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Cited by 304Sleep and related disordersSleep and Work-Related FatigueCircadian rhythm and melatonin

Sleep duration and risk of all-cause mortality: A flexible, non-linear, meta-regression of 40 prospective cohort studies

Liu, Tong-Zu, Xu, Chang, Rota, Matteo, Cai, Hui, Zhang, Chao, Shi, Ming-Jun, Yuan, Rui-Xia, Weng, Hong +3 more·2017·Sleep Medicine Reviews
DOI 10.1016/j.smrv.2016.02.005
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Abstract

Approximately 27-37% of the general population experience prolonged sleep duration and 12-16% report shortened sleep duration. However, prolonged or shortened sleep duration may be associated with serious health problems. A comprehensive, flexible, non-linear meta-regression with restricted cubic spline (RCS) was used to investigate the dose-response relationship between sleep duration and all-cause mortality in adults. Medline (Ovid), Embase, EBSCOhost-PsycINFO, and EBSCOhost-CINAHL Plus databases, reference lists of relevant review articles, and included studies were searched up to Nov. 29, 2015. Prospective cohort studies investigating the association between sleep duration and all-cause mortality in adults with at least three categories of sleep duration were eligible for inclusion. We eventually included in our study 40 cohort studies enrolling 2,200,425 participants with 271,507 deaths. A J-shaped association between sleep duration and all-cause mortality was present: compared with 7 h of sleep (reference for 24-h sleep duration), both shortened and prolonged sleep durations were associated with increased risk of all-cause mortality (4 h: relative risk [RR] = 1.05; 95% confidence interval [CI] = 1.02-1.07; 5 h: RR = 1.06; 95% CI = 1.03-1.09; 6 h: RR = 1.04; 95% CI = 1.03-1.06; 8 h: RR = 1.03; 95% CI = 1.02-1.05; 9 h: RR = 1.13; 95% CI = 1.10-1.16; 10 h: RR = 1.25; 95% CI = 1.22-1.28; 11 h: RR = 1.38; 95% CI = 1.33-1.44; n = 29; P < 0.01 for non-linear test). With regard to the night-sleep duration, prolonged night-sleep duration was associated with increased all-cause mortality (8 h: RR = 1.01; 95% CI = 0.99-1.02; 9 h: RR = 1.08; 95% CI = 1.05-1.11; 10 h: RR = 1.24; 95% CI = 1.21-1.28; n = 13; P < 0.01 for non-linear test). Subgroup analysis showed females with short sleep duration a day (<7 h) were at high risk of all-cause mortality (4 h: RR = 1.07; 95% CI = 1.02-1.13; 5 h: RR = 1.08; 95% CI = 1.03-1.14; 6 h: RR = 1.05; 95% CI = 1.02-1.09), but males were not (4 h: RR = 1.01; 95% CI = 0.96-1.06; 5 h: RR = 1.02; 95% CI = 0.97-1.08; 6 h: RR = 1.02; 95% CI = 0.98-1.06). The current evidence suggests that insufficient or prolonged sleep may increase all-cause mortality. Women may be more susceptible to short sleep duration on all-cause mortality.

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  • Shorter sleep duration (<7 h) in women and longer sleep duration (>8 h) in both women and men are associated with increased all-cause mortality risk.

    “shorter sleep duration (<7 h) in women and longer sleep duration (>8 h) in both women and men were associated with increased all-cause mortality risk”

    From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [340]

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Authors
Liu, T.-Z., Xu, C., Rota, M., Cai, H., Zhang, C., Shi, M.-J., Yuan, R.-X., Weng, H., Meng, X.-Y., Kwong, J. S. W., & Sun, X.
Affiliations
  • Wuhan University (CN)
  • Hubei University of Medicine (CN)
  • Mario Negri Institute for Pharmacological Research (IT)
  • Vanderbilt University (US)
  • Zhongnan Hospital of Wuhan University (CN)
  • Sichuan University (CN)
Corresponding author
  • Liu, Tong-Zu
  • Kwong, Joey S.W.
  • Sun, Xin
ORCID
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2017-04
Volume
32
Pages
28-36
ISSN
1087-0792 (ISSN-L)
DOI
10.1016/j.smrv.2016.02.005
OpenAlex
W2291807268
Cited by
302
References
76
Citations by year
2026: 15 · 2025: 24 · 2024: 42 · 2023: 46 · 2022: 35 · 2021: 31 · 2020: 25 · 2019: 26 · 2018: 26 · 2017: 22 · 2016: 10
FWCI
3.67
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Sleep Medicine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
Funders
National Natural Science Foundation (30972975)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
sleep duration, all-cause mortality, long sleep, J-shaped association, dose-response relationship, nonlinear relationship, restricted cubic splines, nocturnal sleep, adults, sleep health, mortality risk factors
MeSH terms
Humans, Mortality, Risk Factors, Sex Factors, Sleep Wake Disorders, Time Factors

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