Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults
Open Access
- 30 September 2020
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA Neurology
- Vol. 77 (10), 1241-1251
- https://doi.org/10.1001/jamaneurol.2020.2108
Abstract
This cross-sectional study investigates whether rapid eye movement sleep is associated with greater risk of mortality in 2 independent cohorts and explores whether another sleep stage could be driving these findings. Importance Rapid eye movement (REM) sleep has been linked with health outcomes, but little is known about the relationship between REM sleep and mortality. Objective To investigate whether REM sleep is associated with greater risk of mortality in 2 independent cohorts and to explore whether another sleep stage could be driving the findings. Design, Setting, and Participants This multicenter population-based cross-sectional study used data from the Outcomes of Sleep Disorders in Older Men (MrOS) Sleep Study and Wisconsin Sleep Cohort (WSC). MrOS participants were recruited from December 2003 to March 2005, and WSC began in 1988. MrOS and WSC participants who had REM sleep and mortality data were included. Analysis began May 2018 and ended December 2019. Main Outcomes and Measures All-cause and cause-specific mortality confirmed with death certificates. Results The MrOS cohort included 2675 individuals (2675 men [100%]; mean [SD] age, 76.3 [5.5] years) and was followed up for a median (interquartile range) of 12.1 (7.8-13.2) years. The WSC cohort included 1386 individuals (753 men [54.3%]; mean [SD] age, 51.5 [8.5] years) and was followed up for a median (interquartile range) of 20.8 (17.9-22.4) years. MrOS participants had a 13% higher mortality rate for every 5% reduction in REM sleep (percentage REM sleep SD = 6.6%) after adjusting for multiple demographic, sleep, and health covariates (age-adjusted hazard ratio, 1.12; fully adjusted hazard ratio, 1.13; 95% CI, 1.08-1.19). Results were similar for cardiovascular and other causes of death. Possible threshold effects were seen on the Kaplan-Meier curves, particularly for cancer; individuals with less than 15% REM sleep had a higher mortality rate compared with individuals with 15% or more for each mortality outcome with odds ratios ranging from 1.20 to 1.35. Findings were replicated in the WSC cohort despite younger age, inclusion of women, and longer follow-up (hazard ratio, 1.17; 95% CI, 1.03-1.34). A random forest model identified REM sleep as the most important sleep stage associated with survival. Conclusions and Relevance Decreased percentage REM sleep was associated with greater risk of all-cause, cardiovascular, and other noncancer-related mortality in 2 independent cohorts. Question Is less rapid eye movement (REM) sleep associated with increased mortality? Findings In this cross-sectional study of 4050 individuals from 2 independent cohorts, lower amounts of REM sleep were associated with increased risk of all-cause mortality. There was a 13% higher mortality rate over 12.1 years for every 5% reduction in REM sleep in a cohort of 2675 older men, and the finding was replicated in a cohort of 1375 middle-aged men and women followed-up for 20.8 years. Meaning Less REM sleep is associated with increased mortality risk.Keywords
This publication has 61 references indexed in Scilit:
- Associations Between Sleep Architecture and Sleep‐Disordered Breathing and Cognition in Older Community‐Dwelling Men: The Osteoporotic Fractures in Men Sleep StudyJournal of the American Geriatrics Society, 2011
- Association of Sleep Characteristics and Cognition in Older Community-Dwelling Men: the MrOS Sleep StudySleep, 2011
- Self-reported sleep duration, all-cause mortality, cardiovascular mortality and morbidity in FinlandSleep Medicine, 2011
- Obstructive Sleep Apnea-Hypopnea and Incident Stroke The Sleep Heart Health StudyAmerican Journal of Respiratory and Critical Care Medicine, 2010
- Understanding survival analysis: Kaplan-Meier estimateInternational Journal of Ayurveda Research, 2010
- Prevalence and Correlates of Sleep‐Disordered Breathing in Older Men: Osteoporotic Fractures in Men Sleep StudyJournal of the American Geriatrics Society, 2007
- Obstructive Sleep Apnea as a Risk Factor for Stroke and DeathThe New England Journal of Medicine, 2005
- Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study — A large observational study of the determinants of fracture in older menContemporary Clinical Trials, 2005
- Phylogeny and the function of REM sleepBehavioural Brain Research, 1995
- Drug data coding and analysis in epidemiologic studiesEuropean Journal of Epidemiology, 1994