Mortality Associated With Sleep Duration and Insomnia

Kripke, Daniel F.; Garfinkel, Lawrence; Wingard, Deborah L.; Klauber, Melville R.; Marler, Matthew

doi:10.1001/archpsyc.59.2.131

Cited by 1,419 publications

(1,095 citation statements)

References 36 publications

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“…In the current analysis, the study by Kripke et al53 represented more than one third of the entire cohort, and this large study has implications to the interpretation of the results. This cohort was a diverse group of adults who were friends or relatives of American of Cancer Society volunteers who were aged between 30 and 102 years.…”

Section: Discussionmentioning

confidence: 92%

“…A total of 74 studies met the inclusion criteria; the process of study selection is shown in Figure 1 8, 9, 11, 12, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89,...…”

Section: Resultsmentioning

confidence: 99%

“…** References 11, 21, 23, 25, 26, 27, 29, 32, 33, 34, 36, 39, 40, 41, 44, 46, 47, 48, 49, 51, 52, 53, 54, 56, 57, 61, 64, 66, 68, 70, 71, 72, 77, 79, 80, 84, 86, 87, 88.…”

Section: Notesmentioning

confidence: 99%

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Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

Kwok

Kontopantelis

Kuligowski

et al. 2018

JAHA

331

227

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BackgroundThere is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality.Methods and ResultsWe conducted a systematic review, meta‐analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We utilized linear and nonlinear dose‐response meta‐analysis models and used DerSimonian–Laird random‐effects meta‐analysis models of risk ratios, with inverse variance weighting, and the I2 statistic to quantify heterogeneity. Seventy‐four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose‐response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self‐reported duration of sleep >8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio, 1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes.ConclusionsDivergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

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Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

Kwok

Kontopantelis

Kuligowski

et al. 2018

JAHA

331

227

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“…In particular, the focus was directed to 'prescription sleeping pills,' usage was reported in times per month, and prescription sleeping pills were separated from 'Librium' and 'Valium' as distinct categories. By the late 1990s, with powerful desktop computers becoming available, the coded and compiled data could be analyzed with Cox proportional hazards models simultaneously adjusting for 32 covariates [3,4]. In the new study, the minimum mortality risk, though still coded as 7 h, indicated that the best survival was with 6.5-7.4 h reported sleep.…”

Section: Introductionmentioning

confidence: 99%

“…In the new study, the minimum mortality risk, though still coded as 7 h, indicated that the best survival was with 6.5-7.4 h reported sleep. Some surprises in CPSII were that reported sleep durations \6.5 h were less common and less associated with mortality risk than long reported sleep C7.5 h. This might reduce motivations to drug patients to sleep for more than 7.5 h. Reported insomnia predicted slightly (but significantly) improved survival, but greater sleeping pill use retained a dose-response association with decreased survival after adjusting for dozens of covariates [4]. Sleeping pill treatment was associated with much more risk than reported insomnia.…”

Section: Introductionmentioning

confidence: 99%

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Kripke

2015

Drug Saf

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Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p \ 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival. Key PointsMost sleeping pills e.g., benzodiazepines and ''Z'' benzodiazepine agonists (like eszopiclone) are associated with early death, and they most probably cause serious increases in mortality.Benzodiazepine agonist sleeping pills and diphenhydramine should not be prescribed for insomnia, except in long-term controlled trials and hospice care.

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