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Sleep Duration, Comorbidities, and Mortality in Korean Health Examinees: A Prospective Cohort Study
Sukhong Min, Woo-Kyoung Shin, Katherine De la Torre, Dan Huang, Hyung-Suk Yoon, Aesun Shin, Ji-Yeob Choi, Daehee Kang
J Prev Med Public Health. 2023;56(5):458-466.   Published online September 26, 2023
DOI: https://doi.org/10.3961/jpmph.23.311
  • 1,197 View
  • 71 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The association between long sleep duration and mortality is frequently attributed to the confounding influence of comorbidities. Nevertheless, past efforts to account for comorbidities have yielded inconsistent outcomes. The objective of this study was to evaluate this relationship using a large prospective cohort in Korea.
Methods
The study included 114 205 participants from the Health Examinees Study, who were followed for a median of 9.1 years. A composite comorbidity score was developed to summarize the effects of 21 diseases. Using Cox proportional hazards regression, hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and cardiovascular mortality associated with sleep duration were estimated. These estimates were adjusted for socio-demographic factors, lifestyle factors, body mass index, and comorbidity score. Additionally, a stratified analysis by subgroups with and without comorbidities was conducted.
Results
Throughout the follow-up period, 2675 deaths were recorded. After all adjustments, an association was observed between a sleep duration of 8 hours or more and all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). However, no such association was detected in the stratified analysis for the subgroups based on comorbidity status.
Conclusions
Long sleep duration was found to be associated with all-cause mortality among Koreans, even after adjusting for comorbidities. Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.
Summary
Korean summary
- 한국의 대규모 코호트 자료를 이용, 긴 수면 시간과 사망률 간의 연관성이 동반 상병으로 인한 교란 효과로 인한 것인지를 검토하였다. - 수면 시간과 총 사망률, 암 사망률, 심혈관질환 사망률 간의 연관성을 확인하였고, 이 중 총 사망률과 긴 수면 시간이 동반 상병 지수로 보정 한 뒤에도 유의한 연관성을 보였다.
Key Message
Using a large prospective cohort in Korea, the association between long sleep duration and mortality was evaluated, after adjusting for the confounding influence of comorbidities. When 114,205 participants from the Health Examinees Study were followed for a median of 9.1 years, sleep duration of 8 hours or more were found to be associated with all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.
The Effect of Sleep Duration on the Risk of Unintentional Injury in Korean Adults
Yeon-Yong Kim, Un-Na Kim, Jin-Seok Lee, Jong-Heon Park
J Prev Med Public Health. 2014;47(3):150-157.   Published online May 30, 2014
DOI: https://doi.org/10.3961/jpmph.2014.47.3.150
  • 11,318 View
  • 91 Download
  • 6 Crossref
AbstractAbstract PDF
Objectives

The decrease or increase in sleep duration has recently been recognized as a risk factor for several diseases, including hypertension and obesity. Many studies have explored the relationship of decreased sleep durations and injuries, but few have examined the relationship between increased sleep duration and injury. The objective of this research is to identify the risk for injury associated with both decreased and increased sleep durations.

Methods

Data from the 2010 Community Health Survey were used in this study. We conducted logistic regression with average sleep duration as the independent variable, injury as a dependent variable, and controlling for age, sex, occupation, education, region (cities and provinces), smoking, alcohol use, body mass index, hypertension, diabetes, arthritis, and depression. Seven categories of sleep duration were established: ≤4, 5, 6, 7, 8, 9, and ≥10 hours.

Results

Using 7 hours of sleep as the reference, the adjusted injury risk (odds ratio) for those sleeping a total of ≤4 h/d was 1.53; 1.28 for 5 hours, for 1.11 for 6 hours, 0.98 for 8 hours, 1.12 for 9 hours, and 1.48 for ≥10 hours. The difference in risk was statistically significant for each category except for the 8 and 9 hours. In this study, risk increased as the sleep duration decreased or increased, except for the 8 and 9 hours.

Conclusions

This research found that either a decrease or increase in sleep duration was associated with an increased risk for injury. The concept of proper sleep duration can be evaluated by its associated injury risk.

Summary

Citations

Citations to this article as recorded by  
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Relationship Between Current Sleep Duration and Past Suicidal Ideation or Attempt Among Korean Adolescents
Sung-In Jang, Kwang-Sig Lee, Eun-Cheol Park
J Prev Med Public Health. 2013;46(6):329-335.   Published online November 28, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.6.329
  • 10,273 View
  • 100 Download
  • 15 Crossref
AbstractAbstract PDF
Objectives

To comprehensively examine the relationship between current sleep duration and past suicidal idea or attempt among Korean adolescents.

Methods

Data came from the 2009 Korea Youth Risk Behavior Web-based Survey with 75 066 participants (with the participation rate of 97.6%) in 800 middle and high schools. Binary logistic regression was conducted by gender and depressed mood to identify significant factors for suicidal ideation/attempt. The dependent variable was the log odds of suicidal ideation/attempt, while the independent/control variables were sleep duration and other demographic, socio-economic and health-related factors.

Results

A negative association between sleep duration and suicidal ideation or attempt was weaker for those with depressed mood than for those without such experience in Korea for Year 2009. The odds ratio of suicidal ideation/attempt regarding less than 4 hours of sleep compared to 6 to 7 hours of sleep, was smaller in a group with depressed mood than in a group without such experience, for example, 1.64 (95% confidence interval [CI], 1.29 to 2.08) vs. 2.06 (95% CI, 1.34 to 3.17) for men's suicidal ideation, 2.50 (95% CI, 1.69 to 3.69) vs. 3.89 (95% CI, 1.74 to 8.66) for men's suicidal attempt. A negative association between age (or self-rated health) and suicidal ideation/attempt was also weaker for those with depressed mood than for those without such experience in the nation for the year.

Conclusions

There was a negative association between sleep duration and suicidal ideation/attempt in Korea for Year 2009 and this association was weaker for those with depressed mood than for those without such experience. Based on the findings of this study, adolescents' better mental health and longer, more comfortable sleep might help to prevent their suicidal ideation and attempt in Korea.

Summary

Citations

Citations to this article as recorded by  
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A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study
Yohwan Yeo, Seung Hyun Ma, Sue Kyung Park, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo
J Prev Med Public Health. 2013;46(5):271-281.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.271
  • 12,731 View
  • 163 Download
  • 69 Crossref
AbstractAbstract PDF
Objectives

Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea.

Methods

The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines.

Results

The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ≤5 hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ≥10 hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ≥60 years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ≤5 hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (≤5 and ≥10 hours).

Conclusions

Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

Summary

Citations

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JPMPH : Journal of Preventive Medicine and Public Health