Sleep duration and mortality in Korean adults: a population-based prospective cohort study

Sohyeon Kwon, Hyeyoung Lee, Jong Tae Lee, Min Jeong Shin, Sangbum Choi, Hannah Oh

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15 Citations (Scopus)


Background: Increasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer. However, the relationship with mortality is not clear, particularly in non-European populations. In this study, we investigated the association between sleep duration and mortality in a population-based prospective cohort of Korean adults. Methods: This analysis included 34,264 participants (14,704 men and 19,560 women) of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2013 who agreed to mortality follow-up through December 31, 2016. Sleep duration was self-reported at baseline and was categorized into four groups: ≤4, 5–6, 7–8, and ≥ 9 h/day. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations with mortality (all-cause as well as CVD- and cancer-specific), adjusting for potential confounders. Results: During up to 9.5 years of follow-up, we identified a total of 1028 deaths. We observed the lowest mortality at 5–6 h/day sleep. Compared with 7–8 h/day of sleep, short (≤4 h/day) and long (≥9 h/day) sleep were associated with a 1.05-fold (95% CI = 0.79–1.39) and 1.47-fold (95% CI = 1.15–1.87) higher all-cause mortality, respectively. After additional adjustment for self-rated health, the positive association with short sleep disappeared (HR = 0.99, 95% CI = 0.75–1.32) and the association with long sleep was slightly attenuated (HR = 1.38, 95% CI = 1.08–1.76). Long sleep was also nonsignificantly positively associated with both cancer-mortality (HR = 1.30, 95% CI = 0.86–1.98) and CVD-mortality (HR = 1.27, 95% CI = 0.73–2.21). There was no statistically significant evidence for nonlinearity in the relationships between sleep duration and mortality (all-cause as well as CVD- and cancer-specific). Effect modification by age, sex, education, and occupation were not statistically significant. Conclusions: Our findings suggest that long sleep duration is associated with an increased all-cause mortality in Korean adults.

Original languageEnglish
Article number1623
JournalBMC Public Health
Issue number1
Publication statusPublished - 2020 Dec 1

Bibliographical note

Funding Information:
H.O. and S.K. were supported by the National Research Foundation of Korea (NRF) grants (2019R1G1A1004227, 2019S1A3A2099973) and Korea University Grant (K1808781). The funders were not involved in the study design or data analysis and the views expressed in this publication are those of the authors. Acknowledgements

Funding Information:
This work was supported by the pilot study of the 「Korea National Health and Nutrition Examination Survey linked Cause of Death data」 by the Korea Centers for Disease Control and Prevention.

Publisher Copyright:
© 2020, The Author(s).


  • Asian
  • Cohort study
  • Death
  • Mortality
  • Race
  • Sleep

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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