Stanford University, Palo Alto, California.
University of California San Diego, San Diego.
JAMA Neurol. 2020 Oct 1;77(10):1241-1251. doi: 10.1001/jamaneurol.2020.2108.
Rapid eye movement (REM) sleep has been linked with health outcomes, but little is known about the relationship between REM sleep and mortality.
To investigate whether REM sleep is associated with greater risk of mortality in 2 independent cohorts and to explore whether another sleep stage could be driving the findings.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter population-based cross-sectional study used data from the Outcomes of Sleep Disorders in Older Men (MrOS) Sleep Study and Wisconsin Sleep Cohort (WSC). MrOS participants were recruited from December 2003 to March 2005, and WSC began in 1988. MrOS and WSC participants who had REM sleep and mortality data were included. Analysis began May 2018 and ended December 2019.
All-cause and cause-specific mortality confirmed with death certificates.
The MrOS cohort included 2675 individuals (2675 men [100%]; mean [SD] age, 76.3 [5.5] years) and was followed up for a median (interquartile range) of 12.1 (7.8-13.2) years. The WSC cohort included 1386 individuals (753 men [54.3%]; mean [SD] age, 51.5 [8.5] years) and was followed up for a median (interquartile range) of 20.8 (17.9-22.4) years. MrOS participants had a 13% higher mortality rate for every 5% reduction in REM sleep (percentage REM sleep SD = 6.6%) after adjusting for multiple demographic, sleep, and health covariates (age-adjusted hazard ratio, 1.12; fully adjusted hazard ratio, 1.13; 95% CI, 1.08-1.19). Results were similar for cardiovascular and other causes of death. Possible threshold effects were seen on the Kaplan-Meier curves, particularly for cancer; individuals with less than 15% REM sleep had a higher mortality rate compared with individuals with 15% or more for each mortality outcome with odds ratios ranging from 1.20 to 1.35. Findings were replicated in the WSC cohort despite younger age, inclusion of women, and longer follow-up (hazard ratio, 1.17; 95% CI, 1.03-1.34). A random forest model identified REM sleep as the most important sleep stage associated with survival.
Decreased percentage REM sleep was associated with greater risk of all-cause, cardiovascular, and other noncancer-related mortality in 2 independent cohorts.
快速眼动 (REM) 睡眠与健康结果有关，但 REM 睡眠与死亡率之间的关系知之甚少。
在 2 个独立队列中研究 REM 睡眠是否与更高的死亡率风险相关，并探讨是否有另一个睡眠阶段可能导致了这些发现。
设计、地点和参与者：这项多中心基于人群的横断面研究使用了来自老年男性睡眠障碍研究（MrOS）睡眠研究和威斯康星州睡眠队列（WSC）的数据。MrOS 参与者于 2003 年 12 月至 2005 年 3 月招募，WSC 于 1988 年开始。纳入有 REM 睡眠和死亡率数据的 MrOS 和 WSC 参与者。分析于 2018 年 5 月开始，2019 年 12 月结束。
所有原因和特定原因的死亡率均通过死亡证明确认。
MrOS 队列包括 2675 人（2675 名男性[100%]；平均[标准差]年龄 76.3[5.5]岁），中位（四分位间距）随访 12.1（7.8-13.2）年。WSC 队列包括 1386 人（753 名男性[54.3%]；平均[标准差]年龄 51.5[8.5]岁），中位（四分位间距）随访 20.8（17.9-22.4）年。在调整了多个人口统计学、睡眠和健康协变量后，MrOS 参与者的 REM 睡眠时间每减少 5%，死亡率就会增加 13%（REM 睡眠时间标准差为 6.6%）（年龄调整后的风险比，1.12；完全调整后的风险比，1.13；95%CI，1.08-1.19）。心血管和其他死亡原因的结果也类似。Kaplan-Meier 曲线显示可能存在阈值效应，尤其是癌症；与 REM 睡眠时间为 15%或以上的参与者相比，REM 睡眠时间少于 15%的参与者每个死亡率结果的死亡率都更高，比值比范围为 1.20 至 1.35。尽管 WSC 队列中的参与者年龄更小、包括女性和随访时间更长，但结果仍在该队列中得到了复制（风险比，1.17；95%CI，1.03-1.34）。随机森林模型确定 REM 睡眠是与生存最相关的最重要的睡眠阶段。
在 2 个独立队列中，REM 睡眠时间减少与全因、心血管和其他非癌症相关死亡率的风险增加相关。
