Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210.
Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, NY 11794-8338.
Sleep Health. 2020 Feb;6(1):48-59. doi: 10.1016/j.sleh.2019.09.005. Epub 2019 Nov 4.
The Women's Health Initiative (WHI), a longitudinal study of more than 161,000 postmenopausal women across the United States, provides an opportunity to investigate the link between sleep health and healthy aging. The purpose of this paper was to systematically review all published WHI articles examining sleep as a predictor of health outcomes and health behaviors/quality of life outcomes. A strength of the WHI is that for most participants, sleep measures were completed before a major health diagnosis, with a significant portion of participants also providing sleep measures after diagnosis. Twenty-three WHI articles were identified and examined for this review. The combination of sleep duration and insomnia symptoms was the most commonly investigated sleep measure. The results indicated that both short (≤6 hours) and long (≥9 hours) sleep duration were associated with a higher risk of cardiovascular disease, colorectal cancer, mortality, cognitive decline, and poor diet. Insomnia symptoms, frequent snoring, and risk of sleep-disordered breathing (SDB) were also associated with increased risk for ischemic stroke and cardiovascular disease. However, many significant results were attenuated after multivariable adjustment. Limitations of these WHI examinations include the use of different categories for sleep measures across studies and a lack of examination by race/ethnicity. Owing to the longitudinal study design, large sample size, and long-term follow-up for health outcomes, the WHI serves as a rich resource for examining associations between sleep characteristics, demographics, and health in postmenopausal women.
妇女健康倡议(WHI)是一项针对美国超过 161000 名绝经后妇女的纵向研究,为研究睡眠健康与健康老龄化之间的关系提供了机会。本文的目的是系统地回顾所有发表的 WHI 文章,这些文章研究了睡眠作为健康结果和健康行为/生活质量结果的预测因素。WHI 的一个优势是,对于大多数参与者来说,睡眠测量是在重大健康诊断之前完成的,而且很大一部分参与者在诊断后也提供了睡眠测量。本综述共确定并检查了 23 篇 WHI 文章。睡眠持续时间和失眠症状的组合是最常研究的睡眠测量指标。结果表明,短睡(≤6 小时)和长睡(≥9 小时)都与心血管疾病、结直肠癌、死亡率、认知能力下降和不良饮食有关。失眠症状、频繁打鼾和睡眠呼吸障碍(SDB)风险也与缺血性中风和心血管疾病风险增加有关。然而,许多显著的结果在多变量调整后减弱了。这些 WHI 检查的局限性包括在研究中使用不同的睡眠测量类别以及缺乏按种族/族裔进行检查。由于采用了纵向研究设计、样本量大、对健康结果的长期随访,WHI 为研究绝经后妇女的睡眠特征、人口统计学和健康之间的关联提供了丰富的资源。