A Nine-Year Follow-up Study of Sleep Patterns and Mortality in Community-Dwelling Older Adults in Taiwan
A Nine-Year Follow-up Study of Sleep Patterns and Mortality in Community-Dwelling Older Adults in Taiwan
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DOI：
10.5665/sleep.2884
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发表时间：
2013-08-01
期刊：
影响因子：
5.6
通讯作者：
Chou, Pesus
中科院分区：
文献类型：
--
作者：
Chen, Hsi-Chung;Su, Tung-Ping;Chou, Pesus
研究目的：同时探讨老年人失眠与死亡率、睡眠时间及催眠药使用的关系。设计：固定队列研究。背景：台湾台北石牌社区。参与者：共4,064名65岁以上的参与者完成研究。干预：不/A。测量与结果：失眠分类采用排除性分层算法，将失眠分为“无失眠”、“主观睡眠质量差”、“匹兹堡睡眠质量指数与睡眠质量指数”；5失眠、1个月失眠障碍和6个月失眠障碍。主要结果变量为9年全因死亡率。在全因死亡率分析中，当比例风险回归模型排除使用催眠药、抑郁症状和总睡眠时间时，具有匹兹堡睡眠质量指数和5失眠症的受试者的死亡风险更高(HR：1.21，95%CI：1.01-1.45)。在完整模型中，频繁使用催眠药和长时间睡眠预示着更高的死亡率。然而，在完整的模型中，没有观察到“匹兹堡睡眠质量指数5失眠”受试者的死亡风险增加。相反，患有6个月DSM-IV失眠障碍的个体过早死亡的风险较低(HR：0.64，95%CI：0.43-0.96)。结论：在社区居住的老年人样本中，长时间睡眠和频繁使用催眠药预示着死亡风险增加。失眠和死亡率之间的关联受到失眠定义和其他与睡眠模式相关的参数的影响。
Study Objectives: To simultaneously explore the associations between mortality and insomnia, sleep duration, and the use of hypnotics in older adults.Design: A fixed cohort study.Setting: A community in Shih-Pai area, Taipei, Taiwan.Participants: A total of 4,064 participants over the age of 65 completed the study.Intervention: N/A.Measurements and Results: Insomnia was classified using an exclusionary hierarchical algorithm, which categorized insomnia as "no insomnia," "subjective poor sleep quality," "Pittsburgh Sleep Quality Index > 5 insomnia," "1-month insomnia disorder," and "6-month insomnia disorder." The main outcome variables were 9-year all-cause mortality rates. In the all-cause mortality analyses, when hypnotic use, depressive symptoms and total sleep time were excluded from a proportional hazards regression model, subjects with "Pittsburgh Sleep Quality Index > 5 insomnia" had a higher mortality risk (HR: 1.21, 95% CI: 1.01-1.45). In the full model, frequent hypnotic use and long sleep duration predicted higher mortality rates. However, the increased mortality risk for subjects with " Pittsburgh Sleep Quality Index > 5 insomnia" was not observed in the full model. On the contrary, individuals with a 6-month DSM-IV insomnia disorder had a lower risk for premature death (HR: 0.64, 95% CI: 0.43-0.96).Conclusions: Long sleep duration and frequent hypnotics use predicted an increased mortality risk within a community-dwelling sample of older adults. The association between insomnia and mortality was affected by insomnia definition and other parameters related to sleep patterns.