![]() ![]() One major limitation of previous studies is the absence of assessment for daytime symptoms of insomnia. This meta-analysis highlights uncertainties about mortality risk given methodological differences between individual studies. A recent meta-analysis 1 of 17-studies including over 36 million individuals found no difference in mortality risk for those with or without symptoms of insomnia after controlling for potential confounders 1 (e.g., age, sex, marital status). Contrastingly, in a sample of 1.1 million adults aged 30 years or older, Kripke and colleagues found a 14% reduction in mortality risk for those with insomnia symptoms compared to those who do not experience symptoms of insomnia 30. Similarly, in a recent study of 15,511 individuals aged 50 years or older, Mahmood and colleges 31 found significant associations between selected nocturnal insomnia symptoms (i.e., difficultly initiating sleep, early morning awakenings, nonrestorative sleep) and all-cause mortality. In a sample of 3430 individuals aged 35 years or older, Chein and colleagues found a 15% increase in mortality risk for those experiencing frequent insomnia symptoms compared to those without symptoms 22. Whilst some studies support a positive association between symptoms of insomnia and mortality risk 22, 23, 24 others report no association 25, 26, 27, 28, 29, or even a negative association 30. This overactivation has been associated with hypertension, diabetes, and ultimately, increased mortality risk 1, 20, 21.ĭespite consistent associations between insomnia symptoms and morbidity, empirical evidence linking insomnia symptoms and mortality is unclear. Furthermore, several studies have found individuals with insomnia symptoms experience increased activation of the hypothalamic–pituitary–adrenal (HPA 15) axis and autonomic nervous system, which can cause increased heart rate and irregular heart rate variability 16, 17, 18, 19. Due to the increased prevalence of self-harm and suicide seen in psychiatric disorders (e.g., depression), the comorbidity of insomnia symptoms with these psychiatric disorders may indirectly increase the risk of mortality 1. Several studies have documented associations between insomnia symptoms and psychiatric disorders, namely depression and anxiety 5, 6, 7, 8, increased cardio-metabolic disease risk, including hypertension 9, 10, 11, diabetes 12, 13, and inflammatory diseases 14. ![]() In addition, to meet diagnostic criteria for the disorder 3, these nocturnal and daytime symptoms must occur at least three times a week, for a duration of at least three months despite adequate opportunity to sleep.Įmpirical evidence suggests that the symptoms of insomnia are strongly associated with significant medical comorbidity. An important criterion, and pertinent to this study, is that the sleep disturbance must also be accompanied by significant daytime impairment, such as memory or concentration difficulties, daytime fatigue, sleepiness, and/or negative mood 3, 4. Insomnia disorder includes nocturnal symptoms of difficulties falling asleep, maintaining sleep and/or early morning awakenings with an inability to fall back to sleep 3. Insomnia disorder is estimated to affect approximately 770 million people worldwide, with an estimated 2.5 million individuals affected in Australia alone 1, 2. Findings may be therapeutically helpful by reassuring individuals with nocturnal insomnia symptoms alone that their longevity is unlikely to be impacted. Findings suggest daytime symptoms drive increased mortality risk associated with insomnia symptoms. Subsequent analyses showed this association was driven by daytime symptoms (adjusted HR Q1vsQ5 = 1.66,, p < .0001), since nocturnal symptoms alone were not associated with increased mortality (adjusted HR Q1vsQ5 = 0.89,, p = .28). Insomnia symptom severity was associated with increased mortality in the most severe quintile (adjusted HR Q1vsQ5 = 1.26, 95%CI, p = .02). In the median follow up of 9.2 years, there were 17,403 person-years at risk and the mortality rate was 8-per 100 person-years. Multivariable Cox models were conducted to assess associations between insomnia symptom severity and mortality risk. Frequency of symptoms were combined to calculate an insomnia symptom score ranging from 0 (no symptoms) to 24 (sever symptoms) and quintiles of the score were constructed to provide a range of symptom severity. Insomnia symptoms were defined by nocturnal symptoms (difficulty falling asleep, difficulty maintaining sleep, early morning awakenings) and daytime symptoms (concentration difficulties, effort, inability to get going). Data was used from 1969 older adults who participated in the Australian Longitudinal Study of Ageing. The current study examined the association between insomnia symptoms and all-cause mortality in older adults (≥ 65 years).
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