Clinical review
Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future

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Summary

This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.g., Japan, Israel, Sweden, Finland, the United Kingdom) show similar relationships. We discuss possible mechanisms, including cardiovascular disease, obesity, physiologic stress, immunity, and socioeconomic status. We put forth a social–ecological framework to explore five possible pathways for the relationship between sleep duration and mortality, and we conclude with a four-point agenda for future research.

Section snippets

Sleep duration and mortality: the evidence

Over 40 years of evidence indicate a strong association between nightly sleep duration and mortality risk.1, 2 In general, sleep duration is associated with mortality in a U-shaped fashion, such that the lowest risk is most often found in the group who report sleep durations of 7–8 h (See Table 1, Table 2 for a summary of their findings). Nearly uniformly, mortality risk increases with further deviation from the 7–8 hr range.

Sleep duration and mortality: the possible mechanisms

While previous literature clearly describes an association between mortality and both short and long sleep, the remainder of this review will focus on mechanisms and pathways primarily associated with only short sleep, as short and long sleepers seem to represent distinct groups.41 Effects for long sleep may be larger, but we chose to focus on short sleep for two reasons. First, shorter sleep appears to be a more salient issue in our society where insufficient sleep is a major public health

Sleep duration and mortality: the potential pathways

In Fig. 1, we present a social–ecological model90 of the determinants of sleep. This model allows for multiple levels of effects, namely the micro-system, the meso-system, and macro-system. Specific components of each layer are listed in detail in the diagram, and range from individual characteristics and health behaviors in the micro-system, school and work environments in the meso-system, and policy and physical environments in the macro-system. This theoretical pathway has considerable

Sleep duration and mortality: the future

Many questions remain regarding the sleep-mortality relationship. A better understanding of the physiological/psychosocial connections between amount of sleep and shortened lifespan is critical. Simply documenting this relationship is no longer sufficient – we must explore possible mechanisms and pathways as well as develop targeted interventions that can positively alter this relationship. We propose several directions for the future:

First, research programs should investigate long and short

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