Figure 1Nonparametric regression curve for the relation of sleep duration with all-cause and disease-specific mortality, the Korean Multi-center Cancer Cohort (KMCC) study. (A) All-cause mortality. ICD-10 codes of A00-Z99. (B) Cancer mortality. ICD-10 codes of C00-C99. (C) CVD mortality. ICD-10 codes of I00-I99. (D) Respiratory disease mortality. ICD-10 codes of J00-J99, A15-A19. (E) Mortality from external cause. ICD-10 codes of S00-S99, T00-T99, V01-X59. (F) Mortality from not elsewhere classified cause. ICD-10 codes of R00-R99.1p-value for the non-linear relation between sleep duration and mortality tested by restricted cubic splines. HR, hazard ratio; CI, confidence interval.
Table 1.General characteristics of the study population at the time of enrollment in the Korean Multi-center Cancer Cohort study according to sleep duration (n=13 164)
|
Sleep duration (h)
|
|
|
≤ 5 (n = 1674) |
6 (n = 2954) |
7 (n = 3778) |
8 (n = 3319) |
9 (n = 910) |
≥10 (n = 529) |
|
Category (mean±SD) |
|
|
|
|
|
|
p-value1
|
Age (y) |
61.1±12.0 |
54.1±13.5 |
53.1±13.0 |
53.6±12.8 |
55.8±13.2 |
58.4±12.8 |
<0.001 |
Body mass index (kg/m2) |
23.6±3.3 |
23.8±3.3 |
23.8±3.2 |
23.8±3.2 |
23.8±3.2 |
23.8±3.4 |
0.18 |
Waist circumference (cm) |
84.7±8.7 |
84.8±8.6 |
84.2±8.9 |
84.4±8.4 |
84.6±9.7 |
85.8±9.6 |
0.21 |
Category (%) |
|
|
|
|
|
|
p-value2
|
Female |
65.9 |
58.0 |
56.6 |
58.1 |
61.0 |
52.4 |
<0.001 |
Educated3
|
18.8 |
28.5 |
34.6 |
33.2 |
27.5 |
28.9 |
<0.001 |
Current smoker |
24.7 |
27.9 |
28.4 |
27.1 |
23.2 |
29.7 |
<0.001 |
Current drinker |
34.6 |
41.5 |
40.8 |
37.5 |
34.5 |
40.5 |
<0.001 |
Past medical history |
|
|
|
|
|
|
|
Hypertension |
18.3 |
12.6 |
11.3 |
11.3 |
12.1 |
15.6 |
<0.001 |
Diabetes mellitus |
6.9 |
5.0 |
4.3 |
5.2 |
4.4 |
5.5 |
0.004 |
Cardiovascular disease |
6.7 |
3.5 |
3.6 |
3.3 |
3.6 |
6.2 |
<0.001 |
Respiratory disease4
|
8.3 |
6.9 |
6.2 |
6.3 |
6.7 |
6.7 |
0.13 |
Thyroid disease |
1.9 |
1.9 |
2.0 |
1.6 |
3.2 |
2.8 |
0.06 |
Metabolic syndrome |
|
|
|
|
|
|
|
Comorbidity of hypertension5
|
24.3 |
18.6 |
16.7 |
15.8 |
20.2 |
23.1 |
<0.001 |
Comorbidity of diabetes mellitus6
|
7.5 |
5.6 |
5.3 |
6.1 |
4.8 |
7.0 |
0.01 |
Abdominal obesity7
|
13.3 |
12.2 |
11.4 |
10.9 |
13.3 |
16.8 |
0.14 |
Low HDL cholesterol8
|
13.3 |
12.4 |
10.5 |
11.4 |
12.2 |
15.7 |
0.46 |
High triglyceride9
|
15.2 |
12.5 |
10.4 |
11.8 |
12.2 |
16.8 |
0.01 |
≥3 of components |
15.6 |
11.4 |
9.7 |
10.0 |
12.6 |
15.3 |
<0.001 |
Hypercholesterolemia |
|
|
|
|
|
|
|
High total cholesterol10
|
14.1 |
10.9 |
10.2 |
10.4 |
12.6 |
14.4 |
0.08 |
High LDL cholesterol11
|
22.6 |
19.1 |
17.2 |
19.0 |
20.3 |
25.3 |
0.08 |
Table 2.HRs and 95% CIs for disease-specific mortalities according to sleep duration in the Korean Multi-center Cancer Cohort study
Sleep duration (h) |
No. of cohorts |
No. of deaths |
aHR (95% CI)1
|
p-value2
|
All-cause mortality3
|
|
|
|
|
≤5 |
1674 |
278 |
1.21 (1.03, 1.41) |
0.001 |
6 |
2954 |
348 |
1.10 (0.95, 1.27) |
|
7 |
3778 |
388 |
1.00 (reference) |
|
8 |
3319 |
354 |
1.03 (0.89, 1.19) |
|
9 |
910 |
127 |
1.36 (1.11, 1.67) |
|
≥10 |
529 |
85 |
1.36 (1.07, 1.72) |
|
Total |
13 164 |
1580 |
|
|
Cancer mortality4
|
|
|
|
|
≤5 |
1674 |
75 |
0.93 (0.70, 1.23) |
0.91 |
6 |
2954 |
108 |
0.94 (0.73, 1.21) |
|
7 |
3778 |
141 |
1.00 (reference) |
|
8 |
3319 |
135 |
1.09 (0.84, 1.38) |
|
9 |
910 |
41 |
1.21 (0.85, 1.72) |
|
≥10 |
529 |
26 |
1.08 (0.71, 1.65) |
|
Total |
13 164 |
526 |
|
|
CVD mortality5
|
|
|
|
|
≤5 |
1674 |
76 |
1.40 (1.02, 1.93) |
0.09 |
6 |
2954 |
86 |
1.25 (0.92, 1.69) |
|
7 |
3778 |
81 |
1.00 (reference) |
|
8 |
3319 |
76 |
1.04 (0.76, 1.42) |
|
9 |
910 |
26 |
1.26 (0.81, 1.96) |
|
≥10 |
529 |
18 |
1.37 (0.82, 2.29) |
|
Total |
13 164 |
363 |
|
|
Respiratory disease mortality6
|
|
|
|
|
≤5 |
1674 |
31 |
1.85 (1.05, 3.26) |
0.01 |
6 |
2954 |
33 |
1.75 (1.02, 3.02) |
|
7 |
3778 |
22 |
1.00 (reference) |
|
8 |
3319 |
19 |
0.98 (0.52, 1.82) |
|
9 |
910 |
13 |
2.38 (1.18, 4.76) |
|
≥10 |
529 |
8 |
1.98 (0.87, 4.49) |
|
Total |
13 164 |
126 |
0.30 |
|
Mortality from external cause7
|
|
|
|
|
≤5 |
1674 |
29 |
1.12 (0.71, 1.78) |
0.49 |
6 |
2954 |
35 |
0.83 (0.54, 1.27) |
|
7 |
3778 |
53 |
1.00 (reference) |
|
8 |
3319 |
49 |
1.06 (0.72, 1.57) |
|
9 |
910 |
15 |
1.27 (0.72, 2.27) |
|
≥10 |
529 |
8 |
1.01 (0.48, 2.13) |
|
Total |
13 164 |
189 |
|
|
Mortality from not elsewhere classified cause8
|
|
|
|
|
≤5 |
1674 |
20 |
1.10 (0.59, 2.04) |
0.001 |
6 |
2954 |
27 |
1.35 (0.78, 2.36) |
|
7 |
3778 |
24 |
1.00 (reference) |
|
8 |
3319 |
15 |
0.72 (0.38, 1.38) |
|
9 |
910 |
12 |
1.96 (0.97, 3.96) |
|
≥10 |
529 |
14 |
3.29 (1.68, 6.47) |
|
Total |
13 164 |
112 |
|
|
Table 3.HRs and 95% CIs for all-cause and disease-specific mortalities by sleep duration in gender-stratified analyses within the Korean Multi-center Cancer Cohort study
Cause of death |
No. of cohorts |
Total no. of deaths |
Sleep duration (h)
|
≤5
|
6
|
7
|
8
|
9
|
≥10
|
p-value2
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
All-cause mortality3
|
Men |
5447 |
923 |
137 |
1.10 (0.89, 1.36) |
205 |
1.09 (0.90, 1.30) |
241 |
1.00 (ref) |
223 |
1.02 (0.85, 1.23) |
65 |
1.28 (0.97, 1.69) |
52 |
1.15 (0.85, 1.56) |
0.35 |
Women |
7717 |
657 |
141 |
1.41 (1.12, 1.79) |
143 |
1.16 (0.92, 1.46) |
147 |
1.00 (ref) |
131 |
1.03 (0.81, 1.30) |
62 |
1.50 (1.11, 2.02) |
33 |
1.87 (1.28, 2.73) |
0.002 |
Cancer mortality4
|
Men |
5447 |
344 |
40 |
0.78 (0.54, 1.13) |
71 |
0.90 (0.66, 1.22) |
100 |
1.00 (ref) |
93 |
1.03 (0.77, 1.36) |
20 |
0.93 (0.57, 1.50) |
20 |
1.03 (0.63, 1.67) |
0.65 |
Women |
7717 |
182 |
35 |
1.26 (0.80, 2.00) |
37 |
1.05 (0.67, 1.65) |
41 |
1.00 (ref) |
42 |
1.20 (0.78, 1.85) |
21 |
1.87 (1.10, 3.17) |
6 |
1.23 (0.52, 2.90) |
0.28 |
CVD mortality5
|
Men |
5447 |
169 |
33 |
1.43 (0.89, 2.30) |
38 |
1.21 (0.77, 1.91) |
38 |
1.00 (ref) |
39 |
1.06 (0.68, 1.67) |
9 |
1.05 (0.51, 2.19) |
12 |
1.53 (0.79, 2.95) |
0.29 |
Women |
7717 |
194 |
43 |
1.48 (0.97, 2.28) |
48 |
1.32 (0.87, 2.00) |
43 |
1.00 (ref) |
37 |
1.00 (0.64, 1.55) |
17 |
1.40 (0.80, 2.46) |
6 |
1.13 (0.48, 2.67) |
0.26 |
Mortality from external cause6
|
Men |
5447 |
121 |
12 |
0.82 (0.42, 1.62) |
21 |
0.80 (0.46, 1.39) |
34 |
1.00 (ref) |
38 |
1.27 (0.80, 2.03) |
10 |
1.43 (0.70, 2.91) |
6 |
1.01 (0.42, 2.43) |
0.47 |
Women |
7717 |
68 |
17 |
1.40 (0.71, 2.75) |
14 |
0.86 (0.43, 1.73) |
19 |
1.00 (ref) |
11 |
0.67 (0.32, 1.41) |
5 |
0.94 (0.35, 2.54) |
2 |
0.89 (0.21, 3.85) |
0.66 |
Respiratory disease mortality7
|
Men |
5447 |
80 |
17 |
1.51 (0.73, 3.13) |
24 |
1.88 (0.98, 3.60) |
15 |
1.00 (ref) |
11 |
0.82 (0.37, 1.79) |
10 |
3.12 (1.37, 7.11) |
3 |
0.97 (0.28, 3.41) |
0.17 |
Women |
7717 |
46 |
14 |
2.42 (0.95, 6.19) |
9 |
1.45 (0.53, 3.97) |
7 |
1.00 (ref) |
8 |
1.18 (0.43, 3.30) |
3 |
1.48 (0.38, 5.80) |
5 |
5.43 (1.68, 17.52) |
0.008 |
Mortality from not elsewhere classified cause8
|
Men |
5447 |
56 |
8 |
1.10 (0.45, 2.73) |
13 |
1.22 (0.56, 2.66) |
13 |
1.00 (ref) |
8 |
0.72 (0.30, 1.75) |
6 |
2.31 (0.85, 6.25) |
8 |
3.71 (1.49, 9.25) |
0.005 |
Women |
7717 |
56 |
12 |
1.14 (0.48, 2.75) |
14 |
1.74 (0.77, 3.93) |
11 |
1.00 (ref) |
7 |
0.69 (0.25, 1.86) |
6 |
2.29 (0.83, 6.31) |
6 |
2.55 (0.91, 7.12) |
0.004 |
Table 4.HRs and 95% CIs for all-cause and disease-specific mortalities by sleep duration in age-stratified analyses within the Korean Multi-center Cancer Cohort study
Cause of death |
No. of cohorts |
Total no. of deaths |
Sleep duration (h)
|
≤5
|
6
|
7
|
8
|
9
|
≥10
|
p-value2
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
No. of deaths |
HR (95% CI)1
|
All-cause mortality3
|
Age<60 |
7626 |
357 |
41 |
1.35 (0.94, 1.93) |
71 |
0.83 (0.62, 1.11) |
126 |
1.00 (ref) |
82 |
0.81 (0.61, 1.07) |
23 |
1.06 (0.68, 1.65) |
14 |
1.01 (0.58, 1.77) |
0.42 |
Age≥60 |
5538 |
1223 |
237 |
1.23 (1.03, 1.47) |
277 |
1.22 (1.03, 1.45) |
262 |
1.00 (ref) |
272 |
1.13 (0.95, 1.33) |
104 |
1.49 (1.18, 1.87) |
71 |
1.48 (1.13, 1.93) |
0.001 |
Cancer mortality4
|
Age<60 |
7626 |
132 |
13 |
0.97 (0.70, 1.35) |
23 |
1.11 (0.82, 1.50) |
52 |
1.00 (ref) |
29 |
1.29 (0.97, 1.71) |
9 |
1.33 (0.89, 2.00) |
6 |
1.13 (0.69, 1,84) |
0.73 |
Age≥60 |
5538 |
394 |
62 |
1.07 (0.58, 1.97) |
85 |
0.64 (0.39, 1.04) |
89 |
1.00 (ref) |
106 |
0.68 (0.43, 1.07) |
32 |
0.98 (0.48, 2.00) |
20 |
1.01 (0.43, 2.37) |
0.97 |
CVD mortality5
|
Age<60 |
7626 |
55 |
6 |
1.37 (0.54, 3.48) |
12 |
1.00 (0.48, 2.09) |
18 |
1.00 (ref) |
13 |
0.94 (0.46, 1.93) |
5 |
1.58 (0.58, 4.30) |
1 |
0.57 (0.07, 4.30) |
0.85 |
Age≥60 |
5538 |
308 |
70 |
1.41 (1.00, 1.98) |
74 |
1.31 (0.94, 1.84) |
63 |
1.00 (ref) |
63 |
1.07 (0.76, 1.52) |
21 |
1.22 (0.74, 2.01) |
17 |
1.52 (0.88, 2.60) |
0.08 |
Mortality from external cause6
|
Age<60 |
7626 |
78 |
9 |
1.35 (0.63, 2.89) |
12 |
0.63 (0.32, 1.23) |
29 |
1.00 (ref) |
20 |
0.89 (0.50, 1.57) |
5 |
1.04 (0.40, 2.71) |
3 |
1.05 (0.32, 3.47) |
0.79 |
Age≥60 |
5538 |
111 |
20 |
1.00 (0.55, 1.82) |
23 |
1.01 (0.57, 1.80) |
24 |
1.00 (ref) |
29 |
1.34 (0.78, 2.31) |
10 |
1.50 (0.72, 3.16) |
5 |
1.03 (0.39, 2.72) |
0.87 |
Respiratory disease mortality7
|
Age<60 |
7626 |
14 |
4 |
7.60 (1.32, 43.9) |
5 |
3.76 (0.71, 19.9) |
2 |
1.00 (ref) |
3 |
1.93 (0.32, 11.7) |
0 |
NA |
0 |
NA |
NA |
Age≥60 |
5538 |
112 |
27 |
1.80 (1.03, 3.34) |
28 |
1.67 (0.93, 2.97) |
20 |
1.00 (ref) |
16 |
0.88 (0.46, 1.70) |
13 |
2.65 (1.31, 5.39) |
8 |
2.25 (0.98, 5.16) |
0.004 |
Mortality from not elsewhere classified cause8
|
Age<60 |
7626 |
10 |
2 |
8.18 (0.97, 68.94) |
3 |
3.34 (0.53, 21.26) |
2 |
1.00 (ref) |
2 |
1.14 (0.15, 8.60) |
0 |
NA |
1 |
10.78 (0.82, 141.46) |
NA |
Age≥60 |
5538 |
102 |
18 |
1.00 (0.52, 1.90) |
24 |
1.27 (0.71, 2.28) |
22 |
1.00 (ref) |
13 |
0.67 (0.34, 1.35) |
12 |
2.02 (0.98, 4.15) |
13 |
3.15 (1.56, 6.34) |
0.001 |