The Association Between Insomnia Symptoms and Mortality: A Prospective Study of US Men

Study Questions:

What is the association between insomnia symptoms and all-cause and cause-specific mortality?


This was a prospective cohort study of 23,447 men participating in the Health Professionals Follow-up Study (HPFS). In 2004, the participants in HPFS were asked about the frequency of difficulty initiating sleep, difficulty maintaining sleep, early morning awakenings, and nonrestorative sleep. Patients were followed through 2010. The authors used Cox proportional hazard models to calculate the hazard ratios (HRs) of mortality across categories of each insomnia symptom.


In adjusted analyses, the multivariable HRs of total mortality were 1.25 (95% confidence interval [CI], 1.04-1.50) for difficulty initiating sleep, 1.09 (95% CI, 0.97-1.24) for difficulty maintaining sleep, 1.04 (95% CI, 0.88-1.22) for early morning awakenings, and 1.24 (95% CI, 1.05-1.46) for nonrestorative sleep. Men with difficulty initiating sleep and nonrestorative sleep also had an increased risk of cardiovascular disease-specific mortality, when compared to men without these symptoms.


The authors concluded that difficulty initiating sleep and nonrestorative sleep are associated with a modestly higher risk of mortality.


The authors presented results from a large prospective study about the hazards of insomnia, corroborating previous studies. Although the impact was only modest, the authors provided sufficient and consistent evidence about particular insomnia symptoms that may be modifiable.

Clinical Topics: Heart Failure and Cardiomyopathies, Sleep Apnea

Keywords: Incidence, Sleep Initiation and Maintenance Disorders, Follow-Up Studies, Cardiology, Cardiovascular Diseases, Sleep Apnea Syndromes

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