title: Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.
abstract: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.
  
  
  
  The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.
  
  
  
  A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.
  
  
  
  During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).
  
  
  
  Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.
authors.affiliation: Anders Broström, PhD Professor, Department of Clinical Neurophysiology, University Hospital, Linköping, and Department of Nursing, School of Health and Welfare, Jönköping University, Sweden. Ake Wahlin, PhD Professor, Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden Urban Alehagen, PhD Professor, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden. Martin Ulander, PhD MD and Sleep Specialist, Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden. Peter Johansson, PhD Associate Professor, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Broström
authors.forename: Ake
authors.initials: A
authors.lastname: Wahlin
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen
authors.forename: Martin
authors.initials: M
authors.lastname: Ulander
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D057566:Self Report; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000401:mortality*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain