Changes in sleep score and leisure-time physical activity, their combination, and all-cause mortality in middle-aged and older Chinese adults: The Dongfeng-Tongji cohort study.

To prospectively investigate the associations of longitudinal changes in sleep score and LTPA and their combination with all-cause mortality. Among 12,543 participants (mean age: 66.1 years) from the Dongfeng-Tongji cohort, we calculated sleep score (range, 0–4, integrating bedtime, sleep duration, sleep quality, and midday napping, higher score indicating healthier sleep) and LTPA at baseline (2008–2010) and the first follow-up (2013) surveys and their 5-year changes (defining stable sleep score as no change and stable LTPA as change within 150 min/week). We prospectively documented deaths from the first follow-up survey (2013) through December 31, 2018. During a mean 5.5-year follow-up, 792 deaths occurred. The 5-year changes in sleep score and LTPA were inversely associated with all-cause mortality risk, regardless of their initial values. When assessing 5-year changes in sleep score and LTPA jointly, compared with the stable sleep score-stable LTPA group, the decreased sleep score-decreased LTPA group had a 40 % (5–85 %) higher all-cause mortality risk, whereas the increased sleep score-increased LTPA group had a 34 % (9–52 %) lower risk. The direction of the joint association was mainly driven by sleep score change. Participants maintaining sleep scores ≥ 3 and LTPA ≥ 150 min/week over 5 years had a 44 % (28–56 %) lower all-cause mortality risk. Promoting sleep hygiene and LTPA together may benefit efforts in reducing mortality risk, with particular attention to monitoring long-term sleep health. • The 5-year changes in sleep score and LTPA were inversely associated with all-cause mortality risk. • Decreased sleep scores combined with decreased LTPA were associated with a higher all-cause mortality risk. • Increased sleep scores combined with increased LTPA were associated with a lower all-cause mortality risk. • The joint association of changes in sleep score and LTPA with all-cause mortality was driven by the sleep score change. • Maintaining healthy sleep habits and sufficient LTPA together over time may benefit reducing mortality risk. [ABSTRACT FROM AUTHOR]