期刊
SLEEP MEDICINE REVIEWS
卷 48, 期 -, 页码 -出版社
W B SAUNDERS CO LTD
DOI: 10.1016/j.smrv.2019.101215
关键词
Insomnia symptom; Difficulty falling asleep; Difficulty maintaining sleep; Early morning awakening; Non-restorative sleep; Mortality; Prospective cohort study; Meta-analysis
资金
- Fundamental Research Funds for the Central Universities - Research on Evidence-Based Social Science [16LZUJBWTD013]
- Chinese high-level public university post-graduate project from China Scholarship Council
Growing evidence indicates that insomnia may be associated with mortality. However, these findings have been inconsistent. We systematically searched MEDLINE and EMBASE to identify prospective cohort studies that assessed the association between insomnia disorder/individual insomnia symptoms and the risk of mortality among adults aged >= 18 yrs. We addressed this association using summary hazard ratios (HRs) and 95% confidence intervals (CIs) calculated using random-effects meta-analysis, and the GRADE approach to rate the certainty of evidence. Twenty-nine cohorts including 1,598,628 individuals (55.3% men; mean age 63.7 yrs old) with a median follow-up duration of 10.5 yrs proved eligible. Difficulty falling asleep (DFA) and non-restorative sleep (NRS) were associated with an increased risk of all-cause mortality (DFA: HR = 1.13, 95%CI 1.03 to 1.23, p = 0.009, moderate certainty; NRS: HR = 1.23, 95%CI 1.07 to 1.42, p = 0.003, high certainty) and cardiovascular disease mortality (DFA: 1.20, 95%CI: 1.01, 1.43; p = 0.04, moderate certainty; NRS: HR = 1.48, 95%CI 1.06 to 2.06, p = 0.02, moderate certainty). Convincing associations between DFA and all-cause mortality were restricted to the mid to older-aged population (moderate credibility). Insomnia disorder, difficulty maintaining sleep, and early morning awakening proved to be unassociated with all-cause and cardiovascular disease mortality. No insomnia symptoms proved to be associated with cancer-related mortality. (C) 2019 Elsevier Ltd. All rights reserved.
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