The relationship between sleep duration and all-cause mortality in the older people: an updated and dose-response meta-analysis

Background: Short or long sleep duration is proposed as a potential risk factor for all-cause mortality in the older people, yet the results of published studies are not often reproducible. Methods: Literature retrieval, study selection and data extraction were completed independently and in duplicate. Only prospective cohort studies were included. Effect-size estimates are expressed as hazard ratio (HR) and 95% confidence interval (CI). Results: Summary data from 28 articles, involving a total of 95,259 older people, were meta-analyzed. Overall analyses revealed a remarkably significant association between long sleep duration and all-cause mortality (adjusted HR=1.24, 95% CI: 1.16-1.33, P<.001), whereas only marginal significance was observed for short sleep duration (adjusted HR=1.04; 95% CI: 1.00-1.09; P=.033). Funnel plots suggested no publication bias for short sleep duration (P=.392). The probability of publication bias was high for long sleep duration (P=.020), yet the trim-and-fill method strengthened its significance in predicting all-cause mortality. In subgroup analyses, the association of long sleep duration with all-cause mortality was statistically significant in both women (HR=1.48; 95% CI: 1.18-1.86; P=.001) and men (HR=1.31; 95% CI: 1.10-1.58; P=.003). By contrast, with regard to short sleep duration, statistical significance was observed in men (HR=1.13; 95% CI: 1.04-1.24; P=.007), but not in women (HR=1.00; 95% CI: 0.85-1.18; P=.999) (Two-sample Z test P=.099). Besides gender, geographic region, sleep survey method, baseline age and follow-up interval were identified as possible causes of between-study heterogeneity in subgroup analyses. Further dose-response regression analyses revealed that trend estimation was more obvious for long sleep duration (regression coefficient: 0.13; P<.001) than for short sleep duration (regression coefficient: 0.02; P=.046). Conclusions: Our findings indicate a significantly increased risk of all-cause mortality associated with long sleep duration, especially in women, as well as with short sleep duration in men only.