ABSTRACT
Background:
Both short and long
sleep durations are adversely associated with numerous chronic conditions, including
cardiovascular disease (CVD), diabetes,
hypertension, and
mortality. The American
Academy of
Sleep Medicine recommends
adults in the
United States sleep at least 7 hours and less than 9 hours per night to maintain optimal
health. It remains unclear how
sleep duration trajectories over
time are associated with
mortality.
Methods:
This observational
cohort study includes 46,928 Black and
White adults (mean age 53 ± 9 years)
who enrolled in the Southern
Community Cohort Study between 2002-2009 and completed a follow-up
survey in 2008-2013. Participants were categorized into nine
sleep duration trajectory categories based on the reported average
sleep duration between study enrollment and at follow-up. Participant vital status and date and
cause of death were ascertained via linkage to the National
Death Index through 2022. Cox
regression analysis was performed to estimate
hazard ratios (HR) and 95%
confidence intervals (CI) for the
association between
sleep duration trajectory and all-cause and cause-specific
mortality (CVD,
cancer, and
neurodegenerative disease) after
adjustment for sociodemographic characteristics,
health behaviors, and clinical factors.
Results:
During a median 12.6 years of follow-up, we documented 13,579 deaths, including 4,135 from CVD, 3,067 from
cancer, and 544 from
neurodegenerative diseases. Compared to the optimal
sleep duration trajectory (maintaining 7-9 hours), all sub-optimal trajectories were associated with significant 6 to 33% greater
risk of all-cause
mortality in fully adjusted models. Compared to the optimal
sleep trajectory, three of the sub-optimal trajectories were associated with increased CVD
mortality, with HRs ranging from 1.20 to 1.34. The short-long trajectory was associated with the greatest
risk of all-cause
mortality (HR1.33; 95%CI 1.21, 1.46) and the long-short trajectory was associated with the greatest CVD
mortality risk (HR1.34; 95%CI 1.10, 1.65). The healthy-long trajectory was associated with the greatest
risk of
cancer mortality (HR 1.19; 95%CI1.00, 1.41). None of the sub-optimal trajectories was associated with
neurodegenerative disease mortality.
Conclusions:
Suboptimal
sleep duration trajectories were associated with increased
risk of all-cause
mortality as well as CVD
mortality. Findings highlight the importance of maintaining healthy
sleep duration throughout midlife to reduce
mortality risk.
