There is apt evidence in favor of a significant association between sleep and mortality. So far, most studies examine sleep problems using comprehensive, time-consuming tools and questions. In this study, we investigated the ability of four simple “yes” or “no” answered questions (i.e. easiness to fall asleep, restful upon awakening, sleep satisfaction and presence of insomnia) to predict 12-year all-cause and cardiovascular mortality in a rural population of 1519 citizens. The sample consisted of 652 males and 867 females, with a mean age of 56.9 years old (range 15–102 years old). Age, gender, education, smoking, body mass index and health status were used as confounders in the Cox proportional hazard models. 293 (19.3%) deaths were recorded. After adjusting for confounders, difficulty to fall asleep was significantly related to an increased risk of cardiovascular death in smokers (aHR 3.71, 95% CI 1.01–13.62). Male individuals, not feeling restful upon awakening were at a significantly increased risk of all-cause (aHR 2.08, 95% CI 1.33–3.24) and cardiovascular mortality (aHR 6.24, 95% CI 1.90–20.49), in the latter case only if they were non-smokers. Smokers, not satisfied with their sleep, were at a significantly increased risk of cardiovascular death (aHR 5.44, 95% CI 1.73–17.09). The presence of insomnia significantly increased the risk of all-cause mortality (aHR 8.10, 95% CI 1.66–39.57) in smokers of basic education and cardiovascular mortality (aHR 26.68 95% CI 4.78–148.49) in smokers. In conclusion, simple sleep questions can predict mortality, at least in rural populations. Future studies should expand these results to other populations.
Sleep Mortality Cardiovascular Questions Insomnia
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Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
da Silva AA, de Mello RG, Schaan CW, Fuchs FD, Redline S, Fuchs SC. Sleep duration and mortality in the elderly: a systematic review with meta-analysis. BMJ Open. 2016;6(2):e008119.CrossRefPubMedPubMedCentralGoogle Scholar
Shen X, Wu Y, Zhang D. Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: a meta-analysis of prospective cohort studies. Sci Rep. 2016;6:21480.CrossRefPubMedPubMedCentralGoogle Scholar
Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002;251(3):207–16.CrossRefPubMedGoogle Scholar
Rod NH, Vahtera J, Westerlund H, et al. Sleep disturbances and cause-specific mortality: results from the GAZEL cohort study. Am J Epidemiol. 2011;173(3):300–9.CrossRefPubMedGoogle Scholar
Rod NH, Kumari M, Lange T, Kivimäki M, Shipley M, Ferrie J. The joint effect of sleep duration and disturbed sleep on cause-specific mortality: results from the Whitehall II cohort study. PLoS One. 2014;9(4):e91965.CrossRefPubMedPubMedCentralGoogle Scholar
Gómez-Olivé FX, Thorogood M, Kandala NB, et al. Sleep problems and mortality in rural South Africa: novel evidence from a low-resource setting. Sleep Med. 2014;15(1):56–63.CrossRefPubMedGoogle Scholar
Hamer M, Batty GD, Kivimaki M. Sleep loss due to worry and future risk of cardiovascular disease and all-cause mortality: the Scottish Health Survey. Eur J Prev Cardiol. 2012;19(6):1437–43.CrossRefPubMedGoogle Scholar
Howrey BT, Peek MK, Raji MA, Ray LA, Ottenbacher KJ. Self-reported sleep characteristics and mortality in older adults of mexican origin: results from the Hispanic established population for the epidemiologic study of the elderly. J Am Geriatr Soc. 2012;60(10):1906–11.CrossRefPubMedPubMedCentralGoogle Scholar
Kojima M, Wakai K, Kawamura T, et al. Sleep patterns and total mortality: a 12-year follow-up study in Japan. J Epidemiol. 2000;10(2):87–93.CrossRefPubMedGoogle Scholar
Qiu L, Sautter J, Liu Y, Gu D. Age and gender differences in linkages of sleep with subsequent mortality and health among very old Chinese. Sleep Med. 2011;12(10):1008–17.CrossRefPubMedPubMedCentralGoogle Scholar
Hublin C, Partinen M, Koskenvuo M, Kaprio J. Heritability and mortality risk of insomnia-related symptoms: a genetic epidemiologic study in a population-based twin cohort. Sleep. 2011;34(7):957–64.CrossRefPubMedPubMedCentralGoogle Scholar
Rockwood K, Davis HS, Merry HR, MacKnight C, McDowell I. Sleep disturbances and mortality: results from the Canadian Study of Health and Aging. J Am Geriatr Soc. 2001;49(5):639–41.CrossRefPubMedGoogle Scholar
Althuis MD, Fredman L, Langenberg PW, Magaziner J. The relationship between insomnia and mortality among community-dwelling older women. J Am Geriatr Soc. 1998;46(10):1270–3.CrossRefPubMedGoogle Scholar
Darviri C, Artemiadis A, Tigani X, Darvyri P, Gnardellis C. Religiosity as a predictor of mortality: a retrospective cohort study in 1519 rural citizens in Greece. Psychol Health. 2016;31(9):1080–90.CrossRefPubMedGoogle Scholar
Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37.CrossRefPubMedGoogle Scholar
Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015;66:143–72.CrossRefPubMedGoogle Scholar
McNamara JP, Wang J, Holiday DB, et al. Sleep disturbances associated with cigarette smoking. Psychol Health Med. 2014;19(4):410–9.CrossRefPubMedGoogle Scholar
Krishnan V, Dixon-Williams S, Thornton JD. Where there is smoke… there is sleep apnea: exploring the relationship between smoking and sleep apnea. Chest. 2014;146(6):1673–80.CrossRefPubMedPubMedCentralGoogle Scholar
Lavie L, Lavie P. Smoking interacts with sleep apnea to increase cardiovascular risk. Sleep Med. 2008;9(3):247–53.CrossRefPubMedGoogle Scholar
Zhang J, Lam SP, Li SX, Li AM, Wing YK. The longitudinal course and impact of non-restorative sleep: a five-year community-based follow-up study. Sleep Med. 2012;13(6):570–6.CrossRefPubMedGoogle Scholar
Wakasugi M, Kazama JJ, Narita I, et al. Association between combined lifestyle factors and non-restorative sleep in Japan: a cross-sectional study based on a Japanese health database. PLoS One. 2014;9(9):e108718.CrossRefPubMedPubMedCentralGoogle Scholar
Sivertsen B, Krokstad S, Øverland S, Mykletun A. The epidemiology of insomnia: associations with physical and mental health. The HUNT-2 study. J Psychosom Res. 2009;67(2):109–16.CrossRefPubMedGoogle Scholar
Rhee CW, Kim JY, Park BJ, Li ZM, Ahn YO. Impact of individual and combined health behaviors on all causes of premature mortality among middle aged men in Korea: the Seoul Male Cohort Study. J Prev Med Public Health. 2012;45(1):14–20.CrossRefPubMedPubMedCentralGoogle Scholar
McEwen BS, Gianaros PJ. Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease. Ann N Y Acad Sci. 2010;1186:190–222.CrossRefPubMedPubMedCentralGoogle Scholar