Sleep duration and mortality in the elderly: a systematic review with meta-analysis

Objective The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals. Design Systematic review and meta-analysis of population-based cohort studies. Setting Articles were retrieved from international and national electronic databases. Study selection Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded. Data extraction Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran's Q and the I2 statistics, respectively, and sensitivity analyses were conducted. Primary and secondary outcome measures All-cause and cardiovascular mortality. Results Overall, 27 cohort studies were selected, comprising >70 000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90). Conclusions Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.

[1]  D. Hudgel,et al.  The association between obesity and short sleep duration: a population-based study. , 2005, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[2]  F. Aujard,et al.  Artificially accelerated aging by shortened photoperiod alters early gene expression (Fos) in the suprachiasmatic nucleus and sulfatoxymelatonin excretion in a small primate, Microcebus murinus , 2001, Neuroscience.

[3]  Yu-Hsuan Lin,et al.  Nighttime sleep, Chinese afternoon nap, and mortality in the elderly. , 2007, Sleep.

[4]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[5]  J. Kark,et al.  Siesta and mortality in a Mediterranean population: a community study in Jerusalem. , 2003, Sleep.

[6]  N. Minois.  Longevity and aging: beneficial effects ofexposure to mild stress , 2004, Biogerontology.

[7]  M. S. Patel,et al.  An introduction to meta-analysis. , 1989, Health Policy.

[8]  Sonia Ancoli-Israel,et al.  Sleep and its disorders in aging populations. , 2009, Sleep medicine.

[9]  Markku Partinen,et al.  Sleep and mortality: a population-based 22-year follow-up study. , 2007, Sleep.

[10]  C. Guilleminault,et al.  Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. , 2004, Sleep.

[11]  Jenny Lee,et al.  Long sleep duration is associated with higher mortality in older people independent of frailty: a 5-year cohort study. , 2014, Journal of the American Medical Directors Association.

[12]  K. Morgan.  Hypnotics, Sleep, and Mortality in Elderly People , 1992, Journal of the American Geriatrics Society.

[13]  Pasquale Strazzullo,et al.  Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. , 2011, European heart journal.

[14]  F. Fuchs,et al.  Risk factors for cardiovascular disease in the very elderly: results of a cohort study in a city in southern Brazil , 2011, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[15]  V Mor,et al.  Dying trajectory in the last year of life: does cancer trajectory fit other diseases? , 2001, Journal of palliative medicine.

[16]  Steven B Heymsfield,et al.  Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. , 2005, Sleep.

[17]  D. Bliwise.  Invited commentary: cross-cultural influences on sleep--broadening the environmental landscape. , 2008, American journal of epidemiology.

[18]  D. Dinges,et al.  Neuroimmunologic aspects of sleep and sleep loss. , 2001, Seminars in clinical neuropsychiatry.

[19]  S Duval,et al.  Trim and Fill: A Simple Funnel‐Plot–Based Method of Testing and Adjusting for Publication Bias in Meta‐Analysis , 2000, Biometrics.

[20]  Susan Redline,et al.  Association of sleep time with diabetes mellitus and impaired glucose tolerance. , 2005, Archives of internal medicine.

[21]  C. Martyn,et al.  Larks and owls and health, wealth, and wisdom , 1998, BMJ.

[22]  F. Cappuccio,et al.  Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. , 2010, Sleep.

[23]  Qi Zhang,et al.  Meta-Analysis of Self-Reported Daytime Napping and Risk of Cardiovascular or All-Cause Mortality , 2015, Medical science monitor : international medical journal of experimental and clinical research.

[24]  E. van Cauter,et al.  Impact of Sleep and Sleep Loss on Neuroendocrine and Metabolic Function , 2007, Hormone Research in Paediatrics.

[25]  N. Seki,et al.  [Relationships between walking hours, sleeping hours, meaningfulness of life (ikigai) and mortality in the elderly: prospective cohort study]. , 2001, Nihon eiseigaku zasshi. Japanese journal of hygiene.

[26]  S. Ancoli-Israel,et al.  Gender differences in nighttime sleep and daytime napping as predictors of mortality in older adults: the Rancho Bernardo study. , 2013, Sleep medicine.

[27]  R. Kane,et al.  The Association Between Geriatric Syndromes and Survival , 2012, Journal of the American Geriatrics Society.

[28]  S. Kuriyama,et al.  Long sleep duration and cause‐specific mortality according to physical function and self‐rated health: the Ohsaki Cohort Study , 2013, Journal of sleep research.

[29]  J. Kark,et al.  Over 8 hours of sleep--marker of increased mortality in Mediterranean population: follow-up population study. , 2003, Croatian medical journal.

[30]  J. Wardle,et al.  Sleep duration and health in young adults. , 2006, Archives of internal medicine.

[31]  J. Cohen-Mansfield,et al.  Sleep duration, nap habits, and mortality in older persons. , 2012, Sleep.

[32]  Sonia Ancoli-Israel,et al.  Sleep disturbances and risk of frailty and mortality in older men. , 2012, Sleep medicine.

[33]  D. Kang,et al.  A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study , 2013, Journal of preventive medicine and public health = Yebang Uihakhoe chi.

[34]  E. Hartmann,et al.  Psychological differences between long and short sleepers. , 1972, Archives of general psychiatry.

[35]  D. Kripke,et al.  Mortality related to actigraphic long and short sleep. , 2011, Sleep medicine.

[36]  P. Prinz.  Sleep and Sleep Disorders in Older Adults , 1995, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[37]  T. Gill,et al.  Sleep Complaints in Community‐Living Older Persons: A Multifactorial Geriatric Syndrome , 2007, Journal of the American Geriatrics Society.

[38]  A. Tamakoshi,et al.  Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. , 2009, Sleep.

[39]  M. Marmot,et al.  Cross-sectional versus prospective associations of sleep duration with changes in relative weight and body fat distribution: the Whitehall II Study. , 2008, American journal of epidemiology.

[40]  C. Meisinger,et al.  Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study. , 2007, Sleep.

[41]  F. Cappuccio,et al.  Quantity and Quality of Sleep and Incidence of Type 2 Diabetes A systematic review and meta-analysis , 2010 .

[42]  D. Papanicolaou,et al.  The Pathophysiologic Roles of Interleukin-6 in Human Disease , 1998, Annals of Internal Medicine.

[43]  S. Heymsfield,et al.  Sleep duration associated with mortality in elderly, but not middle-aged, adults in a large US sample. , 2008, Sleep.

[44]  Susan Redline,et al.  Association of usual sleep duration with hypertension: the Sleep Heart Health Study. , 2006, Sleep.

[45]  D. Kripke,et al.  Self-reported Sleep Complaints With Long and Short Sleep: A Nationally Representative Sample , 2004, Psychosomatic medicine.

[46]  Steven B. Heymsfield,et al.  Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey , 2006, Hypertension.

[47]  Ngianga-Bakwin Kandala,et al.  Meta-analysis of short sleep duration and obesity in children and adults. , 2008, Sleep.

[48]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[49]  K. Chien,et al.  Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. , 2010, Sleep.

[50]  Pasquale Strazzullo,et al.  Quantity and Quality of Sleep and Incidence of Type 2 Diabetes , 2009, Diabetes Care.

[51]  D J Foley,et al.  Sleep complaints among elderly persons: an epidemiologic study of three communities. , 1995, Sleep.

[52]  M. Marmot,et al.  Correlates of short and long sleep duration: a cross-cultural comparison between the United Kingdom and the United States: the Whitehall II Study and the Western New York Health Study. , 2008, American journal of epidemiology.

[53]  Brian E Henderson,et al.  Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: the Multiethnic Cohort Study. , 2013, Preventive medicine.

[54]  S. Gibson,et al.  Geriatric syndromes as predictors of adverse outcomes of hospitalization , 2007, Internal medicine journal.

[55]  Ngianga-Bakwin Kandala,et al.  Gender-Specific Associations of Short Sleep Duration With Prevalent and Incident Hypertension: The Whitehall II Study , 2007, Hypertension.

[56]  J. Broman,et al.  Sleep complaints predict coronary artery disease mortality in males: a 12‐year follow‐up study of a middle‐aged Swedish population , 2002, Journal of internal medicine.

[57]  Gregor Hasler,et al.  The association between short sleep duration and obesity in young adults: a 13-year prospective study. , 2004, Sleep.

[58]  Etsuji Suzuki,et al.  Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study. , 2009, Preventive medicine.

[59]  D. Kripke,et al.  Mortality associated with sleep duration and insomnia. , 2002, Archives of general psychiatry.

[60]  F. Rodríguez‐Artalejo,et al.  Sleep Duration and Mortality According to Health Status in Older Adults , 2010, Journal of the American Geriatrics Society.

[61]  O. Franco,et al.  Fragmentation and stability of circadian activity rhythms predict mortality: the Rotterdam study. , 2015, American journal of epidemiology.

[62]  Yong Zhao,et al.  Daytime napping and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. , 2015, Sleep medicine.

[63]  Terry Young,et al.  Increasing sleep duration for a healthier (and less obese?) population tomorrow. , 2008, Sleep.

[64]  R. Stewart,et al.  Association between sleep duration and all‐cause mortality in old age: 9‐year follow‐up of the Bambuí Cohort Study, Brazil , 2011, Journal of sleep research.

[65]  A. King,et al.  Habitual sleep durations and health in a 50-65 year old population. , 1994, Journal of clinical epidemiology.

[66]  C. Brayne,et al.  Daytime Napping and the Risk of All-Cause and Cause-Specific Mortality: A 13-Year Follow-up of a British Population , 2014, American journal of epidemiology.

[67]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[68]  N. Black,et al.  The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. , 1998, Journal of epidemiology and community health.

[69]  J. Antó,et al.  Relationship of health behaviours to five-year mortality in an elderly cohort. , 1995, Age and ageing.

[70]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[71]  A. Jette,et al.  Personal health practices and mortality among the elderly. , 1984, American journal of public health.

[72]  T. Su,et al.  A nine-year follow-up study of sleep patterns and mortality in community-dwelling older adults in Taiwan. , 2013, Sleep.

[73]  D. Kripke,et al.  Long sleep and mortality: rationale for sleep restriction. , 2004, Sleep medicine reviews.

[74]  S. Drummond,et al.  Who are the long sleepers? Towards an understanding of the mortality relationship. , 2007, Sleep medicine reviews.

[75]  Risto Sippola,et al.  Self-reported sleep duration, all-cause mortality, cardiovascular mortality and morbidity in Finland. , 2011, Sleep medicine.

[76]  F. Hu,et al.  Correlates of long sleep duration. , 2006, Sleep.

[77]  L P Knudsen,et al.  Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. , 1987, American journal of public health.

[78]  L. Gallicchio,et al.  Sleep duration and mortality: a systematic review and meta‐analysis , 2009, Journal of sleep research.

[79]  Atul Malhotra,et al.  A prospective study of sleep duration and coronary heart disease in women. , 2003, Archives of internal medicine.

[80]  S. Cummings,et al.  Self‐Reported Sleep and Nap Habits and Risk of Mortality in a Large Cohort of Older Women , 2009, Journal of the American Geriatrics Society.

[81]  Paul J Rathouz,et al.  Self-Reported and Measured Sleep Duration: How Similar Are They? , 2008, Epidemiology.