Sleep disorder, Mediterranean diet, and all-cause and cause-specific mortality: a prospective cohort study

Abstract

Background There is a bidirectional effect between sleep disorders and Mediterranean diet (MED), but the joint effect of MED and sleep disorders on mortality is unclear. The aim of this study was to investigate whether there is a synergistic effect of adherence to MED and sleep disorders on all-cause and cause-specific mortality. Methods The study included 23,212 individuals in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. A 9-point evaluation score, alternative Mediterranean diet (aMED) index was used to assess adherence to MED. Sleep disorder and hours of sleep were assessed by structured questionnaires. Cox regression models were used to assess the relationship between sleep disorders, aMED and all-cause mortality, cause-specific mortality (cardiovascular-related death, cancer-related death). The interaction effect of sleep disorders with aMED on mortality was further assessed. Results Results showed that participants with lower aMED and presence of sleep disorders had significantly higher risk of all-cause mortality and cardiovascular-related mortality (HR, 2.16, 95% CI, 1.49–3.13, P < 0.0001; HR, 2.68, 95% CI, 1.58–4.54, P = 0.0003). A significant interaction effect was found between aMED and sleep disorders on cardiovascular mortality (p for interaction = 0.033). No significant interaction existed between aMED and sleep disorders on all-cause mortality (p for interaction = 0.184) and cancer-related mortality (p for interaction = 0.955). Conclusions Poorer adherence to MED and sleep disorders synergistically increased long-term all-cause mortality and cardiovascular mortality in NHANES population.

Mediterranean Diet and Cardiovascular Disease: The Moderating Role of Adequate Sleep—Results from the ATTICA Cohort Study (2002–2022)

“…It should be mentioned that the relationship between the adherence to the MD along with sleep habits and CVD is rarely explored. Recently, in the National Health and Nutrition Examination Survey (NHANES), it was found that lower adherence to a MD and sleep disorders synergistically increased all-cause and CVD mortality [ 21 ]. This study seems to be in line with our observation that sleep duration modifies the association between adherence to the MD and CVD risk.…”

“…Sleep disorders such as sleep apnea have been associated with increased CVD risk [ 20 ]. To the best of our knowledge, the relation among MD, sleep and CVD risk has been studied in only one previous study, by Wang et al, in which they evaluated 23,212 individuals from the National Health and Nutrition Examination Survey (NHANES), and found that lower adherence to a MD in the presence of sleep disorders synergistically increase all-cause and CVD mortality [ 21 ]. However, it should be clarified that this study examined only sleep disorders, and not normal sleep habits, in relation to mortality (i.e., all-cause and CVD mortality).…”

Associations between Milk Intake and Sleep Disorders in Chinese Adults: A Cross-Sectional Study

“…Current treatment options include non-pharmacological and pharmacological treatments (including melatonin, antipsychotic medication, antidepressants, α−adrenergic agonists, and sedative-hypnotic drugs) [ 3 ]. It is worth noting that the impact of dietary factors, including milk on sleep disorders, have received substantial attention [ 4 , 5 , 6 ].…”