Reviewgold2016

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

Andressa Alves da Silva · Renato Gorga Bandeira de Mello · Camila Wohlgemuth Schaan · Flávio Danni Fuchs · Susan S Redline · Sandra Cristina Pereira Costa Fuchs

313 citations0/0 files storedBMJ Open

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Abstract

OBJECTIVE: The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals. DESIGN: Systematic review and meta-analysis of population-based cohort studies. SETTING: Articles were retrieved from international and national electronic databases. STUDY SELECTION: Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded. DATA EXTRACTION: Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran's Q and the I(2) statistics, respectively, and sensitivity analyses were conducted. PRIMARY AND SECONDARY OUTCOME MEASURES: All-cause and cardiovascular mortality. RESULTS: Overall, 27 cohort studies were selected, comprising >70,000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥ 30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥ 2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90). CONCLUSIONS: Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.

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References

2009Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement 2009Introduction to Meta‐Analysis 2000Trim and Fill: A Simple Funnel‐Plot–Based Method of Testing and Adjusting for Publication Bias in Meta‐Analysis 2021Introduction to Meta‐Analysis 1998The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.2004Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan 2010Sleep Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies 2011Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies

Cited by

2020Effects of physical activity programs on sleep outcomes in older adults: a systematic review 2021Association of Sleep Duration With All- and Major-Cause Mortality Among Adults in Japan, China, Singapore, and Korea 2018Association between sleep duration and metabolic syndrome: a cross-sectional study 2018Sleep duration and mortality – Does weekend sleep matter?

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