Self-Reported Sleep and Nap Habits and Risk of Mortality in a Large Cohort of Older Women

Authors

  • Katie L. Stone PhD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Susan K. Ewing MS,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Sonia Ancoli-Israel PhD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Kristine E. Ensrud MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Susan Redline MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Douglas C. Bauer MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Jane A. Cauley DrPH,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Teresa A. Hillier MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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  • Steven R. Cummings MD

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniaDepartment of Psychiatry, University of California at San Diego, San Diego, California§Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MinnesotaDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota#Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio**Department of Medicine, University of California at San Francisco, San Francisco, California††Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡‡Kaiser Permanente Center for Health Research, Portland, Oregon.
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Address correspondence to Katie L. Stone, San Francisco Coordinating Center, California Pacific Medical Center Research Institute, 185 Berry Street, Lobby 5, 5th floor, Suite 5700, San Francisco, CA 94107. E-mail: kstone@sfcc-cpmc.net

Abstract

OBJECTIVES: To determine the association between self-reported sleep and nap habits and mortality in a large cohort of older women.

DESIGN: Study of Osteoporotic Fractures prospective cohort study.

SETTING: Four communities within the United States.

PARTICIPANTS: Eight thousand one hundred one Caucasian women aged 69 and older (mean age 77.0).

MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Deaths during 7 years of follow-up were confirmed with death certificates. Underlying cause of death was assigned according to the International Classification of Diseases, Ninth Revision, Clinical Modification.

RESULTS: In multivariate models, women who reported napping daily were 44% more likely to die from any cause (95% confidence interval (CI)=1.23–1.67), 58% more likely to die from cardiovascular causes (95% CI=1.25–2.00), and 59% more likely to die from noncardiovascular noncancer causes (95% CI=1.24–2.03) than women who did not nap daily. This relationship remained significant in relatively healthy women (those who reported no comorbidities). Women who slept 9 to 10 hours per 24 hours were at greater risk of death from cardiovascular and other (noncardiovascular, noncancer) causes than those who reported sleeping 8 to 9 hours.

CONCLUSION: Older women who reported napping daily or sleeping at least 9 hours per 24 hours are at greater risk of death from all causes except cancer. Future research could determine whether specific sleep disorders contribute to these relationships.

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