Sleep duration and health among older adults: Associations vary by how sleep is measured

Abstract

Background—Cohort studies have found that short and long sleep are both associated with worse outcomes, compared to intermediate sleep times. While demonstrated biological mechanisms could explain health effects for short sleep, long-sleep risk is puzzling. Most studies reporting the U shape use a single question about sleep duration, a measurement method that does not correlate highly with objectively measured sleep. We hypothesized that the U shape, especially the poor outcomes for long sleepers, may be an artifact of how sleep is measured. Methods—We examined the cross-sectional prevalence of fair/poor health by sleep hour categories (≤6, ≤7, ≤8, ≤9, >9 hours) in a national U.S. sample of adults aged 62–90 that included several types of sleep measures (n=727). Survey measures were: a single question; usual bedtimes and waking times; and a three-day sleep log. Actigraphy measures were the sleep interval and total sleep time. Fair/poor health was regressed on sleep hour categories adjusted for demographics, with tests for both linear trend and U shape. Results—Adjusted odds ratios of fair/poor health across sleep hour categories from the single question were 4.6, 2.2, referent (8 hours), 1.8 and 6.9. There was high prevalence of fair/poor health for ≤ 6 hours for all sleep measures, but the long sleep effect was absent for sleep logs and actigraphy measures. Conclusion—Associations between long sleep and poor health may be specific to studies measuring sleep with survey questions. As cohorts with actigraphy mature, our understanding of how sleep affects health may change