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TOPLINE:

In a cohort study of more than 45,000 US residents from lower household income groups, nearly two thirds of adults had suboptimal sleep duration trajectories over 5 years, with irregular sleep trajectories associated with up to a 29% higher risk for all-cause mortality.

METHODOLOGY:

• Researchers investigated the association between 5-year sleep duration trajectories and all-cause and cause-specific mortality among 46,928 US adults (mean age, 53.0 years; 65.4% women; 63.3% Black individuals) who were recruited from community health centers across 12 southeastern states in the United States between 2002 and 2009.
• Participants filled out a questionnaire at enrollment regarding their sociodemographic characteristics, health behaviors, and health history and were requested to complete a follow-up survey between 2008 and 2013.
• Sleep duration was classified into three categories: Short (< 7 hours), healthy (7-9 hours), and long (> 9 hours), with nine sleep trajectories identified on the basis of changes or consistency in these sleep duration categories from enrollment to follow-up.
• The analysis included linkage to the National Death Index through December 2022 to ascertain mortality outcomes.

TAKEAWAY:

• More than 65% of participants did not maintain optimal 5-year sleep duration trajectories; maintaining short sleep durations and transitioning from short to healthy sleep durations and vice versa were the most common suboptimal sleep trajectories.
• Suboptimal sleep trajectories were associated with an increased risk for all-cause mortality; compared with participants who slept for 7-9 hours, those who maintained long sleep durations (hazard ratio [HR], 1.27; 95% CI, 1.14-1.41) and those who transitioned from short to long sleep durations (HR, 1.29; 95% CI, 1.17-1.42) and from long to short sleep durations (HR, 1.19; 95% CI, 1.05-1.35) showed the highest risk for mortality.
• The risk for cardiovascular disease mortality was also elevated in participants who transitioned from long to short sleep durations and vice versa.
• The association between suboptimal sleep trajectories and the risk for mortality was stronger among White adults and those with a household income of $15,000 or more.

IN PRACTICE:

“Although the Black participants with low SES [socioeconomic status] in the SCCS [Southern Community Cohort Study] were more likely to have suboptimal sleep trajectories, our results suggest the potential health effects of suboptimal sleep may be weaker in these populations. This may be due in part to the presence of unmeasured cultural, behavioral, or societal factors (eg, racism or environmental factors) that may confound or attenuate the potential effect of sleep duration trajectory,” said the authors of the study. An accompanying editorial noted, “This study presented promising results that could be leveraged in future studies aimed at the reduction of premature risk of mortality. Sleep is both a biological state and a modifiable behavior, offering opportunities to improve population health and reduce health disparities in mortality rates.”

SOURCE:

This study was led by Kelsie M. Full, PhD, MPH, Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. It was published online on February 27, 2025, in JAMA Network Open. Dayna A. Johnson, PhD, MPH, MSW, MS of the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, wrote the editorial, also published in JAMA Network Open.

LIMITATIONS:

Sleep duration was self-reported, and the follow-up question differed from the question at baseline. The authors noted that self-reported sleep duration typically overestimates actual sleep duration, which may have introduced bias. This study lacked information on the use of sleep medications by the participants.

DISCLOSURES:

The cohort study was supported by a grant from the National Cancer Institute of the National Institutes of Health. This study also received grants from the National Institute on Aging and Alzheimer’s Association. One author reported receiving grant funding from the Memorial Sloan Kettering Cancer Center and serving as a member of the National Council on Radiation Protection and Measurements.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.