Published in IJCP March 2023
Editorial
Sleep Quality and Premature Mortality
March 10, 2023 | Veena Aggarwal
Public health
     


Young people who have good sleep quality are at lower risk of premature mortality, all-cause or due to cardiovascular disease (CVD), cancer or other causes, compared to individuals who have poor sleep quality. These findings from a new study were presented at the American College of Cardiology’s Annual Scientific Session held in New Orleans earlier this month.1,2

A total of 1,72,321 people, aged 50 years (average), from the United States were enrolled for the present study. All of them had been a part of the National Health Interview Survey conducted by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics between 2013 and 2018. Half (54%) of the participants were women. Through this study, the researchers aimed to examine the impact of sleep behavior on life expectancy. The National Death Index records were used to ascertain the association between sleep and mortality, both all-cause and cause-specific.

Five parameters were used to determine the pattern score: Sleep duration of 7 to 8 hours (ideal), difficulty falling asleep no more than 2 times in a week, trouble staying asleep no more than 2 times a week, not using any sleep medication and feeling rested after waking up at least 5 days a week. Each variable was given a score of 0 or 1 with a maximum score of 5 indicating the highest quality sleep.

Over 4.3 years (median) of follow-up, 8,681 deaths were recorded; CVDs accounted for 2,610 deaths (30%), while 2,052 (24%) were from cancer and the remaining (46%) were due to other causes. The all-cause mortality was reduced by 30% among those who had all five favorable sleep factors with a hazard ratio (HR) of 0.7 when compared to participants who either had none or had one favorable sleep factor. Death due to CVD decreased by 21% (HR 0.79), while deaths due to cancer declined by 19% (HR 0.81). They also had 40% less probability of dying due to other causes such as infections, accidents or neurodegenerative diseases like dementia and Parkinson’s disease (HR 0.6).

When the role of gender was examined among the participants who had a score of 5, men had 4.7 years longer life expectancy at age 30 years versus those who had none or only one favorable sleep measure, whereas in women with all five favorable sleep factors, the life expectancy was greater by only 2.4 years. This variation, despite similar quality of sleep, needs further study, note the authors.

Maintaining good sleep hygiene is important for health and well-being. By demonstrating an association between sleep pattern and life expectancy, this study highlights that while it is important to get adequate hours of sleep daily, a good sleep quality holds equal significance. There are four components of sleep quality: sleep efficiency (the percentage of time actually spent asleep while in bed), sleep duration, sleep latency (time it takes a person to fall asleep) and wake after sleep onset (difficulty in staying asleep).

Good sleep quality heals and is restful, i.e., you feel rested after getting up in the morning. But if you wake up
feeling tired or feel sleepy during the day, this denotes poor quality sleep. Hence, patients should be enquired about their sleep habits as a routine “as part of their overall health assessment and disease management planning”.

Here are few tips to improve sleep hygiene:

  • Get up at the same time every day.
  • Go to bed when you are ready to sleep.
  • Avoid drinking tea/coffee or caffeinated drinks nearer to your bedtime.
  • Remove cell phones, computers, TV, tablets, etc. from the bedroom.
  • If you are anxious and unable to sleep, try meditation, deep breathing or progressive muscle relaxation to calm the mind and relax the muscles.

References

  1. ACC Press Release. Getting good sleep could add years to your life. Feb. 23, 2023. Available at: https://www.acc.org/About-ACC/Press-Releases/2023/02/22/21/35/Getting-Good-Sleep-Could-Add-Years-to-Your-Life. Accessed Feb. 27, 2023.
  2. Higher-quality sleep may reduce risk for mortality. Feb. 23, 2023. Available at: https://www.healio.com/news/cardiology/20230223/higherquality-sleep-may-reduce-risk-for-mortality. Accessed Feb. 27, 2023.