title: Insomnia with short sleep duration and mortality: the Penn State cohort.
abstract: OBJECTIVE
  Because insomnia with objective short sleep duration is associated with increased morbidity, we examined the effects of this insomnia subtype on all-cause mortality.
  
  
  METHODS
  Longitudinal.
  
  
  METHODS
  Sleep laboratory.
  
  
  METHODS
  1,741 men and women randomly selected from Central Pennsylvania.
  
  
  METHODS
  Participants were studied in the sleep laboratory and were followed-up for 14 years (men) and 10 years (women). "Insomnia" was defined by a complaint of insomnia with duration > or = 1 year. "Normal sleeping" was defined as absence of insomnia. Polysomnographic sleep duration was classified into two categories: the "normal sleep duration group" subjects who slept > or = 6 h and the "short sleep duration group" subjects who slept < 6 h. We adjusted for age, race, education, body mass index, smoking, alcohol, depression, sleep disordered breathing, and sampling weight.
  
  
  RESULTS
  The mortality rate was 21% for men and 5% for women. In men, mortality risk was significantly increased in insomniacs who slept less than 6 hours compared to the "normal sleep duration, no insomnia" group, (OR = 4.00, CI 1.14-13.99) after adjusting for diabetes, hypertension, and other confounders. Furthermore, there was a marginally significant trend (P = 0.15) towards higher mortality risk from insomnia and short sleep in patients with diabetes or hypertension (OR = 7.17, 95% CI 1.41-36.62) than in those without these comorbid conditions (OR = 1.45, 95% CI 0.13-16.14). In women, mortality was not associated with insomnia and short sleep duration.
  
  
  CONCLUSIONS
  Insomnia with objective short sleep duration in men is associated with increased mortality, a risk that has been underestimated.
authors.affiliation: Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. avgontzas@psu.edu
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Vgontzas
authors.forename: Duanping
authors.initials: D
authors.lastname: Liao
authors.forename: Slobodanka
authors.initials: S
authors.lastname: Pejovic
authors.forename: Susan
authors.initials: S
authors.lastname: Calhoun
authors.forename: Maria
authors.initials: M
authors.lastname: Karataraki
authors.forename: Maria
authors.initials: M
authors.lastname: Basta
authors.forename: Julio
authors.initials: J
authors.lastname: Fernández-Mendoza
authors.forename: Edward O
authors.initials: EO
authors.lastname: Bixler
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D012307:Risk Factors; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D013997:Time Factors