Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Sukhong Min (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Woo-Kyoung Shin (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Katherine De la Torre (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Dan Huang (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Hyung-Suk Yoon (Department of Surgery, University of Florida College of Medicine) ;
  • Aesun Shin (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Ji-Yeob Choi (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Daehee Kang (Department of Preventive Medicine, Seoul National University College of Medicine)
  • Received : 2023.07.07
  • Accepted : 2023.09.08
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

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.

Keywords

Acknowledgement

This study was supported by the National Genome Research Institute, the Korea Centers for Disease Control and Prevention, and a grant from the Seoul National University Hospital. We would like to thank the study participants and all members of the KoGES HEXA study group. The funding source played a role in the design of the study and the collection of data.

References

  1. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 2010;33(5):585-592.  https://doi.org/10.1093/sleep/33.5.585
  2. Yin J, Jin X, Shan Z, Li S, Huang H, Li P, et al. Relationship of sleep duration with all-cause mortality and cardiovascular events: a systematic review and dose-response meta-analysis of prospective cohort studies. J Am Heart Assoc 2017;6(9):e005947. 
  3. Akerstedt T, Narusyte J, Alexanderson K, Svedberg P. Sleep duration, mortality, and heredity-a prospective twin study. Sleep 2017;40(10):zsx135. 
  4. Svensson T, Saito E, Svensson AK, Melander O, Orho-Melander M, Mimura M, et al. Association of sleep duration with all- and major-cause mortality among adults in Japan, China, Singapore, and Korea. JAMA Netw Open 2021;4(9):e2122837. 
  5. Grandner MA, Hale L, Moore M, Patel NP. Mortality associated with short sleep duration: the evidence, the possible mechanisms, and the future. Sleep Med Rev 2010;14(3):191-203.  https://doi.org/10.1016/j.smrv.2009.07.006
  6. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med 2017;32:246-256.  https://doi.org/10.1016/j.sleep.2016.08.006
  7. Jike M, Itani O, Watanabe N, Buysse DJ, Kaneita Y. Long sleep duration and health outcomes: a systematic review, meta-analysis and meta-regression. Sleep Med Rev 2018;39:25-36.  https://doi.org/10.1016/j.smrv.2017.06.011
  8. Svensson T, Inoue M, Saito E, Sawada N, Iso H, Mizoue T, et al. The association between habitual sleep duration and mortality according to sex and age: the Japan Public Health Center-based Prospective Study. J Epidemiol 2021;31(2):109-118.  https://doi.org/10.2188/jea.JE20190210
  9. Magee CA, Holliday EG, Attia J, Kritharides L, Banks E. Investigation of the relationship between sleep duration, all-cause mortality, and preexisting disease. Sleep Med 2013;14(7):591-596.  https://doi.org/10.1016/j.sleep.2013.02.002
  10. Cai H, Shu XO, Xiang YB, Yang G, Li H, Ji BT, et al. Sleep duration and mortality: a prospective study of 113 138 middle-aged and elderly Chinese men and women. Sleep 2015;38(4):529-536.  https://doi.org/10.5665/sleep.4564
  11. Kwon S, Lee H, Lee JT, Shin MJ, Choi S, Oh H. Sleep duration and mortality in Korean adults: a population-based prospective cohort study. BMC Public Health 2020;20(1):1623. 
  12. Ramar K, Malhotra RK, Carden KA, Martin JL, Abbasi-Feinberg F, Aurora RN, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2021;17(10):2115-2119.  https://doi.org/10.5664/jcsm.9476
  13. Alvarez GG, Ayas NT. The impact of daily sleep duration on health: a review of the literature. Prog Cardiovasc Nurs 2004;19(2):56-59.  https://doi.org/10.1111/j.0889-7204.2004.02422.x
  14. Matsubayashi H, Nagai M, Dote K, Turana Y, Siddique S, Chia YC, et al. Long sleep duration and cardiovascular disease: associations with arterial stiffness and blood pressure variability. J Clin Hypertens (Greenwich) 2021;23(3):496-503.  https://doi.org/10.1111/jch.14163
  15. Zhou L, Yu K, Yang L, Wang H, Xiao Y, Qiu G, et al. Sleep duration, midday napping, and sleep quality and incident stroke: the Dongfeng-Tongji cohort. Neurology 2020;94(4):e345-e356.  https://doi.org/10.1212/WNL.0000000000008739
  16. Wang C, Bangdiwala SI, Rangarajan S, Lear SA, AlHabib KF, Mohan V, et al. Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries. Eur Heart J 2019;40(20):1620-1629.  https://doi.org/10.1093/eurheartj/ehy695
  17. Yeo Y, Ma SH, Park SK, Chang SH, Shin HR, Kang D, et al. A prospective cohort study on the relationship of sleep duration with all-cause and disease-specific mortality in the Korean Multi-center Cancer Cohort study. J Prev Med Public Health 2013;46(5):271-281.  https://doi.org/10.3961/jpmph.2013.46.5.271
  18. Health Examinees Study Group. The Health Examinees (HEXA) study: rationale, study design and baseline characteristics. Asian Pac J Cancer Prev 2015;16(4):1591-1597.  https://doi.org/10.7314/APJCP.2015.16.4.1591
  19. Shin S, Lee HW, Kim CE, Lim J, Lee JK, Lee SA, et al. Egg consumption and risk of metabolic syndrome in Korean adults: results from the Health Examinees Study. Nutrients 2017;9(7):687. 
  20. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011;364(8):719-729.  https://doi.org/10.1056/NEJMoa1010679
  21. Sullivan LM, Massaro JM, D'Agostino RB Sr. Presentation of multivariate data for clinical use: the Framingham Study risk score functions. Stat Med 2004;23(10):1631-1660.  https://doi.org/10.1002/sim.1742
  22. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.  https://doi.org/10.1016/0021-9681(87)90171-8
  23. Wilunda C, Abe SK, Svensson T, Sawada N, Tsugane S, Wada K, et al. Sleep duration and risk of cancer incidence and mortality: a pooled analysis of six population-based cohorts in Japan. Int J Cancer 2022;151(7):1068-1080.  https://doi.org/10.1002/ijc.34133
  24. Li Y, Cai S, Ling Y, Mi S, Fan C, Zhong Y, et al. Association between total sleep time and all cancer mortality: non-linear dose-response meta-analysis of cohort studies. Sleep Med 2019;60:211-218.  https://doi.org/10.1016/j.sleep.2019.03.026
  25. Ma QQ, Yao Q, Lin L, Chen GC, Yu JB. Sleep duration and total cancer mortality: a meta-analysis of prospective studies. Sleep Med 2016;27-28:39-44.  https://doi.org/10.1016/j.sleep.2016.06.036
  26. Tao F, Cao Z, Jiang Y, Fan N, Xu F, Yang H, et al. Associations of sleep duration and quality with incident cardiovascular disease, cancer, and mortality: a prospective cohort study of 407,500 UK biobank participants. Sleep Med 2021;81:401-409.  https://doi.org/10.1016/j.sleep.2021.03.015
  27. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J 2011;32(12):1484-1492.  https://doi.org/10.1093/eurheartj/ehr007
  28. da Silva AA, de Mello RG, Schaan CW, Fuchs FD, Redline S, Fuchs SC. Sleep duration and mortality in the elderly: a systematic review with meta-analysis. BMJ Open 2016;6(2):e008119. 
  29. Jin Q, Yang N, Dai J, Zhao Y, Zhang X, Yin J, et al. Association of sleep duration with all-cause and cardiovascular mortality: a prospective cohort study. Front Public Health 2022;10:880276. 
  30. Akerstedt T, Trolle-Lagerros Y, Widman L, Ye W, Adami HO, Bellocco R. Sleep duration and mortality, influence of age, retirement, and occupational group. J Sleep Res 2022;31(3):e13512. 
  31. Youngstedt SD, Kripke DF. Long sleep and mortality: rationale for sleep restriction. Sleep Med Rev 2004;8(3):159-174.  https://doi.org/10.1016/j.smrv.2003.10.002
  32. Bliwise DL, King AC, Harris RB. Habitual sleep durations and health in a 50-65 year old population. J Clin Epidemiol 1994;47(1):35-41.  https://doi.org/10.1016/0895-4356(94)90031-0
  33. Born J, Lange T, Hansen K, Molle M, Fehm HL. Effects of sleep and circadian rhythm on human circulating immune cells. J Immunol 1997;158(9):4454-4464.  https://doi.org/10.4049/jimmunol.158.9.4454
  34. Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 1999;8(3):175-183. https://doi.org/10.1046/j.1365-2869.1999.00155.x