title: Sleep duration and mortality in the elderly: a systematic review with meta-analysis.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals.
  
  
  METHODS
  Systematic review and meta-analysis of population-based cohort studies.
  
  
  METHODS
  Articles were retrieved from international and national electronic databases.
  
  
  METHODS
  Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded.
  
  
  METHODS
  Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran's Q and the I(2) statistics, respectively, and sensitivity analyses were conducted.
  
  
  METHODS
  All-cause and cardiovascular mortality.
  
  
  RESULTS
  Overall, 27 cohort studies were selected, comprising >70,000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥ 30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥ 2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90).
  
  
  CONCLUSIONS
  Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.
authors.affiliation: Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Andressa Alves
authors.initials: AA
authors.lastname: da Silva
authors.affiliation: Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Renato Gorga Bandeira
authors.initials: RG
authors.lastname: de Mello
authors.affiliation: Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Camila Wohlgemuth
authors.initials: CW
authors.lastname: Schaan
authors.affiliation: Division of Cardiology, National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Flávio D
authors.initials: FD
authors.lastname: Fuchs
authors.affiliation: Department of Medicine, Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Fuchs
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D012306:Risk; D012890:Sleep; D012893:Sleep Wake Disorders / Q000401:mortality*; D013997:Time Factors
keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE; Meta-analysis; SLEEP MEDICINE; Systematic review