Mortality associated with nonrestorative short sleep or nonrestorative long time-in-bed in middle-aged and older adults

Abstract

Associations of sleep duration with human health could differ depending on whether sleep is restorative. Using data from 5804 participants of the Sleep Heart Health Study, we examined the longitudinal association of sleep restfulness combined with polysomnography-measured total sleep time (TST) or time in bed (TIB), representing different sleeping behaviors, with all-cause mortality. Among middle-aged adults, compared with restful intermediate TST quartile, the lowest TST quartile with feeling unrested was associated with higher mortality (hazard ratio [HR], 1.54; 95% confidence interval [CI] 1.01–2.33); the highest TST quartile with feeling rested was associated with lower mortality (HR, 0.55; 95% CI 0.32–0.97). Among older adults, the highest TIB quartile with feeling unrested was associated with higher mortality, compared with restful intermediate TIB quartile (HR, 1.57; 95% CI 1.23–2.01). Results suggest a role of restorative sleep in differentiating the effects of sleep duration on health outcomes in midlife and beyond.

Combined Use of Sleep Quality and Duration Is More Closely Associated With Mortality Risk Among Older Adults: A Population-based Kyoto-Kameoka Prospective Cohort Study

“…39 Nonetheless, our findings were similar to those of a research that evaluated the association between objective sleep duration and mortality risk. 40 We also showed that the reproducibility of sleep duration assessments based on self-reporting was moderate in this older cohort population; thus, the evaluations of sleep duration were likely to be relatively stable. Second, as the sleep status assessments were conducted only at baseline, participants' sleep status may have changed A c c e p t e d V e r s i o n 17 during the follow-up period.…”

Lifestyle Elements for Improving Mental and Physical Health in Japanese University Students: Subjective Sleep Quality is a Common Key Factor

“…Subjective sleep restfulness has begun to attract attention as a predictor of mortality risk. 30 Sleep quality can influence mental and physical outcomes such as depression, 31 academic performance, 32 and fatigue. 33,34 Although sleep duration is also an important indicator, sleep quality is more useful as a subjective measure to predict health because subjective sleep duration often does not coincide with actual sleep duration, excluding bedtime.…”

“…Subjective sleep restfulness has begun to attract attention as a predictor of mortality risk. 30 Sleep quality can influence mental and physical outcomes such as depression, 31 academic performance, 32 and fatigue. 36 In the current study, participants with high subjective sleep quality exhibited a higher frequency of AE and a longer duration of PR, but the daily step count and RE were not significantly different.…”

The association between subjective–objective discrepancies in sleep duration and mortality in older men

“…While physiological sleep need may decrease with age, there is no clear reduction in time in bed 57 , suggesting excessive time in bed relative to physiological sleep need in older adults. Epidemiological evidence suggests that objective longer time in bed is associated with higher total mortality in older adults independent of objective sleep duration per se 17 , 58 . In addition, there is evidence linking objective long time in bed and self-reported long sleep duration 59 .…”