Associations Between Self-Reported Sleep Duration and Mortality in Employed Individuals: Systematic Review and Meta-Analysis.


Pienaar PR(1)(2), Kolbe-Alexander TL(1)(3)(4), van Mechelen W(2)(4)(5)(6), Boot CRL(2)(7), Roden LC(8), Lambert EV(1), Rae DE(1).
Author information:
(1)Health Through Physical Activity Lifestyle and Sport Research Centre & Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, Department of Human Biology, 37716University of Cape Town, South Africa.
(2)Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University, Amsterdam UMC, the Netherlands.
(3)School of Health and Wellbeing, 95789University of Southern Queensland, Ipswich, Queensland, Australia.
(4)Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, 95789The University of Queensland, Brisbane, Queensland, Australia.
(5)School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Ireland.
(6)Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, the Netherlands.
(7)Behavioural Science Institute
(BSI), Radboud University, Nijmegen, the Netherlands.
(8)School of Life Sciences, Faculty of Health and Life Sciences, 2706Coventry University, United Kingdom.


OBJECTIVE: Sleeping less or more than the 7-8 h has been associated with mortality in the general population, which encompasses diversity in employment status, age and community settings. Since sleep patterns of employed individuals may differ to those of their unemployed counterparts, the nature of their sleep-mortality relationship may vary. We therefore investigated the association between self-reported sleep duration and all-cause mortality (ACM) or cardiovascular disease mortality (CVDM) in employed individuals. DATA SOURCES: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, searches between January 1990 and May 2020 were conducted in PubMed, Web of Science and Scopus. Inclusion/exclusion criteria: Included were prospective cohort studies of 18-64-year-old disease-free employed persons with sleep duration measured at baseline, and cause of death recorded prospectively as the outcome. Gray literature, case-control or intervention design studies were excluded. DATA EXTRACTION: Characteristics of the studies, participants, and study outcomes were extracted. The quality and risk of bias were assessed using the Newcastle-Ottawa Scale. DATA SYNTHESIS: The pooled relative risks (RR) with 95% confidence intervals (CI) were obtained with a random-effects model and results presented as forest plots. Heterogeneity and sensitivity analysis were assessed. RESULTS: Shorter sleep duration (≤6 h) was associated with a higher risk for (ACM) (RR: 1.16, 95% CI: 1.11 -1.22) and CVDM (RR: 1.26, 95% CI: 1.12 -1.41) compared to 7-8 h of sleep, with no significant heterogeneity. The association between longer sleep (≥8 h) and ACM (RR: 1.18, 95% CI:1.12 -1.23, P < 0.001) needs to be interpreted cautiously owing to high heterogeneity (I2 = 86.0%, P < 0.001). CONCLUSION: Interventions and education programs targeting sleep health in the workplace may be warranted, based on our findings that employed individuals who report shorter sleep appear to have a higher risk for ACM and CVDM.