The joint effect of sleep duration and disturbed sleep on cause-specific mortality: results from the Whitehall II cohort study.
BACKGROUND
Both sleep duration and sleep quality are related to future health, but their combined effects on mortality are unsettled. We aimed to examine the individual and joint effects of sleep duration and sleep disturbances on cause-specific mortality in a large prospective cohort study.


METHODS
We included 9,098 men and women free of pre-existing disease from the Whitehall II study, UK. Sleep measures were self-reported at baseline (1985-1988). Participants were followed until 2010 in a nationwide death register for total and cause-specific (cardiovascular disease, cancer and other) mortality.


RESULTS
There were 804 deaths over a mean 22 year follow-up period. In men, short sleep (≤ 6 hrs/night) and disturbed sleep were not independently associated with CVD mortality, but there was an indication of higher risk among men who experienced both (HR = 1.57; 95% CI: 0.96-2.58). In women, short sleep and disturbed sleep were independently associated with CVD mortality, and women with both short and disturbed sleep experienced a much higher risk of CVD mortality (3.19; 1.52-6.72) compared to those who slept 7-8 hours with no sleep disturbances; equivalent to approximately 90 additional deaths per 100,000 person years. Sleep was not associated with death due to cancer or other causes.


CONCLUSIONS
Both short sleep and disturbed sleep are independent risk factors for CVD mortality in women and future studies on sleep may benefit from assessing disturbed sleep in addition to sleep duration in order to capture health-relevant features of inadequate sleep.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Copenhagen Stress Research Center, Copenhagen, Denmark.
Naja Hulvej
NH
Rod
Department of Epidemiology and Public Health, University College London, London, England.
Meena
M
Kumari
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Theis
T
Lange
Department of Epidemiology and Public Health, University College London, London, England.
Mika
M
Kivimäki
Department of Epidemiology and Public Health, University College London, London, England.
Martin
M
Shipley
Department of Epidemiology and Public Health, University College London, London, England; School of Social and Community Medicine, University of Bristol, Bristol, England.
Jane
J
Ferrie
D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D012892:Sleep Deprivation / Q000150:complications*; D015996:Survival Rate; D013997:Time Factors