Sleep duration, body composition and mortality: a prospective study of 156,565 Mexican adults.

Sleep Duration and Mortality

Body Mass Index, Playing Position, Race, and the Cardiovascular Mortality of Retired Professional Football Players

The aim of the present study was to clarify the association between waist circumference and all-cause and cardiovascular disease (CVD) mortality risk in relatively lean Japanese subjects. A total of 3,554 men and 4,472 women who had no history of CVD were examined and their waist circumference measured at baseline. The subjects were aged ≥40 years and were obtained from 3 prospective cohort studies during 1988-1996. Hazard ratios for all-cause and CVD mortality were analyzed over a follow-up period of 14.7 years using a Cox proportional hazards model and penalized spline method, after adjustment for study cohort, age, smoking, alcohol drinking, hypertension, dyslipidemia, and diabetes. Compared with the lowest quintile, the highest quintile of waist circumference in men was associated with a linear reduction in all-cause mortality risk (multivariate-adjusted hazard ratio, 0.73; 95% confidence interval: 0.60-0.89; P for trend=0.001). CVD mortality risk was increased in men aged ≤65 years with a higher waist circumference. This relationship was U-shaped. Waist circumference was not associated with all-cause or CVD mortality risk in women. Waist circumference was associated inversely with increased risk of all-cause death in men, but not in women. Middle-aged men with a greater waist circumference potentially have an increased risk of CVD mortality.

A shorter sleep duration has been identified as a risk factor for cardiovascular diseases and increased mortality. It has been hypothesized that a short sleep duration may be linked to changes in ghrelin and leptin production, leading to an alteration of stress hormone production. Here, we conducted a systematic review and meta-analysis to investigate the potential relationship between a sleep duration and cardiovascular disease mortality. We conducted a comprehensive search of Ovid Medline In-Process and other non-indexed citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Scopus from database inception to March 2017. Observational studies were included if the studies reported hazard ratios or odds ratios of the associations between sleep durations (short and long) and cardiovascular disease mortality. Data were extracted by a reviewer and then reviewed by two separate reviewers. Conflicts were resolved through consensus. Using the DerSimonian and Laird random effects models, we calculated pooled hazard ratios and pooled odds ratios with 95% confidence intervals (CI). Subgroup analyses were performed to explore potential sources of heterogeneity. The quality of the included studies and publication bias were assessed. In total, our meta-analysis included 19 studies (31 cohorts) with a total of 816,995 individuals with 42,870 cardiovascular disease mortality cases. In pooled analyses, both short (risk ratio 1.19; 95% CI 1.13 to 1.26, P<0.001, I2=30.7, Pheterogeneity=0.034), and long (risk ratio 1.37; 95% CI 1.23 to 1.52, P<0.001, I2=79.75, Pheterogeneity<0.001) sleep durations were associated with a greater risk of cardiovascular disease mortality. Both short (<7 hours) and long sleep durations (>9 hours) can increase the risk of overall cardiovascular disease mortality, particularly in Asian populations and elderly individuals. Future epidemiological studies would ideally include objective sleep measurements, rather than self-report measures, and all potential confounders, such as genetic variants.

Leisure-Time Physical Activity Is Associated With Reduced Risks of Mortality in Adults With General or Abdominal Obesity in Mexico.

Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants

ObjectiveThe purpose of this study was to investigate the combined effect of self-reported sleep durations and physical activity (PA) on all cause and cardiovascular diseases mortality.MethodsTwenty-nine thousand fifty-eight participants (48.5% male, median age 49 years) from the National Health and Nutrition Examination Survey cycles 2007 to 2016 were included. We classified sleep duration into five categories (< 5.5 h/d,5.5–6.5 h/d,6.5–7.5 h/d,7.5–8.5 h/d, ≥ 8.5 h/d) and classified PA levels into three groups (high, medium and low). PA information and self-reported sleep duration were obtained by questionnaire. We derived 15 PA–sleep duration combinations. The primary endpoint was all-cause mortality, and the major secondary endpoint was cardiovascular diseases (CVD) mortality as of December 2022.ResultsMedian follow-up was 91 months. Compared with standard sleep duration (6.5–7.5 h/d), both shorter (< 5.5 h/d) and longer (≥ 8.5 h/d) sleep durations increased risks of all-cause mortality and CVD mortality in low PA. The deleterious associations of sleep duration with all outcomes was amplified by lower PA. There was no significant reduction in CVD mortality risk associated with increased physical activity during short sleep duration (< 6.5 h/d). During standard sleep, low PA significantly increased CVD mortality risk. At medium physical activity, both short and long sleep increased cardiovascular mortality. It was also found that sleep duration (≥ 8.5 h/d) was associated with a increase in all-cause and cardiovascular mortality at both low and high PA levels.ConclusionsThis study suggested that low PA significantly increased the association of self-reported long and short sleep durations with all-cause and CVD mortality. All cause mortality appears to benefit from medium physical activity, while medium PA did not. Physical activity did not significantly reduce the risk of CVD mortality.

BackgroundCalcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated.MethodsThis prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999–2018). All-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality were obtained through linkage to the National Death Index. Survey-weighted multivariate Cox regression was performed to compute hazard ratios (HRs) and 95% confidential intervals (CIs) for the associations of calcium levels with risks of mortality. Restricted cubic spline analyses were performed to examine the non-linear association of calcium levels with all-cause and disease-specific mortality.ResultsA total of 51,042 individuals were included in the current study. During an average of 9.7 years of follow-up, 7,592 all-cause deaths were identified, including 2,391 CVD deaths and 1,641 cancer deaths. Compared with participants in the first quartile (Q1) of serum calcium level [≤2.299 mmol/L], the risk of all-cause mortality was lower for participants in the second quartile (Q2) [2.300–2.349 mmol/L], the third quartile (Q3) [2.350–2.424 mmol/L] and the fourth quartile (Q4) [≥2.425 mmol/L] with multivariable-adjusted HRs of 0.81 (95% CI, 0.74–0.88), 0.78 (95% CI, 0.71–0.86), and 0.80 (95% CI, 0.73, 0.88). Similar associations were observed for CVD mortality, with HRs of 0.82 (95% CI, 0.71–0.95), 0.87 (95% CI, 0.74–1.02), and 0.83 (95% CI, 0.72, 0.97) in Q2–Q4 quartile. Furthermore, the L-shaped non-linear associations were detected for serum calcium with the risk of all-cause mortality. Below the median of 2.350 mmol/L, per 0.1 mmol/L higher serum calcium was associated with a 24% lower risk of all-cause mortality (HR: 0.76, 95% CI, 0.70–0.83), however, no significant changes were observed when serum calcium was above the median. Similar L-shaped associations were detected for serum calcium with the risk of CVD mortality with a 25% reduction in the risk of CVD death per 0.1 mmol/L higher serum calcium below the median (HR: 0.75, 95% CI, 0.65–0.86).ConclusionL-shaped associations of serum calcium with all-cause and CVD mortality were observed in US adults, and hypocalcemia was associated with a higher risk of all-cause mortality and CVD mortality.

Cohort studies about the sleep duration on the risk of death among Chinese older adults are still lacking. The aim of this study was to examine whether extremely long or short sleep duration was associated with mortality in Chinese adults aged 65 years or older. We included participants aged 65 years or older in 2011 at baseline in 23 provinces from the Chinese Longitudinal Healthy Longevity Survey who were followed up in 2014/2018 in China. Sleep duration was categorized as short sleep duration (< 7 hours) and long sleep duration (> 8 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and mortality. Among 9578 participants, short sleep duration was associated with an 11% higher risk of death (adjusted hazard ratio [aHR]: 1.11; 95% confidence interval [CI]: 1.02-1.20) and long sleep duration was associated with a 24% higher risk of death (aHR: 1.24; 95% CI: 1.15-1.34), after adjustment for all covariates. There was a U-shaped association between sleep duration and all-cause mortality (nonlinear, P < .0001). Stratified analyses showed that the risk was higher among older people who smoked and with a higher level of education both for short and long sleepers than for those who never smoked and were illiterate (P value for interaction < .05). There was a U-shaped association between sleep duration and all-cause mortality in Chinese older adults, especially in more educated individuals and smokers. Du M, Liu M, Liu J. The association between sleep duration and the risk of mortality in the Chinese older adults: a national cohort study. J Clin Sleep Med. 2021;17(9):1821-1829.

BackgroundSleep duration and physical activity (PA) are critical factors influencing mortality risk. However, the interaction between sleep duration and PA with mortality risk among cancer survivors has not been well explored.MethodsThis cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007–2018. Multivariable Cox regression analysis and restricted cubic splines were employed to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the association of sleep duration and PA with mortality risk in cancer survivors. Multiplicative and additive interaction terms were constructed to assess interaction effects.ResultsThe study included a total of 2,528 adult cancer survivors (aged≥20 years). Sleep duration exhibited a U-shaped association with all-cause and cancer-specific mortality, while demonstrating an inverted L-shaped association with cardiovascular disease (CVD) mortality. Compared to physically inactive participants, those with adequate PA had lower risks of all-cause mortality (HR = 0.542, 95% CI: 0.540–0.543), cancer mortality (HR = 0.486, 95% CI: 0.484–0.488), and CVD mortality (HR = 0.759, 95% CI: 0.755–0.763) among cancer survivors. A significant additive interaction was found between extreme sleep duration and PA on all-cause mortality risk among cancer survivors (long sleep duration: relative excess risk due to interaction (RERI) = 1.514, 95% CI: 1.504–1.525; short sleep duration: RERI = 0.725, 95% CI: 0.713–0.737).ConclusionExtreme sleep duration and lack of PA were associated with mortality risk in cancer survivors independently and jointly. Maintain appropriate sleep duration and doing regular PA may synergistically improve cancer survival among cancer survivors.

Background/Introduction Evidence regarding the potential health effects of sleep characteristics among individuals with type 2 diabetes (T2D) is limited. Purpose We aimed to examine sleep characteristics in relation to subsequent risk of cardiovascular disease (CVD), including coronary heart disease (CHD), and stroke, and all-cause and cause-specific mortality among individuals with T2D. Methods We prospectively followed 21,902 men and women with T2D at baseline or diagnosed during follow-up (Nurses' Health Study: 1986-2018, Health Professionals Follow-Up Study: 1986-2018). Sleep characteristics, including sleep duration, snoring, sleep apnea, and sleep quality, were repeatedly assessed using self-reported questionnaires at baseline and follow-up. Associations of sleep characteristics with CVD risk and mortality were assessed using Cox proportional hazards models with adjustments for demographic, dietary and lifestyle factors, and medical history. Results During 170,355 and 196,458 person-years of follow-up in participants with T2D, there were 2,486 incident CVD events and 3,922 deaths, respectively. Compared with sleeping for 7-8 h/day, the multivariable-adjusted hazard ratios (HRs) of sleeping for ≤5 h/day were 1.21 (1.02, 1.45) for CVD incidence, 1.24 (1.20, 1.51) for CHD incidence, 1.40 (1.24, 1.58) for total mortality, 1.52 (1.20, 1.92) for CVD mortality, and 1.27 (1.01, 1.61) for other non-CVD and non-cancer mortality, while the HRs of ≥10 h/day were 1.42 (1.21, 1.66) for total mortality, and 1.63 (1.20, 2.10) for other non-CVD and non-cancer mortality. Furthermore, compared with participants without habitual snoring, those with habitual snoring had a 21%, 24%, 18%, and 33% higher risk for CVD incidence, CHD incidence, CVD mortality, and total mortality, respectively. Compared with participants without diagnosed sleep apnea, those with sleep apnea had a 27%-58% higher risk for CVD incidence, CVD mortality, and total mortality. In addition, lower habitual sleep quality, including sleep difficulties and restless sleep, was associated with a substantially higher risk of CVD, CHD, or CVD mortality. No associations were observed between sleep characteristics with risk of stroke and cancer mortality in individuals with T2D. Conclusions Short and long sleep durations as well as habitual snoring, sleep apnea, and lower sleep quality were independently associated with higher risks of CVD incidence and mortality, particularly CVD mortality in individuals with T2D.

The impact of dietary fat intake on long-term human health has attracted substantial research interest, and the health effects of diverse dietary fats depend on available food sources. Yet there is a paucity of data elucidating the links between dietary fats from specific food sources and health. To study associations of dietary plant and animal fat intake with overall mortality and cardiovascular disease (CVD) mortality. This large prospective cohort study took place in the US from 1995 to 2019. The analysis of men and women was conducted in the National Institutes of Health-AARP Diet and Health Study. Data were analyzed from February 2021 to May 2024. Specific food sources of dietary fats and other dietary information were collected at baseline, using a validated food frequency questionnaire. Hazard ratios (HRs) and 24-year adjusted absolute risk differences (ARDs) were estimated using multivariable-adjusted Cox proportional hazards regression. The analysis included 407 531 men and women (231 881 [56.9%] male; the mean [SD] age of the cohort was 61.2 [5.4] years). During 8 107 711 person-years of follow-up, 185 111 deaths were ascertained, including 58 526 CVD deaths. After multivariable adjustment (including adjustment for the relevant food sources), a greater intake of plant fat (HRs, 0.91 and 0.86; adjusted ARDs, -1.10% and -0.73%; P for trend < .001), particularly fat from grains (HRs, 0.92 and 0.86; adjusted ARDs, -0.98% and -0.71%; P for trend < .001) and vegetable oils (HRs, 0.88 and 0.85; adjusted ARDs, -1.40% and -0.71%; P for trend < .001), was associated with a lower risk for overall and CVD mortality, respectively, comparing the highest to the lowest quintile. In contrast, a higher intake of total animal fat (HRs, 1.16 and 1.14; adjusted ARDs, 0.78% and 0.32%; P for trend < .001), dairy fat (HRs, 1.09 and 1.07; adjusted ARDs, 0.86% and 0.24%; P for trend < .001), or egg fat (HRs, 1.13 and 1.16; adjusted ARDs, 1.40% and 0.82%; P for trend < .001) was associated with an increased risk for mortality for overall and CVD mortality, respectively, comparing the highest to the lowest quintile. Replacement of 5% energy from animal fat with 5% energy from plant fat, particularly fat from grains or vegetable oils, was associated with a lower risk for mortality: 4% to 24% reduction in overall mortality, and 5% to 30% reduction in CVD mortality. The findings from this prospective cohort study demonstrated consistent but small inverse associations between a higher intake of plant fat, particularly fat from grains and vegetable oils, and a lower risk for both overall and CVD mortality. A diet with a high intake of animal-based fat, including fat from dairy foods and eggs, was also shown to be associated with an elevated risk for both overall and CVD mortality.

Previous studies have yielded varying conclusions about the relationship between sleep duration and cardiovascular disease (CVD) mortality across different populations. Therefore, it is crucial to examine this relationship specifically within the U.S. chest pain population. This study aims to evaluate the association between sleep duration and cardiovascular disease (CVD) mortality among a U.S. population presenting with chest pain. This prospective cohort study included 70,190 participants from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). Participants who reported ever experiencing chest pain or discomfort, with severe chest pain lasting more than half an hour, were categorized as having chest pain. Mortality data were obtained by linking the cohort database with the National Death Index as of December 31, 2018. Cardiovascular disease (CVD) mortality was classified according to the 10th revision of the International Classification of Diseases (ICD-10) and included the following codes: I00-I09 (acute rheumatic fever, chronic rheumatic heart disease), I11 (hypertensive heart disease), I13 (hypertensive heart and kidney disease), I20-I25 (ischemic heart disease), I26-I28 (pulmonary embolism and other acute pulmonary heart disease), I29, I30-I51 (other forms of heart disease), and I60-I69 (cerebrovascular disease). Data were analyzed between June and July 2024. Among 2,952 US patients with chest pain, the mean age was 57.92 ± 11.63 years, with 1,424 males (49.01%). A total of 1,439 participants (48.74%) reported sleeping ≤ 6 h, while 376 participants (12.73%) reported sleeping > 9 h. After a median follow-up of 85.92 months, there were 164 CVD-related deaths. Compared with patients who had normal sleep duration, those with insufficient sleep had an adjusted hazard ratio (HR) of 1.99 (95% confidence interval [CI], 1.36–2.89; P < 0.001) for CVD mortality, while those with excessive sleep had an adjusted HR of 2.39 (95% CI, 1.37–4.16; P = 0.002). Sensitivity analyses, which excluded patients who died within 2 years of follow-up (sleep duration ≤ 6 h: HR, 1.94; 95% CI, 1.31–2.87; sleep duration > 9 h: HR, 2.40; 95% CI, 1.29–4.44) or those with a baseline history of cancer (sleep duration ≤ 6 h: HR, 1.98; 95% CI, 1.27–3.07; sleep duration > 9 h: HR, 2.86; 95% CI, 1.51–5.41), demonstrated that the association between sleep duration and CVD mortality remained robust. Further exclusion of patients with incomplete data (sleep duration ≤ 6 h: HR, 2.23; 95% CI, 1.51–3.30; sleep duration > 9 h: HR, 2.47; 95% CI, 1.35–4.53) also supported these findings, indicating a consistent relationship between sleep duration and CVD mortality among US chest pain patients. Both longer and shorter sleep durations are associated with increased cardiovascular disease mortality in the U.S. chest pain population.

Introduction: Physical activity and sleep are closely related behaviors with suggested synergistic influence on cardiovascular health. Physical activity potentially modifies associations between sleep and mortality. Our aim was to study the interrelationships between sleep, leisure-time physical activity (LTPA), a history of sports, and mortality. Methods: A prospective cohort of former elite male athletes (n = 1,028), and age- and region-matched nonathlete men (n = 610) completed a health questionnaire in 1985. Their mortality was followed up until December 31, 2011. Analyses included Cox proportional hazards models with sleep duration and sleep quality as main predictors of all-cause and cardiovascular disease (CVD) mortality. Results: Sleep duration or sleep quality were not independently associated with mortality after controlling for socioeconomic and lifestyle factors. The interaction between sleep duration and LTPA was significant, with higher risk of all-cause and CVD mortality if sleeping 6 hours or less and not achieving 450 metabolic equivalent minutes LTPA weekly, as compared with sleeping 6.5–8.5 hours and achieving 450 metabolic equivalent minutes of LTPA. Also, the relative excess risk due to interaction between short sleep and low LTPA was significant for CVD mortality. Discussion: Significant interactions between sleep duration and LTPA with regard to mortality were observed. In particular, short sleep and low LTPA jointly predicted all-cause and CVD mortality irrespective of a history of sports. Findings suggest important synergistic associations of short sleep and low LTPA with CVD mortality risk.

To evaluate the relations between sleep characteristics and cardiovascular risk factors and napping behavior, and to assess whether daytime napping leads to subsequent better or worse sleep. The sample consisted of 224 (African American, Caucasian, and Asian) middle-aged men and women. Sleep measures included nine nights of actigraphy and sleep diaries, sleep questionnaires, and one night of polysomnography to measure sleep disordered breathing. More frequent napping was associated with shorter nighttime sleep duration averaged across the nine nights of actigraphy (especially among African Americans), more daytime sleepiness, more pain and fatigue by diary, and increased body mass index and waist circumference. Shorter nighttime sleep duration was associated with taking a nap during the next day and taking a nap was associated with less efficient sleep the next night. Napping in middle-aged men and women is associated with overall less nighttime sleep in African Americans and lower sleep efficiency as measured by actigraphy, and increased BMI and central adiposity. These findings point to the importance of measuring of napping in understanding associations of sleep with cardiovascular risk.