Burden of disease due to sleep duration and sleep problems in the elderly

The Centers for Disease Control and Prevention emphasizes conceptualizing sleep as a healthy behavior. Although a large literature exists documenting the morbidity or mortality of suboptimal sleep, fewer investigations have examined the burden of disease in a single number combining morbidity and mortality. This study examined the morbidity, as measured by health-related quality of life (HRQOL), mortality, and quality-adjusted life years (QALY) due to suboptimal (inadequate or excessive) sleep. We ascertained respondents' HRQOL scores and mortality status from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) with mortality follow-up data through December 31, 2011 for respondents aged 65 and older (n = 2380). We estimated mean QALY according to duration of sleep, minutes to fall asleep, number of sleeping problems, and daytime impact. More than one third of participants reported a suboptimal sleep duration. Short sleep duration had a greater adverse impact on morbidity, with reductions in HRQOL, while long sleep duration had a greater adverse impact on mortality. Compared to participants who reported between 7 and 9 hours of sleep per night, mean QALYs were significantly lower among participants who slept 10 or more hours a night (7.8 QALY; decrease of 9.8 QALY). This study confirmed the association between suboptimal sleep and greater burden of disease among the elderly US population. Our findings provide support for treating sleep as a healthy (health risk) behavior, thereby having implications for primary care providers and public health surveillance.