Association between Sleep Duration and Mortality Is Mediated by Markers of Inflammation and Health in Older Adults: The Health, Aging and Body Composition Study

Hall, Martica; Smagula, Stephen F.; Boudreau, Robert M.; Ayonayon, Hilsa N.; Goldman, Suzanne E.; Harris, Tamara B.; Naydeck, Barbara L.; Rubin, Susan M.; Samuelsson, Laura B.; Satterfield, Suzanne; Stone, Katie L.; Visser, Marjolein; Newman, Anne B.

doi:10.5665/sleep.4394

Cited by 121 publications

(101 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our main novel findings is that the mortality risk associated with prolonged nighttime blood oxygen desaturation (≥10% TST SaO 2 <90%) and short sleep duration was substantively attenuated by adjustment for inflammatory burden alone and other medical burden/lifestyle factors; note that the attenuation after adjusting for inflammatory burden and other health status covariates separately (Models 2a and 2b) then together (Model 3) suggests these adjustments accounted for some shared and some distinct variance in mortality risk that was attributed to these sleep characteristics (in Model 1). These findings are consistent with prior research on self-reported sleep duration, inflammation, disease, and mortality (40), and suggests these aspects of sleep may be linked to mortality through concurrent inflammation and disease.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Actigraphy- and Polysomnography-Measured Sleep Disturbances, Inflammation, and Mortality Among Older Men

et al. 2016

Self Cite

View full text Add to dashboard Cite

Objectives To evaluate whether objectively-measured sleep characteristics are associated with mortality risk independent of inflammatory burden and comorbidity. Methods The MrOS Sleep Study (conducted in 2003-2005) included community-dwelling older men (n=2531; average age of 76.3 (5.5 s.d.)). Sleep measures from in-home polysomnography and wrist actigraphy and assessments of serum inflammatory markers levels (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), tumor necrosis factor-α soluble receptor II (sTNF-RII) and interferon–γ (IFN-γ)) were obtained. Vital status was ascertained over an average follow-up of 7.4 (1.9 s.d.) years. Results Three of the seven main sleep measures examined were independently associated with greater inflammatory burden. Mortality risk associated with prolonged (≥10% total sleep time) blood oxygen desaturation and short (<5 hours) sleep duration was attenuated to non-significance after adjusting for inflammatory burden or medical burden/lifestyle factors. Severe blood oxygen desaturation (adjusted hazard ratio (aHR)=1.57, 95% confidence interval (CI): 1.11-2.22), sleep fragmentation (aHR=1.32, 95% CI: 1.12-1.57), and a lower percentage of sleep in rapid eye movement (REM; aHR per s.d.=0.90, 95% CI: 0.93-0.97) were independently associated with mortality. Conclusions Short sleep duration and prolonged blood oxygen desaturation were independently associated with inflammatory burden, which attenuated associations between these sleep characteristics and mortality. Medical and lifestyle factors also substantially attenuated most sleep-mortality associations, suggesting complex relations between sleep, inflammation, and disease. Sleep fragmentation, severe blood oxygen desaturation, and the percentage of sleep time in REM were independently related to mortality risk. Future studies with repeated measures of mediators/confounds will be necessary to achieve a mechanistic understanding of sleep-related mortality risk.

show abstract

Section: Discussionsupporting

confidence: 91%

“…To our knowledge, the only prior investigation of whether inflammation attenuates sleep-related mortality risk relied on self-reported sleep duration (40). The current report therefore aimed to determine whether objectively measured sleep characteristics are associated with mortality risk independent of concurrent inflammation.…”

mentioning

confidence: 99%

Actigraphy- and Polysomnography-Measured Sleep Disturbances, Inflammation, and Mortality Among Older Men

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…A total of 74 studies met the inclusion criteria; the process of study selection is shown in Figure 1 8, 9, 11, 12, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89,...…”

Section: Resultsmentioning

confidence: 99%

“…** References 11, 21, 23, 25, 26, 27, 29, 32, 33, 34, 36, 39, 40, 41, 44, 46, 47, 48, 49, 51, 52, 53, 54, 56, 57, 61, 64, 66, 68, 70, 71, 72, 77, 79, 80, 84, 86, 87, 88.…”

Section: Notesmentioning

confidence: 99%

Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

Kwok

Kontopantelis

Kuligowski

et al. 2018

JAHA

313

227

View full text Add to dashboard Cite

BackgroundThere is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality.Methods and ResultsWe conducted a systematic review, meta‐analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We utilized linear and nonlinear dose‐response meta‐analysis models and used DerSimonian–Laird random‐effects meta‐analysis models of risk ratios, with inverse variance weighting, and the I2 statistic to quantify heterogeneity. Seventy‐four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose‐response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self‐reported duration of sleep >8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio, 1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes.ConclusionsDivergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.

show abstract

“…and mortality. 9,10 Evidence also suggests that electroencephalography (EEG) based sleep time can be used to identify a "normal sleep duration" insomnia phenotype and positively predict those individuals most likely to respond to cognitive behavioral treatment intervention (the now recognized first-line therapy for insomnia). 11 Additional phenotypes are emerging through the use of sleep biomarkers related to depressive and anxiety disorders and/or stress-related insomnia.…”

Section: Scientific Investigationsmentioning

confidence: 99%

The Accuracy, Night-to-Night Variability, and Stability of Frontopolar Sleep Electroencephalography Biomarkers

Levendowski

Ferini‐Strambi

Gamaldo

et al. 2017

Journal of Clinical Sleep Medicine

101

View full text Add to dashboard Cite

Study Objectives: To assess the validity of sleep architecture and sleep continuity biomarkers obtained from a portable, multichannel forehead electroencephalography (EEG) recorder. Methods: Forty-seven subjects simultaneously underwent polysomnography (PSG) while wearing a multichannel frontopolar EEG recording device (Sleep Profiler). The PSG recordings independently staged by 5 registered polysomnographic technologists were compared for agreement with the autoscored sleep EEG before and after expert review. To assess the night-to-night variability and first night bias, 2 nights of self-applied, in-home EEG recordings obtained from a clinical cohort of 63 patients were used (41% with a diagnosis of insomnia/depression, 35% with insomnia/obstructive sleep apnea, and 17.5% with all three). The between-night stability of abnormal sleep biomarkers was determined by comparing each night's data to normative reference values. Results: The mean overall interscorer agreements between the 5 technologists were 75.9%, and the mean kappa score was 0.70. After visual review, the mean kappa score between the autostaging and five raters was 0.67, and staging agreed with a majority of scorers in at least 80% of the epochs for all stages except stage N1. Sleep spindles, autonomic activation, and stage N3 exhibited the least between-night variability (P < .0001) and strongest between-night stability. Antihypertensive medications were found to have a significant effect on sleep quality biomarkers (P < .02). Conclusions: A strong agreement was observed between the automated sleep staging and human-scored PSG. One night's recording appeared sufficient to characterize abnormal slow wave sleep, sleep spindle activity, and heart rate variability in patients, but a 2-night average improved the assessment of all other sleep biomarkers. Commentary: Two commentaries on this article appear in this issue on pages 771 and 773.

show abstract

Association between Sleep Duration and Mortality Is Mediated by Markers of Inflammation and Health in Older Adults: The Health, Aging and Body Composition Study

Abstract: Inflammatory markers, lifestyle, and health status explained mortality risk associated with short sleep, while the mortality risk associated with long sleep was explained predominantly by lifestyle and health status.

Cited by 121 publications

References 42 publications

Actigraphy- and Polysomnography-Measured Sleep Disturbances, Inflammation, and Mortality Among Older Men

Actigraphy- and Polysomnography-Measured Sleep Disturbances, Inflammation, and Mortality Among Older Men

Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

The Accuracy, Night-to-Night Variability, and Stability of Frontopolar Sleep Electroencephalography Biomarkers

Contact Info

Product

Resources

About