Prediagnosis Sleep Duration, Napping, and Mortality Among Colorectal Cancer Survivors in a Large US Cohort.
Prediagnosis lifestyle factors can influence colorectal cancer (CRC) survival. Sleep deficiency is linked to metabolic dysfunction and chronic inflammation, which may contribute to higher mortality from cardiometabolic conditions and promote tumor progression. We hypothesized that prediagnosis sleep deficiency would be associated with poor CRC survival. No previous study has examined either nighttime sleep or daytime napping in relation to survival among men and women diagnosed with CRC.



We examined self-reported sleep duration and napping prior to diagnosis in relation to mortality among 4869 CRC survivors in the NIH-AARP Diet and Health Study. Vital status was ascertained by linkage to the Social Security Administration Death Master File and the National Death Index. We examined the associations of sleep and napping with mortality using traditional Cox regression (total mortality) and Compositing Risk Regression (cardiovascular disease [CVD] and CRC mortality). Models were adjusted for confounders (demographics, cancer stage, grade and treatment, smoking, physical activity, and sedentary behavior) as well as possible mediators (body mass index and health status) in separate models.



Compared to participants reporting 7-8 hours of sleep per day, those who reported <5 hr had a 36% higher all-cause mortality risk (Hazard Ratio (95% Confidence Interval), 1.36 (1.08-1.72)). Short sleep (<5 hr) was also associated with a 54% increase in CRC mortality (Substitution Hazard Ratio (95% Confidence Interval), 1.54 (1.11-2.14)) after adjusting for confounders and accounting for competing causes of death. Compared to no napping, napping 1 hr or more per day was associated with significantly higher total and CVD mortality but not CRC mortality.



Prediagnosis short sleep and long napping were associated with higher mortality among CRC survivors.
Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA.
Qian
Q
Xiao
George Washington Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA.
Hannah
H
Arem
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Ruth
R
Pfeiffer
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Charles
C
Matthews
D000368:Aged; D000073116:Cancer Survivors / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D057566:Self Report; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000150:complications* / Q000503:physiopathology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
colorectal cancer; mortality.; napping; sleep