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

Long nighttime sleep duration and risk of renal tubular damage: evidence from rural China and a Mendelian randomization analysis

OBJECTIVE

Renal tubular damage, a pivotal pathological feature of chronic kidney disease (CKD), predicts disease progression. While extreme nighttime sleep duration is linked to glomerular injury by prior studies, its impact on tubular damage remains unclear. Given that 7-9 h of sleep per night is widely recommended for maintaining overall health, this study aimed to assess whether long nighttime sleep duration is associated with renal tubular damage using both observational and genetic evidence.

METHODS

We analyzed 2,683 adults in rural China to assess the link between nighttime sleep duration and renal tubular damage (measured by retinol-binding protein and β2-microglobulin). Mendelian randomization (MR) analysis was performed to assess the causal relationship between prolonged nighttime sleep duration and elevated kidney injury molecule-1 (KIM-1) levels.

RESULTS

Multivariate logistic regression indicated that sleeping more than 9 h per night was associated with a 1.38-fold increased risk of renal tubular damage (95% CI: 1.11-1.71) compared to 7-9 h of sleep, with particularly pronounced effects observed in elderly individuals and women. MR analysis further supported a causal relationship between genetically predicted long nighttime sleep duration and elevated KIM-1 levels (β: 0.994, 95% CI: 0.282-1.707), suggesting a genetic predisposition linking prolonged sleep duration with renal tubular damage.

CONCLUSIONS

Our findings provide observational and genetic evidence linking prolonged nighttime sleep to increased renal tubular damage risk. Given that 7-9 h of sleep per night is the widely accepted recommendation for maintaining overall health, our results emphasize the potential risks of excessive sleep duration exceeding 9 h.

Sleep Duration and All-Cause Mortality

Sleep, as a behavioural lifestyle factor, has so far received limited attention in medical risk assessment. Nonetheless, behavioural lifestyle factors can offer valuable insights into the health status of applicants. Health trackers enable the continuous recording of lifestyle factors such as physical activity and sleep patterns. Currently, there is a dearth of experience in incorporating such data when calculating premiums, as well as in understanding the correlation between continuously recorded lifestyle factors and mortality/morbidity. Hence, the literature was reviewed to examine the association between sleep duration and all-cause mortality to derive dose-response rates. Relative risks were calculated by pooling data from 10 selected studies comprising over 3 million study participants. The findings suggest that both short (<6 hours) and long sleep duration (>9 hours) are associated with an increased risk of all-cause mortality.

Effects of Sleep Deprivation on Physical and Mental Health Outcomes: An Umbrella Review

The increasing prevalence of reduced habitual sleep duration presents a significant public health challenge, impacting cardiovascular health, metabolic function and mental well-being. This umbrella review analyses findings from systematic reviews and meta-analyses to comprehensively evaluate the consequences of sleep deprivation (SD) on health. The databases searched included PubMed, Scopus, and Web of Science. Inclusion criteria focused on adult populations with SD and systematic reviews/meta-analyses. Twenty-nine articles were included in the final synthesis, encompassing a variety of health outcomes. Key findings highlight a U-shaped relationship between sleep duration and all-cause mortality, with both short (<7 h) sleep durations associated with increased risks. SD was a significant risk factor for cardiovascular diseases such as hypertension, stroke and coronary heart disease. Alongside heightened risks of metabolic disorders, like obesity and type 2 diabetes. Moreover, SD contributed to elevated anxiety levels, impaired emotional regulation. As well as increased susceptibility to stress and depressive symptoms. This synthesis underscores the critical importance of maintaining recommended sleep duration (typically 7-9 h for adults) to mitigate these health risks effectively. The findings support the need for robust public health interventions aimed at promoting healthy sleep habits to reduce the burden of associated health conditions and enhance overall well-being.

Bidirectional association between physical activity and sleep in healthy Japanese super-seniors: the Japan Healthy Aging Study (J-HAS)

To address the challenges of an ageing population, it is important to promote health by identifying factors for healthy ageing. The aim of this study was to investigate the bidirectional association between physical activity (PA) and sleep in healthy Japanese super-seniors over the age of 80. For approximately 1 year, 124 participants wore wearable devices and answered daily lifestyle questionnaires. PA was defined as daily step count and minutes in light activity. Sleep was measured using 24-h total sleep time (TST) and time in bed (TIB). Associations were analysed bidirectionally using multilevel mixed-effects linear regression models. Fully adjusted models revealed significant and inverse associations between sleep and PA from the same 24-h period. Similarly, the results were significant and inverse with PA from the day before as exposure and the next 24-h sleep measures as outcome. The between-individual associations between sleep measures and PA from the subsequent day were significant and inverse. However, there was a positive within-individual association between TST and step count from the subsequent day. The study suggests that associations between PA and sleep in super-seniors differ from patterns previously described in younger adults. Very old individuals with increasing 24-h total sleep time may compensate for a lower step count on one day by increasing their step count the following day.

Impact of age on sleep duration and health outcomes: Evidence from four large cohort studies

BACKGROUND

Sleep duration (SD) is a critical determinant of health, with both short and long SD associated with increased risks of morbidity and mortality. However, distinct ages may exhibit unequal sleep needs. Few studies have addressed the modulation of age on SD associated all-cause mortality (AM). This study aimed to investigate age- and gender-specific associations between SD and AM.

METHODS

Four national cohort studies were conducted: National Health and Nutrition Examination Survey (NHANES), Survey of Health, Ageing and Retirement in Europe (SHARE), Chinese Longitudinal Healthy Longevity Survey (CLHLS), and China Health and Retirement Longitudinal Study (CHARLS). Data pre-processing such as integration, weighting and interpolation was conducted following cohort-specific user manuals. Restricted cubic spline (RCS) was used to test the nonlinear relationship. Kaplan-Meier and Cox regression survival analysis were used to evaluate the association between SD and AM. The moderation of mortality by SD was subsequently investigated in adult, middle-age, elderly and longevity.

RESULTS

RCS analysis showed a nonlinear correlation between SD and AM in the four cohorts(P < 0.001). Survival analysis reveals 6-8 h to be the optimal SD. Subgroup analyses showed a higher risk in adults with ≤5 h than ≥9 h (HR: 2.95 [1.90-4.59] vs 1.83 [1.08-3.12]), and a similar risk in middle age (HR: 2.42 [1.76-3.32] vs 2.44 [1.64-3.61]). In contrast, four datasets suggest a higher risk of the elderly being affected by long SD. Adults (HR = 1.82 [1.14-2.92], P = 0.012) and middle age (NHANES: HR = 1.50 [1.04-2.16], P = 0.029; SHARE: HR = 3.04 [1.10-8.41], P = 0.032) significantly increased the risk of short sleep compared to elderly.

CONCLUSIONS

SD associated mortality risk varies with age. Young adults should avoid poor sleep, while elderly should avoid sleeping too much.

Sleep health: an unappreciated key player in colorectal cancer

Colorectal cancer (CRC) poses a significant threat to human life and health. Global cancer prevalence data in 2022 indicated that the number of new cases of CRC was about 1.92 million and the deaths were around 900,000. A variety of risk factors, including genes and environment, can induce the occurrence of CRC. Previous studies have focused on the impact of dietary patterns on the development of CRC and have ignored sleep factors. Sleep deprivation is a common problem as people's work pressure increases. Sleep disorders can lead to metabolic and immune system dysregulation in people, contributing to the development and progression of many tumors. At present, there are few reports on the relationship between sleep disorders and tumors. Therefore, the purpose of this paper is to summarize and interpret the relationship between various sleep disorders and the onset and progression of CRC. This review is the first to investigate the possible mechanisms of sleep leading to CRC from the perspectives of metabolic reprogramming, intestinal microbiota disorders, and the release of inflammatory factors. In conclusion, this study highlights the rational sleep pattern and duration, which can help inhibit the occurrence of CRC.

Association of poor sleep quality with clinical variables in nontuberculous mycobacterial pulmonary disease

BACKGROUND

The high prevalence of poor sleep quality in patients with chronic respiratory diseases makes it an important clinical topic. However, the prevalence and characteristics of poor sleep quality in those with nontuberculous mycobacterial pulmonary disease and its association with clinical variables remain unclear.

METHODS

This retrospective study involved patients with nontuberculous mycobacterial pulmonary disease between June 2017 and May 2022. The prevalence of poor sleep quality was measured by the Pittsburgh Sleep Quality Index was used to and its association with clinical variables including age, sex, laboratory data, pulmonary function, respiratory symptoms, mental health, health-related quality of life, and physical function was assessed.

RESULTS

The median age of 233 participants was 65 years, with poor sleep quality present in 123 patients (52.8%) who were older, female, and unemployed with dyspnea, anxiety symptoms, low health-related quality of life, and low exercise capacity. Many reported that they "cannot get to sleep within 30 min," "wake up in the middle of the night or early morning," "have to get up to use the bathroom," "cannot breathe comfortably," or "cough or snore loudly." Multivariate logistic regression analysis indicated a significant association between poor sleep quality, female sex, and low health-related quality of life.

CONCLUSION

Our results suggested that for the patients in this study, a multidisciplinary management that considers poor sleep quality is required and assessment of sleep quality as a screening is needed.

Sleep Duration Polygenic Risk and Phenotype: Associations with Biomarkers of Accelerated Aging in the Baltimore Longitudinal Study of Aging

We sought to explore whether genetic risk for, and self-reported, short sleep are associated with biological aging and whether age and sex moderate these associations. Participants were a subset of individuals from the Baltimore Longitudinal Study of Aging who had complete data on self-reported sleep (n = 567) or genotype (n = 367). Outcomes included: Intrinsic Horvath age, Hannum age, PhenoAge, GrimAge, and DNAm-based estimates of plasminogen activator inhibitor-1 (PAI-1) and granulocyte count. Results demonstrated that polygenic risk for short sleep was positively associated with granulocyte count; compared to those reporting <6 hr sleep, those reporting >7 hr demonstrated faster PhenoAge and GrimAge acceleration and higher estimated PAI-1. Polygenic risk for short sleep and self-reported sleep duration interacted with age and sex in their associations with some of the outcomes. Findings highlight that polygenic risk for short sleep and self-reported long sleep is associated with variation in the epigenetic landscape and subsequently aging.

Quadratic associations between sleep and multimorbidity among the older population in China: Evidence from CLHLS 2011 to 2018

OBJECTIVES

To investigate the relationship between sleep and multimorbidity, including the associations between sleep duration and multimorbidity, as well as between sleep quality and multimorbidity.

METHODS

Using data from the three latest waves of the Chinese Longitudinal Health Longevity Study (2011, 2014, and 2018), a binary panel regression was conducted to investigate the quadratic relationship between sleep duration and multimorbidity. Subsequently, quadratic fitting and robustness analysis were further utilized to strengthen the verification of this relationship.

RESULTS

From 2011 to 2018, the prevalence of multimorbidity increased, with average rates of 0.309, 0.345, and 0.367, respectively. Meanwhile, sleep duration was 7.45, 7.34, and 7.39, but sleep quality showed a declining trend with scores of 3.70, 3.63, and 3.47, respectively. Furthermore, the regression analysis revealed that the odds ratios (OR) for the relationship between sleep duration and multimorbidity, and between the square of sleep duration and multimorbidity were 0.734, with 95 % CI = [0.6272, 0.8582] and 1.016, with 95 % CI = [1.0058, 1.0262], respectively. From the quadratic relationship, it is evident that the multimorbidity among older Chinese adults initially decreases and then increases with long sleep durations.

CONCLUSIONS

The multimorbidity was significantly different among individuals with different sleep duration. A U-shaped relationship was observed between sleep duration and multimorbidity, whereby both short and excessive sleep durations were associated with higher rates of multimorbidity. Additionally, a negative association was found between sleep quality and multimorbidity, indicating that higher sleep quality was linked to lower rates of multimorbidity.

The Relationship Between Psychological Distress and Sleep Quality Among Middle-Aged and Older Adults: The Moderating Effect of Gender

BACKGROUND

Symptoms of psychological distress such as depression and anxiety as well as gender are known to be associated with sleep quality in middle-aged and older adults. However, little is known about the effect on sleep quality of interactions among these factors.

PURPOSE

This study was developed to investigate the moderating effect of gender on the relationship between psychological distress and sleep quality in middle-aged and older adults.

METHODS

A cross-sectional design, secondary data analysis of data on 5,590 individuals aged ≥ 45 years from the Taiwan Biobank database (2009-2018) was used. In this database, psychological distress was assessed using the Patient Health Questionnaire-4, and sleep quality was assessed using a self-report, one-question scale. Demographic data and health-related variables were evaluated as potential confounding factors. A hierarchical regression was conducted to examine the moderating effect of gender on the relationship between psychological distress and sleep quality after adjusting for potential confounders.

RESULTS

The participants with severe psychological distress were found to have a lower mean quality of sleep than those without ( p < .01), and males returned a better mean quality of sleep score than females ( p < .01). Moreover, a significant interaction effect between psychological distress and gender on sleep quality score was found ( b = 0.123, SE = 0.022, p = .03). In terms of participants with severe psychological distress, males reported significantly poorer sleep quality than females.

CONCLUSIONS

The findings provide evidence that gender moderates the relationship between sleep quality and psychological distress. Also, in terms of individuals with severe psychological distress, males reported worse sleep quality than women, indicating psychological distress impacts sleep quality in men more than women. Nurses should be aware of these findings when working with clinical professionals to tailor gender-specific education interventions to improve sleep quality and psychological health.

Sleep quality, daytime sleepiness, and risk of falling: results from an exploratory cross-sectional study

PURPOSE

There is growing recognition of the importance of managing sleep disorders in the elderly, particularly given their complexity within a multidimensional framework. The aim of the present study is to investigate whether sleep quality and daytime sleepiness are associated with the risk of falls in older adults.

METHODS

This study included patients aged 75 years or older who were consecutively evaluated at the Geriatric Service, University Hospital of Monserrato, Cagliari, Italy. Participants underwent geriatric assessment, including sleep analysis using the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), as well as an assessment of risk of falls with Performance Oriented Mobility Assessment (POMA).

RESULTS

The study included 206 subjects, of whom 70.4% were women, with a median age of 83 years. A total of 141 participants (68.4%) had poor sleep quality, and 43 (20.9%) had excessive daytime sleepiness (EDS). Among people at high risk of falls, 85 participants had bad sleep quality, and 24 a satisfying one (χ2: 8.23, p = 0.0029); additionally, 77 participants did not exhibit daytime sleepiness, while 32 did (χ2: 9.03, p = 0.0027). To further explore these results, we designed logistic regressions, considering dichotomized PSQI and dichotomized ESS as independent variables, and dichotomized POMA as the dependent variable, and finally adjusted them for confounders. The adjusted model for PSQI yielded OR: 2.04 (95%CI 1.02-4.10), and the adjusted model for ESS yielded OR: 2.56 (95%CI 1.17-5.91).

CONCLUSIONS

Our study demonstrated that an increased estimated risk of falling is associated with poor sleep quality and EDS in older adults, independently of the confounders.

Non-linear association of sleep duration with osteoarthritis among U.S. middle-aged and older adults

BACKGROUND

The duration of sleep is linked to a range of disorders. Osteoarthritis (OA) stands as one of the most prevalent forms of arthritis and serves as a leading cause of disability. The correlation between the duration of sleep and OA remains ambiguous. Research indicates that waist circumference correlates with sleep duration and OA, respectively. This study aimed to investigate the association of sleep duration with OA and the mediated effect of waist circumference.

METHODS

The study sample comprised adults who were participants in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. Insufficient sleep is characterized by a duration of less than seven hours, whereas 7-8 h is considered appropriate, and 9 h or more is categorized as a long sleep duration. Three models were employed in this study. Model 1 was not adjusted for any covariates, while Model 2 was adjusted for sex, age, and race. Model 3 has been adjusted to account for all covariates. Utilizing multivariable logistic regression, subgroup analysis, interaction tests and smoothing curve fitting, the correlation between sleep duration and OA was explored. The mediating effect of waist circumference on the association between sleep duration and OA was investigated through mediation analysis.

RESULTS

In this study, 9380 did not have OA, while 2424 were diagnosed with the ailment. After multivariable adjustment, the odds ratios (OR) for OA were 1.19 (95% CI 1.06, 1.34; P = 0.0026) for people with insufficient sleep duration and 1.18 (95% CI 1.03, 1.35 P = 0.0142) for participants with long sleep duration. Sleep duration and the incidence of OA were found to be related in a U-shaped manner. Additionally, 12.1% of the correlation between sleep duration and OA appeared to be mediated by waist circumference.

CONCLUSIONS

Increased OA was found to be correlated in a U-shaped manner with sleep duration in the middle-aged and elderly cohorts. Both insufficient and long sleep duration contribute to an elevated risk of developing OA. A potential mediating factor in the association between OA and sleep duration is waist circumference. Focus on sleep health and visceral obesity in middle-aged and older adults is necessary.

To nap or not? Evidence from a meta-analysis of cohort studies of habitual daytime napping and health outcomes

Habitual daytime napping is a common behavioral and lifestyle practice in particular countries and is often considered part of a normal daily routine. However, recent evidence suggests that the health effects of habitual daytime napping are controversial. We systematically searched PubMed, Web of Science, Embase, and Cochrane Library databases from inception to March 9, 2024, to synthesize cohort studies of napping and health outcome risk. A total of 44 cohort studies with 1,864,274 subjects aged 20-86 years (mean age 56.4 years) were included. Overall, habitual napping increased the risk of several adverse health outcomes, including all-cause mortality, cardiovascular disease, metabolic disease, and cancer, and decreased the risk of cognitive impairment and sarcopenia. Individuals with a napping duration of 30 min or longer exhibited a higher risk of all-cause mortality, cardiovascular disease, and metabolic disease, whereas those with napping durations less than 30 min had no significant risks. No significant differences in napping and health risks were observed for napping frequency, percentage of nappers, sample size, sex, age, body mass index, follow-up years, or comorbidity status. These findings indicate that individuals with a long napping duration should consider shortening their daily nap duration to 30 min or less.

Functional Assessment of >18 Years Old Patients at Internal Medicine Ward-Relationship with In-Hospital and 30-Day Mortality

Objective

To evaluate the connection between the items included in the AVD-DezIs score (a questionnaire about basic and instrumental activities of daily living and other topics related to social and personal life) and in-hospital and 30-day mortality after discharge.

Methods

Prospective cohort study of hospitalizations in the Internal Medicine ward from 2014 to 2020, including >18 years old patients with a fully completed AVD-DezIs. To identify in-hospital and 30 days mortality, univariate and multivariate logistic models were applied, including random effects if justified.

Results

A total of 19,771 episodes of hospitalization were included. In the univariate analysis, except for the presence of isolation and financial insufficiency, all the items were predictors of mortality in-hospital or within 30 days after discharge. In multivariate analysis, older age, male sex, longer hospital stay, higher Charlson score, deficiency in all four activities of daily living, deficiency in meal preparation and housekeeping, presence of pain/depression, immobility, and malnutrition are associated with a higher probability of in-hospital death whereas older age, male gender, higher Charlson score, longer length of hospital stay, deficiency in personal hygiene, ambulation, and eating habits, as well as the presence of incontinence and malnutrition, are associated with a higher probability of 30 days after discharge death.

Discussion/Conclusion

Except for isolation and financial insufficiency, all items were individually associated with the outcomes. When they are considered in conjunction and taking into account sex, age, comorbidities and length of stay, the predictive ability of in-hospital and 30 days mortality differed.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Associations of accelerometer-measured sedentary behavior and physical activity with sleep in older adults

BACKGROUND

Few studies have examined the non-linear relationships of objectively-measured sedentary behavior and physical activity with insomnia symptoms in older adults. We investigated such relationships of sedentary and physically-active behaviors with total sleep time and nocturnal wakefulness.

METHODS

We recruited adults aged 60 years and above who have received health check-ups or been to geriatric outpatient services from a hospital setting. Sedentary and physically-active behaviors, total sleep time, and wakefulness time after sleep onset were measured by Actigraphy, and their relationships were estimated using generalized additive models.

RESULTS

The 157 older adults receiving health-related services slept 7.5 h (20.8 min awake) on average per day. Total sleep time was negatively associated with sedentary and physically-active behaviors. By contrast, a U-shape relationship was found between sedentary behavior and wakefulness time after sleep onset, with a turning point at a daily sedentary time of 10.9 h.

CONCLUSION

Longer high-intensity physical activity time was related to a shorter wakefulness time after sleep onset. By contrast, daily sedentary time longer than 10.9 h was related to shorter total sleep time but more nocturnal wakefulness time. Future nonpharmacological strategies for sleep improvement should consider the sedentary threshold.

Associations between daytime napping, sleep duration, and depression and 15 cardiovascular diseases: a Mendelian randomization study

Background

Numerous studies have documented the effects of daytime napping, sleep duration, and depression on cardiovascular diseases (CVDs). However, the evidence has been gleaned from observational studies that might be riddled with confounding variables and the possibility of reverse causation bias. Therefore, the present study employed a Mendelian randomization (MR) methodology to meticulously explore the relationships between daytime napping, sleep duration, and depression, and the risk profiles of CVDs.

Methods

Genome-wide significant genetic variants associated with daytime napping, sleep duration, and depression were used as the instrumental variables (IVs). Data on the genetic correlations between these IVs and 15 CVDs were derived from the United Kingdom (UK) Biobank, Finnish Genome Studies, and other large-scale collaborations. We conducted both univariate and multivariate MR analyses to assess the overall effects and mediated relationships after adjusting for potential confounders, including body mass index (BMI), smoking status, and type 2 diabetes. The effect sizes were estimated using inverse variance-weighted (IVW) regression.

Results

The MR analysis revealed that an increased risk of heart failure (HF) [odds ratio (OR): 1.366; 95% confidence interval (CI): 1.013-1.842; P=0.04], coronary atherosclerosis (OR: 1.918; 95% CI: 1.257-2.927; P=0.003), myocardial infarction (MI) (OR: 1.505; 95% CI: 1.025-2.211; P=0.04), and coronary artery disease (CAD) (OR: 1.519; 95% CI: 1.130-2.043; P=0.006) was significantly associated with genetically predicted daytime napping. Prolonged sleep duration was found to be related to a reduced risk of HF (OR: 0.995; 95% CI: 0.993-0.998; P=2.69E-04), peripheral vascular disease (PVD) (OR: 0.984; 95% CI: 0.971-0.997; P=0.02), and CAD (OR: 0.997; 95% CI: 0.994-0.999; P=0.006). Additionally, a statistically significant positive relationship was observed between depressive disorders and the occurrence of atrial fibrillation (AF) (OR: 1.298, 95% CI: 1.065-1.583, P=0.01), indicating a heightened susceptibility. The multivariable MR analyses substantiated the reliability of the observed associations between daytime napping and the incidence of HF and CAD, following adjustments for genetically predicted BMI and smoking. The sensitivity analysis did not reveal any evidence of horizontal pleiotropy or heterogeneity, thus supporting the validity of the study's results.

Conclusions

This MR investigation posits a potential causal nexus between daytime napping, sleep duration, and depression, and the genesis of CVDs, offering new perspectives on the prevention and management of CVDs.

Relationship between activity and sleep, as measured through a wearable accelerometer, and appropriate cardioverter defibrillator interventions: a prospective SafeHeart substudy

AIMS

Physical activity has shown association with ventricular arrhythmia, however, the role of specific behavioral patterns over a 24 h cycle remains unknown. Therefore, we aimed to explore associations between physical behavior and appropriate implantable cardioverter defibrillator (ICD) therapy.

METHODS AND RESULTS

We included patients with an ICD at two European sites, who wore wrist-based accelerometers capturing 24 h movement and sleep behaviours for 28 days. Behavioural measures included activity volume, duration and intensity, sleep duration, and efficiency. Participants were followed for 12 months for the outcome of appropriate ICD therapy. Cox proportional hazard models with restricted cubic splines were used for the analysis. Lastly, the predictive capacity was tested. A total of 253 ICD patients were included (mean age 63.5 (±10.2), 48 (19.0%) female). During follow-up, 40 participants (15.8%) received appropriate ICD therapy; 32 anti-tachycardia pacing (ATP) only (12.6%), 5 shock only (2.0%), and 3 combined ATP and shock (1.2%). In the adjusted model, high inactive duration (HR 1.40 (95% 1.10-1.78)), peak walking cadence (HR 1.07 (95% 1.03-1.12)), and total sleep duration (HR 1.50 (1.02-2.22)) were associated with the outcome. The dose-response relationship was U-shaped for inactive duration with a cut-off at 16 h, and linear for peak cadence and sleep. The prediction model reached an area under the receiver operating characteristic curve of 0.70 ± 0.03, with highest accuracy in the first months.

CONCLUSION

Wearable-derived 24 h movement and sleep behaviours collected over 28 days were associated with later appropriate ICD therapy risk. Testing of the predictive value of digital biomarkers for enhanced risk stratification of ventricular arrhythmia warrants larger prospective studies.

CLINICAL TRIAL REGISTRATION

National Trial Registration (NL9218, http://onderzoekmetmensen.nl/).

Influence of race and age in sleep duration and mortality relationship among adults in the United States: results from the 2004 NHIS-NDI record linkage study

Limited information exists on age and racial disparities in sleep duration and mortality in the United States (US) population. This study compared the association between mortality and sleep duration within distinct races and age groups in the US. This study used data on 26,915 US citizens (≥ 18 years) from the 2004 wave of the National Health Interview Survey, linked to the National Death Index prospective mortality through 2019. Cox proportional hazard models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality by sleep duration, race (Whites, Black/African Americans, and Others (AIAN, Asian, and Native Hawaiian or other Pacific Islander)), and age (< 40, 40-60, and ≥ 60 years), while controlling for covariates such as sex, education, smoking status, disease history, and other vital factors. Race and age significantly modified the sleep duration-mortality relationship. Compared to other races, White participants exhibited higher mortality risks at all hours except at 5-6 h [HR: 0.993, 95% CI: 0.923-1.069]. Likewise, sleep duration associated mortality risks varied by age. Those at greater risk included < 40 years sleeping for 1-4 h [HR: 2.461, 95% CI: 1.446-4.187], 40-< 60 years sleeping for less than 7 h and more than 8 h, and ≥ 60 years sleeping for 9 h [HR: 1.309, 95% CI: 1.162-1.475] and ≥ 10 h [HR: 1.662, 95% CI: 1.486-1.858]. Age and race were significant effect modifiers in the sleep duration-mortality relationship. Thus, it is important to consider these factors when evaluating mortality risks associated with sleep patterns.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-024-00536-x.

Prevalence and associated factors of napping among older adults in the Philippines

BACKGROUND

The aim of the study is to estimate the prevalence and associated factors of insomnia among older adults in the Philippines.

METHODS

In all, 5206 cross-sectional nationally representative data from older adults (≥ 60 years) of the 2018 Longitudinal Study on Ageing and Health in the Philippines (LSAHP) was analysed. Napping frequency and duration were assessed by self-report.

RESULTS

The prevalence of regular nappers was 35.7%, low or moderate napping (1-59 min) was 10.5% and long napping (≥ 60 min) duration was 25.2%. In the final adjusted model, older age was not significantly associated with low or moderate napping duration but older age was positively associated with long napping duration. High wealth status, physical activity and late insomnia were positively associated with low or moderate napping duration. High wealth status, urban residence, daily activity limitations, and physical activity were positively associated, and currently working status, poor self-rated health status and current alcohol use were negatively associated with long napping duration.

CONCLUSION

One in four older adults reported long napping duration. Sociodemographic, health status and behaviour and sleep parameters were associated with low or moderate and/or long napping duration.

The best modality and dose of physical activity to improve sleep quality in older adults: A Bayesian dose-response meta-analysis

BACKGROUND

The beneficial effects of physical activity on sleep quality in older adults are well-established. However, determining the optimal dose of physical activity remains unclear. This study aimed to investigate the dose-response relationship between physical activity and sleep quality in older adults.

METHODS

A comprehensive search was conducted across six electronic databases from inception to May 2024. Included were randomized controlled trials assessing the impact of physical activity on sleep quality in older adults. Changes in sleep quality scores were analyzed using a normal-likelihood model with an identity link function.

RESULTS

Fifty-one studies involving 5890 participants met the inclusion criteria. The dose-response relationship was best described by a "J" shaped curve. The minimum significant dose was 195 metabolic equivalents of tasks (METs)-min/week (Hedges'g = -0.39, SE: 0.27, 95%CrI: -0.82 to 0), with the optimum dose identified as 440 METs-min/week (Hedges'g = -0.85, SE: 0.26, 95%CrI: -1.24 to -0.37). The tolerated dose was also 820 METs-min/week (Hedges'g = -0.85, SE: 0.26, 95%CrI: -1.24 to -0.37). The optimal dose of 440 METs/min/week consistently improved sleep quality across various physical activities. Additionally, participant characteristics such as age, sex, and exercise intensity may moderate the effects of different physical activities.

CONCLUSION

This study identified the optimal weekly dose of physical activity to enhance sleep quality in older adults, highlighting the effectiveness of various physical activities. It also explored moderating factors affecting intervention outcomes. These findings provide valuable insights for tailoring personalized physical activity programs in clinical settings.

Use of mHealth Technologies to Increase Sleep Quality among Older Adults: A Scoping Review

Sleep disorders increase with age and are known risk factors for several mental and physical diseases. They also significantly contribute to a lower quality of life. Nonpharmaceutical approaches, such as cognitive behavioral therapy for insomnia, sleep hygiene advice, relaxation exercises, and physical activity programs, can be delivered directly to patients via mHealth technologies, thereby increasing the accessibility of such interventions and reducing health care-related costs. This scoping review aims to evaluate the effectiveness of mHealth interventions for improving sleep quality among older adults. Published studies in the last 10 years (2013-2023) were identified by searching electronic medical databases (PubMed, PsycINFO, CINAHL, and Scopus) in July 2023 and were independently reviewed by two different authors. The analysis of the data was performed in 2023. The research retrieved 693 records; after duplicates were removed, 524 articles were screened based on their title and abstract, and 28 of them were assessed in full text. A total of 23 studies were excluded because they did not meet the inclusion criteria in terms of population age (60 years or over) or type of intervention (mHealth-based) or because they addressed secondary insomnia. A total of five studies were included in this review, and all of them reported improvements in subjective sleep quality after the application of the mHealth interventions. Two studies also conducted objective assessments of sleep outcomes using actigraphy, reporting improvements only in some of the variables considered. Despite the limited number of available studies, these results are promising and encourage further research.

A narrative review of lifestyle management guidelines for metabolic dysfunction-associated steatotic liver disease

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatotic liver disease management guidelines have been published worldwide; we aimed to summarize, categorize, and compare their lifestyle intervention recommendations.

APPROACH AND RESULTS

We searched metabolic dysfunction-associated steatotic liver disease/NAFLD management guidelines published between January 1, 2013, and June 31, 2024, through databases including PubMed/MEDLINE, Cochrane, and CINAHL. In total, 35 qualifying guidelines were included in the final analysis. Guideline recommendations were categorized into 5 domains (ie, weight reduction goals, physical activity, nutrition, alcohol, and tobacco smoking) and were ranked based on how frequently they appeared. A recommendation was defined as widely adopted if recommended in ≥24 (≥66.6%) of the guidelines. These included increasing physical activity; reducing body weight by 7%-10% to improve steatohepatitis and/or fibrosis; restricting caloric intake; undertaking 150-300 or 75-150 minutes/week of moderate or vigorous-intensity physical activity, respectively; and decreasing consumption of commercially produced fructose. The least mentioned topics, in ≤9 of the guidelines, evaluated environmental determinants of health, mental health, referring patients for psychological or cognitive behavioral therapy, using digital health interventions, and assessing patients' social determinants of health.

CONCLUSIONS

Most guidelines recommend weight reduction through physical activity and improving nutrition, as these have proven positive effects on health outcomes when sustained. However, gaps regarding mental health and the social and environmental determinants of metabolic dysfunction-associated steatotic liver disease were found. To optimize behavioral modifications and treatment, we recommend carrying out studies that will provide further evidence on social support, environmental factors, and mental health, as well as further exploring digital health interventions.

Longitudinal associations between biopsychosocial stress indicators and sleep in older Puerto Rican adults

OBJECTIVES

To examine the association of biopsychosocial stress indicators (perceived stress, perceived discrimination, stressful life events, and allostatic load) with sleep outcomes (sleep duration and insomnia symptoms) and to examine sex and age interactions for associations between stress and sleep in older Puerto Rican adults.

METHODS

Secondary analyses were performed with 830 participants (72% female) from wave 2 (2006-2011) of the Boston Puerto Rican Health Study (BPRHS), a prospective population-based cohort study (45-75years at baseline) and Boston Puerto Rican Osteoporosis Study (BPROS) (2007-2012), an ancillary study of the BPRHS. Recruitment occurred in randomly selected census blocks using door-to-door and community-based activities. In-home data collection visits included a baseline assessment and follow-up interviews. Questionnaires assessed perceived stress, discrimination, stressful life events, and sleep. Allostatic load indicators were measured objectively. Regression models controlled for sociodemographic, behavioral, and health factors, with interaction analyses, followed by sex- and sex-by-age-stratified analyses.

RESULTS

In the prior 2years, participants with chronic stress had 50% greater odds of reporting nonoptimal sleep duration (<7 or >9 hours). Life events trajectories were significantly related to insomnia symptoms. Men ≥65years who experienced chronic stress had greater insomnia symptoms than women, or than men with low stress or acute stress.

CONCLUSIONS

Stressful life events may affect sleep duration and insomnia symptoms among older Puerto Rican adults, particularly men 65 years and older who experienced chronic stress. Given the differences in sleep patterns experienced by older adults and their relationships with health outcomes, identifying methods to support sleep health among those with chronic stress is important.

Pro-vegetarian dietary patterns and mortality by all-cause and specific causes in an older Mediterranean population

PURPOSE

Pro-vegetarian (PVG) dietary patterns have shown health benefits, although the evidence concerning their association with mortality is scarce, particularly in older populations. We investigated the effect of three defined PVG patterns on all-cause, cardiovascular disease (CVD) and cancer mortality risk in an older Mediterranean population.

METHODS

We analysed baseline data from 597 adults aged 65 and older who participated in a population-based cross-sectional study, and mortality during a 12-year period. We used a validated food frequency questionnaire to estimate the adherence in tertiles to three evidence-based PVG dietary patterns: a general PVG pattern (gPVG) and two specific variations (healthful -hPVG, and unhealthful -uPVG). The gPVG pattern incorporated data from 12 food groups, consisting of 7 plant-based and 5 animal-based. The hPVG and uPVG versions included information from 18 food groups (4 food groups added and the splitting of 2 food groups). We used Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusting for relevant covariates.

RESULTS

After the 12-years follow-up period, moderate adherence to hPVG pattern was associated with lower all-cause and CVD mortality whereas greater adherence to uPVG pattern was associated with higher all-cause and CVD mortality. Compared with those in the lowest tertile, participants in the second tertile of adherence to the hPVG pattern showed a significant lower risk of all-cause mortality (HR = 0.59; 95%CI: 0.43, 0.82) and CVD mortality (HR = 0.47; 0.28, 0.78). Participants in the highest tertile of adherence to the uPVG showed an increased mortality risk of all-cause (HR = 1.53; 1.07, 2.19) and CVD (HR = 2.10; 1.19, 3.70). No significant associations were found between adherence to any of the PVG dietary patterns and cancer mortality.

CONCLUSION

Moderate adherence to a healthy PVG pattern reduced the long-term mortality risk for all-cause and CVD in an older Mediterranean population, while higher adherence to an unhealthy PVG pattern increased the risk of all-cause and CVD mortality.

Sleep Duration and Functional Disability Among Chinese Older Adults: Cross-Sectional Study

BACKGROUND

The duration of sleep plays a crucial role in the development of physiological functions that impact health. However, little is known about the associations between sleep duration and functional disability among older adults in China.

OBJECTIVE

This study aimed to explore the associations between sleep duration and functional disabilities in the older population (aged≥65 years) in China.

METHODS

The data for this cross-sectional study were gathered from respondents 65 years and older who participated in the 2018 survey of the China Health and Retirement Longitudinal Study, an ongoing nationwide longitudinal investigation of Chinese adults. The duration of sleep per night was obtained through face-to-face interviews. Functional disability was assessed according to activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. The association between sleep duration and functional disability was assessed by multivariable generalized linear models. A restricted cubic-spline model was used to explore the dose-response relationship between sleep duration and functional disability.

RESULTS

In total, 5519 participants (n=2471, 44.77% men) were included in this study with a mean age of 73.67 years, including 2800 (50.73%) respondents with a functional disability, 1978 (35.83%) with ADL disability, and 2299 (41.66%) with IADL disability. After adjusting for potential confounders, the older adults reporting shorter (≤4, 5, or 6 hours) or longer (8, 9, or ≥10 hours) sleep durations per night exhibited a notably increased risk of functional disability compared to that of respondents who reported having 7 hours of sleep per night (all P<.05), which revealed a U-shaped association between sleep duration and dysfunction. When the sleep duration fell below 7 hours, increased sleep duration was associated with a significantly lower risk of functional disability (odds ratio [OR] 0.85, 95% CI 0.79-0.91; P<.001). When the sleep duration exceeded 7 hours, the risk of functional disability associated with a prolonged sleep duration increased (OR 1.16, 95% CI 1.05-1.29; P<.001).

CONCLUSIONS

Sleep durations shorter and longer than 7 hours were associated with a higher risk of functional disability among Chinese adults 65 years and older. Future studies are needed to explore intervention strategies for improving sleep duration with a particular focus on functional disability.

Association of Life's Essential 8 and Simple 7 Scores With Mortality: Comparison With Pooled Cohort Equation

Background

In 2022, the Life's Simple 7 (LS7) score was replaced with the Life's Essential 8 (LE8) score as a tool to measure cardiovascular health. The risk prediction values of LE8 and LS7 scores for mortality have not been compared. Additionally, the risk prediction value of these scores has not been compared with the pooled cohort equations (PCE) in individuals aged 40 to 79 years.

Objectives

This study compared the risk prediction value of the: 1) LE8 and LS7 scores in the overall population; and 2) LE8 score, LS7 score, and PCE in the 40- to 79-year-old age group for all-cause and cardiovascular mortality in a nationally representative US population.

Methods

The LS7 and LE8 scores and the PCE were calculated in the National Health and Nutrition Examination Survey cycles 2007 to 2018. All-cause and cardiovascular mortality were identified by linking the participants to the National Death Index. The C-statistics of the respective weighted Cox models were used to compare the risk prediction value of the standardized scores.

Results

Among 21,721 individuals included, the C-statistics for all-cause mortality were 0.823 (95% CI: 0.803-0.843) and 0.819 (95% CI: 0.799-0.838) in the LE8 and LS7 score-based models, respectively. The C-statistics for cardiovascular mortality were 0.887 (95% CI: 0.857-0.905) for the LE8 score-based model and 0.883 (95% CI: 0.861-0.905) for the LS7 score-based model. Among 12,943 individuals aged 40 to 79 years, the C-statistics for the outcome of all-cause mortality were 0.756 (95% CI: 0.732-0.779), 0.674 (95% CI: 0.646-0.701), and 0.681 (95% CI: 0.656-0.706) for the PCE, LS7 score, and LE8 score-based models, respectively.

Conclusions

The LS7 and LE8 scores had similar risk prediction values for all-cause and cardiovascular mortality. Among 40- to 79-year-old individuals, the PCE had better risk discrimination in the LE8 and LS7 scores in predicting all-cause mortality.

Sleep patterns and long-term mortality among older Israeli adults: a population-based study

ABSTRACT

Introduction

The joint association of night-time sleep duration and daytime napping (siesta) with mortality remains elusive. We explored sleep patterns and long-term mortality in older adults and tested whether the relationship is modified by cognitive function.

Methods

We analysed data from 1519 participants in the National Health and Nutrition Survey of older adults aged 65+ years ('Mabat Zahav'), conducted by the Israel Center for Disease Control during 2005-2006. A detailed questionnaire was administered at study entry to gather information on sleeping habits, including night-time sleep duration and siesta. A Mini-Mental State Examination was administered to assess cognitive status (score <27 considered impaired). Mortality data were obtained from the Ministry of Health (last follow-up: June 2019; 782 deaths). Cox models were constructed to estimate the HRs for mortality associated with sleep patterns, defined according to night sleep duration (>8 vs ≤8 hours) and siesta (Y/N). Spline regression models were constructed to examine the linearity of the association across cognitive statuses.

Results

Sleep categories among participants (mean age 75; 53% women) included 291 (19.2%) with long night sleep and siesta, 139 (9.1%) with long night sleep and no siesta, 806 (53.1%) with short night sleep and siesta, and 283 (18.6%) with short night sleep and no siesta. HRs for mortality were 2.07 (95% CI: 1.63 to 2.62), 1.63 (95% CI: 1.22 to 2.18) and 1.43 (95% CI: 1.16 to 1.76) in the former three versus latter sleep patterns, respectively. Multivariable adjustment for sociodemographic, behavioural and clinical covariates attenuated the HRs to 1.27-1.41 (all p<0.05). The relationship between night sleep duration and mortality was linear (plinearity=0.047) among cognitively preserved individuals and U-shaped (pnon-linearity<0.001) among cognitively impaired ones.

Conclusions

Prolonged night sleep and siesta were associated with increased mortality, a relationship that varied by cognitive performance.

Generalized sleep decoding with basal ganglia signals in multiple movement disorders

Sleep disturbances profoundly affect the quality of life in individuals with neurological disorders. Closed-loop deep brain stimulation (DBS) holds promise for alleviating sleep symptoms, however, this technique necessitates automated sleep stage decoding from intracranial signals. We leveraged overnight data from 121 patients with movement disorders (Parkinson's disease, Essential Tremor, Dystonia, Essential Tremor, Huntington's disease, and Tourette's syndrome) in whom synchronized polysomnograms and basal ganglia local field potentials were recorded, to develop a generalized, multi-class, sleep specific decoder - BGOOSE. This generalized model achieved 85% average accuracy across patients and across disease conditions, even in the presence of recordings from different basal ganglia targets. Furthermore, we also investigated the role of electrocorticography on decoding performances and proposed an optimal decoding map, which was shown to facilitate channel selection for optimal model performances. BGOOSE emerges as a powerful tool for generalized sleep decoding, offering exciting potentials for the precision stimulation delivery of DBS and better management of sleep disturbances in movement disorders.

Years of life lost due to insufficient sleep and associated economic burden in China from 2010-18

Background

Research on the health and economic costs due to insufficient sleep remains scant in developing countries. In this study we aimed to estimate the years of life lost (YLLs) due to short sleep and quantify its economic burden in China.

Methods

We estimated both individual and aggregate YLLs due to short sleep (ie, ≤6 hours) among Chinese adults aged 20 years or older by sex and five-year age groups in 2010, 2014, and 2018. YLL estimates were derived from 1) the prevalence of short sleep using three survey waves of the China Family Panel Studies, 2) relative mortality risks from meta-analyses, and 3) life tables in China. YLL was the difference between the estimated life expectancy of an individual in the short sleep category vs in the recommended sleep category. We estimated the economic cost using the human capital approach.

Results

The sample sizes of the three survey waves were 31 393, 31 207, and 28 618. Younger age groups and men had more YLLs due to short sleep compared to their counterparts. For individuals aged 20-24, men had an average YLL of nearly 0.95, in contrast to the approximate 0.75 in women across the observed years of 2010, 2014, and 2018. The trend in individual YLLs remained consistent over these years. In aggregate, China experienced a rise from 66.75 million YLLs in 2010 to 95.29 million YLLs in 2014, and to 115.05 million YLLs in 2018. Compared to 2010 (USD 191.83 billion), the associated economic cost in 2014 increased to USD 422.24 billion, and the cost in 2018 more than tripled (USD 628.15 billion). The percentage of cost to Chinese gross domestic product in corresponding years was 3.23, 4.09, and 4.62%.

Conclusions

Insufficient sleep is associated with substantial YLLs in China, potentially impacting the population's overall life expectancy. The escalating economic toll attributed to short sleep underscores the urgent need for public health interventions to improve sleep health at the population level.

The Role of Telemedicine in Children with Obstructive Sleep Apnea Syndrome (OSAS): A Review of the Literature

The advent of telemedicine marked a significant turning point in the healthcare landscape, introducing a revolutionary approach to the delivery of medical care. Digital technologies easily connect health professionals and patients, overcoming geographical and temporal barriers. Telemedicine has been used for sleep disorders including obstructive sleep apnea syndrome (OSAS) since the mid-1990s. In adult patients with OSAS, telemedicine is helpful both for consultation and diagnosis, the latter obtained through remote recordings of oxygen saturation and further parameters registered with telemonitored respiratory polygraphy or polysomnography. Remote monitoring can be used to follow up the patient and verify adherence to daily treatments including continuous positive airway pressure (CPAP). In children, studies on the role of telemedicine in OSAS are scarce. This narrative review aims to describe the application of telemedicine in children with obstructive sleep apnea syndrome (OSAS), assessing its advantages and disadvantages. In patients with OSA, telemedicine is applicable at every stage of patient management, from diagnosis to treatment monitoring also in pediatric and adolescent ages. While telemedicine offers convenience and accessibility in healthcare delivery, its application in managing OSAS could be associated with some disadvantages, including limitations in physical examination, access to diagnostic tools, and education and counseling; technology barriers; and privacy concerns. The adoption of a hybrid approach, integrating both in-office and virtual appointments, could effectively meet the needs of children with OSAS. However, more studies are needed to fully assess the effectiveness and safety of telemedicine in the pediatric population.

Effectiveness of binaural beat music combined with rhythmical photic stimulation on older people with depressive symptoms in long-term care institution: a quasi-experimental pilot study

BACKGROUND

Many older adults residing in long-term care often face issues like poor sleep, reduced vitality, and depression. Non-pharmacological approaches, specifically Binaural Beat Music (BBM) and Rhythmic Photic Stimulation (RPS), may alleviate these symptoms, yet their efficacy in this demographic has not been extensively explored.

AIMS

This study investigated the effects of combined BBM and RPS interventions on sleep quality, vitality, and depression among older residents with depressive symptoms in long-term care facilities.

METHODS

Using a quasi-experimental design, a total of 88 older adults with depressive symptoms from Taiwanese daytime care centers were divided into the BBM with RPS, and Sham groups (44 each). They underwent 20-minute daily sessions of their assigned treatment for two weeks. The BBM with RPS group listened to 10 Hz binaural beat music with 10 Hz photic stimulation glasses, and the Sham group received non-stimulating music and glasses.

RESULTS

After the intervention, participants in the BBM with RPS groups showed significant improvements in vitality and depressive mood, with a notable increase in sympathetic nervous system activity. Conversely, the Sham group exhibited significant deterioration in vitality and mental health, with a significant increase in parasympathetic activity. Additionally, compared with the Sham group, the BBM and RPS groups showed significant improvements in vitality, mental health, and depression, with a significant increase in sympathetic nervous activity.

CONCLUSION

The two-week intervention suggests that the combination of BBM and RPS, as a non-invasive intervention, can potentially improve vitality, mental health, and depressive mood among older adults in long-term care institutions.

The association of short and long sleep with mortality in men and women

Both short (< 6 hr) and long (> 8 hr) sleep are associated with increased mortality. We here investigated whether the association between sleep duration and all-cause, cardiovascular disease and cancer mortality differs between men and women. A cohort of 34,311 participants (mean age and standard deviation = 50.5 ± 15.5 years, 65% women), with detailed assessment of sleep at baseline and up to 20.5 years of follow-up (18 years for cause-specific mortality), was analysed using Cox proportional hazards model to estimate HRs with 95% confidence intervals. After adjustment for covariates, all-cause, cardiovascular disease and cancer mortalities were increased for both < 5 hr and ≥ 9 hr sleep durations (with 6 hr as reference). For all-cause mortality, women who slept < 5 hr had a hazard ratio = 1.54 (95% confidence interval = 1.32-1.80), while the corresponding hazard ratio was 1.05 (95% confidence interval = 0.88-1.27) for men, the interaction being significant (p < 0.05). For cardiovascular disease mortality, exclusion of the first 2 years of exposure, as well as competing risk analysis eliminated the originally significant interaction. Cancer mortality did not show any significant interaction. Survival analysis of the difference between the reference duration (6 hr) and the short duration (< 5 hr) during follow-up showed a gradually steeper reduction of survival time for women than for men for all-cause mortality. We also observed that the lowest cancer mortality appeared for the 5-hr sleep duration. In conclusion, the pattern of association between short sleep duration and all-cause mortality differed between women and men, and the difference between men and women increased with follow-up time.

Trajectories of sleep duration and quality and their association with mild cognitive impairment, frailty, and all-cause mortality

OBJECTIVES

To identify longitudinal trajectories of sleep duration and quality and estimate their association with mild cognitive impairment, frailty, and all-cause mortality.

METHODS

We used data from three waves (2009, 2014, 2017) of the WHO Study on Global Aging and Adult Health in Mexico. The sample consisted of 2722 adults aged 50 and over. Sleep duration and quality were assessed by self-report. Sleep trajectories were determined by applying growth mixture models. Mixed-effects logistic (mild cognitive impairment) and ordinal logistic (frailty), and Cox proportional hazards (all-cause mortality) models were fitted.

RESULTS

Three classes for sleep duration ("optimal-stable," "long-increasing," and "short-decreasing") and quality ("very good-increasing," "very good-decreasing," and "moderate/poor stable") were identified. Compared to the optimal-stable group, the long-increasing trajectory had greater odds for mild cognitive impairment (odds ratio=1.68, 95% CI: 1.01-2.78) and frailty (odds ratio=1.66, 95% CI: 1.13-2.46), and higher risk for all-cause mortality (hazard ratio=1.91, 95% CI: 1.14-3.19); and the short-decreasing class had a higher probability of frailty (odds ratio=1.83, 95% CI: 1.26-2.64). Regarding the sleep quality, the moderate/poor stable trajectory had higher odds of frailty (odds ratio=1.71, 95% CI: 1.18-2.47) than very good-increasing group.

CONCLUSIONS

These results have important implications for clinical practice and public health policies, given that the evaluation and treatment of sleep disorders need more attention in primary care settings. Interventions to detect and treat sleep disorders should be integrated into clinical practice to prevent or delay the appearance of alterations in older adults' physical and cognitive function. Further research on sleep quality and duration is warranted to understand their contribution to healthy aging.

Longitudinal association of sleep duration with possible sarcopenia: evidence from CHARLS

OBJECTIVES

There are limited data on the relationship between sleep duration and possible sarcopenia. Hence, this study aimed to investigate the associations of sleep duration with possible sarcopenia and its defining components based on the China Health and Retirement Longitudinal Study (CHARLS).

DESIGN

A retrospective cohort study.

SETTING

This study was conducted on participants aged over 45 years applying the 2011 baseline and 2015 follow-up survey from CHARLS covering 450 villages, 150 counties and 28 provinces.

PARTICIPANTS

Data from 5036 individuals (2568 men and 2468 women) free of possible sarcopenia at baseline were analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

The dose-response relationship between sleep duration and possible sarcopenia.

RESULTS

During 4 years of follow-up, 964 (19.14%) participants developed possible sarcopenia. Compared with participants who slept 6-8 hours per night, those with shorter sleep duration (<6 hours per night) were independently associated with 22% (OR, 1.22; 95% CI, 1.04 to 1.44) increased risk of developing possible sarcopenia and 27% (OR, 1.27; 95% CI, 1.04 to 1.57) increased risk of developing low handgrip strength after controlling for potential confounders. Long sleep duration (>8 hours per night) was not significantly associated with incident possible sarcopenia. The plots of restricted cubic splines exhibited an atypical inverse J-shaped association between sleep duration and possible sarcopenia. Subgroup analysis showed a stronger association between sleep duration and possible sarcopenia in participants aged 45-59 years and composed of male populations.

CONCLUSIONS

Short sleep duration was a potential risk factor for possible sarcopenia and low handgrip strength. The improvement of sleep duration should be considered a target in early preventive and administrative strategies against the development of handgrip strength decline and further reduced the occurrence of sarcopenia.

Examining the effects of binaural beat music on sleep quality, heart rate variability, and depression in older people with poor sleep quality in a long-term care institution: A randomized controlled trial

OBJECTIVE

This study aimed to examine the effects of binaural beat music (BBM) on sleep quality, heart rate variability, and depression in older people with poor sleep quality in a long-term care institution.

METHODS

A single-blind randomized controlled trial design was employed, and 64 older participants with poor sleep quality were recruited from a long-term care institution in Taiwan. Participants were randomized into the BBM group or control group and received 14 days of intervention. During the intervention period, participants in the experimental group listened to 20 min of Taiwanese Hokkien oldies embedded with BBM once in the morning and afternoon three times a week. Participants in the control group only listened to Taiwanese Hokkien oldies. Questionnaires and heart rate variability analysis were used to assess participants' sleep quality, heart rate variability, and depressive symptoms.

RESULTS

Significant improvements were observed in sleep quality, along with an increase in heart rate variability means of heart rate and normal sinus beats, and a decrease in low-frequency normalized units and depression severity in the BBM group after the intervention. In the control group, effects on sleep quality were inconsistent, heart rate variability showed significant improvements in some autonomic nervous function regulation, and depression severity was significantly decreased. Furthermore, the BBM group showed a significant improvement in sleep quality and a significant reduction in sympathetic nervous activity compared with the control group.

CONCLUSION

This study demonstrates that 14 days of BBM intervention, a non-invasive intervention, could improve sleep quality and depression in older people with poor sleep quality in long-term care institutions. Geriatr Gerontol Int 2024; 24: 297-304.

Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS)

BACKGROUND

Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults.

METHODS

Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes.

RESULTS

In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance.

CONCLUSIONS

Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.

Poor sleep quality increases mortality risk: A population-based longitudinal prospective study in community-dwelling middle-aged and older adults

OBJECTIVES

To assess the association between sleep quality and all-cause mortality in community-dwelling adults living in rural Ecuador.

METHODS

Individuals aged ≥40years enrolled in the prospective population-based Three Villages Study cohort were included. Sleep quality was assessed by means of the Pittsburgh Sleep Quality Index. Study participants were evaluated at baseline and at every annual door-to-door survey until they remained enrolled in the study. Mixed models Poisson regression for repeated Pittsburgh Sleep Quality Index determinations and multivariate Cox-proportional hazards models were fitted to estimate mortality risk according to sleep quality.

RESULTS

Analysis included 1494 individuals (mean age: 56.6 ± 12.5years; 56% women) followed for a median of 6.3 ± 3.3years. At baseline, 978 (65%) individuals had good sleep quality and 516 (35%) had poor sleep quality. The effects of Pittsburgh Sleep Quality Index scores changing over time on mortality was confounded by the impact of the SARS-CoV-2 pandemic on both. One hundred ninety-five individuals (13%) died during the follow-up, resulting in a crude mortality rate of 1.58 per 100 person years (95% C.I.: 1.27-1.88) for individuals with good sleep quality, and 3.18 (95% C.I.: 2.53-3.82) for those with poor sleep quality at baseline. A multivariate Cox-proportional hazards model showed that individuals with poor sleep quality at baseline were 1.38 times (95% C.I.: 1.02-1.85) more likely to die compared to those with good sleep quality; in this model, increased age, poor physical activity, and high fasting glucose remained significant.

CONCLUSIONS

Poor sleep quality is associated with increased mortality risk among middle-aged and older adults.

Associations between food insecurity and Sleep Duration, Quality, and Disturbance among older adults from six low- and middle-income countries

OBJECTIVES

Although food insecurity has been associated with poor sleep outcomes in young and middle-aged adults, few studies have examined this relationship in older adults. This study aimed to examine the relationship between food insecurity and sleep duration, quality, and disturbance among older adults in six low-income countries (LMICs).

DESIGN AND SETTING

We analyzed nationally representative cross-sectional data from 33,460 adults (≥50 years) from the Study on global AGEing and adult health (SAGE).

MEASUREMENTS

Food insecurity (FI) was assessed using two questions regarding the frequency of eating less and hunger caused by a lack of food. Sleep outcomes included self-reported sleep duration, sleep quality, and sleep disturbances (difficulty falling asleep, frequent sleep interruptions, and early awakening) assessed based on self-reports over two nights. Multivariable logistic regression was used to assess country-specific relationships between food insecurity and sleep outcomes, and random-effects models were used to estimate pooled associations.

RESULTS

The prevalence of FI among older adults in the overall population was 16.2%. In pooled analyses, FI was significantly associated with long sleep duration ≥ 9 h (OR=1.58, 95% CI: 1.30 to 1.93; P=0.001). There were also significant pooled associations between FI and poor sleep quality (OR=1.34, 95% CI: 1.14 to 1.56; P < 0.001) and sleep disturbances (OR=1.44, 95% CI: 1.08 to 1.91; P = 0.014).

CONCLUSIONS

In conclusion, the current study found that FI is adversely associated with sleep duration, quality and disturbances in older adults, with some heterogeneity by country. The findings suggest food policies and intervention programs are needed for vulnerable households.

The Association between Caffeine Consumption from Coffee and Tea and Sleep Health in Male and Female Older Adults: A Cross-Sectional Study

Poor sleep health is common in older adults and is associated with negative health outcomes. However, the relationship between caffeine consumption and sleep health at an older age is poorly understood. This study investigated the association between caffeine consumption and sleep health in community-dwelling older males and females in The Netherlands. Cross-sectional analyses were performed using data from 1256 participants aged 61-101 years from the Longitudinal Ageing Study Amsterdam. Self-reported questions assessed sleep disturbances (including sleep latency, continuity, and early awakening), sleep duration, and perceived sleep quality. Caffeine consumption was determined with questions about frequency, quantity, and type of coffee and tea consumption. Logistic and linear regression models were used, controlling for potential confounders, and interaction by sex and age was tested. Caffeine consumption showed significant interactions with sex (p < 0.005) in association with sleep health outcomes. Older females who abstained from caffeine consumption reported more sleep disturbances (β = 0.64 [95%CI 0.13; 1.15]) and had greater odds of short sleep duration (<7 h/day) (OR = 2.26 [95% CI 1.22; 4.20]) compared to those who consumed caffeine. No associations were observed for long sleep duration (>8 h/day) and perceived sleep quality. No associations were observed in older males. Caffeine abstinence was associated with more sleep disturbances and short sleep duration in older females, but not in males. The observed association in older females may reflect reverse causation, suggesting that females may have different motivations for discontinuing caffeine consumption than males.

Association of time-varying sleep duration and cognitive function with mortality in the elderly: a 12-year community-based cohort study

BACKGROUND

Sleeping problems and cognitive impairment are common in elders. Baseline sleep duration and cognitive status are predictors of mortality. But few studies have explored whether longitudinal changes in sleep duration and cognitive function are related to mortality in older adults. The present study investigated the time-varying relationships of sleep duration and cognitive function with subsequent mortality among community-dwelling elders by using 12 years of repeated-measure data.

METHODS

Taichung Community Health Study for Elders (TCHS-E) is a retrospective, population-based cohort that started in 2009 (wave 1) with a total of 912 elders aged 65 years or above. Follow up was conducted in 2010 (wave 2), 2018 (wave 3), and 2020 (wave 4). Sleep duration and Mini-Mental State Examination (MMSE) forms were executed at baseline and three visits during follow-up. Time-varying Cox proportional hazards regression estimated adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs).

RESULTS

During about 12 years (9,396 person-years) follow-up, 329 deaths from all causes were documented, including 102 deaths due to expanded cardiovascular disease (CVD). In the multivariable-adjusted, time-varying Cox proportional hazard model, the adjusted HR values of all-cause mortality were 1.47 (1.02-2.12) for sleep duration > 9 h/day (vs. 7 h/day) and 1.81 (1.26-2.59) for MMSE < 27 (vs. 30). The adjusted HR values of the expanded CVD mortality were 2.91 (1.24-6.83) for MMSE of 29; 2.69 (1.20-6.05) for MMSE of 27-28; and 4.32 (95% CI: 1.92-9.74) for MMSE < 27. The dose-dependent relationship was significant (p < 0.001). The combinations of sleep duration longer than 9 h/day and MMSE < 27 were linked with the highest risks for expanded CVD and all-cause mortality.

CONCLUSIONS

Long sleep duration and low cognitive function were jointly and independently linked with higher risk of mortality in elders residing in community.

Association between electroencephalogram-based sleep characteristics and physical health in the general adult population

We examined the associations between electroencephalogram (EEG)-based sleep characteristics and physical health parameters in general adults via a cross-sectional study recruiting 100 volunteers aged 30-59 years. Sleep characteristics were measured at home using a portable multichannel electroencephalography recorder. Using the k-means +  +  clustering method, according to 10 EEG-based parameters, participants were grouped into better (n = 39), middle (n = 46), and worse (n = 15) sleep groups. Comparing 50 physical health parameters among the groups, we identified four signals of difference (P < 0.05), including systolic (sBP) and diastolic blood pressure (dBP), γ-glutamyl transpeptidase (γ-GTP), and serum creatinine, where sBP reached a Bonferroni-corrected threshold (P < 0.001). The sBP was higher by 7.9 (95% confidence interval 1.9-13.9) and 15.7 (7.3-24.0) mmHg before adjustment and 5.4 (- 0.1-10.9) and 8.7 (1.1-16.3) mmHg after adjustment for age, sex, body mass index, smoking, drinking habits, and 3% oxygen desaturation index in the middle and worse sleep groups, respectively, than in the better group. As another approach, among 500 combinations of EEG-based and physical health parameters, there were 45 signals of correlation, of which 4 (N1% and sBP, dBP, γ-GTP, and triglycerides) reached a Bonferroni-corrected threshold (P < 0.0001). Thus, EEG-based sleep characteristics are associated with several physical health parameters, particularly sBP.

An Update on Sleep Duration, Obesity, and Mortality Risk in Women

Sleep health is an essential component to overall health. Because of numerous societal, economic, and biological factors, obtaining adequate sleep poses a unique challenge to aging women. Yet, women have been traditionally understudied in sleep research. An increasing body of research supports abnormal sleep duration as a risk factor for obesity, cardiovascular disease, and mortality. This review focuses specifically on 3 areas of the discussion of insufficient sleep in women: (1) the mysterious poor health of long sleepers, (2) the potential underlying mechanisms linking abnormal sleep duration and cardiometabolic health, and (3) the need to investigate multiple levels of social determinants driving sleep disparities.

Association between sleep duration and hearing threshold shifts of adults in the United States: National Health and Nutrition Examination Survey, 2015-2016

BACKGROUND

Obstructive sleep apnea (OSA) is linked to hearing loss (HL). Another sleep characteristics, sleep duration might also be associated with HL, but prior evidence is limited. This study is aimed to investigate the association between sleep duration and hearing level in the adult US population.

METHODS

In total, a sample of 2777 individuals aged 20-69 years from the 2015-2016 National Health and Nutrition Examination Survey cycle (NHANES, 2015-2016) were investigated in this study. Self-reported sleep duration data was classified into the short-sleep (< 7 h), normal-sleep (7-9 h), and long-sleep (> 9 h) group. Multivariable linear regression models between sleep duration and hearing threshold shifts were estimated. Interactions between sleep duration and age, gender, race, OSA were also considered, and the study population was stratified by age, gender, race, and OSA to analyze the potential disparities among adults in different subgroups.

RESULTS

Long-sleep duration was positively associated with speech- and high-frequency pure-tone average (PTA) thresholds with statistical significance (β = 1.31, 95%CI: 0.10, 2.53, P = 0.0347, and β = 2.71, 95%CI: 0.69, 4.74, P = 0.0087, respectively). When stratified by age, short sleep duration was positively associated with low-, and speech-frequency PTAs (P = 0.0140 and 0.0225, respectively) for adults aged 40-59 years, and long-sleep duration was positively associated with low-, and speech-frequency PTAs (P = 0.0495 and 0.0142, respectively) for adults aged 60-69 years with statistical significance. There was statistically significant interaction between OSA and sleep duration on speech-frequency PTA, but no significant interaction between either gender or race with sleep duration on hearing thresholds among US adults.

CONCLUSION

Short/long sleep durations are associated with worse hearing level comparing to sleep 7-9 h in the American adults. Nonoptimal sleep duration may be a potential risk factor for HL.

Association between napping and cognitive impairment: A systematic review and meta-analysis

STUDY OBJECTIVES

Increasing evidence suggests that napping is associated with cognitive impairment and dementia, but the conclusions are inconsistent. Moreover, the extent of the risk is uncertain. We therefore conducted a systematic review and meta-analysis to quantify the connection between napping and cognitive impairment.

METHODS

We performed a systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library for studies that were published up to June 2023, and assessed associations between napping and cognitive impairment. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as the effect sizes for all studies. Heterogeneity and potential publication biases were assessed.

RESULTS

A total of 4535 papers were retrieved, with 20 reports assessing the relationships between napping and cognitive impairment. Pooled analysis indicated that napping was associated with dementia (OR = 1.14; 95% CI: 1.07-1.21). Importantly, we found that those napping longer than 30, 45, and 60 min/day were 35%, 41%, and 40%, respectively, more likely to have an increased risk of cognitive impairment (30 min: OR = 1.35; 95% CI: 1.24-1.48; 45 min: OR = 1.41; 95% CI: 1.27-1.58; 60 min: OR = 1.40; 95% CI: 1.26-1.56). North America and Europe showed that associations existed between napping and cognitive impairment (North America: OR = 1.15; 95% CI: 1.04-1.27; Europe: OR = 1.13; 95% CI: 1.08-1.18).

CONCLUSIONS

This meta-analysis indicated associations between long napping durations and cognitive impairment or dementia, suggesting that longer napping might be a potential risk factor of adverse cognitive outcomes.

Bedtime, sleep duration, and sleep quality and all-cause mortality in middle-aged and older Chinese adults: The Dongfeng-Tongji cohort study

OBJECTIVE

This study aims to investigate the associations of bedtime and its combination with sleep duration and sleep quality with all-cause mortality.

METHODS

We conducted a prospective cohort study using data collected from 2008 to 2018 in the Dongfeng-Tongji cohort. Among 40,097 participants aged 62.1 on average at baseline, we applied Cox regression models to assess hazard ratios and 95% confidence intervals for mortality risk.

RESULTS

During a mean follow-up of 8.2years, 4345 deaths were documented. U-shaped associations of bedtime and sleep duration with all-cause mortality were observed. Compared with bedtime between 10:01 PM and 11:00 PM, the hazard ratio (95% confidence interval) for all-cause mortality was 1.34 (1.20-1.49) for ≤9:00 PM, 1.18 (1.09-1.27) for 9:01-10:00 PM, and 1.50 (1.13-2.00) for >12:00 AM, respectively. Participants with sleep duration of <6, 6-<7, 8-<9, and ≥9 h/night had a respective 39%, 21%, 11%, and 25% higher all-cause mortality risk than those sleeping 7-<8 h/night. Additionally, participants with a healthy sleep score of 3, characterized as proper bedtime (10:01 PM-12:00 AM), moderate sleep duration (7-<8h/night), and good/fair sleep quality, had a significantly 36% (hazard ratio, 0.64; 95% confidence interval, 0.56-0.74) lower all-cause mortality risk than those with a score of 0.

CONCLUSIONS

Individuals with early or late bedtimes and short or long sleep duration were at higher all-cause mortality risks. Having healthy sleep habits may significantly reduce death risk.

Multi-dimensional sleep and mortality: The Multi-Ethnic Study of Atherosclerosis

STUDY OBJECTIVES

Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality.

METHODS

The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010-2013). 1726 participants were followed for a median of 6.9 years (Q1-Q3, 6.4-7.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori.

RESULTS

After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index.

CONCLUSION

More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.

Sleep Duration, Comorbidities, and Mortality in Korean Health Examinees: A Prospective Cohort Study

OBJECTIVES

The association between long sleep duration and mortality is frequently attributed to the confounding influence of comorbidities. Nevertheless, past efforts to account for comorbidities have yielded inconsistent outcomes. The objective of this study was to evaluate this relationship using a large prospective cohort in Korea.

METHODS

The study included 114 205 participants from the Health Examinees Study, who were followed for a median of 9.1 years. A composite comorbidity score was developed to summarize the effects of 21 diseases. Using Cox proportional hazards regression, hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and cardiovascular mortality associated with sleep duration were estimated. These estimates were adjusted for socio-demographic factors, lifestyle factors, body mass index, and comorbidity score. Additionally, a stratified analysis by subgroups with and without comorbidities was conducted.

RESULTS

Throughout the follow-up period, 2675 deaths were recorded. After all adjustments, an association was observed between a sleep duration of 8 hours or more and all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). However, no such association was detected in the stratified analysis for the subgroups based on comorbidity status.

CONCLUSIONS

Long sleep duration was found to be associated with all-cause mortality among Koreans, even after adjusting for comorbidities. Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.