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The intuition of an association between sleep duration and mortality goes back to the 1970s. Since then, many prospective studies have suggested that short and long sleepers have an increased risk of all-cause and cause-specific mortality compared to subjects who sleep 7–8 hours per night. In the recent publication by Kabat and colleagues, data from the Women’s Health Initiative (WHI) were used to examine sleep duration, insomnia, and use of sleep medications in relation to total and cause-specific mortality (cardiovascular, cancer, other) [1]. A total of 158,203 subjects in the combined clinical trial and observational study components of the WHI were included, among which a total of 30,400 deaths occurred, including 8857 cardiovascular disease (CVD) deaths, 9284 cancer deaths, and 11,928 other deaths over a median of 17.8 years. Sleep duration, sleep quality, assessed by the WHI Insomnia Rating Score, and use of sleep aids (alcohol or medication) were recorded at baseline and information on duration and quality of sleep was collected at multiple time points for most cohort members. Women with the lowest and highest number of hours of sleep per night (≤ 5 h or ≥ 9 h) had higher body mass index (BMI) and systolic blood pressure, higher levels of depression, use of sleep aids, fair-to-poor health, and a history of diabetes, CVD, or cancer. Moreover, they had lower levels of physical activity and were less likely to be white, to be college graduates, or to report ever use of hormone therapy. Women with insomnia had higher BMI, more pack-years of smoking, higher systolic blood pressure, higher proportions of use of sleep aids, higher proportions of diabetes, CVD, and/or cancer, and higher levels of depression. Short and long sleep durations measured at the baseline visit were associated with increased risk of total mortality, CVD mortality, and other mortality, but not with cancer mortality. Insomnia reported at baseline showed a weak inverse association with total and CVD mortality. Use of sleep aids was associated with increased risk of total mortality, CVD mortality, and other mortality. In time-dependent analysis, insomnia only showed a borderline positive association with cancer mortality. The association of short sleep duration with total mortality and CVD mortality was unchanged, while that with other mortality was strengthened and the association of long sleep duration with all four outcomes was strengthened. Use of sleep aids was positively associated with mortality.


  • Patrizia Monteleone


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