Sleep duration as a predictor and prognosticator for cancer survivors in the community
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Objective
Sleep and cancer are intricately interconnected. We used a nationally representative sample to study the effect of sleep duration on cancer incidence and prognosis, aiming to propose an optimal sleep duration and generalize it to community populations.
Methods
Data from participants aged ≥18 years in the National Health and Nutrition Examination Survey (NHANES, 2005-2018) were analyzed (n=37,338). Self-reported sleep duration was analyzed alongside mortality data from the National Death Index as of 12/31/2019. Primary outcomes included all-cause mortality, cancer-specific mortality, and non-cancer mortality. Odds ratios (OR), hazard ratios (HR), and corresponding 95% confidence intervals (CI) were calculated using logistic regression and Cox proportional hazards regression, respectively. Restricted cubic spline (RCS) analysis was used to explore potential non-linear associations.
Results
The prevalence of cancer was 10.12%. After adjusting for confounders, >7 hours of sleep was strongly associated with an increased OR for cancer incidence (1.18 (1.04,1.33) for (7-8] and 1.54 (1.28,1.86) for (8-14.5]). During a median follow-up of 6.1 years, 341 cancer-related deaths and 661 non-cancer-related deaths occurred. fully adjusted models, compared with 7 hours of sleep, >7 hours of sleep significantly increased the HR of all-cause mortality (1.40 (1.06,1.84) for (7-8] and 1.90 (1.42,2.54) for (8-14.5]); cancer mortality (1.20 (0.77,1.87) for (7-8] and 1.70 (1.05,2.73) for (8- 14.5], 1.70 (1.05,2.73)) and non-cancer mortality (1.50 (1.07,2.12) for (7-8], 2.03 (1.42,2.90) for (8-14.5]). Stratified analysis, RCS analysis and sensitivity analysis yielded consistent results.
Conclusions
This study suggests that the optimal sleep duration should be 7 hours, as excessive sleep may increase cancer risk and mortality risk in cancer survivors. Our findings should be useful for health education and promotion in primary care and clinical practice.
