title: A nine-year follow-up study of sleep patterns and mortality in community-dwelling older adults in Taiwan.
abstract: OBJECTIVE
  To simultaneously explore the associations between mortality and insomnia, sleep duration, and the use of hypnotics in older adults.
  
  
  METHODS
  A fixed cohort study.
  
  
  METHODS
  A community in Shih-Pai area, Taipei, Taiwan.
  
  
  METHODS
  A total of 4,064 participants over the age of 65 completed the study.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  Insomnia was classified using an exclusionary hierarchical algorithm, which categorized insomnia as "no insomnia," "subjective poor sleep quality," "Pittsburgh Sleep Quality Index > 5 insomnia," "1-month insomnia disorder," and "6-month insomnia disorder." The main outcome variables were 9-year all-cause mortality rates. In the all-cause mortality analyses, when hypnotic use, depressive symptoms and total sleep time were excluded from a proportional hazards regression model, subjects with "Pittsburgh Sleep Quality Index > 5 insomnia" had a higher mortality risk (HR: 1.21, 95% CI: 1.01-1.45). In the full model, frequent hypnotic use and long sleep duration predicted higher mortality rates. However, the increased mortality risk for subjects with "Pittsburgh Sleep Quality Index > 5 insomnia" was not observed in the full model. On the contrary, individuals with a 6-month DSM-IV insomnia disorder had a lower risk for premature death (HR: 0.64, 95% CI: 0.43-0.96).
  
  
  CONCLUSIONS
  Long sleep duration and frequent hypnotics use predicted an increased mortality risk within a community-dwelling sample of older adults. The association between insomnia and mortality was affected by insomnia definition and other parameters related to sleep patterns.
authors.affiliation: Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hsi-Chung
authors.initials: HC
authors.lastname: Chen
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000401:mortality*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D006993:Hypnotics and Sedatives
keywords: Insomnia; older adults; sleep duration; sleep pattern; use of hypnotics
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