Objectives: To reveal sleep health phenotypes in older adults and examine their associations with time to 5-year all-cause and cardiovascular mortality. Design: Prospective longitudinal cohorts. Setting: The Study of Osteoporotic Fractures and Outcomes of Sleep Disorders in Older Men Study. Participants: N = 1722 men and women aged ≥65 years matched 1:1 on sociodemographic and clinical measures. Measurements: Self-reported habitual sleep health characteristics (satisfaction, daytime sleepiness, timing, efficiency, and duration) measured at an initial visit and longitudinal follow-up for mortality. Results: Latent class analysis revealed 3 sleep health phenotypes: (1) heightened sleep propensity (HSP; medium to long duration, high sleepiness, high efficiency/satisfaction; n = 322), (2) average sleep (AS; medium duration, average efficiency, high satisfaction, low sleepiness; n = 1,109), and (3) insomnia with short sleep (ISS; short to medium duration, low efficiency/satisfaction, moderate sleepiness; n = 291). Phenotype predicted time to all-cause mortality (χ2 = 9.4, P =.01), with HSP conferring greater risk than AS (hazard ratio [95% confidence interval] = 1.48 [1.15-1.92]) or ISS (1.52 [1.07-2.17]), despite ISS reporting the poorest mental and physical health. Although sex did not formally moderate the relationship between phenotype and mortality, subgroup analyses indicated that these findings were driven primarily by women. Phenotype did not predict cardiovascular mortality. Conclusions: These analyses support the utility of examining multidimensional sleep health profiles by suggesting that the combination of long sleep, high efficiency/satisfaction, and daytime sleepiness—previously identified as independent risk factors—may be components of a single high-risk sleep phenotype, HSP. Further investigation of sex differences and the mechanisms underlying mortality risk associated with HSP is warranted.
Bibliographical noteFunding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging , the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810 , U01 AG042124 , U01 AG042139 , U01 AG042140 , U01 AG042143 , U01 AG042145 , U01 AG042168 , U01 AR066160 , and UL1 TR000128 . The National Heart, Lung, and Blood Institute provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194 , R01 HL070848 , R01 HL070847 , R01 HL070842 , R01 HL070841 , R01 HL070837 , R01 HL070838 , and R01 HL070839 . The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grant numbers: R01 AG005407 , R01 AR35582 , R01 AR35583 , R01 AR35584 , R01 AG005394 , R01 AG027574 , and R01 AG027576 . This work was also supported by R01 AG056331 (Wallace), R35 HL135818 (Redline), and R01 AG047139 (Buysse/Hall). Appendix A
© 2019 National Sleep Foundation.
- Latent class analysis
- Sleep health
- Sleep propensity