Sleep Duration/Quality with Health Outcomes: An Umbrella Review of Meta-Analyses of Prospective Studies
Open accessAbstract
Background: To quantitatively evaluate the evidence of duration and quality of sleep as measured by multiple health outcomes. Methods: This review is registered with PROSPERO, number CRD42021235587. We systematically searched three databases from inception until November 15, 2020. For each meta-analysis, the summary effect size using fixed and random effects models, the 95% confidence interval, and the 95% prediction interval were assessed; heterogeneity, evidence of small-study effects, and excess significance bias were also estimated. According to the above metrics, we evaluated the credibility of each association. Results: A total of 85 meta-analyses with 36 health outcomes were included in the study. We observed highly suggestive evidence for an association between long sleep and an increased risk of all-cause mortality. Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep and increased risk of overweight and/or obesity; poor sleep quality and increased risk of diabetes mellitus and gestational diabetes mellitus. Conclusions: Only the evidence of the association of long sleep with an increased risk of all-cause mortality was graded as highly suggestive. Additional studies are needed to be conducted. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021235587
AI snapshot
Written from the paper’s full text.
TL;DR
This umbrella review of 36 articles and 85 meta-analyses found only long sleep duration with increased all-cause mortality reached highly suggestive evidence; other sleep-duration/quality associations were mostly suggestive, weak, or unconfirmed. It assessed 36 health outcomes using fixed/random effects, prediction intervals, heterogeneity, small-study effects, excess significance, and AMSTAR-1 quality appraisal.
Key findings
- The review included 36 articles, 85 meta-analyses, and 36 health outcomes; the median number of original studies per meta-analysis was 7 (range 3–27), median cases 4,848 (range 156–219,518), and median participants 113,226 (range 1,230–2,311,390).
- Only long sleep duration with increased all-cause mortality was graded highly suggestive; no association reached convincing evidence. The abstract reports suggestive evidence for long sleep with five outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and development or death of stroke), short sleep with overweight and/or obesity, and poor sleep quality with diabetes mellitus and gestational diabetes mellitus.
- 52 of 85 meta-analyses (61%) were nominally significant at P < 0.05 under random effects. For sleep duration, 10/78 (13%) random-effects estimates were significant at P < 1×10−6 and 28/78 (36%) fixed-effects estimates were significant; for sleep quality, none of 7 random-effects estimates reached P < 1×10−6 and 3/7 (43%) fixed-effects estimates were significant.
- Heterogeneity was I2 ≤ 50% in 44/78 (56%) sleep-duration meta-analyses, 50–75% in 28/78 (36%), and >75% in 6/78 (8%). Small-study effects were found in 21/78 (27%) duration and 2/7 (29%) quality meta-analyses; excess significance in 22/78 (28%) and 3/7 (43%), respectively.
Methods
- Umbrella review registered with PROSPERO CRD42021235587; searched PubMed, EMBASE, and Web of Science from inception to November 15, 2020, for systematic reviews/meta-analyses of prospective studies on sleep duration/quality and any health outcome.
- Included 36 articles covering 85 meta-analyses and 36 outcomes; extracted effect sizes (OR/RR/HR), 95% CIs, cases/population, and assessed fixed/random effects, 95% prediction intervals, I2 heterogeneity, Egger’s test for small-study effects, excess significance bias, and AMSTAR-1 methodological quality.
- Evidence was graded as convincing, highly suggestive, suggestive, or weak using criteria based on P-value thresholds, number of cases, largest-study significance, prediction intervals, small-study effects, and excess significance.
Limitations
- The paper states it found no convincing evidence; 39% of associations (n = 33) were rated weak or not confirmed, and further research is needed. It also states there is no rigorous evidence that lengthening or shortening sleep duration reduces these outcomes.
- The paper states limited studies prevented subgroup analyses (e.g., age, sex, geographical location) and sensitivity analyses; many meta-analyses lacked dose-response information and compared high vs. low sleep duration without defining thresholds.
- The paper states it included only published meta-analyses of prospective studies with available data, excluding RCTs, and for sleep quality only included meta-analyses using the PSQI. It also did not examine errors of the meta-analyses or quality of primary studies. Evident from the design: the included evidence is observational, limiting causal inference.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 19 cited sources checked · 0 supported · 0 flagged
- Findingown data
Suggestive evidence supports an association between short sleep and increased risk of overweight and/or obesity.
“short sleep and increased risk of overweight and/or obesity;”
Quote in the paperSubstantial claim - Findingown data
For coronary heart disease, per 1-h reduction was graded as weak evidence.
“| Coronary heart disease | Per 1-h reduction | <0.05 but >0.001 | 58 (29–75) | (0.93–1.23) | 0.097 | 5/5.09 | 0.961 | No | Yes/No | Weak |”
Quote in the paperNot a substantial claim - Findingown data
Suggestive evidence supports an association between long sleep and increased risk of mortality of coronary heart disease.
“Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke);”
Quote in the paperSubstantial claim - Findingown data
Highly suggestive evidence supports an association between long sleep and an increased risk of all-cause mortality.
“We observed highly suggestive evidence for an association between long sleep and an increased risk of all-cause mortality.”
- Also stated in: § Conclusions · plain
“Only the evidence of the association of long sleep with an increased risk of all-cause mortality was graded as highly suggestive.”
Quote in the paperSubstantial claim - Also stated in: § Conclusions · plain
- Findingown data
Suggestive evidence supports an association between long sleep and increased risk of stroke mortality.
“Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke);”
Quote in the paperSubstantial claim
- Findingown data
For sleep duration, the studies with the smallest standard error for each association suggested that 30 of 78 were significant at P < 0.05.
“The studies with the smallest SE for each association suggested that 30 of 78 were significant at P < 0.05.”
Quote in the paperNot a substantial claim - Findingown data
Suggestive evidence supports an association between poor sleep quality and increased risk of diabetes mellitus.
“poor sleep quality and increased risk of diabetes mellitus and gestational diabetes mellitus.”
Quote in the paperSubstantial claim - Findingown data
For coronary artery disease, short sleep versus reference was graded as suggestive evidence.
“| Coronary artery disease | Short vs. Ref | <0.001 but >10−6 | 24.9 (0–62) | (0.98–1.25) | 0.019 | 4/3.01 | 0.495 | No | Yes/No | Suggestive |”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supports an association between long sleep and increased risk of the development or death of stroke.
“Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke);”
Quote in the paperSubstantial claim - Findingown data
For hypertension, long sleep versus reference was graded as no association.
“| Hypertension | Long vs. Ref | >0.05 | 48.2 (0–79) | (0.52–1.76) | 0.147 | 1/1.42 | 0.677 | No | No/No | No association |”
Quote in the paperNot a substantial claim - Findingown data
Suggestive evidence supports an association between long sleep and increased risk of dyslipidaemia.
“Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke);”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supports an association between poor sleep quality and increased risk of gestational diabetes mellitus.
“poor sleep quality and increased risk of diabetes mellitus and gestational diabetes mellitus.”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supports an association between long sleep and increased risk of stroke.
“Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke);”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supported an association between long sleep and increased risk of stroke mortality.
“Moreover, suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep duration and increased risk of overweight and/or obesity.”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supported an association between long sleep and increased risk of mortality of coronary heart disease.
“Moreover, suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep duration and increased risk of overweight and/or obesity.”
Quote in the paperSubstantial claim - Findingown data
Of the 7 meta-analyses about sleep quality, 3 (42%) showed low heterogeneity (I2 < 50%).
“Of the 7 meta-analyses about sleep quality, 3 (42%) showed low heterogeneity (I2 < 50%), and 2 (29%) separately showed substantial heterogeneity (I2 > 50% and I2 ≤ 75%) and considerable heterogeneity (I2 > 75%; Table 2).”
Quote in the paperNot a substantial claim - Findingown data
Suggestive evidence supported an association between long sleep and increased risk of stroke.
“Moreover, suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep duration and increased risk of overweight and/or obesity.”
Quote in the paperSubstantial claim - Findingown data
For sleep duration, no association presented convincing evidence.
“For sleep duration, no association presented convincing evidence, the only evidence of long sleep duration with an increased risk of all-cause mortality was categorized as highly suggestive, and the methodological quality was moderate (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supported an association between long sleep and increased risk of the development or death of stroke.
“Moreover, suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep duration and increased risk of overweight and/or obesity.”
Quote in the paperSubstantial claim - Findingown data
For sleep quality, suggestive evidence suggested poor sleep quality was associated with an increased risk of diabetes mellitus.
“For sleep quality, no association presented convincing or highly suggestive evidence, whereas suggestive evidence suggested that poor sleep quality was associated with an increased risk of diabetes mellitus and gestational diabetes mellitus.”
Quote in the paperSubstantial claim - Findingown data
For sleep duration, 14 associations were supported by weak evidence.
“Moreover, 14 associations were supported by weak evidence.”
Quote in the paperNot a substantial claim - Findingown data
For the 7 sleep-quality meta-analyses, no 95% prediction interval excluded the null value.
“When 95% PIs were evaluated, we found that no meta-analysis excluded the null value (Table 2).”
Quote in the paperNot a substantial claim - Findingown data
For sleep quality, the median AMSTAR-1 score across all studies was 7 (range 5 to 8).
“For sleep quality, the median AMSTAR-1 score achieved across all studies was 7 (range from 5 to 8).”
Quote in the paperNot a substantial claim - Findingown data
For sleep quality, no association presented convincing or highly suggestive evidence.
“For sleep quality, no association presented convincing or highly suggestive evidence, whereas suggestive evidence suggested that poor sleep quality was associated with an increased risk of diabetes mellitus and gestational diabetes mellitus.”
Quote in the paperSubstantial claim - Findingown data
Suggestive evidence supported an association between long sleep and increased risk of dyslipidaemia.
“Moreover, suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep duration and increased risk of overweight and/or obesity.”
Quote in the paperSubstantial claim - Findingown data
Evidence of excess significance was observed in 22 (28%) of 78 meta-analyses about sleep duration.
“When taking the largest study estimate as to the plausible effect size, 22 (28%) of 78 meta-analyses and 3 (43%) of 7 meta-analyses about duration and quality of sleep respectively showed evidence of excess significance (Table 2).”
Quote in the paperSubstantial claim - Findingown data
The methodological quality for the association of long sleep duration with all-cause mortality was moderate.
“For sleep duration, no association presented convincing evidence, the only evidence of long sleep duration with an increased risk of all-cause mortality was categorized as highly suggestive, and the methodological quality was moderate (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Of the 7 meta-analyses about sleep quality, 2 (29%) showed considerable heterogeneity (I2 > 75%).
“Of the 7 meta-analyses about sleep quality, 3 (42%) showed low heterogeneity (I2 < 50%), and 2 (29%) separately showed substantial heterogeneity (I2 > 50% and I2 ≤ 75%) and considerable heterogeneity (I2 > 75%; Table 2).”
Quote in the paperNot a substantial claim - Findingown data
Suggestive evidence supported an association between short sleep duration and increased risk of overweight and/or obesity.
“Moreover, suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep duration and increased risk of overweight and/or obesity.”
Quote in the paperSubstantial claim - Findingown data
Of the 7 meta-analyses about sleep quality, 2 (29%) showed substantial heterogeneity (I2 > 50% and I2 ≤ 75%).
“Of the 7 meta-analyses about sleep quality, 3 (42%) showed low heterogeneity (I2 < 50%), and 2 (29%) separately showed substantial heterogeneity (I2 > 50% and I2 ≤ 75%) and considerable heterogeneity (I2 > 75%; Table 2).”
Quote in the paperNot a substantial claim - Findingown data
For atrial fibrillation, not-short versus short was graded as no association.
“| Atrial fibrillation | Not-short vs. Short | >0.05 | 66.1 (0–90) | (0.07–20.51) | 0.607 | 1/0.86 | 0.860 | No | No/No | No association |”
Quote in the paperNot a substantial claim - Findingown data
For sleep duration, the only association categorized as highly suggestive was long sleep duration with increased risk of all-cause mortality.
“For sleep duration, no association presented convincing evidence, the only evidence of long sleep duration with an increased risk of all-cause mortality was categorized as highly suggestive, and the methodological quality was moderate (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Evidence of excess significance was observed in 3 (43%) of 7 meta-analyses about sleep quality.
“When taking the largest study estimate as to the plausible effect size, 22 (28%) of 78 meta-analyses and 3 (43%) of 7 meta-analyses about duration and quality of sleep respectively showed evidence of excess significance (Table 2).”
Quote in the paperNot a substantial claim - Findingown data
For sleep duration, the remaining 31 associations were not confirmed.
“The remaining 31 associations were not confirmed.”
Quote in the paperNot a substantial claim - Findingown data
Evidence of small-study effects according to Egger's test was observed in 21 (27%) of 78 meta-analyses about sleep duration.
“According to Egger's test, evidence of small-study effects was observed in 21 (27%) of 78 meta-analyses and 2 (29%) of 7 meta-analyses about duration and quality of sleep, respectively (Table 2).”
Quote in the paperNot a substantial claim - Findingown data
For sleep duration, the median AMSTAR-1 score across all studies was 6 out of 11 (range 2 to 9).
“For sleep duration, the median AMSTAR-1 score achieved across all studies was 6 out of 11 (range from 2 to 9).”
Quote in the paperNot a substantial claim - Findingown data
Evidence of small-study effects according to Egger's test was observed in 2 (29%) of 7 meta-analyses about sleep quality.
“According to Egger's test, evidence of small-study effects was observed in 21 (27%) of 78 meta-analyses and 2 (29%) of 7 meta-analyses about duration and quality of sleep, respectively (Table 2).”
Quote in the paperNot a substantial claim - Findingcitation
Long sleep duration is associated with an increased risk of mortality of coronary heart disease.
“We also found suggestive evidence that long sleep duration is associated with an increased risk of mortality of coronary heart disease (28).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [28] Kwok, 2018, Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis, J Am Heart Assoc. source
Not checked in the free run.
- Findingown data
52 (61%) of the 85 meta-analyses were nominally statistically significant at P < 0.05 under random-effects models.
“Overall, 85 published meta-analyses were included, and 52 (61%) were nominally statistically significant at P < 0.05 under the random-effects models.”
Quote in the paperNot a substantial claim - Findingcitation
Short sleep duration is linked with increased risk of overweight or obesity only in children.
“Suggestive evidence also showed that short sleep duration is linked with the increased risk of overweight or obesity only observed in children (50).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [50] Miller, 2018, Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies, Sleep. source
Not checked in the free run.
- Findingnone given
Abnormal duration or quality of sleep was significantly associated with an extensive range of adverse health-related outcomes.
“In conclusion, abnormal duration or quality of sleep was significantly associated with an extensive range of adverse health-related outcomes.”
Quote in the paperSubstantial claim - Findingcitation
Long sleep duration is positively linked with the morbidity of stroke.
“Suggestive evidence has shown that long sleep duration is positively linked with the morbidity of stroke (32) and mortality of stroke per 1-h increase in sleep duration (42).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32] Leng, 2015, Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis, Neurology. source
Not checked in the free run.
- Findingcitation
Poor sleep quality is associated with an increased risk of diabetes mellitus.
“Regarding sleep quality, we found that poor sleep quality is associated with an increased risk of diabetes mellitus (56) and gestational diabetes mellitus (53).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [56] Anothaisintawee, 2016, Sleep disturbances compared to traditional risk factors for diabetes development: systematic review and meta-analysis, Sleep Med Rev. source
Not checked in the free run.
- Findingown data
Overall, 85 published meta-analyses were included.
“Overall, 85 published meta-analyses were included, and 52 (61%) were nominally statistically significant at P < 0.05 under the random-effects models.”
Quote in the paperNot a substantial claim - Findingown data
For sleep quality, suggestive evidence suggested poor sleep quality was associated with an increased risk of gestational diabetes mellitus.
“For sleep quality, no association presented convincing or highly suggestive evidence, whereas suggestive evidence suggested that poor sleep quality was associated with an increased risk of diabetes mellitus and gestational diabetes mellitus.”
Quote in the paperSubstantial claim - Findingown data
For sleep quality, 3 associations were supported by weak evidence.
“Moreover, 3 associations were supported by weak evidence and 2 associations were not confirmed.”
Quote in the paperNot a substantial claim - Findingown data
Based on the umbrella review, the highly suggestive evidence only supported that long sleep duration was associated with an increased risk of all-cause mortality.
“Based on our umbrella review, although 36 studies explored 36 unique associations, the highly suggestive evidence only supported that long sleep duration was associated with an increased risk of all-cause mortality.”
Quote in the paperSubstantial claim - Findingcitation
Poor sleep quality is associated with an increased risk of gestational diabetes mellitus.
“Regarding sleep quality, we found that poor sleep quality is associated with an increased risk of diabetes mellitus (56) and gestational diabetes mellitus (53).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [53] Zhang, 2020, The effect of sleep impairment on gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies, Sleep Med. source
Not checked in the free run.
- Findingcitation
Long sleep duration is positively linked with mortality of stroke per 1-h increase in sleep duration.
“Suggestive evidence has shown that long sleep duration is positively linked with the morbidity of stroke (32) and mortality of stroke per 1-h increase in sleep duration (42).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] Wang, 2016, Sleep duration and risk of stroke events and stroke mortality: a systematic review and meta-analysis of prospective cohort studies, Int J Cardiol. source
Not checked in the free run.
- Findingown data
Most of the investigated meta-analyses achieved a moderate-to-high quality score.
“Moreover, we followed the AMSTAR-1 criteria to assess the methodological quality of selected studies in our umbrella review, and most of the investigated meta-analyses achieved a moderate-to-high quality score.”
Quote in the paperNot a substantial claim - Findingown data
For sleep quality, 2 associations were not confirmed.
“Moreover, 3 associations were supported by weak evidence and 2 associations were not confirmed.”
Quote in the paperNot a substantial claim - Findingown data
The quality of the evidence was rated weak or not confirmed for 39% of the associations (n = 33).
“In addition, the quality of the evidence was rated weak or not confirmed for 39% of the associations (n = 33).”
Quote in the paperSubstantial claim - Findingcitation
Long sleep duration is associated with an increased risk of all-cause mortality.
“In this umbrella review, evidence of the association of long sleep duration with an increased risk of all-cause mortality (25), was the only one categorized as highly suggestive, and the methodological quality was moderate in the above outcome.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] Yin, 2017, Relationship of sleep duration with all-cause mortality and cardiovascular events: a systematic review and dose-response meta-analysis of prospective cohort studies, J Am Heart Assoc. source
Not checked in the free run.
- Interpretationreasoning
There is no rigorous evidence that lengthening or shortening sleep duration can lead to a smaller frequency of these outcomes.
“Although long or short sleep is associated with an increased risk of some health outcomes, there is no rigorous evidence that lengthening or shortening sleep duration can lead to a smaller frequency of these outcomes.”
Quote in the paperSubstantial claim - Study design and conductown data
Owing to limited studies, the umbrella review failed to conduct subgroup analysis or sensitive analysis.
“Secondly, owing to the limited studies, we failed to conduct subgroup analysis (e.g., exploring by age, sex, geographical location), or sensitive analysis (e.g., excluding studies with high risks), and other relevant factors might have been missed.”
Quote in the paperNot a substantial claim - Study design and conductnone given
The umbrella review followed the AMSTAR-1 criteria to assess the methodological quality of selected studies.
“Moreover, we followed the AMSTAR-1 criteria to assess the methodological quality of selected studies in our umbrella review, and most of the investigated meta-analyses achieved a moderate-to-high quality score.”
Quote in the paperSubstantial claim - Interpretationreasoning
Abnormal duration or quality of sleep is harmful to human health.
“Abnormal duration or quality of sleep is harmful to human health, but further high-quality prospective studies and better designed trials are needed to generate definite conclusions.”
Quote in the paperSubstantial claim- Rests on an assumption: The associations between sleep duration or quality and health outcomes reflect causal effects.
- Premisecitation
The PSQI is currently the only standardized clinical instrument that covers a broad range of indicators relevant to sleep quality.
“The PSQI is currently the only standardized clinical instrument that covers a broad range of indicators relevant to sleep quality (116).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [116] Mollayeva, 2016, The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis, Sleep Med Rev. source
Not checked in the free run.
- Interpretationcitation
The association between a long duration of sleep and mortality may be explained by residual confounding and comorbidities.
“The association between a long duration of sleep and mortality may be explained by residual confounding and comorbidities (64).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] Stranges, 2008, Correlates of short and long sleep duration: a cross-cultural comparison between the United Kingdom and the United States: the Whitehall II Study and the Western New York Health Study, Am J Epidemiol. source
Not checked in the free run.
- Premisecitation
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.”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [59] Bellavia, 2014, Sleep duration and survival percentiles across categories of physical activity, Am J Epidemiol. source
Not checked in the free run.
- cites [60] Magee, 2013, Investigation of the relationship between sleep duration, all-cause mortality, and preexisting disease, Sleep Med. source
Not checked in the free run.
- cites [61] Xiao, 2014, Sleep duration and total and cause-specific mortality in a large US cohort: interrelationships with physical activity, sedentary behavior, and body mass index, Am J Epidemiol. source
Not checked in the free run.
- cites [62] Yeo, 2013, A prospective cohort study on the relationship of sleep duration with all-cause and disease-specific mortality in the Korean Multi-center Cancer Cohort study, J Prev Med Public Health. source
Not checked in the free run.
- Classified as probably not a substantial claim. 12
- May combine two claims. 21
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe case number exceeded 1,000 in 81 meta-analyses.
“The case number exceeded 1,000 in 81 meta-analyses.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataTen meta-analyses had 95% prediction intervals excluding the null value, including cognitive disorders, stroke, diabetes, all cancer mortality, all-cause mortality, mortality (both all-cause and cause-specific), stroke mortality, obesity, overweight and/or obesity, and the development or death of stroke.
“When 95% PIs were evaluated, we found that 10 meta-analyses [cognitive disorders, stroke, diabetes, all cancer mortality, all-cause mortality, mortality (both all-cause and cause-specific), stroke mortality, obesity, overweight and/or obesity, and the development or death of stroke] excluded the null value (Table 2).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataOf 78 meta-analyses from 32 articles regarding sleep duration, summary random effects estimates were significant at P < 1 × 10−6 in 10 (13%), and summary fixed effects estimates were significant in 28 (36%).
“Of the 78 meta-analyses from 32 articles regarding sleep duration, the summary random effects estimates were significant at P < 1 × 10−6 in 10 (13%) meta-analyses, and the summary fixed effects estimates were significant in 28 (36%) meta-analyses (Supplementary Table S4).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFor sleep quality, the studies with the smallest standard error for each association suggested that 5 of 7 were significant at P < 0.05, and a more conservative effect than the summary random effects was observed in 5 (71%) meta-analyses.
“The studies with the smallest standard error for each association suggested that 5 of 7 were significant at P < 0.05, and a more conservative effect than the summary random effects was observed in 5 (71%) meta-analyses.”
Quote in the paperNot a substantial claimMay combine two claims. The quote only partly states this claim.
Findingown dataThe umbrella review included 36 articles covering 85 meta-analyses and 36 health outcomes.
“A total of 85 meta-analyses with 36 health outcomes were included in the study.”
- Also stated in: § Study Selection · plain
“Ultimately, 36 articles were included in our umbrella review for analysis.”
- Also stated in: § Characteristics of Included Meta-Analyses · plain
“These included studies covered 85 meta-analyses, which reported associations between duration and quality of sleep and 36 different outcomes.”
Quote in the paperNot a substantial claim- Also stated in: § Study Selection · plain
May combine two claims.
Findingown dataOut of 7 meta-analyses from 5 articles regarding sleep quality, summary fixed-effects and random-effects estimates were significant at P < 0.05, but at P < 1 × 10−6 random effects were not significant in any, and 3 (43%) produced significant fixed-effects results.
“Out of the 7 meta-analyses from 5 articles regarding sleep quality, the summary fixed-effects and random-effects estimates were significant at P < 0.05. However, when we used (P < 1 × 10−6) as a threshold for significance, the summary random effects estimates were not significant in any meta-analyses, and 3 (43%) meta-analyses produced significant summary results using the fixed-effects methods (S”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThirty-nine (50%) sleep-duration meta-analyses reported that the largest study effect was nominally statistically significant (P < 0.05), and a more conservative effect than the summary random effects was observed in 57 (73%) meta-analyses.
“Thirty-nine (50%) meta-analyses reported that the largest study effect was nominally statistically significant, with a P < 0.05, and a more conservative effect than the summary random effects was observed in 57 (73%) meta-analyses.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn all included studies regarding sleep duration, approximately 44 (56%) had I2 ≤ 50%, 28 (36%) had I2 between 50 and 75%, and 6 (8%) had I2 > 75%.
“In all the included studies regarding sleep duration, approximately 44 (56%) studies had a lower heterogeneity, with I2 ≤ 50%; approximately 28 (36%) studies had substantial heterogeneity estimates, with I2 between 50 and 75%; and 6 (8%) studies had considerable heterogeneity estimates, with I2 > 75% (Table 2).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFor sleep duration, 15% of studies were rated high, 79% moderate, and 6% low by AMSTAR-1.
“The studies were rated at three levels: 15% were rated as “high,” 79% were rated as “moderate,” and 6% were classified as “low.””
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe common flaws in the included meta-analyses were that gray literature was not considered in the literature search (item 4) and the list of excluded studies was not presented (item 5).
“The common flaws were that gray literature was not considered in the literature search (item 4), and the list of excluded studies was not presented (item 5).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFor sleep quality, approximately 40% of studies were rated high, 60% moderate, and none low by AMSTAR-1.
“Approximately 40% were rated as being of “high,” 60% as “moderate” quality, and no meta-analysis was categorized into low quality according to the AMSTAR-1 criteria.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenMany meta-analyses lacked dose-response information and compared high vs. low sleep duration without defining thresholds for these categories.
“Many meta-analyses lacked dose-response information and compared high vs. low sleep duration without defining thresholds for these categories.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe umbrella review was conducted according to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses (PRISMA) guidelines and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement.
“The umbrella review was conducted according to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses guidelines (Supplementary Table S1) (6), and the guidance of the Meta-analysis of Observational Studies in Epidemiology statement (Supplementary Table S2) (7).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [6] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med. source
Not checked in the free run.
- cites [7] Stroup, 2000, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group, JAMA. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe umbrella review is registered with PROSPERO, number CRD42021235587.
“This review is registered with PROSPERO, number CRD42021235587.”
- Also stated in: § Methods · plain
“The study protocol was registered in the PROSPERO database for systematic reviews and meta-analyses (registration number: CRD42021235587).”
Quote in the paperNot a substantial claim- Also stated in: § Methods · plain
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo investigators independently extracted data from the included studies using a custom-made data extraction form, and discrepancies were verified by a third author.
“Two investigators (X-YL and F-HL) independently extracted the related data from the included studies using a custom-made data extraction form. In the case of discrepancies, the data were subsequently verified by a third author (CG).”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenThe electronic databases PubMed, EMBASE, and Web of Science were searched systematically from inception until November 15, 2020.
“The electronic databases, PubMed, EMBASE, and the Web of Science were searched systematically from inception until November 15, 2020, to identify related systematic reviews and meta-analyses of observational studies.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductown dataTwo investigators independently rated the methodological quality of included systematic reviews and meta-analyses with the Assessment of Multiple Systematic Reviews (AMSTAR-1) tool.
“To study the quality of the reporting of the included systematic reviews and meta-analyses, two investigators (CG and X-YL) independently rated the methodological quality with the Assessment of Multiple Systematic Reviews (AMSTAR-1) tool.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenTwo authors independently scrutinized articles based on titles and abstracts, and disagreements were resolved by discussion and consensus with a senior advisor.
“Two authors (CG and X-YL) independently scrutinized articles based on titles and abstracts. If needed, full articles were retrieved for a final decision. Disagreements between the two reviewers were resolved by discussion and consensus with a senior advisor (T-TG).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationSelf-reported short or long sleep duration and poor sleep quality may be consistently associated with adverse health outcomes.
“self-reported short or long sleep duration (often defined as <6 or 7 and >8 or 9 h, respectively) and poor sleep quality [Pittsburgh Sleep Quality Index (PSQI) > 5] may be consistently associated with adverse health outcomes”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [2] Roncoroni, 2021, The association of sleep duration and feeling rested with health in US Hispanic women, Sleep Med. source
Not checked in the free run.
- cites [3] Park, 2021, Short or long sleep duration and CKD: a Mendelian Randomization Study, J Am Soc Nephrol. source
Not checked in the free run.
- cites [4] Blair, 2015, Poor sleep quality and associated inflammation predict preterm birth: heightened risk among African Americans, Sleep. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe umbrella review used the criteria of evidence grading to evaluate the evidence categorization.
“We also used the criteria of evidence grading to evaluate the evidence categorization.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe relationship between abnormal duration or quality of sleep and other outcomes could be genuine, but there is still limited evidence for them.
“The relationship between abnormal duration or quality of sleep and other outcomes could be genuine, but there is still limited evidence for them.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe umbrella review searched three databases through a rigorous strategy, and two authors independently extracted the information.
“In addition, we searched three databases through a rigorous strategy, and two authors independently extracted the information.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe umbrella review only evaluated published meta-analyses of prospective studies with available data; meta-analyses of randomized controlled trials were not included.
“Thirdly, we only evaluated published meta-analyses of prospective studies with available data, therefore, meta-analyses of randomized controlled trials were not included in our study.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataThe umbrella review used standardized criteria to explore the extent of heterogeneity and potential bias among the included studies and further assessed the strength of claimed associations to identify which was the most credible evidence.
“We used standardized criteria to explore the extent of heterogeneity and potential bias among the included studies and further assessed the strength of claimed associations to identify which was the most credible evidence.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningThe umbrella review did not examine any error of the meta-analyses or the quality of the primary studies.
“Lastly, we did not examine any error of the meta-analyses or the quality of the primary studies, as these were beyond the scope of our umbrella review.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationDepressive symptoms, low socioeconomic status, low level of physical activity, unemployment, undiagnosed health conditions, poor general health, and cancer-related fatigue have all been shown to be associated with long sleep.
“In particular, depressive symptoms, low socioeconomic status, low level of physical activity, unemployment, undiagnosed health conditions, poor general health, and cancer-related fatigue have all been shown to be associated with long sleep (64).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] Stranges, 2008, Correlates of short and long sleep duration: a cross-cultural comparison between the United Kingdom and the United States: the Whitehall II Study and the Western New York Health Study, Am J Epidemiol. source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductreasoningFor sleep quality, only systematic reviews and meta-analyses assessing sleep quality by the PSQI questionnaire were included.
“Fourthly, for sleep quality, only systematic reviews and meta-analyses assessing sleep quality by the PSQI questionnaire were included in this umbrella review.”
Quote in the paperSubstantial claim
The paper relies on this without support.
A quantitative appraisal of epidemiological credibility is lacking, as are examinations of potential bias between sleep quantity/quality and health outcomes and assessments of the most influential outcomes.
“Although previous studies have examined this topic using various methodologies, a quantitative appraisal of epidemiological credibility is lacking, as are examinations of the potential bias between the quantity and quality of sleep and health-related outcomes and assessments of the most influential outcomes.”
The paper relies on this without support.
The associations between sleep duration or quality and health outcomes reflect causal effects.
“Abnormal duration or quality of sleep is harmful to human health, but further high-quality prospective studies and better designed trials are needed to generate definite conclusions.”
The paper relies on this without support.
The included meta-analyses provide valid estimates of the associations between sleep and health outcomes.
“Lastly, we did not examine any error of the meta-analyses or the quality of the primary studies, as these were beyond the scope of our umbrella review.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Sleep data were correlated with health outcomes such as cardiovascular health, obesity, and type 2 diabetes.
“Furthermore, sleep data were correlated with various health outcomes, such as cardiovascular health, obesity, and type 2 diabetes [242], highlighting sleep data‘s significance in understanding overall health.”
From The emergence of AI-based wearable sensors for digital health technology: a review (2023) · cites this paper as [242]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Table 2 lists highly suggestive associations beyond long sleep and all-cause mortality
MajorThe text says this was the only highly suggestive association, but Table 2 also grades long sleep and stroke as highly suggestive.
“the only evidence of long sleep duration with an increased risk of all-cause mortality was categorized as highly suggestive”
“| | Long vs. Average | <10−6 | 68 (42–82) | (0.93–2.23) | 0.486 | 9/2.73 | 0.000 | Yes | No/Yes | Highly suggestive |”
Dyslipidaemia is called an increased-risk finding despite a null result
MajorThe evidence-grading summary describes increased dyslipidaemia risk with long sleep, whereas Table 2 labels that comparison "No association"; Table 1 also reports a relative risk below one with a confidence interval spanning one.
“suggestive evidence supported the associations between long sleep and increased risk of 5 health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke)”
“| | Long vs. Ref | >0.05 | 63.9 (38–79) | (0.65–1.48) | 0.249 | 3/5.79 | 6.291 × 1010 | No | No/No | No association |”
Conflicting counts of significant largest sleep-quality studies
MinorThe same section says that the studies with the smallest standard error were significant in both five of seven and two of seven sleep-quality meta-analyses.
“The studies with the smallest standard error for each association suggested that 5 of 7 were significant at P < 0.05”
“The studies with the smallest SE for each association suggested that two of 7 were significant at P < 0.05.”
Sleep-quality results are not all significant under both models
MinorThe summary says the fixed- and random-effects estimates were significant for the seven sleep-quality meta-analyses, but Table 1 reports confidence intervals spanning one under both models for all-cause mortality.
“Out of the 7 meta-analyses from 5 articles regarding sleep quality, the summary fixed-effects and random-effects estimates were significant at P < 0.05.”
“| All-cause mortality | Kwok et al. (28), 2018 | 10 | RR | Poor vs. Good | 1.03 (0.93–1.14) | 1.03 (0.98–1.09) |”
Sleep-duration article count changes from 32 to 33
MinorThe summary-effect section attributes the sleep-duration meta-analyses to 32 articles, while the methodological-quality section gives 33 included sleep-duration studies.
“Of the 78 meta-analyses from 32 articles regarding sleep duration”
“The methodological quality of the included studies regarding sleep duration (n = 33) and sleep quality (n = 5) was assessed by AMSTAR-1”
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Flagged first, then by citations
Research works printed but not linked: 1
- Daly, 1990, Impaired awake cerebral perfusion in sleep apnea [abstract], Am Rev Respir Dis., 141, A376
Cited by
Sorted by citations
The emergence of AI-based wearable sensors for digital health technology: a review
Shajari, S., Kuruvinashetti, K., Komeili, A., & Sundararaj, U. (2023) · Sensors · doi:10.3390/s23239498 · Cited by 535 · see citing works
- Authors
- Gao, C., Guo, J., Gong, T.-T., Lv, J.-L., Li, X.-Y., Liu, F.-H., Zhang, M., Shan, Y.-T., Zhao, Y.-H., & Wu, Q.-J.
- Affiliations
- Sheng Jing Hospital (CN)
- University of Washington (US)
- Corresponding author
- Gong, Ting-Ting
- Wu, Qi-Jun
- Venue
- Frontiers in Medicine
- Publisher
- Frontiers Media SA
- Published
- 2022-01-20
- Volume
- 8
- Pages
- 813943-813943
- ISSN
- 2296-858X (ISSN-L)
- PMC
- PMC8811149
- OpenAlex
- W4205430803
- Semantic Scholar
- 78854db390fdfe2740c402897db00ac4d1199c85
- Cited by
- 88
- References
- 117
- Citations by year
- 2026: 15 · 2025: 29 · 2024: 21 · 2023: 15 · 2022: 8
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (82073647)
- Liaoning Revitalization Talents Program
- Shengjing Hospital
- 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, sleep quality, all-cause mortality, long sleep, short sleep duration, stroke, dyslipidemia, coronary heart disease mortality, obesity, diabetes mellitus, gestational diabetes mellitus, health outcomes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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