Sleep Patterns and Long-term Mortality Among Older Israeli Adults: a Population-based Study

Overview

Journal BMJ Public Health

Publisher BMJ Publishing Group

Date 2025 Feb 28

PMID 40018247

Authors

Saar Ashri

Gali Cohen

Tal Hasin

Lital Keinan-Boker

Yariv Gerber

Affiliations

Soon will be listed here.

Abstract

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 (p=0.047) among cognitively preserved individuals and U-shaped (p<0.001) among cognitively impaired ones.

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

References

Watson N, Badr M, Belenky G, Bliwise D, Buxton O, Buysse D . Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015; 11(6):591-2. PMC: 4442216. DOI: 10.5664/jcsm.4758. View

Ma Y, Liang L, Zheng F, Shi L, Zhong B, Xie W . Association Between Sleep Duration and Cognitive Decline. JAMA Netw Open. 2020; 3(9):e2013573. PMC: 7506513. DOI: 10.1001/jamanetworkopen.2020.13573. View

Wuorela M, Lavonius S, Salminen M, Vahlberg T, Viitanen M, Viikari L . Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up. BMC Geriatr. 2020; 20(1):120. PMC: 7106830. DOI: 10.1186/s12877-020-01516-9. View

Uddin M, Tewari D, Al Mamun A, Kabir M, Niaz K, Wahed M . Circadian and sleep dysfunction in Alzheimer's disease. Ageing Res Rev. 2020; 60:101046. DOI: 10.1016/j.arr.2020.101046. View

Watanabe D, Yoshida T, Watanabe Y, Yamada Y, Miyachi M, Kimura M . Combined Use of Sleep Quality and Duration Is More Closely Associated With Mortality Risk Among Older Adults: A Population-based Kyoto-Kameoka Prospective Cohort Study. J Epidemiol. 2022; 33(12):591-599. PMC: 10635816. DOI: 10.2188/jea.JE20220215. View

Hu W, Han Q, Chu J, Sun N, Li T, Feng Z . Mechanism of the association between sleep quality and mortality in middle-aged and older adults: A prospective study analysis of the UK Biobank. Arch Gerontol Geriatr. 2023; 113:105051. DOI: 10.1016/j.archger.2023.105051. View

Liu Y, Wheaton A, Chapman D, Croft J . Sleep duration and chronic diseases among U.S. adults age 45 years and older: evidence from the 2010 Behavioral Risk Factor Surveillance System. Sleep. 2013; 36(10):1421-7. PMC: 3773191. DOI: 10.5665/sleep.3028. View

Kim Y, Wilkens L, Schembre S, Henderson B, Kolonel L, Goodman M . Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: the Multiethnic Cohort Study. Prev Med. 2013; 57(4):377-85. PMC: 3947517. DOI: 10.1016/j.ypmed.2013.06.017. View

Burazeri G, Gofin J, Kark J . Over 8 hours of sleep--marker of increased mortality in Mediterranean population: follow-up population study. Croat Med J. 2003; 44(2):193-8. View

10.

Russell K, Rodman H, Pak V . Sleep insufficiency, circadian rhythms, and metabolomics: the connection between metabolic and sleep disorders. Sleep Breath. 2023; 27(6):2139-2153. DOI: 10.1007/s11325-023-02828-x. View

11.

Mesas A, Lopez-Garcia E, Leon-Munoz L, Guallar-Castillon P, Rodriguez-Artalejo F . Sleep duration and mortality according to health status in older adults. J Am Geriatr Soc. 2010; 58(10):1870-7. DOI: 10.1111/j.1532-5415.2010.03071.x. View

12.

Zhang N, Chen F, Wang C, Yan P . Incidence of cognitive impairment after hypothetical interventions on depression, nighttime sleep duration, and leisure activity engagement among older Chinese adults: An application of the parametric g-formula. Front Public Health. 2023; 11:1088833. PMC: 9975736. DOI: 10.3389/fpubh.2023.1088833. View

13.

You Y, Luo J, Elstgeest L, Zhang Y, Tan S, Raat H . Associations between health indicators and sleep duration of American adults: NHANES 2011-16. Eur J Public Health. 2021; 31(6):1204-1210. DOI: 10.1093/eurpub/ckab172. View

14.

Zhang S, Xie L, Yu H, Zhang W, Qian B . Association between nighttime-daytime sleep patterns and chronic diseases in Chinese elderly population: a community-based cross-sectional study. BMC Geriatr. 2019; 19(1):124. PMC: 6489270. DOI: 10.1186/s12877-019-1136-9. View

15.

Leng Y, Wainwright N, Cappuccio F, Surtees P, Hayat S, Luben R . Daytime napping and the risk of all-cause and cause-specific mortality: a 13-year follow-up of a British population. Am J Epidemiol. 2014; 179(9):1115-24. PMC: 3992821. DOI: 10.1093/aje/kwu036. View

16.

Utsumi T, Yoshiike T, Kaneita Y, Aritake-Okada S, Matsui K, Nagao K . The association between subjective-objective discrepancies in sleep duration and mortality in older men. Sci Rep. 2022; 12(1):18650. PMC: 9636161. DOI: 10.1038/s41598-022-22065-8. View

17.

da Silva A, de Mello R, Schaan C, Fuchs F, Redline S, Fuchs S . Sleep duration and mortality in the elderly: a systematic review with meta-analysis. BMJ Open. 2016; 6(2):e008119. PMC: 4762152. DOI: 10.1136/bmjopen-2015-008119. View

18.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

19.

Wang C, Bangdiwala S, Rangarajan S, Lear S, Alhabib K, Mohan V . Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries. Eur Heart J. 2018; 40(20):1620-1629. PMC: 6528160. DOI: 10.1093/eurheartj/ehy695. View

20.

Dzierzewski J, Sabet S, Ghose S, Perez E, Soto P, Ravyts S . Lifestyle Factors and Sleep Health across the Lifespan. Int J Environ Res Public Health. 2021; 18(12). PMC: 8296445. DOI: 10.3390/ijerph18126626. View