Abstract
Objective
This study aimed to examine the relationship between sleep duration and all-cause
mortality, and to assess the role of cognitive impairment, physical disability, and
chronic conditions on this association among very old adults.
Design
A prospective cohort study.
Setting and Participants
Within the Chinese Longitudinal Healthy Longevity Surveys, 17,637 oldest-old aged
80-105 years were followed up to 10 years (2005- 2014).
Measures
Data on sleep duration at baseline were based on self-report and were categorized
as short (<7 hour), moderate (7-9 hours), and long sleep (>9 hours). Information on
cognitive function using the Mini-Mental State Examination (MMSE), physical disability
using Activities of Daily Living (ADL), and chronic conditions including diabetes,
heart disease, stroke, asthma, and cancer were collected at baseline based on a structured
questionnaire. Information about vital status was ascertained and confirmed by a close
family member or village doctor of the participant during the follow-up. Data were
analyzed using Cox proportional hazards models, with adjustment for potential confounders.
Results
During the follow-up of 10 years, 11,067 (62.7%) participants died. The multivariate-adjusted
hazard ratios (HRs) with 95% confidence interval (CI) for mortality were 1.03 (0.98-1.09)
for short sleep and 1.13 (1.08-1.18) for long sleep compared with moderate sleep duration.
In stratified analysis by cognitive impairment, physical disability, and chronic conditions,
the risk of morality was present only among people with MMSE scores ≤24 but did not
differ much when stratified by physical disability and chronic conditions. There was
a statistically significant interaction between long sleep and cognitive impairment
on mortality (P for interaction = .002).
Conclusions and Implications
Long sleep duration is associated with higher risk of mortality in very old adults
independently of health conditions. Cognitive impairment may enhance this association.
These findings suggest that health practitioners and families should be aware of the
potential adverse prognosis associated with long sleep.
Keywords
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Article info
Publication history
Published online: April 09, 2020
Footnotes
This work was supported by the National Natural Science Foundation of China (Grant 91746205, Grant 71673199, Grant 81771519) and the Swedish Research Council (Grant 2017-00981).
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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