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VOLUME 31, ISSUE 08


Sleep Duration Associated with Mortality in Elderly, but not Middle-Aged, Adults in a Large US Sample

James E. Gangwisch, PhD1; Steven B. Heymsfield, MD2; Bernadette Boden-Albala, DrPH3; Ruud M. Buijs, PhD4,5; Felix Kreier, MD, PhD4; Mark G. Opler, PhD1,9; Thomas G. Pickering, MD, DPhil6; Andrew G. Rundle, DrPH7; Gary K. Zammit, PhD8; Dolores Malaspina, MD9

1Columbia University College of Physicians and Surgeons, Department of Psychiatry, Division of Medical Genetics, New York, NY; 2Merck Research Laboratories, Rahway, NJ; 3Columbia University College of Physicians and Surgeons, Department of Neurology and Department of Sociomedical Sciences, New York, NY; 4Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; 5Inst. Invest. Biomedicus, UNAM, DF, Mexico; 6Columbia University College of Physicians and Surgeons, Department of Medicine, Behavioral Cardiovascular Health & Hypertension Program, New York, NY; 7Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY; 8Columbia University College of Physicians and Surgeons, Department of Psychiatry and Clinilabs Sleep Disorders Institute, New York, NY; 9New York University School of Medicine, Department of Psychiatry, New York, NY



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Study Objectives:

To explore age differences in the relationship between sleep duration and mortality by conducting analyses stratified by age. Both short and long sleep durations have been found to be associated with mortality. Short sleep duration is associated with negative health outcomes, but there is little evidence that long sleep duration has adverse health effects. No epidemiologic studies have published multivariate analyses stratified by age, even though life expectancy is 75 years and the majority of deaths occur in the elderly.

Design:

Multivariate longitudinal analyses of the first National Health and Nutrition Examination Survey using Cox proportional hazards models.

Setting:

Probability sample (n = 9789) of the civilian noninstitutionalized population of the United States between 1982 and 1992.

Participants:

Subjects aged 32 to 86 years.

Measurements and Results:

In multivariate analyses controlling for many covariates, no relationship was found in middle-aged subjects between short sleep of 5 hours or less and mortality (hazards ratio [HR] = 0.67, 95% confidence interval [CI] 0.43-1.05) or long sleep of 9 hours or more and mortality (HR = 1.04, 95% CI 0.66-1.65). A U-shaped relationship was found only in elderly subjects, with both short sleep duration (HR = 1.27, 95% CI 1.06-1.53) and long sleep duration (HR = 1.36, 95% CI 1.15-1.60) having significantly higher HRs.

Conclusions:

The relationship between sleep duration and mortality is largely influenced by deaths in elderly subjects and by the measurement of sleep durations closely before death. Long sleep duration is unlikely to contribute toward mortality but, rather, is a consequence of medical conditions and age-related sleep changes.
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