Abstract
BackgroundIncreasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer. However, the relationship with mortality is not clear, particularly in non-European populations. In this study, we investigated the association between sleep duration and mortality in a population-based prospective cohort of Korean adults.MethodsThis analysis included 34,264 participants (14,704 men and 19,560 women) of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2013 who agreed to mortality follow-up through December 31, 2016. Sleep duration was self-reported at baseline and was categorized into four groups: ≤4, 5–6, 7–8, and ≥ 9 h/day. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations with mortality (all-cause as well as CVD- and cancer-specific), adjusting for potential confounders.ResultsDuring up to 9.5 years of follow-up, we identified a total of 1028 deaths. We observed the lowest mortality at 5–6 h/day sleep. Compared with 7–8 h/day of sleep, short (≤4 h/day) and long (≥9 h/day) sleep were associated with a 1.05-fold (95% CI = 0.79–1.39) and 1.47-fold (95% CI = 1.15–1.87) higher all-cause mortality, respectively. After additional adjustment for self-rated health, the positive association with short sleep disappeared (HR = 0.99, 95% CI = 0.75–1.32) and the association with long sleep was slightly attenuated (HR = 1.38, 95% CI = 1.08–1.76). Long sleep was also nonsignificantly positively associated with both cancer-mortality (HR = 1.30, 95% CI = 0.86–1.98) and CVD-mortality (HR = 1.27, 95% CI = 0.73–2.21). There was no statistically significant evidence for nonlinearity in the relationships between sleep duration and mortality (all-cause as well as CVD- and cancer-specific). Effect modification by age, sex, education, and occupation were not statistically significant.ConclusionsOur findings suggest that long sleep duration is associated with an increased all-cause mortality in Korean adults.
Highlights
Increasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer
We examined the relationship between sleep duration and mortality in a population-based prospective cohort of Korean men and women
During up to 9.5 years of follow up, 34, 264 participants contributed a total of 181,440 personyears and 1028 total deaths (216 CVD deaths and 352 cancer deaths)
Summary
Increasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer. Studies have shown that poor quality and quantity of sleep may have negative health effects Both short and long sleep are associated with increased risks of type 2 diabetes [7], cardiovascular disease (CVD) [8], and certain types of cancer [9, 10]. In particular, has been associated with alteration in glucose metabolism, upregulation of appetite [6], and increased levels of Creactive protein (a pro-inflammatory marker) [11] and carotid intima-media thickness (atherosclerosis indicators) [12] Through these relationships with intermediate endpoints and biomarkers, sleep duration is likely to be associated with mortality. To identify the most susceptible populations, we examined the effect modification by demographic and socioeconomic factors
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