Associations between chronotype, morbidity and mortality in the UK Biobank cohort.
Associations between chronotype, morbidity and mortality in the UK Biobank cohort.
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DOI：
10.1080/07420528.2018.1454458
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发表时间：
2018-08
影响因子：
2.8
通讯作者：
von Schantz M
中科院分区：
文献类型：
--
作者：
Knutson KL;von Schantz M
晚睡型（即晚上偏好）和晚睡时间与更高的发病率有关，包括代谢功能障碍和心血管疾病的发病率更高。然而，迄今为止，还没有人研究过时间型是否与死亡风险相关。我们的目的是在一项大型队列研究（英国生物库）中检验夜间型与死亡率增加相关的假设。我们的分析包括433，268名年龄在38-73岁的成年人，平均随访6.5年。主要暴露是时间类型，通过一个自我报告的问题进行评估，将参与者定义为明确的早晨类型、中度早晨类型、中度晚上类型或明确的晚上类型。主要结局为全因死亡率和心血管疾病（CVD）死亡率。还比较了不同时间型组的患病率。分析调整了年龄、性别、种族、吸烟、体重指数、睡眠时间、社会经济状况和合并症。更大的晚上，特别是作为一个明确的晚上类型，与所有合并症的患病率较高显着相关。比较明确的晚上型和明确的早晨型，与心理障碍的关联最强（OR 1.94，95% CI 1.86至2.02，p=<.001），其次为糖尿病（OR 1.30，95% CI 1.24至1.36，p=<.001），神经系统疾病（OR 1.25，95% CI 1.20至1.30，p=<.001），胃肠道/腹部疾病（OR 1.23，95% CI 1.19至1.27，p=<.001）和呼吸系统疾病（OR 1.22，95% CI 1.18至1.26，p=<.001）。死亡总人数为10，534人，其中2，127人死于心血管疾病。以生理时钟类型为序变量，夜间活动程度越高，全因死亡率（HR 1.02，95% CI 1.004 - 1.05，p= 0.017）和CVD死亡率（HR 1.04，95% CI 1.00 - 1.09，p= 0.06）风险增加越小。与明确的早晨类型相比，明确的晚上类型的全因死亡风险显著增加（HR 1.10，95% CI 1.02至1.18，p= 0.012）。这是第一次报告夜间类型的死亡率增加是与以前的报告增加水平的心脏代谢危险因素在这一组一致。夜间类型的死亡风险可能是由于行为，心理和生理风险因素，其中许多可能是由于内部生理时间和外部强加的工作和社会活动时间之间的长期不一致。这些发现表明，有必要研究可能的干预措施，旨在改变个人的昼夜节律或允许夜间类型更大的工作时间灵活性。
Later chronotype (i.e. evening preference) and later timing of sleep have been associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease. However, no one has examined whether chronotype is associated with mortality risk to date. Our objective was to test the hypothesis that being an evening type is associated with increased mortality in a large cohort study, the UK Biobank. Our analysis included 433,268 adults aged 38-73 at the time of enrolment and an average 6.5-year follow-up. The primary exposure was chronotype, as assessed through a single self-reported question defining participants as definite morning types, moderate morning types, moderate evening types, or definite evening types. The primary outcomes were all-cause mortality and mortality due to cardiovascular disease (CVD). Prevalent disease was also compared among the chronotype groups. Analyses were adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status and comorbidities. Greater eveningness, particularly being a definite evening type, was significantly associated with a higher prevalence of all comorbidities. Comparing definite evening type to definite morning type, the associations were strongest for psychological disorders (OR 1.94, 95% CI 1.86 to 2.02, p=<.001), followed by diabetes (OR 1.30, 95% CI 1.24 to 1.36, p=<.001), neurological disorders (OR 1.25, 95% CI 1.20 to 1.30, p=<.001), gastrointestinal/abdominal disorders (OR 1.23, 95% CI 1.19 to 1.27, p=<.001), and respiratory disorders (OR 1.22, 95% CI 1.18 to 1.26, p=<.001). The total number of deaths was 10,534, out of which 2,127 were due to CVD. Greater eveningness, based on chronotype as an ordinal variable, was associated with a small increased risk of all-cause mortality (HR 1.02, 95% CI 1.004 to 1.05, p=.017) and CVD mortality (HR 1.04, 95% CI 1.00 to 1.09, p=.06). Compared to definite morning types, definite evening types had significantly increased risk of all-cause mortality (HR 1.10, 95% CI 1.02 to 1.18, p=.012). This first report of increased mortality in evening types is consistent with previous reports of increased levels of cardiometabolic risk factors in this group. Mortality risk in evening types may be due to behavioural, psychological, and physiological risk factors, many of which may be attributable to chronic misalignment between internal physiological timing and externally imposed timing of work and social activities. These findings suggest the need for researching possible interventions aimed at either modifying circadian rhythms in individuals or at allowing evening types greater working hour flexibility.
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