Sleep duration and risk of all-cause mortality: A flexible, non-linear, meta-regression of 40 prospective cohort studies

Liu, Tong-Zu; Xu, Chang; Rota, Matteo; Cai, Hui; Chao, Zhang; Shi, Ming; Yuan, Ruixia; Weng, Hong; Meng, Xiangyu; Kwong, Joey S.W.; Sun, Xin

doi:10.1016/j.smrv.2016.02.005

Cited by 226 publications

(152 citation statements)

References 64 publications

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“…The lack of association between long weekend sleep duration and mortality in the present paper does not appear to align with the meta-analyses finding a U-shaped (Cappuccio et al, 2010;Gallicchio & Kalesan, 2009;Silva et al, 2016) or J-shaped (Liu et al, 2017) relationship. One reason for the difference is probably that previous work has focused on weekday sleep only.…”

Section: Discussioncontrasting

confidence: 96%

Sleep duration and mortality – Does weekend sleep matter?

Åkerstedt

Ghilotti

Grotta

et al. 2018

Journal of Sleep Research

114

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Previous studies have found a U-shaped relationship between mortality and (weekday) sleep duration. We here address the association of both weekday and weekend sleep duration with overall mortality. A cohort of 43,880 subjects was followed for 13 years through record-linkages. Cox proportional hazards regression models with attained age as time-scale were fitted to estimate multivariable-adjusted hazard ratios and 95% confidence intervals for mortality; stratified analyses on age (<65 years, ≥65 years) were conducted. Among individuals <65 years old, short sleep (≤5 hr) during weekends at baseline was associated with a 52% higher mortality rate (hazard ratios 1.52; 95% confidence intervals 1.15-2.02) compared with the reference group (7 hr), while no association was observed for long (≥9 hr) weekend sleep. When, instead, different combinations of weekday and weekend sleep durations were analysed, we observed a detrimental association with consistently sleeping ≤5 hr (hazard ratios 1.65; 95% confidence intervals 1.22-2.23) or ≥8 hr (hazard ratios 1.25; 95% confidence intervals 1.05-1.50), compared with consistently sleeping 6-7 hr per day (reference). The mortality rate among participants with short sleep during weekdays, but long sleep during weekends, did not differ from the rate of the reference group. Among individuals ≥65 years old, no association between weekend sleep or weekday/weekend sleep durations and mortality was observed. In conclusion, short, but not long, weekend sleep was associated with an increased mortality in subjects <65 years. In the same age group, short sleep (or long sleep) on both weekdays and weekend showed increased mortality. Possibly, long weekend sleep may compensate for short weekday sleep.

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Section: Discussioncontrasting

confidence: 96%

Sleep duration and mortality – Does weekend sleep matter?

Åkerstedt

Ghilotti

Grotta

et al. 2018

Journal of Sleep Research

114

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“…(15) 181 (24) 197 (53) 103 (74) Previous cancer 1394 (10) 55 (10) 126 (8) 330 (8) 520 (10) 366 (11) Previous CVD 1 356 (3) 20 (4) 34 (2) 94 (2) 113 (2) Self-reported, heart attack and heart failure. The U-shaped association between sleep duration and mortality essentially agrees with previous meta-analyses, 1-3,14 except for Liu et al, 14 who found a J-shaped one. The explanation of the U-shaped association between sleep duration and mortality has been discussed in most previous work in this area.…”

Section: Discussionsupporting

confidence: 89%

Sleep Duration, Mortality, and Heredity—A Prospective Twin Study

Åkerstedt

Narusyte

Alexanderson

et al. 2017

Sleep

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Introduction:A number of studies have shown a U-shaped association between sleep duration and mortality. Since sleep duration is partly genetically determined, it seems likely that its association with mortality is also genetically influenced. The purpose of the present study was to investigate the influence on heredity on the association between sleep duration and mortality. Methods: We used a cohort of 14 267 twins from the Swedish Twin Registry. Results: A Cox proportional hazards regression analysis, adjusted for a number of covariates, confirmed a clear U shape with a hazard ratio (HR) = 1.34 and 95% confidence interval (CI) = 1.15-1.57 for a sleep duration of ≤6.5 hours and HR = 1.18 (CI = 1.07-1.30) for sleep of ≥9.5 hours. Reference value was 7.0 hours. A co-twin analysis of 1942 twins discordant on mortality showed a HR = 2.66 (CI = 1.17-6.04) for long (≥9.5 hours) sleep in monzygotic twins and an HR = 0.66 (CI = 0.20-2.14) for short (<6.5 hours) sleep. In dizygotic twins, no association was significant. The heritability for mortality was 28% for the whole group, while it was 86% for short sleepers and 42% for long sleepers. Thus, the link with mortality for long sleep appears to be more due to environmental factors than to heredity, while heritability dominates among short sleepers. Conclusions: We found that both long and short sleep were associated with higher total mortality, that the difference in mortality within twin pairs is associated with long sleep, and that short sleep has a higher heritability for mortality, while long sleep is associated with more environmental influences on mortality. Keywords: CVD, cancer, sleep duration, TST, sleep quality, snoring. INTRODUCTIONOne of the most common questions concerning sleep is: "how much should we sleep?" Several systematic reviews on sleep duration and mortality have found that the optimal sleep duration is 7 hours, with a significant increase of overall mortality for individuals with short (≤6 hours) or long (≥8 hours) sleep. 1-3In a critical review, Kurina et al. 4 argue that results from the literature are not totally consistent. The analysis of Kurina et al. included 42 studies and only 14 of these showed a U-shaped relationship, while 23 studies (43%) showed no association at all, and the remainder showed associations for either short or long sleep. Their main arguments against the presence of a U-shaped association between sleep and mortality are the heterogeneity in the measurement of sleep duration and in its categorization, the use of different methods and variables for adjusting for potential confounders across studies, and different age ranges. In a study focusing on age, we found that the association between sleep duration and mortality was stronger in young age groups than in older individuals, but the effect was significant for those of 70 years of age and below (Akerstedt et al., subm).One weakness with prior studies is that the exposure variable in most cases has asked for "usual sleep duration" or some similar phrasing. This may in...

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“…As such, interventions to promote daily PA in older adults might positively impact their sleep quality via increased sleep duration. Given the importance of sleep duration to future morbidity (Cappuccio et al, ) and mortality (Liu et al, ), the current findings have important implications for improving the overall health of older adults.…”

Section: Discussionmentioning

confidence: 74%

“…Such changes might negatively impact subsequent health. Older adults with short sleep duration have increased risk of all‐cause mortality (Hall et al, ; Liu et al, ), which might be attributed to increased inflammation (Hall et al, ). Underactive older adults are also less likely to experience healthy ageing as defined by (a) the absence of major chronic disease, cognitive impairment and major limitation of physical function; and (b) preserved good mental health (Hamer, Lavoie, & Bacon, ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of dynamic, bidirectional associations in older adult physical activity and sleep quality

Best

Falck

Landry

et al. 2018

Journal of Sleep Research

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Sleep quality and physical activity (PA) appear to be interrelated; thus, by promoting one behaviour, it may be possible to improve the other in older adults. Examination of the within-person day-to-day variation in PA and sleep quality could potentially elucidate the directionality of the association of these behaviours. We measured sleep quality (i.e. fragmentation, efficiency, duration and latency) and moderate-to-vigorous PA using the MotionWatch8© over 14 consecutive days and nights in community-dwelling adults (n = 152; age range 53-101 years). Multilevel modelling estimated within-subject autoregressive and cross-lagged effects and between-subject associations between PA and sleep quality. On days when individuals engaged in a high amount of PA on one day (relative to their averages), they were more likely to engage in a high amount of PA on the next day (estimate, 0.19; 95% CI, 0.14, 0.24). Nights in which individuals had a long sleep latency were followed by nights in which they also had a long sleep latency (estimate, 0.09; 95% CI, 0.03, 0.14). In contrast, nights in which individuals slept for a long period of time were followed by nights in which they slept relatively less than their averages (estimate, -0.09; 95% CI, -0.13, -0.04). When individuals engaged in a large amount of PA during the day, they tended to sleep longer that following night (estimate, 0.01; 95% CI, 0.001, 0.02). All other associations between PA and sleep quality were not significant. Increasing PA therefore might increase sleep duration in older adults.

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Sleep duration and risk of all-cause mortality: A flexible, non-linear, meta-regression of 40 prospective cohort studies

Cited by 226 publications

References 64 publications

Sleep duration and mortality – Does weekend sleep matter?

Sleep duration and mortality – Does weekend sleep matter?

Sleep Duration, Mortality, and Heredity—A Prospective Twin Study

Analysis of dynamic, bidirectional associations in older adult physical activity and sleep quality

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