Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 1;18(3):921-926.
doi: 10.5664/jcsm.9664.

Day-to-day variation in sleep duration is associated with increased all-cause mortality

Adarsh Katamreddy  1 , Dipan Uppal  1 , Gokul Ramani  1 , Saul Rios  2 , Jeremy Miles  2 , Yu Chiang Wang  1 , Robert T Faillace  1
Affiliations

Day-to-day variation in sleep duration is associated with increased all-cause mortality

Adarsh Katamreddy et al. J Clin Sleep Med. .

Abstract

Study objectives: There is a paucity of data on the association between day-to-day variation in sleep pattern and all-cause mortality. We aimed to investigate whether day-to-day variation in sleep duration and onset of sleep are associated with cardiovascular and all-cause mortality.

Methods: We used data belonging to 388 unique patients from the Midlife in the United States 2 Biomarker study (2004-2009). Information on sleep onset, duration, and sleep-wake cycles was collected for 7 consecutive days using the Actiwatch device. Sleep irregularity was assessed using mean and standard deviations in sleep duration and time of onset of sleep over 7 days. Cox proportional regression analysis and the Fine and Gray subdistribution method were used with all-cause and cardiovascular mortality, respectively.

Results: Over a median of 8.6 years of follow-up, 37 patients died, including 10 deaths resulting from cardiovascular causes. There was no statistically significant increase in cardiovascular mortality with variation in sleep duration in the highest vs the lowest tertile (hazard ratio, 4.00; 0.45-35.48; P = .21). However, increased all-cause mortality was seen in the highest vs the lowest tertile (hazard ratio, 3.99; 1.33-11.94; P = .01). Multivariable model adjusting for confounders had higher all-cause mortality with increased sleep duration variation in the highest vs the lowest tertile: hazard ratio, 4.85; 1.52-15.49; P < .01).

Conclusions: Day-to-day variation in sleep duration is associated with increased all-cause mortality but not cardiovascular mortality after adjusting for mean sleep duration, inflammation, diabetes, age, body mass index, renal function, and blood pressure. Irregularity in the onset of sleep is not associated with all-cause mortality or cardiovascular mortality.

Citation: Katamreddy A, Uppal D, Ramani G, et al. Day-to-day variation in sleep duration is associated with increased all-cause mortality. J Clin Sleep Med. 2022;18(3):921-926.

Keywords: all-cause mortality; cardiovascular disease mortality; sleep irregularity.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest. All authors have seen and approved this manuscript.

Figures

Figure 1
Figure 1. Flowchart of patients included in the current study as a subset of the MIDUS 2 cohort.
MIDUS 2 = Midlife in the United States 2.
Figure 2
Figure 2. Modified forest plots.
(A) Adjusted model for variation in sleep duration and all-cause mortality. (B) Adjusted model for variation in sleep duration and cardiovascular mortality. (C) Univariate model for variation in onset of sleep and all-cause mortality. SD = standard deviation.
Figure 3
Figure 3. Kaplan-Meier plots for all-cause mortality with log-rank test P value inset.
(A) Grouped by sleep duration SD tertiles. (B) Grouped by sleep timing SD tertiles. SD = standard deviation.
See this image and copyright information in PMC

Comment in

References

    1. Mukherjee S , Patel SR , Kales SN , et al. ; American Thoracic Society Ad Hoc Committee on Healthy Sleep . An official American Thoracic Society statement: the importance of healthy sleep. Recommendations and future priorities . Am J Respir Crit Care Med. 2015. ; 191 ( 12 ): 1450 – 1458 . - PMC - PubMed
    1. Lin J , Jiang Y , Wang G , et al. . Associations of short sleep duration with appetite-regulating hormones and adipokines: a systematic review and meta-analysis . Obes Rev. 2020. ; 21 ( 11 ): e13051 . - PubMed
    1. Taheri S , Lin L , Austin D , Young T , Mignot E . Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index . PLoS Med. 2004. ; 1 ( 3 ): e62 . - PMC - PubMed
    1. Van Laake LW , Lüscher TF , Young ME . The circadian clock in cardiovascular regulation and disease: lessons from the Nobel Prize in Physiology or Medicine 2017 . Eur Heart J. 2018. ; 39 ( 24 ): 2326 – 2329 . - PMC - PubMed
    1. Degaute JP , van de Borne P , Linkowski P , Van Cauter E . Quantitative analysis of the 24-hour blood pressure and heart rate patterns in young men . Hypertension. 1991. ; 18 ( 2 ): 199 – 210 . - PubMed