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Volume 14 No. 05
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Accepted Papers

Scientific Investigations

Sleep Duration Interacts With Lifestyle Risk Factors and Health Status to Alter Risk of All-Cause Mortality: The Rural Chinese Cohort Study

Feiyan Liu, MD1,2,3; Hongyan Zhang, MD, MPH1; Yu Liu, MD2; Xizhuo Sun, MD2; Zhaoxia Yin, MD2; Honghui Li, MD2; Kunpeng Deng, MD4; Yang Zhao, MD1,2; Bingyuan Wang, MD1,2; Yongcheng Ren, MD1,2; Lu Zhang, MD1,2,5; Junmei Zhou, MM, MPH1,2; Chengyi Han, MM, MPH1,2; Xuejiao Liu, MD1,2,5; Dongdong Zhang, MD1,2,5; Guozhen Chen, BA6; Shihao Hong, BA6; Chongjian Wang, MD, MPH, PhD5; Dongsheng Hu, MD, MPH, PhD1,2,3; Ming Zhang, MD, MPH, PhD1,2
1Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; 2The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; 3Guangdong Key Laboratory for Genome Stability and Disease Prevention, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China; 4Yantian Entry-exit Inspection and Quarantine Bureau, Shenzhen, Guangdong, People's Republic of China; 5Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China; 6Department of Clinical Medicine, Shenzhen University, Shenzhen, Guangdong, People's Republic of China

Study Objectives:

Many studies suggest an association of both short and long sleep duration with all-cause mortality, but the effect of co-occurrence of sleep duration and other lifestyle risk factors or health status remains unclear.


A total of 17,184 participants aged 18 years or older from rural areas of China were examined at baseline from 2007 to 2008 and followed up from 2013 to 2014. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI).


During 6-year follow-up, we identified 1,101 deaths. The multivariable-adjusted mortality risk was significantly higher with short-duration sleepers (< 6.5 hours) (HR = 1.37, 95% CI 1.01–1.86) and long-duration sleepers (≥ 9.5 hours) (HR = 1.35, 95% CI 1.05–1.74) versus 6.5–7.5 hours. The multiplicative interaction of long sleep duration with some lifestyle risk factors and health statuses increased the mortality risk in men (low level of physical activity: HR = 1.03, 95% CI 1.02–1.04; hypertension: HR = 1.06, 95% CI 1.04–1.09; type 2 diabetes mellitus [T2DM]: HR = 1.07, 95% CI 1.04–1.11). Similar results were found in women (low level of physical activity: HR = 1.03, 95% CI 1.02–1.05; T2DM: HR = 1.07, 95% CI 1.05–1.10).


Sleep duration could be a predictor of all-cause mortality and its interaction with physical activity, hypertension, and T2DM may increase the risk of mortality.


Liu F, Zhang H, Liu Y, Sun X, Yin Z, Li H, Deng K, Zhao Y, Wang B, Ren Y, Zhang L, Zhou J, Han C, Liu X, Zhang D, Chen G, Hong S, Wang C, Hu D, Zhang M. Sleep duration interacts with lifestyle risk factors and health status to alter risk of all-cause mortality: the Rural Chinese Cohort Study. J Clin Sleep Med. 2018;14(5):857–865.

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