Actigraphy-derived sleep health profiles and mortality in older men and women

Study Objectives To identify actigraphy sleep health profiles in older men (Osteoporotic Fractures in Men Study; N = 2640) and women (Study of Osteoporotic Fractures; N = 2430), and to determine whether profile predicts mortality. Methods We applied a novel and flexible clustering approach (Multiple Coalesced Generalized Hyperbolic mixture modeling) to identify sleep health profiles based on actigraphy midpoint timing, midpoint variability, sleep interval length, maintenance, and napping/inactivity. Adjusted Cox models were used to determine whether profile predicts time to all-cause mortality. Results We identified similar profiles in men and women: High Sleep Propensity [HSP] (20% of women; 39% of men; high napping and high maintenance); Adequate Sleep [AS] (74% of women; 31% of men; typical actigraphy levels); and Inadequate Sleep [IS] (6% of women; 30% of men; low maintenance and late/variable midpoint). In women, IS was associated with increased mortality risk (Hazard Ratio [HR] = 1.59 for IS vs. AS; 1.75 for IS vs. HSP). In men, AS and IS were associated with increased mortality risk (1.19 for IS vs. HSP; 1.22 for AS vs. HSP). Conclusions These findings suggest several considerations for sleep-related interventions in older adults. Low maintenance with late/variable midpoint is associated with increased mortality risk and may constitute a specific target for sleep health interventions. High napping/inactivity co-occurs with high sleep maintenance in some older adults. Although high napping/inactivity is typically considered a risk factor for deleterious health outcomes, our findings suggest that it may not increase risk when it occurs in combination with high sleep maintenance.

Automated summary

Similar sleep health profiles were identified in older men and women, with inadequate sleep health features associated with increased mortality risk. Research suggests that interventions targeting specific sleep health characteristics could potentially reduce mortality risk in older adults.