Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

In the paper

“After round 1 voting, however, the gender-specific votes were collapsed after voting results demonstrated the evidence did not meaningfully suggest different sleep duration recommendations between genders.”

In the paper

“the panel was unable to come to a consensus regarding biologically plausible pathways by which long sleep could explicitly cause poor health”

In the paper

“Consensus could not be reached regarding the appropriateness of sleep durations in the 6-7 hour range, but the median vote indicated this duration was in the inappropriate range.”

In the paper

“There was also consensus that 7-9 hours of sleep were appropriate to support optimal health in adults.”

In the paper

“there was consensus that 6 hours of sleep or less was inappropriate to support optimal health in adults.”

In the paper

“This trend represents a near doubling in the number of U.S. adults sleeping ≤ 6 hours in a 24-hour period from 38.6 million to 70.1 million.51”

What the sources say

• Not checked yetcites [51] Ford ES, Cunningham TJ, Croft JB. Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep 2015;38:829–32. source

In the paper

“In accordance with recommendations of the RAM, the Sleep Duration Consensus Conference panel comprised 15 members, including a moderator (who was also a member of both the Board of Directors of the American Academy of Sleep Medicine and the National Healthy Sleep Awareness Project Strategic Planning Group).”

In the paper

“One hour increments were selected because these were the most commonly-reported units in epidemiologic and experimental studies.”

In the paper

“Panel members were sent a formal letter of invitation from the AASM and SRS, and were required to complete Conflict of Interest disclosures before being officially accepted.”

In the paper

“Panel members were instructed not to discuss the evidence or their votes with each other to ensure independence.”

In the paper

“At present, however, sleep duration is the most widely-studied, best-supported, and most straightforward sleep measure to address in relation to health.”

In the paper

“To avoid further conflicts, panel members were not permitted to participate in similar consensus activities by other organizations.”

In the paper

“A recent Centers for Disease Control and Prevention (CDC) analysis shows that between 1985 and 2012 mean sleep duration decreased and the percentage of adults sleeping ≤ 6 hours in a 24-hour period increased.”

What the sources say

• Not checked yetcites [51] Ford ES, Cunningham TJ, Croft JB. Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep 2015;38:829–32. source

In the paper

“The CDC presently considers this progressive decline in sleep duration a public health epidemic.52”

What the sources say

• Not checked yetcites [52] Centers for Disease Control and Prevention NCfCDaPaHP, Division of Adult and Community Health. Accessed March 27, 2015. Available from:http://www.cdc.gov/features/dssleep/.

In the paper

“In a modification to RAM, the Consensus Conference included a third round of voting, which considered all available evidence and the previous voting results, to establish a single recommendation for the amount of sleep needed to promote optimal health in adults.”

In the paper

“In summary, elevated risk for both overall cardiovascular disease and hypertension is associated with sleep durations less than 6 hours, and possibly for sleep durations of 6-7 hours compared to sleep durations of 7-8 hours.”

In the paper

“Thus, clinical, public policy, and public health activities would all benefit from a consensus recommendation addressing the amount of sleep necessary to support optimal health and functioning in an adult.”

In the paper

“The age cutoffs were based on a meta-analysis of sleep obtained by healthy individuals across the lifespan that showed children and adolescents have longer sleep times than adults, and older adults show no substantial age related declines in sleep duration after the age of 60. 58”

What the sources say

• Not checked yetcites [58] Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004;27:1255–73. source

In the paper

“Sleep timing, self-reported sleep quality, day-to-day variability in sleep duration, napping, and sleep disorders all influence health outcomes in cross-sectional and/or longitudinal studies.56,57”

What the sources say

• Not checked yetcites [56] Buysse DJ. Sleep health: can we define it? Does it matter? Sleep 2014;37:9–17.
• Not checked yetcites [57] Czeisler C. Duration, timing and quality of sleep are each vital for health, performance and safety. Sleep Health 2015;1:5–8. source

In the paper

“Twin studies show sleep duration heritability between 31% and 55%, suggesting substantial genetic influences on sleep need.23,48,49”

What the sources say

• Not checked yetcites [23] Watson NF, Buchwald D, Vitiello MV, Noonan C, Goldberg J. A twin study of sleep duration and body mass index. J Clin Sleep Med 2010;6:11–7. source
• Not checked yetcites [48] de Castro JM. The influence of heredity on self-reported sleep patterns in free-living humans. Physiol Behav 2002;76:479–86. source
• Not checked yetcites [49] Partinen M, Kaprio J, Koskenvuo M, Putkonen P, Langinvainio H. Genetic and environmental determination of human sleep. Sleep 1983;6:179–85. source

In the paper

“A meta-analysis of crosssectional studies found a significant negative association between hours of sleep and body mass index; short sleep duration was significantly associated with obesity.73”

What the sources say

• Not checked yetcites [73] Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 2008;31:619–26. source

In the paper

“All panel members are experts in sleep medicine and/or sleep science.”

In the paper

“The first round of voting is completed without panel interaction to prevent panel members from influencing each other's votes.”

In the paper

“In contrast, another meta-analysis found an association between both short and long sleep and hypertension in cross-sectional studies, but only for short sleep in longitudinal studies.63”

What the sources say

• Not checked yetcites [63] Guo X, Zheng L, Wang J, et al. Epidemiological evidence for the link between sleep duration and high blood pressure: a systematic review and meta-analysis. Sleep Med 2013;14:324–32. source

In the paper

“A panel of 15 experts in sleep medicine and sleep research used a modified RAND Appropriateness Method 54 to develop an evidence based recommendation statement regarding the sleep duration that promotes optimal health in adults aged 18 to 60 years.55”

What the sources say

• Not checked yetcites [54] Fitch K, Bernstein S, Aguilar M, et al. The RAND/UCLA Appropriateness Method User's Manual. Santa Monica, CA: RAND; 2001.
• Not checked yetcites [55] Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep 2015;38:843–4. source

In the paper

“Accepted publications were graded for quality using Oxford criteria.60”

What the sources say

• Not checked yetcites [60] Oxford Center for Evidence Based Medicine. Accessed May 15, 2015. Available from: http://www.cebm.net/ocebm-levels-of-evidence/.

In the paper

“Experimental sleep restriction reduces cellular and whole body insulin sensitivity, lowers glucose tolerance, and raises afternoon and evening levels of cortisol, an insulin antagonist.64,65”

What the sources say

• Not checked yetcites [64] Van Cauter E, Knutson KL. Sleep and the epidemic of obesity in children and adults. Eur J Endocrinol 2008;159Suppl 1:S59–66. source
• Not checked yetcites [65] Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK. Sleep restriction for 1 week reduces insulin sensitivity in healthy men. Diabetes 2010;59:2126–33. source

In the paper

“Sleep duration is associated with mortality risk [38][39][40] and with illnesses ranging from cardiovascular 41 and cerebrovascular 42 disease to obesity, 43 diabetes, 44 cancer, 45,46 and depression.47”

What the sources say

• Not checked yetcites [38][39][40]
• Not checked yetcites [41] Xie D, Li W, Wang Y, et al. Sleep duration, snoring habits and risk of acute myocardial infarction in China population: results of the INTERHEART study. BMC Public Health 2014;14:531. source
• Not checked yetcites [42] Ge B, Guo X. Short and long sleep durations are both associated with increased risk of stroke: a meta-analysis of observational studies. Int J Stroke 2015;10:177–84. source

In the paper

“total sleep duration per 24 hours is the critical factor relative to performance, since split-sleep schedules also show the same sleep dose-response effects.”

What the sources say

• Not checked yetcites [96] Mollicone DJ, Van Dongen HP, Rogers NL, Banks S, Dinges DF. Time of day effects on neurobehavioral performance during chronic sleep restriction. Aviat Space Environ Med 2010;81:735–44. source

In the paper

“Level I evidence demonstrates that cognitive performance involving vigilance attention, cognitive processing speed and working memory, as well as physiological sleep propensity and drowsy driving are all sensitive to sleep duration below 7 hours.”

In the paper

“Three large prospective cohort studies assessed sleep duration and general cancer mortality, with none showing an association for either short or long sleep duration.”

In the paper

“The sleep duration-mortality risk relationship appears relatively stable across demographic groups, with one exception: Increased mortality risk associated with long sleep may be partially explained by age.”

In the paper

“Self-reported sleepiness does not show the latter dynamic and therefore cannot be used to track increasing performance deficits.”

In the paper

“Four studies showed no association between sleep duration and breast cancer, while one showed ≤ 6 hours of sleep was associated with increased risk of breast cancer compared to 7 hours of sleep.”

What the sources say

• Not checked yetcites [46] Kakizaki M, Kuriyama S, Sone T, et al. Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study. Br J Cancer 2008;99:1502–5. source

In the paper

“adults reporting sleep durations of 6.75 to 7.5 hours, and less than 6.75 hours, had a 27% and 73% increase, respectively, in the risk of sleep onset during the MSLT, compared to adults reporting > 7.5 hours of sleep.”

What the sources say

• Not checked yetcites [99] Punjabi NM, Bandeen-Roche K, Young T. Predictors of objective sleep tendency in the general population. Sleep 2003;26:678–83. source

In the paper

“This U-shaped relationship has been demonstrated repeatedly (but not universally) and has been replicated using objective sleep measurement with actigraphy.”

In the paper

“A third study only found an association in those who were overweight or snored, which may signify the impact of sleep apnea and its attendant intermittent hypoxemia.”

What the sources say

• Not checked yetcites [103] Zhang X, Giovannucci EL, Wu K, et al. Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women. Sleep 2013;36:681–8. source

In the paper

“Both meta-analyses found increased mortality risk associated with short sleep and long sleep durations.”

What the sources say

• Not checked yetcites [38] Gallicchio L, Kalesan B. Sleep duration and mortality: a systematic review and meta-analysis. J Sleep Res 2009;18:148–58. source
• Not checked yetcites [111] Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 2010;33:585–92. source

In the paper

“self-reported sleep duration of 7-8 hours was generally associated with the lowest mortality risk, and both short and long sleep duration were associated with increased risk.”

In the paper

“it seems plausible that illness associated inactivity likely increased both subjective reports of sleep duration and mortality risk.”

In the paper

“the only study to assess the relationship between sleep duration and mortality in healthy individuals showed no association; 40 an association was evident only in those who were in poor health at the start of the study.”

What the sources say

• Not checked yetcites [40] Magee CA, Holliday EG, Attia J, Kritharides L, Banks E. Investigation of the relationship between sleep duration, all-cause mortality, and preexisting disease. Sleep Med 2013;14:591–6. source