducible. Objectives: We aimed to investigate whether short or long sleep duration was associated with an increased risk of all-cause mortality in the older people via a comprehensive meta-analysis. Methods: Literature retrieval, study selection and data extraction were completed independently and in duplicate. Effect-size estimates are expressed as relative risk (RR) and its 95% confidence interval (CI). Results: Summary data from 35 articles, involving a total of 106990 older people, were meta-analyzed. Overall analyses revealed a significant association between long sleep duration and all-cause mortality (RR=1.27, 95% CI: 1.19-1.35, P <.001), whereas marginal significance was observed for short sleep duration (RR=1.05; 95% CI: 1.00-1.09; P =.045). There was a low probability of publication bias as indicated by Egger’s test for the association between sleep duration and all-cause mortality. In subgroup analyses, the association between long sleep duration and all-cause mortality was relatively strong in women (RR=1.48, 95% CI: 1.18-1.85, P =.002) relative to men (RR=1.30, 95% CI: 1.10-1.50, P =.001) (Two-sample Z test P = .219). Further dose-response regression analyses showed that trend estimation was not obvious for short sleep duration ( P = .016) compared with long sleep duration ( P < .001), indicating a J-shaped relationship between sleep duration and all-cause mortality. Conclusions: Our findings indicate a J-shaped relationship between sleep duration and all-cause mortality in the older people, with long sleep duration significantly associating with all-cause mortality, especially in women.

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The relationship between sleep duration and all-cause mortality in the older people: an updated and dose-response meta-analysis

10.21203/rs.2.22427/v4 ◽

2020 ◽

Author(s):

Mengyang He ◽

Xiangling Deng ◽

Yuqing Zhu ◽

Luyao Huan ◽

Wenquan Niu

Keyword(s):

Older People ◽

Sleep Duration ◽

Dose Response ◽

Data Extraction ◽

Meta Analysis ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk ◽

Long Sleep ◽

All Cause Mortality

Abstract Background: Short or long sleep duration is proposed as a potential risk factor for all-cause mortality in the older people, yet the results of published studies are not often reproducible. Objectives: We aimed to investigate whether short or long sleep duration was associated with an increased risk of all-cause mortality in the older people via a comprehensive meta-analysis. Methods: Literature retrieval, study selection and data extraction were completed independently and in duplicate. Effect-size estimates are expressed as relative risk (RR) and its 95% confidence interval (CI). Results: Summary data from 35 articles, involving a total of 106990 older people, were meta-analyzed. Overall analyses revealed a significant association between long sleep duration and all-cause mortality (RR=1.27, 95% CI: 1.19-1.35, P <.001), whereas marginal significance was observed for short sleep duration (RR=1.05; 95% CI: 1.00-1.09; P =.045). There was a low probability of publication bias as indicated by Egger’s test for the association between sleep duration and all-cause mortality. In subgroup analyses, the association between long sleep duration and all-cause mortality was relatively strong in women (RR=1.48, 95% CI: 1.18-1.85, P =.002) relative to men (RR=1.30, 95% CI: 1.10-1.50, P =.001) (Two-sample Z test P = .219). Further dose-response regression analyses showed that trend estimation was not obvious for short sleep duration ( P = .016) compared with long sleep duration ( P < .001), indicating a J-shaped relationship between sleep duration and all-cause mortality. Conclusions: Our findings indicate a J-shaped relationship between sleep duration and all-cause mortality in the older people, with long sleep duration significantly associating with all-cause mortality, especially in women.

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Insomnia with objective short sleep duration is associated with cognitive impairment: a first look at cardiometabolic contributors to brain health

SLEEP ◽

10.1093/sleep/zsaa150 ◽

2020 ◽

Author(s):

Julio Fernandez-Mendoza ◽

Fan He ◽

Kristina Puzino ◽

Gregory Amatrudo ◽

Susan Calhoun ◽

...

Keyword(s):

Cognitive Impairment ◽

Sleep Duration ◽

Vascular Cognitive Impairment ◽

Chronic Insomnia ◽

Cardiometabolic Health ◽

Apnea Hypopnea Index ◽

Poor Sleep ◽

Short Sleep Duration ◽

Sleep Difficulty ◽

Short Sleep

Abstract Study Objectives Insomnia with objective short sleep duration has been previously associated with adverse cardiometabolic health outcomes as well as poorer cognitive performance in otherwise noncognitively impaired adults. However, studies demonstrating an increased prevalence of cognitive impairment (CI) in this insomnia phenotype are lacking. Methods We analyzed data from Penn State Adult Cohort (N = 1,524; 48.9 ± 13.4 years; 53.4% women). Self-reported sleep difficulty was defined as normal sleep (n = 899), poor sleep (n = 453), and chronic insomnia (n = 172). Objective short sleep duration was defined as less than 6-h of sleep, based on in-lab, 8-h polysomnography. CI (n = 155) and possible vascular cognitive impairment (pVCI, n = 122) were ascertained using a comprehensive neuropsychological battery. Analyses adjusted for age, sex, race, education, body mass index, apnea/hypopnea index, smoking, alcohol, psychoactive medication, and mental and physical health problems. Results Participants who reported poor sleep or chronic insomnia and slept objectively less than 6 hours were associated with a 2-fold increased odds of CI (OR = 2.06, 95% confidence limits [CL] = 1.15–3.66 and OR = 2.18, 95% CL = 1.07–4.47, respectively) and of pVCI (OR = 1.94, 95% CL = 1.01–3.75 and OR = 2.33, 95% CL = 1.07–5.06, respectively). Participants who reported poor sleep or chronic insomnia and slept objectively more than 6 hours were not associated with increased odds of either CI (OR = 0.72, 95% CL = 0.30–1.76 and OR = 0.75, 95% CL = 0.21–2.71, respectively) or pVCI (OR = 1.08, 95% CL = 0.42–2.74 and OR = 0.76, 95% CL = 0.16–3.57, respectively). Conclusions Insomnia with objective short sleep duration is associated with an increased prevalence of CI, particularly as it relates to cardiometabolic health (i.e. pVCI). These data further support that this insomnia phenotype may be a more biologically severe form of the disorder associated with cardiovascular, cerebrovascular, and neurocognitive morbidity.

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The relationship between sleep duration and all-cause mortality in the older people: an updated and dose-response meta-analysis

10.21203/rs.2.22427/v3 ◽

2020 ◽

Author(s):

Mengyang He ◽

Xiangling Deng ◽

Yuqing Zhu ◽

Luyao Huan ◽

Wenquan Niu

Keyword(s):

Older People ◽

Sleep Duration ◽

Dose Response ◽

Data Extraction ◽

Meta Analysis ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk ◽

Long Sleep ◽

All Cause Mortality

Abstract Background: Short or long sleep duration is proposed as a potential risk factor for all-cause mortality in the older people, yet the results of published studies are not often reproducible. Objectives: We aimed to investigate whether short or long sleep duration was associated with an increased risk of all-cause mortality in the older people via a comprehensive meta-analysis. Methods: Literature retrieval, study selection and data extraction were completed independently and in duplicate. Effect-size estimates are expressed as relative risk (RR) and its 95% confidence interval (CI). Results: Summary data from 35 articles, involving a total of 106990 older people, were meta-analyzed. Overall analyses revealed a significant association between long sleep duration and all-cause mortality (RR=1.27, 95% CI: 1.19-1.35, P <.001), whereas marginal significance was observed for short sleep duration (RR=1.05; 95% CI: 1.00-1.09; P =.045). There was a low probability of publication bias as indicated by Egger’s test for the association between sleep duration and all-cause mortality. In subgroup analyses, the association between long sleep duration and all-cause mortality was relatively strong in women (RR=1.48, 95% CI: 1.18-1.85, P =.002) relative to men (RR=1.30, 95% CI: 1.10-1.50, P =.001) (Two-sample Z test P = .219). Further dose-response regression analyses showed that trend estimation was not obvious for short sleep duration ( P = .016) compared with long sleep duration ( P < .001), indicating a J-shaped relationship between sleep duration and all-cause mortality. Conclusions: Our findings indicate a J-shaped relationship between sleep duration and all-cause mortality in the older people, with long sleep duration significantly associating with all-cause mortality, especially in women.

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