Anders Broström, PhD Professor, Department of Clinical Neurophysiology, University Hospital, Linköping, and Department of Nursing, School of Health and Welfare, Jönköping University, Sweden. Ake Wahlin, PhD Professor, Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden Urban Alehagen, PhD Professor, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden. Martin Ulander, PhD MD and Sleep Specialist, Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden. Peter Johansson, PhD Associate Professor, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
J Cardiovasc Nurs. 2018 Sep/Oct;33(5):422-428. doi: 10.1097/JCN.0000000000000393.
Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.
The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.
A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.
During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).
Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.
短时间和长时间的睡眠都与死亡率增加有关。关于睡眠时长、心血管健康和死亡率之间的关系，老年人的性别特异性差异的相关知识还很匮乏。
本研究旨在检查自我报告的睡眠时长与死亡率之间的关联，并研究这种关联是否具有性别特异性，以及是否受到心血管疾病发病率的调节，还探讨了睡眠时长对死亡率影响的潜在中介因素。
本研究采用了基于人群的观察性横断面设计，并进行了 6 年的随访，主要结局为死亡率。收集了自我评估的睡眠时长、临床检查、超声心动图和血液样本（N 末端脑钠肽前体）。共纳入 675 人（女性占 50%；平均年龄为 78 岁），分为短睡者（≤6 小时；n=231）、正常睡者（7-8 小时；n=338）和长睡者（≥9 小时；n=61）。数据进行了主成分分析。提取心血管疾病（CVD）和高血压因素作为调节因素，并在回归分析中作为中介因素。
随访期间，55 名短睡者（24%）、68 名正常睡者（20%）和 21 名长睡者（34%）死亡。中介分析表明，男性中长睡眠与死亡率独立相关（风险比[HR]，1.8；P=.049），与 CVD 和高血压无关。在短睡的男性中，CVD 是与死亡率相关的一个调节因素（HR，4.1；P=.025）。然而，当使用 N 末端脑钠肽前体时，这种影响变得不显著（HR，3.1；P=.06）。在女性中，发现了一个涉及高血压因素和短睡眠的趋势调节（HR，4.6；P=.09）。
短时间和长时间的睡眠可能被视为风险标志物，尤其是在有心血管疾病的老年男性中。
