Sleep Duration and Total and Cause-Specific Mortality in a Large US Cohort: Interrelationships With Physical Activity, Sedentary Behavior, and Body Mass Index
Open accessAbstract
Both short and long durations of sleep are associated with higher mortality, but little is known about the interrelationship between sleep and other modifiable factors in relation to mortality. In the National Institutes of Health-AARP Diet and Health Study (1995-1996), we examined associations between sleep duration and total, cardiovascular disease (CVD), and cancer mortality among 239,896 US men and women aged 51-72 years who were free of cancer, CVD, and respiratory disease. We evaluated the influence of moderate-to-vigorous physical activity, television viewing, and body mass index (BMI; weight (kg)/height (m)(2)) on the sleep-mortality association and assessed their combined association with mortality. During an average of 14 years of follow-up, we identified 44,100 deaths. Compared with 7-8 hours of sleep per day, both shorter and longer sleep durations were associated with higher total and CVD mortality. We found a greater elevation in CVD mortality associated with shorter sleep among overweight and obese people, suggesting a synergistic interaction between sleep and BMI. People in the unhealthy categories of all 4 risk factors (sleep <7 hours/day, moderate-to-vigorous physical activity ≤1 hour/week, television viewing ≥3 hours/day, and BMI ≥25) had significantly higher all-cause (relative risk (RR) = 1.42, 95% confidence interval (CI): 1.34, 1.52), CVD (RR = 1.90, 95% CI: 1.67, 2.17), and cancer (RR = 1.21, 95% CI: 1.09, 1.34) mortality. Short sleep duration may predict higher mortality, particularly CVD mortality, among overweight and obese people.
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In the National Institutes of Health-AARP Diet and Health Study, short sleep duration predicted cardiovascular disease mortality, especially among overweight and obese people.
“In an analysis of data from the National Institutes of Health–AARP Diet and Health Study, SSD predicted CVD mortality, especially among overweight and obese people, and the combination of SSD, low physical activity, and overweight status was associated with an increased likelihood of all-cause, cardiovascular, and cancer-related mortality.”
From Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association (2016) · cites this paper as [55]
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 [61]
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- Authors
- Xiao, Q., Keadle, S. K., Hollenbeck, A. R., & Matthews, C. E.
- Affiliations
- National Institutes of Health (US)
- National Cancer Institute (US)
- Corresponding author
- Xiao, Qian
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-03
- Volume
- 180
- Issue
- 10
- Pages
- 997-1006
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- PMC
- PMC4224361
- OpenAlex
- W2111016705
- Cited by
- 149
- References
- 33
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 10 · 2023: 9 · 2022: 12 · 2021: 20 · 2020: 11 · 2019: 12 · 2018: 16 · 2017: 14 · 2016: 24 · 2015: 12
- FWCI
- 23.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- American Journal of Epidemiology (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health
- National Cancer Institute
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- sleep duration, mortality, cardiovascular mortality, cancer mortality, physical activity, sedentary behavior, television viewing, body mass index, obesity, overweight, modifiable risk factors, synergistic interaction
- MeSH terms
- Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Obesity, Prospective Studies, Surveys and Questionnaires, Risk Factors, Sleep, Time Factors, United States, Cohort Studies, Body Mass Index, Overweight, Sedentary Behavior
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