Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults
Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults
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DOI：
10.1001/jamaneurol.2020.2108
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发表时间：
2020-10-01
期刊：
影响因子：
29
通讯作者：
Stone, Katie L.
中科院分区：
文献类型：
--
作者：
Leary, Eileen B.;Watson, Kathleen T.;Stone, Katie L.
这项横断面研究在 2 个独立队列中调查了快速眼动睡眠是否与较高的死亡风险相关，并探讨了另一个睡眠阶段是否可能推动这些发现。 重要性 快速眼动 (REM) 睡眠与健康结果相关，但人们对 REM 睡眠与死亡率之间的关系知之甚少。目的 在 2 个独立队列中调查快速眼动睡眠是否与较高的死亡风险相关，并探讨另一个睡眠阶段是否可能推动这一发现。设计、设置和参与者 这项基于人群的多中心横断面研究使用了老年男性睡眠障碍结果 (MrOS) 睡眠研究和威斯康星州睡眠队列 (WSC) 的数据。 MrOS 参与者于 2003 年 12 月至 2005 年 3 月期间招募，WSC 于 1988 年开始。包含有 REM 睡眠和死亡率数据的 MrOS 和 WSC 参与者。分析从 2018 年 5 月开始，到 2019 年 12 月结束。 主要结果和措施 通过死亡证明确认全因和特定原因死亡率。结果 MrOS 队列包括 2675 名个体（2675 名男性 [100%]；平均 [SD] 年龄，76.3 [5.5] 岁），随访中位数（四分位距）为 12.1 (7.8-13.2) 年。 WSC 队列包括 1386 名个体（753 名男性 [54.3%]；平均 [SD] 年龄，51.5 [8.5] 岁），随访中位数（四分位距）为 20.8 (17.9-22.4) 年。在调整多个人口统计、睡眠和健康协变量后（年龄调整风险比，1.12；完全调整风险比，1.13；95% CI，1.08-1.19），MrOS 参与者的 REM 睡眠每减少 5%，死亡率就会增加 13%（REM 睡眠百分比 SD = 6.6%）。心血管死亡原因和其他死因的结果相似。在 Kaplan-Meier 曲线上发现了可能的阈值效应，特别是对于癌症；与每项死亡率结果为 15% 或以上的个体相比，快速眼动睡眠不足 15% 的个体死亡率较高，比值比范围为 1.20 至 1.35。尽管年龄较小、女性参与且随访时间较长，但研究结果在 WSC 队列中得到了重复（风险比，1.17；95% CI，1.03-1.34）。随机森林模型将快速眼动睡眠确定为与生存相关的最重要的睡眠阶段。结论和相关性 在 2 个独立队列中，REM 睡眠百分比的降低与全因死亡率、心血管死亡率和其他非癌症相关死亡率的增加风险相关。问题 快速眼动 (REM) 睡眠百分比降低是否与死亡率增加相关？结果 在这项对来自 2 个独立队列的 4050 名个体进行的横断面研究中，较少的 REM 睡眠时间与全因死亡风险增加相关。在 2675 名老年男性队列中，快速眼动睡眠每减少 5%，在 12.1 年内死亡率就会增加 13%，这一发现在随访 20.8 年的 1375 名中年男性和女性队列中得到了重复。意味着较少的快速眼动睡眠与死亡风险增加有关。
This cross-sectional study investigates whether rapid eye movement sleep is associated with greater risk of mortality in 2 independent cohorts and explores whether another sleep stage could be driving these findings.Importance Rapid eye movement (REM) sleep has been linked with health outcomes, but little is known about the relationship between REM sleep and mortality. Objective To investigate whether REM sleep is associated with greater risk of mortality in 2 independent cohorts and to explore whether another sleep stage could be driving the findings. Design, Setting, and Participants This multicenter population-based cross-sectional study used data from the Outcomes of Sleep Disorders in Older Men (MrOS) Sleep Study and Wisconsin Sleep Cohort (WSC). MrOS participants were recruited from December 2003 to March 2005, and WSC began in 1988. MrOS and WSC participants who had REM sleep and mortality data were included. Analysis began May 2018 and ended December 2019. Main Outcomes and Measures All-cause and cause-specific mortality confirmed with death certificates. Results The MrOS cohort included 2675 individuals (2675 men [100%]; mean [SD] age, 76.3 [5.5] years) and was followed up for a median (interquartile range) of 12.1 (7.8-13.2) years. The WSC cohort included 1386 individuals (753 men [54.3%]; mean [SD] age, 51.5 [8.5] years) and was followed up for a median (interquartile range) of 20.8 (17.9-22.4) years. MrOS participants had a 13% higher mortality rate for every 5% reduction in REM sleep (percentage REM sleep SD = 6.6%) after adjusting for multiple demographic, sleep, and health covariates (age-adjusted hazard ratio, 1.12; fully adjusted hazard ratio, 1.13; 95% CI, 1.08-1.19). Results were similar for cardiovascular and other causes of death. Possible threshold effects were seen on the Kaplan-Meier curves, particularly for cancer; individuals with less than 15% REM sleep had a higher mortality rate compared with individuals with 15% or more for each mortality outcome with odds ratios ranging from 1.20 to 1.35. Findings were replicated in the WSC cohort despite younger age, inclusion of women, and longer follow-up (hazard ratio, 1.17; 95% CI, 1.03-1.34). A random forest model identified REM sleep as the most important sleep stage associated with survival. Conclusions and Relevance Decreased percentage REM sleep was associated with greater risk of all-cause, cardiovascular, and other noncancer-related mortality in 2 independent cohorts.Question Is less rapid eye movement (REM) sleep associated with increased mortality? Findings In this cross-sectional study of 4050 individuals from 2 independent cohorts, lower amounts of REM sleep were associated with increased risk of all-cause mortality. There was a 13% higher mortality rate over 12.1 years for every 5% reduction in REM sleep in a cohort of 2675 older men, and the finding was replicated in a cohort of 1375 middle-aged men and women followed-up for 20.8 years. Meaning Less REM sleep is associated with increased mortality risk.