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Observational Study
. 2020 Oct 1;77(10):1241-1251.
doi: 10.1001/jamaneurol.2020.2108.

Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults

Eileen B Leary  1 , Kathleen T Watson  1 , Sonia Ancoli-Israel  2 , Susan Redline  3 , Kristine Yaffe  4 , Laurel A Ravelo  5 , Paul E Peppard  5 , James Zou  1 , Steven N Goodman  1 , Emmanuel Mignot  1 , Katie L Stone  4   6
Affiliations
Observational Study

Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults

Eileen B Leary et al. JAMA Neurol. .

Erratum in

  • Error in Abstract.
    [No authors listed] [No authors listed] JAMA Neurol. 2020 Oct 1;77(10):1322. doi: 10.1001/jamaneurol.2020.3067. JAMA Neurol. 2020. PMID: 32804204 Free PMC article. No abstract available.

Abstract

Importance: Rapid eye movement (REM) sleep has been linked with health outcomes, but little is known about the relationship between REM sleep and mortality.

Objective: 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.

Main outcomes and measures: All-cause and cause-specific mortality confirmed with death certificates.

Results: 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.

Conclusions and relevance: Decreased percentage REM sleep was associated with greater risk of all-cause, cardiovascular, and other noncancer-related mortality in 2 independent cohorts.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ancoli-Israel reports consulting for Eisai and Merck outside the submitted work. Dr Redline reports grants and personal fees from Jazz Pharmaceuticals, consulting fees from Respicardia, and personal fees from Eisai outside the submitted work. Dr Peppard reports grants from the National Institutes of Health during the conduct of the study. Dr Mignot is a consultant and a principal investigator for clinical trials involving Merck, Jazz Pharmaceuticals, and Takeda and owns stocks in Dreem, Inexia, Orexia, and Alerion. Dr Stone reports grants from the National Institutes of Health during the conduct of the study and grants from Merck outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Unadjusted Kaplan-Meier Plots by Percentage of REM Sleep Quartile and 15% REM Sleep Threshold in the Outcomes of Sleep Disorders in Older Men Study Cohort
Q indicates quarter; REM, rapid eye movement.
See this image and copyright information in PMC

Comment in

  • Should Neurologists Be Concerned With REM Sleep Quantity?
    Jaffee MS, Ashbrook LH, Pavlova MK. Jaffee MS, et al. JAMA Neurol. 2020 Oct 1;77(10):1209-1210. doi: 10.1001/jamaneurol.2020.2122. JAMA Neurol. 2020. PMID: 32663238 No abstract available.
  • Living to Dream-Reply.
    Leary EB, Stone KL, Mignot E. Leary EB, et al. JAMA Neurol. 2021 Apr 1;78(4):495-496. doi: 10.1001/jamaneurol.2021.0056. JAMA Neurol. 2021. PMID: 33646274 No abstract available.
  • Living to Dream.
    Bliwise DL, Trotti LM. Bliwise DL, et al. JAMA Neurol. 2021 Apr 1;78(4):495. doi: 10.1001/jamaneurol.2021.0053. JAMA Neurol. 2021. PMID: 33646279 No abstract available.

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