Summary: During mid-to-late life, getting less than five hours of sleep a night increases the risk of developing heart disease, cancer, and diabetes.
Getting less than five hours of sleep in mid-to-late life could be linked to an increased risk of developing at least two chronic diseases, finds a new study led by UCL researchers.
The research, published in PLOS Medicine, analyzed the impact of sleep duration on the health of more than 7,000 men and women at the ages of 50, 60 and 70, from the Whitehall II cohort study.
Researchers examined the relationship between how long each participant slept for, mortality and whether they had been diagnosed with two or more chronic diseases (multimorbidity)—such as heart disease, cancer or diabetes—over the course of 25 years.
People who reported getting five hours of sleep or less at age 50 were 20% more likely to have been diagnosed with a chronic disease and 40% more likely to be diagnosed with two or more chronic diseases over 25 years, compared to people who slept for up to seven hours.
Additionally, sleeping for five hours or less at the age of 50, 60, and 70 was linked to a 30% to 40% increased risk of multimorbidity when compared with those who slept for up to seven hours.
Researchers also found that sleep duration of five hours or less at age 50 was associated with 25% increased risk of mortality over the 25 years of follow-up—which can mainly be explained by the fact that short sleep duration increases the risk of chronic disease(s) that in turn increase the risk of death.
Lead author, Dr. Severine Sabia (UCL Institute of Epidemiology & Health, and Inserm, Université Paris Cité) said, “Multimorbidity is on the rise in high income countries and more than half of older adults now have at least two chronic diseases. This is proving to be a major challenge for public health, as multimorbidity is associated with high healthcare service use, hospitalizations and disability.
“As people get older, their sleep habits and sleep structure change. However, it is recommended to sleep for seven to eight hours a night—as sleep durations above or below this have previously been associated with individual chronic diseases.
“Our findings show that short sleep duration is also associated with multimorbidity.
“To ensure a better night’s sleep, it is important to promote good sleep hygiene, such as making sure the bedroom is quiet, dark and a comfortable temperature before sleeping. It’s also advised to remove electronic devices and avoid large meals before bedtime. Physical activity and exposure to light during the day might also promote good sleep.”
As part of the study, researchers also assessed whether sleeping for a long duration, of nine hours or more, affected health outcomes. There was no clear association between long sleep durations at age 50 and multimorbidity in healthy people.
However, if a participant had already been diagnosed with a chronic condition, then long sleep duration was associated with around a 35% increased risk of developing another illness. Researchers believe this could be due to underlying health conditions impacting sleep.
Jo Whitmore, senior cardiac nurse at the British Heart Foundation said, “Getting enough sleep allows your body to rest. There are a host of other ways that poor sleep could increase the risk of heart disease or stroke, including by increasing inflammation and increasing blood pressure.
“This research adds to a growing body of research that highlights the importance of getting a good night’s sleep.”
Researchers used self-reported data on sleep, which is likely to be subject to reporting bias, although using data on 4,000 participants whose sleep was measured via an electronic device confirm the findings.
Meanwhile, data on sleep quality was only available for those aged 60 and 70.
The Whitehall II study only involves members of the civil service, who were all employed when recruited to the study and likely to be healthier than the general population.
About this sleep and health research news
Author: Chris Lane
Contact: Chris Lane – UCL
Image: The image is in the public domain
Original Research: Open access.
“Association of sleep duration at age 50, 60, and 70 years with risk of multimorbidity in the UK: 25-year follow-up of the Whitehall II cohort study” by Severine Sabia et al. PLOS Medicine
Association of sleep duration at age 50, 60, and 70 years with risk of multimorbidity in the UK: 25-year follow-up of the Whitehall II cohort study
Sleep duration has been shown to be associated with individual chronic diseases but its association with multimorbidity, common in older adults, remains poorly understood. We examined whether sleep duration is associated with incidence of a first chronic disease, subsequent multimorbidity and mortality using data spanning 25 years.
Methods and findings
Data were drawn from the prospective Whitehall II cohort study, established in 1985 on 10,308 persons employed in the London offices of the British civil service. Self-reported sleep duration was measured 6 times between 1985 and 2016, and data on sleep duration was extracted at age 50 (mean age (standard deviation) = 50.6 (2.6)), 60 (60.3 (2.2)), and 70 (69.2 (1.9)).
Incidence of multimorbidity was defined as having 2 or more of 13 chronic diseases, follow-up up to March 2019. Cox regression, separate analyses at each age, was used to examine associations of sleep duration at age 50, 60, and 70 with incident multimorbidity.
Multistate models were used to examine the association of sleep duration at age 50 with onset of a first chronic disease, progression to incident multimorbidity, and death. Analyses were adjusted for sociodemographic, behavioral, and health-related factors.
A total of 7,864 (32.5% women) participants free of multimorbidity had data on sleep duration at age 50; 544 (6.9%) reported sleeping ≤5 hours, 2,562 (32.6%) 6 hours, 3,589 (45.6%) 7 hours, 1,092 (13.9%) 8 hours, and 77 (1.0%) ≥9 hours. Compared to 7-hour sleep, sleep duration ≤5 hours was associated with higher multimorbidity risk (hazard ratio: 1.30, 95% confidence interval = 1.12 to 1.50; p < 0.001).
This was also the case for short sleep duration at age 60 (1.32, 1.13 to 1.55; p < 0.001) and 70 (1.40, 1.16 to 1.68; p < 0.001). Sleep duration ≥9 hours at age 60 (1.54, 1.15 to 2.06; p = 0.003) and 70 (1.51, 1.10 to 2.08; p = 0.01) but not 50 (1.39, 0.98 to 1.96; p = 0.07) was associated with incident multimorbidity. Among 7,217 participants free of chronic disease at age 50 (mean follow-up = 25.2 years), 4,446 developed a first chronic disease, 2,297 progressed to multimorbidity, and 787 subsequently died.
Compared to 7-hour sleep, sleeping ≤5 hours at age 50 was associated with an increased risk of a first chronic disease (1.20, 1.06 to 1.35; p = 0.003) and, among those who developed a first disease, with subsequent multimorbidity (1.21, 1.03 to 1.42; p = 0.02). Sleep duration ≥9 hours was not associated with these transitions. No association was found between sleep duration and mortality among those with existing chronic diseases.
The study limitations include the small number of cases in the long sleep category, not allowing conclusions to be drawn for this category, the self-reported nature of sleep data, the potential for reverse causality that could arise from undiagnosed conditions at sleep measures, and the small proportion of non-white participants, limiting generalization of findings.
In this study, we observed short sleep duration to be associated with risk of chronic disease and subsequent multimorbidity but not with progression to death. There was no robust evidence of an increased risk of chronic disease among those with long sleep duration at age 50. Our findings suggest an association between short sleep duration and multimorbidity.