Insomnia with Short Sleep Duration and Mortality: The Penn State Cohort

Vgontzas, Alexandros N.; Liao, Duanping; Pejovic, Slobodanka; Calhoun, Susan L.; Karataraki, Maria; Basta, Maria; Fernández-Mendoza, Julio; Bixler, Edward O.

doi:10.1093/sleep/33.9.1159

Cited by 355 publications

(291 citation statements)

References 31 publications

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“…8 Unfortunately, we could not statistically adjust for hypertension or diabetes; thus, our results cannot provide a clear explanation for the high mortality rate of the insomnia group. 10,11,21 However, a previous study that objectively defined insomnia using PSG indicated that short sleep duration is associated with a higher mortality rate, 21 which partially supports our results.…”

Section: Discussionsupporting

confidence: 89%

“…35 Until now, there have been inconsistent findings across studies about the relationship between insomnia and mortality. 21,25,36,37 The SMRs of the insomnia group and the KaplanMeier survival curve analyses showed that insomnia was a risk factor for increased all-cause mortality compared to the no-sleep-disorder group. According to Cox regression analyses, the risk of cardiovascular mortality in the insomnia group was 8.11 times higher even after adjusting for age and sex, and the Kaplan-Meier curve showed that the survival rate of the insomnia group was significantly lower than that of the no-sleep-disorder group.…”

Section: Discussionmentioning

confidence: 99%

“…21 However, these studies relied on subjective symptoms and questionnaires for diagnosis and therefore conflated other sleep disorders with insomnia. In addition, most separated OSA patients from the reference group (with no OSA) based only on apnea-hypopnea index (AHI) or respiratory distress index (RDI) criteria, and did not screen out other sleep disorders.…”

Section: Brief Summarymentioning

confidence: 99%

“…In addition, most separated OSA patients from the reference group (with no OSA) based only on apnea-hypopnea index (AHI) or respiratory distress index (RDI) criteria, and did not screen out other sleep disorders. [20][21][22][23][24] Although previous studies have evaluated the associations of the two common sleep disorders, OSA and insomnia, with mortality, none has compared the two disorders and mortality rate simultaneously. Moreover, data on the mortality rate of patients with insomnia have been inconsistent.…”

Section: Brief Summarymentioning

confidence: 99%

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Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography

Choi

Song

Lee

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: To elucidate the links between the two most prevalent sleep disorders, insomnia and obstructive sleep apnea (OSA), and mortality. Methods: We studied 4,225 subjects who were referred to the Center for Sleep and Chronobiology, Seoul National University Hospital, from January 1994 to December 2008. We divided the subjects into five groups: mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), severe OSA (AHI ≥ 30), insomnia, and a no-sleep-disorder group consisting of subjects without sleep disorders. Standardized mortality ratio (SMR), hazard ratio, and the survival rates of the five groups were calculated and evaluated. Results:The SMR of all-cause mortality was significantly higher in the severe OSA group than in the general population (1.52, 95% CI 1.23-1.85, p < 0.05). The SMR of cardiovascular mortality increased progressively with the severity of OSA (no-sleep-disorder: 0.09, mild: 0.40, moderate: 0.52, severe: 1.79, p < 0.05). Statistical analyses of the hazard ratios indicated that severe OSA is a risk factor for all-cause mortality (HR 3.50, 95% CI 1.03-11.91, p = 0.045) and cardiovascular mortality (HR 17.16, 95% CI 2.29-128.83, p = 0.006). Cardiovascular mortality was also significantly elevated in the insomnia group (HR 8.11, 95% CI 1.03-63.58, p = 0.046). Conclusions: Severe OSA was associated with increased all-cause mortality and cardiovascular mortality compared to the no-sleep-disorder group. Insomnia was associated with increased cardiovascular mortality compared to the no-sleep-disorder group. Keywords: insomnia, OSA, mortality Citation: Choi JW, Song JS, Lee YJ, Won TB, Jeong DU. Increased mortality in relation to insomnia and obstructive sleep apnea in Korean patients studied with nocturnal polysomnography. J Clin Sleep Med. 2017;13(1):49-56. I NTRO DUCTI O NSleep disorders have negative effects on physical and mental health.1-3 Two of the most common sleep disorders are insomnia and obstructive sleep apnea (OSA). The estimated prevalence of insomnia varies according to the criteria used for its definition, ranging from 14.7% for the RDC/ICSD-2 criteria to 22.1% for the DSM-IV-TR criteria. 4 The prevalence of insomnia in Korea is 22.8%. The prevalence is higher in women (25.3%) than in men (20.2%).5 OSA is the second most common sleep disorder with a prevalence of about 3% to 7% in men and 2% to 5% in women. 6 In Korea, an epidemiologic study found that the prevalence of OSA was 4.5% in men and 3.2% in women. Although the mechanistic basis for the association between insomnia and death is unclear, a growing number of studies have suggested that insomnia is related to inflammation, an increase in the activation of the hypothalamic-pituitary-adrenal (HPA) axis, and the sympathetic system, which, in turn, can lead to hypertension, increased heart rate, metabolic dysfunction, and possibly death. [8][9][10][11][12] Moreover, insomnia is comorbid with other psychiatric disorders such as mood disorder and anxiety disorder, which are both closely associated with risk factors for de...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Brief Summarymentioning

confidence: 99%

Section: Brief Summarymentioning

confidence: 99%

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Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography

Choi

Song

Lee

et al. 2017

Journal of Clinical Sleep Medicine

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“…이에리쟈 · 이금재 사회생활 등 일상생활의 많은 영역에 영향을 미치며, 집중력 과 기억력의 저하를 유발하는 원인이 되며 (Ohayon, 2011), 불면증과 같은 수면장애가 만성적으로 나타날 경우 고혈압과 2형 당뇨병 등 의학적 질병 발생과 사망 위험이 증가되므로 (Vgontzas et al, 2010), 최적의 건강상태를 유지하기 위해서 는 수면의 질 관리는 필수적이다.…”

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Factors Influencing Sleep Quality among Middle-aged Male Workers

이에리쟈¹,

이금재²

2014

Korean Journal of Occupational Health Nursing

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Purpose:The purpose of this study was to identify quality of sleep and its influencing factor among middle-aged male workers. Methods: The subjects of this study were 411 middle-aged male workers living in Seoul and Gyeonggi-do. The data were based from self-reported using structured questionnaires asking about low urinary tract symptoms, circadian rhythm, quality of life and sleep quality including general characteristics. The data were collected from September 11 to October 31, 2013 and analyzed by t-test, one-way ANOVA, Pearson correlation coefficient and hierarchical regression. Results: Mean score of the sleep quality was 5.03±2.57 (range: 0~21) and reported as bad sleep quality in 55.7%. Low urinary tract symptoms (β=.30, p<.001), circadian rhythm (β=-.17, p<.001), quality of life (β=-.14, p<.001) were shown as significant association of sleep quality. Conclusion: Strategies to improve sleep quality in middle-aged male workers are necessary and nursing intervention should be developed to improve education program for prevention and management of low urinary tract symptoms. It is also necessary to legalize the institutional devices to upgrade work environment and to place regulations on overtime at work places in order for these workers to obtain sufficient sleep time for recovery of biological rhythms and improving sleep quality.

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