Sleep duration and survival percentiles across categories of physical activity
Abstract
The association between long sleep duration and death is not fully understood. Long sleep is associated with low physical activity, which is a strong predictor of death. Our aim was to investigate the association between sleep duration and death across categories of total physical activity in a large prospective cohort of Swedish men and women. We followed a population-based cohort of 70,973 participants (37,846 men and 33,127 women), aged 45-83 years, from January 1998 to December 2012. Sleep duration and physical activity levels were assessed through a questionnaire. We evaluated the association of interest in terms of mortality rates by estimating hazard ratios with Cox regression and in terms of survival by evaluating 15th survival percentile differences with Laplace regression. During 15 years of follow-up, we recorded 14,575 deaths (8,436 men and 6,139 women). We observed a significant interaction between sleep duration and physical activity in predicting death (P < 0.001). Long sleep duration (>8 hours) was associated with increased mortality risk (hazard ratio = 1.24; 95% confidence interval: 1.11, 1.39) and shorter survival (15th percentile difference = -20 months; 95% confidence interval: -30, -11) among only those with low physical activity. The association between long sleep duration and death might be partly explained by comorbidity with low physical activity.
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An association between long sleep and an increased risk of all-cause mortality was reported previously in studies with high quality and large sample sizes.
“An association between long sleep and an increased risk of all-cause mortality was reported previously in studies with high quality and large sample sizes (59–62), which was consistent with our results.”
From Sleep Duration/Quality with Health Outcomes: An Umbrella Review of Meta-Analyses of Prospective Studies (2022) · cites this paper as [59]
Evidence on the combined effects of physical activity and sleep duration on mortality risk has been inconclusive.
“Evidence on the combined effects of PA and sleep duration on mortality risk has been inconclusive.7,8,9,10”
A higher level of physical activity modifies mortality risks associated with only short sleep duration, only long sleep duration, or both.
“a higher level of PA was reported to modify mortality risks associated with either only short sleep duration, 8 only long sleep duration, 7 or both.10”
An earlier Swedish cohort with a 15-year follow-up demonstrated that the detrimental effects on survival associated with long sleep duration, but not short sleep duration, were most evident among individuals with low levels of physical activity.
“An earlier Swedish cohort with a 15-year follow-up demonstrated that the detrimental effects on survival associated with long sleep duration, but not short sleep duration, were most evident among individuals with low levels of PA. 7”
Several studies have attempted to explore the additive effects of sleep duration and physical activity on mortality risk.
“To date, several studies have attempted to explore the additive effects of sleep duration and PA on mortality risk, reproducing some conflicting findings.7,8,25”
Sufficient physical activity attenuates the mortality risk related to unhealthy sleep.
“these studies have implied that sufficient PA attenuates the mortality risk related to unhealthy sleep.”
Several studies exploring the additive effects of sleep duration and physical activity on mortality risk have reproduced some conflicting findings.
“To date, several studies have attempted to explore the additive effects of sleep duration and PA on mortality risk, reproducing some conflicting findings.7,8,25”
The marginal association between longer sleep duration and late chronotype with lower physical activity converged with a small number of other studies.
“The association between longer sleep duration and late chronotype with lower levels of physical activity found in this study was marginal, but did converge with a small number of other studies examining this question [40, 67, 68].”
From Smoking, screen-based sedentary behavior, and diet associated with habitual sleep duration and chronotype: data from the UK Biobank (2016) · cites this paper as [40]
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- Authors
- Bellavia, A., Akerstedt, T., Bottai, M., Wolk, A., & Orsini, N.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Bellavia, A.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-11-20
- Volume
- 179
- Issue
- 4
- Pages
- 484-491
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2105375900
- Cited by
- 81
- References
- 28
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 8 · 2022: 13 · 2021: 6 · 2020: 2 · 2019: 1 · 2018: 7 · 2017: 6 · 2016: 8 · 2015: 7 · 2014: 5
- FWCI
- 9.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Vetenskapsrådet
- Svenska Läkaresällskapet
- Stockholms Universitet
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep duration, physical activity, mortality, survival, long sleep, physical inactivity, interaction effects, comorbidities
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Mortality, Neoplasms, Surveys and Questionnaires, Regression Analysis, Risk, Sleep, Sweden, Cohort Studies, Exercise, Multivariate Analysis
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