Association of Sleep Duration With All- and Major-Cause Mortality Among Adults in Japan, China, Singapore, and Korea

Svensson, Thomas; Saito, Eiko; Svensson, Akiko Kishi; Melander, Olle; Orho‐Melander, Marju; Mimura, Masaru; Rahman, Shafiur; Sawada, Norie; Koh, Woon‐Puay; Shu, Xiao‐Ou; Tsuji, Ichiro; Kanemura, Seiki; Park, Sung Sup; Nagata, Chisato; Tsugane, Shoichiro; Cai, Hui; Yuan, Jian‐Min; Matsuyama, Sanae; Sugawara, Yumi; Wada, Keiko; Yoo, Keun-Young; Chia, Kee Seng; Boffetta, Paolo; Ahsan, Habibul; Wang, Zheng; Kang, Daehee; Potter, John D.; Inoue, Manami

doi:10.1001/jamanetworkopen.2021.22837

Cited by 91 publications

(66 citation statements)

References 39 publications

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“…In keeping with our findings, another recent large-scale study reported a 20% increased cancer mortality risk among East Asian women with a sleep duration of ≥10 vs 7 hours. 36 Few studies have evaluated the relationship between sleep duration and total cancer incidence among Asians. 11 In a 2018 metaanalysis of cohort and case-control studies conducted in the United States, Asia and Europe, Chen et al 11 reported no association between sleep duration and total cancer incidence in both men and women, which is consistent with our results in men but not women.…”

Section: Discussionmentioning

confidence: 99%

Sleep duration and risk of cancer incidence and mortality: A pooled analysis of six population‐based cohorts in Japan

Wilunda

Abe²,

Svensson

et al. 2022

Intl Journal of Cancer

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Sleep duration is emerging as an important modifiable risk factor for morbidity and mortality. We assessed the association between sleep duration and cancer incidence and mortality among Japanese adults using data from six population‐based cohorts with 271 694 participants. During a total follow‐up period of about 5.9 million person‐years, we identified 40 751 incident cancer cases and 18 323 cancer deaths. We computed study‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression models and pooled the estimates using random‐effects meta‐analysis. Sleep duration of ≥10 hours (vs 7 hours) was associated with increased risk of cancer incidence among women (HR 1.19, 95% CI 1.02‐1.38), but not men, and increased risk of cancer mortality among men (HR 1.18, 95% CI 1.00‐1.39) and women (HR 1.44, 95% CI 1.20‐1.73). Sleep duration of ≤5 hours (vs 7 hours) was not associated with cancer incidence and mortality. However, among postmenopausal women, sleep durations of both ≤5 and ≥10 hours (vs 7 hours) were associated with an increased risk of cancer mortality. Among Japanese adults, sleep duration of ≥10 hours is associated with increased risk of cancer incidence and mortality among women and cancer mortality among men.

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Section: Discussionmentioning

confidence: 99%

Sleep duration and risk of cancer incidence and mortality: A pooled analysis of six population‐based cohorts in Japan

Wilunda

Abe²,

Svensson

et al. 2022

Intl Journal of Cancer

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“…[35][36][37][38] However, self-reported sleep duration has important health implications, including consistent association with mortality across different populations. [39][40][41][42] Additionally, for the entire study period, we lacked other information that may have provided a more in-depth understanding of these disparities, such as quality of sleep, other sleep duration alterations, and medications that may alter sleep pattern and duration.…”

Section: Discussionmentioning

confidence: 99%

“…People with short or long sleep are at increased risk of depression, reduced quality of life, cardiovascular disease, diabetes, and death, among other conditions. [42][43][44][45] Such a persistent gap in sleep duration may thus be a cause and exacerbator of other health disparities, and may serve as an imperfect indicator of overall disparities in health and well-being. For the national objective of achieving health equity, understood as the assurance of the condition of optimal health for all people, 46 it is thus instrumental to also strive for the elimination of socioeconomic and health conditions that prevent racial and ethnic minorities from achieving adequate sleep.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, the potential 20-minute difference in self-reported sleep duration accuracy between White and Black individuals would only minimally explain the disparity between them, as suggested by our sensitivity analysis. Furthermore, self-reported sleep duration has important health implications, including consistent association with mortality across different populations [52][53][54][55][56] and across racial/ethnic groups in the US. 57 Additionally, for the entire study period, we lacked other information that may have provided a more in-depth understanding of these disparities in sleep health, including subjective sleep quality, efficiency, and timing.…”

Section: Discussionmentioning

confidence: 99%

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Temporal Trends in Racial and Ethnic Disparities in Sleep Duration in the United States, 2004–2018

Caraballo

Mahajan

Massey

et al. 2021

Preprint

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ImportanceMinoritized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed over recent years.ObjectiveTo determine 15-year trends in the racial and ethnic differences in self-reported sleep duration among adults in the US.DesignSerial cross-sectional study.SettingNational Health Interview Survey from years 2004–2018.Participants429,195 non-institutionalized adults.ExposuresSelf-reported race, ethnicity, household income, and sex/gender.Main OutcomesTemporal trends and racial/ethnic differences in short- and long-sleep duration (≤6 and ≥10 hours in a 24-hour period, respectively) and racial/ethnic differences in the relationship between sleep duration and age.ResultsThe study sample consisted of 429,195 individuals (mean age 46.5 [SE, 0.08] years; 51.7% female) of which 5.1% identified as Asian, 11.8% as Black, 14.7% as Latino/Hispanic, and 68.5% as White. In 2004, the adjusted estimated prevalence of short-sleep duration and long-sleep duration, respectively, were 31.3% and 2.5% among Asian individuals, 35.3% and 6.4% among Black individuals, 27.0% and 4.6% among Latino/Hispanic individuals, and 27.8% and 3.5% among White individuals. Over the study period, there was a significant increase in the short sleep prevalence among Black, Latino/Hispanic, and White individuals (P≤0.02 for each), whereas prevalence of long sleep changed significantly only among Latino/Hispanic individuals (−1.4 points, P=0.01). In 2018, compared with White individuals, short sleep prevalence among Black and Latino/Hispanic individuals was higher by 10.7 points and 2.6 points, respectively (P≤0.02 each), and long sleep prevalence among Black people was significantly higher by 1.4 points (P=0.01). These racial/ethnic disparities were the greatest among women and among those with middle/high household income. Over the study period, Black individuals younger than 60 years old had the highest prevalence of short sleep compared with those of the same age; and Black individuals had a higher long-sleep duration prevalence than White individuals across all age groups.ConclusionsFrom 2004 to 2018, the prevalence of unrecommended sleep duration was persistently higher among Black individuals. The Black-White disparities were highest among women, individuals who had middle or high income, and among young or middle-aged adults.KEY POINTSQuestionHow have racial and ethnic differences in self-reported sleep duration among US adults changed between 2004 and 2018?FindingsIn this serial cross-sectional study that included 429,195 adults, the prevalence of unrecommended sleep duration was persistently higher among Black individuals over the 15- year study period. These disparities were highest for Black women, Black individuals with middle or high income, and young and middle-aged Black adults.MeaningThere were marked racial and ethnic differences in sleep duration that persisted from 2004 to 2018, which may be contributing to health disparities.

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“…When describing the characteristics of participants, both of total sleep duration and nocturnal sleep duration at baseline were divided into six groups: ≤5, 6, 7, 8, 9, and ≥10 h. Post-lunch napping was divided into four groups: <30, 30–90, and >90 min. The cut points for sleep durations and post-lunch napping were according to previous studies ( 15 , 32 ). Changes in sleep duration over time were evaluated from baseline to 2013 wave 2, and from baseline to 2015 wave 3.…”

Section: Methodsmentioning

confidence: 99%

Prospective association between sleep duration and cognitive impairment: Findings from the China Health and Retirement Longitudinal Study (CHARLS)

Liu

Wang

et al. 2022

Front. Med.

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ObjectiveThe association between sleep duration and cognition are inconclusive. Our study aimed to comprehensively investigate the effects of sleep duration on the risk of cognitive impairment in the middle-aged and older Chinese population.MethodsWe used the longitudinal cohort data from waves 1–4 (2011–2018) of the China Health and Retirement Longitudinal Study (CHARLS). Self-reported exposures included total sleep duration, nocturnal sleep duration, post-lunch napping, and changes in sleep duration over time according to face-to-face interviews. Cognitive function was assessed by a Chinese version of the Modified Mini-Mental State Examination (MMSE).ResultsA total of 7,342 eligible participants were included. The mean age was 61.5 ± 6.5 years, and 48.9% (3,588/7,342) were male. We identified a U-shaped association of total sleep duration as well as nocturnal sleep duration with the risk of cognitive impairment. People with 7–8 h of total sleep duration and 6–7 h of nocturnal sleep had the lowest risk of cognitive impairment. Further results showed that post-lunch napping within 2 h was beneficial to cognition and 60 min was optimal. Moreover, analyses of changes in sleep duration further supported that sleeping less or more was harmful to cognition. Notably, those “excessive-change” sleepers (from ≤6 to ≥9 h, or from ≥9 to ≤6 h) had more risks.ConclusionsKeeping 7–8 h per day was related to the lowest risk of cognitive impairment in midlife and late life, and an optimal post-lunch napping was 60 min for these stable sleepers. Especially, excessive changes in sleep duration over time led to poorer cognition. Our work highlights the importance of optimal sleep habits to cognitive function. The self-reported sleep measures limited our findings, and further studies are needed for verification.

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Association of Sleep Duration With All- and Major-Cause Mortality Among Adults in Japan, China, Singapore, and Korea

Cited by 91 publications

References 39 publications

Sleep duration and risk of cancer incidence and mortality: A pooled analysis of six population‐based cohorts in Japan

Sleep duration and risk of cancer incidence and mortality: A pooled analysis of six population‐based cohorts in Japan

Temporal Trends in Racial and Ethnic Disparities in Sleep Duration in the United States, 2004–2018

Prospective association between sleep duration and cognitive impairment: Findings from the China Health and Retirement Longitudinal Study (CHARLS)

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