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Background: While extreme sleep duration negatively affects mortality and health-related quality of life (HRQOL) in general populations, the relationship remains uncertain in patients with chronic obstructive pulmonary disease (COPD). Objectives: To evaluate the association between sleep duration and mortality and HRQOL in patients with COPD. Methods: We analyzed 3,349 participants with COPD enrolled in the 2007–2015 Korea National Health and Nutrition Examination Survey (KNHANES). Participants aged 40 years or older with a smoking history and prebronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7 were eligible. The participants were categorized as short sleepers (<6 h), 6–8 h, and long sleepers (>8) according to self-reported sleep duration. The outcome variables were all-cause mortality and HRQOL. HRQOL was measured using the European Quality of Life-5 Dimensions (EQ-5D) index. Results: During a median of 6.5 years, 386 (11.5%) participants died. In unadjusted Cox regression analysis, short sleepers with COPD had an increased risk of death (hazard ratio, 1.35; 95% confidence interval [CI]: 1.07–1.71). However, this association was not significant after adjusting for sociodemographic factors, BMI, FEV1, and comorbidities. In unadjusted and adjusted multiple linear regression, short sleepers had significantly worse HRQOL. The adjusted means of the EQ-5D index were 0.88 (95% CI: 0.87–0.89) for short sleepers, 0.90 (95% CI: 0.90–0.91) for 6- to 8-h sleepers, and 0.89 (95% CI: 0.87–0.91) for long sleepers (p = 0.01). Conclusions: In patients with COPD, sleep duration was not associated with all-cause mortality. However, short sleep duration was significantly associated with worse HRQOL. [ABSTRACT FROM AUTHOR]

Introduction: In the general population, short and long sleep durations have been associated with adverse health outcomes. However, this association remains unclear in patients with chronic kidney disease (CKD). We examined the relationship of sleep duration to mortality and health-related quality of life (HRQOL) in individuals with CKD. Methods: A total of 1,783 adults with CKD who participated in the 2007–2015 Korea National Health and Nutrition Examination Survey were analyzed. CKD was defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 m2. Participants were categorized into 3 groups according to self-reported sleep duration: <6 h (short sleepers), 6–8 h, and >8 h (long sleepers). The outcome variables were all-cause mortality and HRQOL. HRQOL was assessed using the European Quality of Life-5 Dimensions (EQ-5D) index. Results: During a median of 6.4 years, 481 (27%) deaths occurred. In unadjusted Cox regression analysis, long sleepers with CKD had an increased risk of death (hazard ratio [HR], 1.62; 95% confidence interval [CI]: 1.26–2.09). This significant association remained after adjusting for age, sex, and BMI (HR, 1.36; 95% CI: 1.05–1.75); however, it was lost after adjusting for CKD stage, social and lifestyle factors, and presence of comorbidities (HR, 1.15; 95% CI: 0.89–1.49). Compared with 6- to 8-h sleepers with CKD, long sleepers with CKD had significantly worse HRQOL in multivariable linear regression models. The adjusted means of the EQ-5D index were 0.80 (95% CI: 0.77–0.82) for short sleepers, 0.81 (95% CI: 0.80–0.82) for 6- to 8-h sleepers, and 0.76 (95% CI: 0.73–0.79) for long sleepers (p = 0.01). Discussion/Conclusion: Long sleep duration is associated with poor HRQOL in Korean adults with CKD. The weak association between long sleep duration and mortality was attenuated after multivariable adjustment in this study. [ABSTRACT FROM AUTHOR]

• Association between sleep duration and mortality in type 2 diabetes remains uncertain. • J-shaped association was identified between sleep duration and mortality in type 2 diabetes. • Long sleep duration (≥ 9 h/day) was significantly associated with an increased risk of mortality. - To evaluate the association between sleep duration and mortality in adults with type 2 diabetes. - This study was a longitudinal analysis of all-cause mortality according to sleep duration based on the 2007–2015 Korea National Health and Nutrition Examination Survey (KNHANES) linked to the Cause of Death data (ver. 1.1). Adult participants with type 2 diabetes were included in the analysis. According to self-reported sleep duration, participants were divided into five groups (≤ 5 [short sleeper], 6, 7, 8, and ≥ 9 h/day [long sleeper]). All missing values were replaced using multiple imputation. We used Cox proportional hazards models to evaluate the relationship between sleep duration and mortality using age as the time scale. - Among the final 51,603 participants who were linked to death certificate data, 5,930 (11.5%) had type 2 diabetes. During a median follow-up of 6.5 years, 735 (12.4%) deaths occurred. In multivariable analysis, a J-shaped association between sleep duration and all-cause mortality was observed (P for quadratic trend = 0.003). In particular, long sleep duration was significantly associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.65; 95% confidence interval, 1.29–2.11. In addition, modifying effects on the relationship between sleep duration and mortality were identified for chronic kidney disease and cancer (P for interaction = 0.003 and 0.002, respectively). - A J-shaped relationship was identified between sleep duration and all-cause mortality in Korean adults with type 2 diabetes. In particular, a long sleep duration was significantly associated with an increased risk of all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess mortality in chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and overlap syndrome, and evaluate which polysomnographic indices-apnea-hypopnea index (AHI) or hypoxemic load measurements-better predict mortality within 10 years.Methods: Adults with symptoms suggestive of sleep apnea and airway disease who underwent both polysomnography and spirometry plus bronchodilator response tests between 2000 and 2018 were included and divided into four groups according to presence of COPD and moderate-to-severe OSA (AHI ≥15/h). We estimated mortality using a Cox model adjusted for demographic/anthropometric covariates and comorbidities; this was called clinical model. To evaluate prognostic performance, we compared the concordance index (C-index) between clinical model and extended models, which incorporated one of polysomnographic indices-AHI, sleep time spent with SpO2 < 90% (TS90), and mean and lowest SpO2.Results: Among 355 participants, patients with COPD alone (57/355, 16.1%) and COPD-OSA overlap syndrome (37/355, 10.4%) had increased all-cause mortality than those who had neither disease (152/355, 42.8%) (adjusted HR, 2.98 and 3.19, respectively). The C-indices of extended models with TS90 (%) and mean SpO2 were significantly higher than that of clinical model (0.765 vs. 0.737 and 0.756 vs. 0.737, respectively; all P < 0.05); however, the C-index of extended model with AHI was not (0.739 vs. 0.737; P = 0.15).Conclusions: In this cohort with symptoms of sleep apnea and airway disease, patients with overlap syndrome had increased mortality, but not higher than in those with COPD alone. The measurement of hypoxemic load, not AHI, better predicted mortality. [ABSTRACT FROM AUTHOR]