Megan Brooks

June 07, 2017

BOSTON — New research suggests that both short and long sleep trajectories from adolescence are associated with poor physiologic and mental health outcomes in adulthood. Adolescents with a trajectory of short sleep seem particularly vulnerable to poor mental well-being as young adults.

"Clinicians should ask about their patients' sleep duration from a very early age and on a regular basis," lead investigator, Thirumagal Kanagasabai, PhD, postdoctoral fellow in environmental epidemiology at McGill University in Montreal, Quebec, Canada, told Medscape Medical News.

"With this information in hand, clinicians can target therapy on an individual basis that could involve behavioral or dietary changes or even medication use. One day, targeting sleep may be a realistic therapeutic option to promote and maintain the physiological and mental health of patients," she said.

Dr Kanagasabai presented the research here at SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies.

The researchers examined sleep trajectories over about 16 years in 3118 participants in two longitudinal studies. Participants were aged 10 to 17 years at baseline and reported their sleep duration up to six times during the study period. 

While about 72% of participants in the study maintained healthy (average) sleep duration over time, about 19% fell below the recommended minimum of 7 hours of sleep per night, while 9% slept longer than 7 hours over time.

Compared with the average sleep trajectory, both short (P = .01) and long (P = .06) sleep trajectories were associated with a higher likelihood of rating their own health as poor or fair, as well as greater mental health problems (P = .01 and P = .03, respectively) in young adulthood.

Table. Odds Ratios for Health Outcomes by Sleep Trajectory

Outcome Odds Ratio: Short Sleep (95% Confidence Interval) Odds Ratio: Long Sleep (95% Confidence Interval)
Poor/fair health 1.82 (1.16 - 2.84) 1.89 (0.98 - 3.63)
Mental health problems 1.66 (1.11 - 2.49) 1.99 (1.07 - 3.69)  


"What's interesting is that we found both decreased and increased sleep duration trajectories are associated with health outcomes (compared to healthy sleep duration trajectory). But the trend toward decreasing sleep duration over time is much more detrimental for both physiological and mental health factors that we looked at," Dr Kanagasabai noted.

Compared with average sleep trajectory, short sleep trajectory (but not long) was also associated with greater odds of high blood pressure (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.06 - 3.12; P = .03), greater distress (β = 1.51; 95% CI, 0.73 - 2.28; P < .01), and lower mental well-being (β = –0.63; 95% CI, –1.15 to –0.10; P = .02).

"It's not surprising that we found short sleep duration trajectory is associated with high blood pressure. Sleep is vital for nighttime blood pressure dipping, which is essential for blood pressure regulation during the day," Dr Kanagasabai said.

This research is novel, she noted, in that it's "nearly impossible to find population-level data that show changes in behaviors, in this case sleep duration, and their effect on health."

Just the Right Amount

"I like the poster and I think it is worth mentioning," Haviva Veler, MD, director, Pediatric Sleep and Breathing Disorders Center, Weill Cornell Medicine and New York-Presbyterian, New York City, who wasn't involved in the study, told Medscape Medical News.

"Of course, the idea that a good amount of sleep is associated with increased well-being, better health as related to cardiovascular and metabolic function, better mental health and mood, and better school performance in adolescents is known and documented," she noted. "But this poster provides more evidence to all the above and in a very unique way. First, the population size of over 3000 subjects is huge and the 15-year follow-up is tremendous and very difficult to do or duplicate.

"Another interesting point that is known but not well studied or understood is the fact that long sleep is hazardous as well, not just short sleep. This project shows again that sleep should happen in just the right amount," said Dr Veler.

A limitation of the study, she noted, is the self-reported, not objective, sleep data.  "It is well known that reports on sleep have significant recollection bias. In studies that compared subjects recalling the amount of sleep they had compared with data collected objectively by devices, the disparity was large and persistent."

"In summary, this is an interesting study looking at a very unique study population, and I will be looking forward to their published data," Dr Veler concluded.

The study had no commercial funding. Dr Kanagasabai and Dr Veler have disclosed no relevant financial relationships.

SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies. Poster 1072. Presented June 6, 2017.

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