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

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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Relationship between Sleep Duration and All-Cause Mortality in the Older People: An Updated and Dose-Response Meta-Analysis

10.21203/rs.2.22427/v1 ◽

2020 ◽

Author(s):

wenquan Niu ◽

Mengyang He ◽

Xiangling Deng ◽

Yuqing Zhu ◽

Luyao Huan

Keyword(s):

Older People ◽

Sleep Duration ◽

Dose Response ◽

Data Extraction ◽

Meta Analysis ◽

Short Sleep Duration ◽

Increased Risk ◽

Long Sleep ◽

All Cause Mortality ◽

Summary Data

Abstract Background Short or long sleep duration is recognized as a potential risk factor for all-cause mortality in the older people, yet the results are not often reproducible. Objectives We aimed to investigate whether sleep duration was associated with an increased risk of all-cause mortality in the older people through a comprehensive meta-analysis. Methods Literature retrieval, research selection and data extraction were done independently and in duplicate. Effect-size estimates are expressed as odds ratio (OR) and 95% confidence interval (CI). Results Summary data from 35 articles, involving 11746 older people, were meta-analyzed. Overall analyses revealed a significant association between long sleep duration and all-cause mortality in the older people (OR=1.27, 95% CI: 1.19-1.35, P <.001), and short sleep duration was marginally related to the all-cause mortality in the older people (OR=1.05; 95% CI: 1.00-1.09; P =.045). The Egger’s test indicated no publication bias between sleep duration and all-cause mortality in the older people. In subgroup analyses, the association with all-cause mortality was reinforced in older people women with long sleep duration (OR=1.48, 95% CI: 1.18-1.85, P =.002) relative to older people men with long sleep duration (OR=1.3, 95% CI: 1.10-1.50, P =.001). Further dose-response analyses showed a J-shaped relationship between sleep duration and all-cause mortality in the older people. Conclusions Our meta-analytical findings demonstrated a J-shaped relationship between sleep duration and all-cause mortality in the older people. For long sleep duration, older people women had a higher mortality rate than older people men.

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Relationship between Sleep Duration and All-Cause Mortality in the Elderly: An Updated and Dose-Response Meta-Analysis. (Preprint)

10.2196/preprints.17705 ◽

2020 ◽

Author(s):

Mengyang He ◽

Xiangling Deng ◽

Wenquan Niu ◽

Yuqing Zhu ◽

Luyao Huan

Keyword(s):

Sleep Duration ◽

Dose Response ◽

Elderly Women ◽

Meta Analysis ◽

The Elderly ◽

Elderly Men ◽

Short Sleep Duration ◽

Increased Risk ◽

Long Sleep ◽

All Cause Mortality

BACKGROUND Short or long sleep duration is recognized as a potential risk factor for all-cause mortality in the elderly, yet the results are not often reproducible. OBJECTIVE We aimed to investigate whether sleep duration was associated with an increased risk of all-cause mortality in the elderly through a comprehensive meta-analysis. METHODS Literature retrieval, research selection and data extraction were done independently and in duplicate. Effect-size estimates are expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS Summary data from 35 articles, involving 11746 elderly people, were meta-analyzed. Overall analyses revealed a significant association between long sleep duration and all-cause mortality in the elderly (OR=1.27, 95% CI: 1.19-1.35, P <.001), and short sleep duration was marginally related to the all-cause mortality in the elderly (OR=1.05; 95% CI: 1.00-1.09; P =.045). The Egger’s test indicated no publication bias between sleep duration and all-cause mortality in the elderly. In subgroup analyses, the association with all-cause mortality was reinforced in elderly women with long sleep duration (OR=1.48, 95% CI: 1.18-1.85, P =.002) relative to elderly men with long sleep duration (OR=1.3, 95% CI: 1.10-1.50, P =.001). Further dose-response analyses showed a J-shaped relationship between sleep duration and all-cause mortality in the elderly. CONCLUSIONS Our meta-analytical findings demonstrated a J-shaped relationship between sleep duration and all-cause mortality in the elderly. For long sleep duration, elderly women had a higher mortality rate than elderly men.

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Sleep Duration and the Risk of Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.635564 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jianian Hua ◽

Hezi Jiang ◽

Hui Wang ◽

Qi Fang

Keyword(s):

Metabolic Syndrome ◽

Cohort Studies ◽

Sleep Duration ◽

Meta Analysis ◽

Short Sleep Duration ◽

Cross Sectional ◽

Short Sleep ◽

Increased Risk ◽

Long Sleep ◽

Cross Sectional Studies

Objective: Epidemiological studies have reported inconsistent findings for the association between sleep duration and metabolic syndrome. We aimed to clarify the effects of short and long sleep durations on metabolic syndrome in adults by performing a meta-analysis.Methods: Adopting random-effects models, this study analyzed the effects of short and long sleep durations based on data from prospective cohort studies and cross-sectional studies retrieved from four electronic databases from inception to May 2020.Results: We collected data from 235,895 participants included in nine prospective cohort studies and 340,492 participants included in 27 cross-sectional studies. In cohort studies, short sleep duration was associated with an increased risk of metabolic syndrome (RR, 1.15; 95% CI, 1.05–1.25, I2 = 63.1%, P < 0.001) compared with normal sleep duration. While long sleep duration was not associated with new-onset metabolic syndrome (RR, 1.02, 0.85–1.18, I2 = 38.0%, P = 0.491). In cross-sectional studies, both short (OR, 1.06, 95% CI, 1.01–1.11, I2 = 66.5%, P < 0.001) and long (OR, 1.11, 95% CI, 1.04–1.17, I2 = 73.8%, P < 0.001) sleep durations were associated with a high prevalence of metabolic syndrome.Conclusions: Only a short sleep duration was associated with an increased risk of metabolic syndrome. Future studies should address whether the association is casual and modifiable.

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Short sleep duration is associated with an increased risk of gestational diabetes: Systematic review and meta-analysis

Proceedings of The Nutrition Society ◽

10.1017/s0029665115004383 ◽

2016 ◽

Vol 75 (OCE1) ◽

Author(s):

A.A. Alghamdi ◽

N.A. Al Afif ◽

G.R. Law ◽

E.M. Scottand ◽

G.TH. Ellison

Keyword(s):

Systematic Review ◽

Gestational Diabetes ◽

Sleep Duration ◽

Meta Analysis ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk

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879Sleep Duration and all-cause and cause-specific mortality in people with diabetes

International Journal of Epidemiology ◽

10.1093/ije/dyab168.430 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Yohannes Adama Melaku ◽

Sarah Appleton ◽

Amy Reynolds ◽

Tiffany Gills ◽

Robert Adams

Keyword(s):

Sensitivity Analysis ◽

Sleep Duration ◽

Dose Response ◽

Mortality Risk ◽

The United States ◽

Diabetic Patients ◽

Short Sleep Duration ◽

Short Sleep ◽

Long Sleep ◽

Specific Mortality

Abstract Background Evidence shows that habitual short and long sleep is associated with higher mortality risk in the general population. However, studies on the association between sleep duration and mortality in people with diabetes are scarce. Methods Data from the National Health Interview Survey (NHIS) of the United States (US) between 2004 and 2014 (N = 32,766) were used. Self-reported habitual sleep duration for those with self-reported doctor diagnosed diabetes was categorized as ≤ 6 hr (short sleep), 7-8 hr (adequate sleep), and ≥9 hr (long sleep). Mortality status and cause of death data were retrieved from the US National Death Index and linked. We used adjusted Cox proportional models to examine the association between sleep duration and mortality risk. Dose-response relationships were quantified. Sensitivity analysis was performed excluding cardiovascular and cancer cases. Results In the median follow-up time of 4.6 years (171,375.2 person-years), 5312 all-cause, 1129 cardiovascular, 1148 cancer and 494 diabetes deaths were recorded. Whereas short sleep duration (adjusted hazard ratio (aHR)=1.04; 95% confidence interval (CI): 0.97, 1.11) in diabetic patients was not associated with all-cause mortality, long sleep duration was positively (aHR=1.43; 95% CI: 1.30, 1.57) associated with increased mortality risk. A similar trend of association was found with cause-specific mortality and the dose-response analysis identified a “J” shape association. Similar results were found upon sensitivity analysis. Conclusions Long but not short sleep duration is associated with all-cause and cause-specific mortality in diabetic patients. Key messages Sleep should be part of behavioural intervention to prevent premature mortality in those with diabetics.

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

Circulation ◽

10.1161/circ.133.suppl_1.mp94 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Julio Fernandez-Mendoza ◽

Fan He ◽

Alexandros N Vgontzas ◽

Duanping Liao ◽

Edward O Bixler

Keyword(s):

Cognitive Impairment ◽

Sleep Duration ◽

Population Sample ◽

Vascular Cognitive Impairment ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk ◽

All Cause Mortality ◽

Penn State ◽

The Relationship

Introduction: Short sleep duration has been associated with increased risk of cardiovascular and cerebrovascular disease (CVD), cognitive impairment (CI) and mortality. However, the role of sleep duration in predicting mortality in the context of CVD and CI is still not well-understood. Hypothesis: Short sleep duration is a key effect modifier of the relationship between CI associated with CVD and all-cause mortality. Methods: We addressed this hypothesis in the Penn State Adult Cohort, a random, general population sample of 1,741 middle-aged adults who were studied in the sleep lab and followed-up for 15y. An in-lab, 8-hour polysomnography was performed to ascertain sleep duration. CI associated with CVD was defined by the presence of hypertension, diabetes, heart disease and/or stroke with impaired higher-order, executive cognitive functioning, including slow processing speed. We tested the interaction between sleep duration and CI associated with CVD on all-cause mortality with multiple logistic regression while adjusting for sex, age, race, obesity, smoking, cholesterol, depression, insomnia, dementia, and sleep apnea. Results: The odds of mortality associated with CI-alone, CVD-alone, and CI associated with CVD were 1.3 (95% CI: 0.7-2.4), 1.7 (95% CI: 1.1-2.8), and 4.6 (95% CI: 2.8-7.7), respectively. As shown in Figure 1, the interaction between CI associated with CVD and sleep duration was significant (p < .01), indicating that the probability of mortality increased significantly as a function of shorter sleep duration in individuals with CI associated with CVD. Conclusion: We found that objective sleep duration modifies the relationship between CI associated with CVD and all-cause mortality in a dose-response manner. Short sleep duration in individuals with probable vascular cognitive impairment (VCI) may serve as a biomarker of the severity of central autonomic dysfunction. Future studies should examine whether improving sleep reduces the odds of mortality in individuals with VCI.

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Abstract MP23: Interplay of Cognitive Impairment and Short Sleep Duration on Cardiovascular and Cerebrovascular Mortality

Circulation ◽

10.1161/circ.141.suppl_1.mp23 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Julio Fernandez-Mendoza ◽

Fan He ◽

Susan L Calhoun ◽

Duanping Liao ◽

Alexandros N Vgontzas ◽

...

Keyword(s):

Cognitive Impairment ◽

Sleep Duration ◽

Mental Health Problems ◽

Middle Age ◽

Experimental Studies ◽

Health Problems ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk ◽

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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Sleep duration and risk of incident stroke by age, sex, and race

Neurology ◽

10.1212/wnl.0000000000006424 ◽

2018 ◽

Vol 91 (18) ◽

pp. e1702-e1709 ◽

Cited By ~ 16

Author(s):

Megan E. Petrov ◽

George Howard ◽

Michael A. Grandner ◽

Dawn Kleindorfer ◽

Jennifer R. Molano ◽

...

Keyword(s):

Black Men ◽

Sleep Duration ◽

Sleep Disordered Breathing ◽

White Men ◽

Short Sleep Duration ◽

Short Sleep ◽

Black And White ◽

Increased Risk ◽

Long Sleep ◽

White Adults

ObjectiveTo investigate the association between reported sleep duration and incident stroke in a US cohort of black and white adults, and evaluate race, age, and sex as potential effect modifiers.MethodsFrom 2008 to 2010, 16,733 black and white adults, aged ≥45 years, without a history of stroke or sleep-disordered breathing from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, reported their habitual sleep duration (<6, 6.0–6.9, 7.0–8.9 [reference], ≥9 hours). Incident strokes were identified through biannual participant contact followed by physician adjudication of medical records. Cox proportional hazards analysis was conducted to calculate hazard ratios of interactions between sleep duration with race, age, sex, and 2-way combinations of these factors on incident stroke adjusting for stroke risk factors and sleep-disordered breathing risk.ResultsThe sample comprised 10.4% (n = 1,747) short sleepers (<6 hours) and 6.8% (n = 1,134) long sleepers (≥9 hours). Over an average 6.1 years follow-up, 460 strokes occurred. There were significant interactions between sleep duration and race (p = 0.018) and sleep duration and race–sex groups (p = 0.0023) in association with incident stroke. Short sleep duration was significantly associated with decreased risk for stroke among black participants (hazard ratio [HR] 0.49 [95% confidence interval (CI) 0.28–0.85]), particularly black men (HR 0.21 [95% CI 0.07–0.69]), whereas long sleep duration was significantly associated with increased risk for stroke among white men (HR 1.71 [95% CI 1.06–2.76]).ConclusionsThe association of sleep duration with incident stroke differs by race and sex, with short sleep duration among black men associated with decreased risk, whereas long sleep duration among white men associated with increased risk for stroke.

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