Sleep Duration and Snoring at Midlife in Relation to Healthy Aging in Women 70 Years of Age or Older

Figures & data

Table 1 Baseline Characteristics of Healthy Agers and Usual Agers in the Nurses’ Health Study

Characteristics	Usual Agers (n=10,950)*	Healthy Agers (n=1354)*
Age at 1986, years^†	60.6 (2.5)	60.1 (2.5)
Education, %
Registered nurse	77.9	73.4
Bachelor	15.8	17.5
Master or doctorate	6.4	9.1
Husband’s education, %
≤ High school	52.2	46.1
College graduate	27.1	30.2
Graduate school	20.6	23.7
Race (white), %	98.5	98.3
Marital status, %
Married	92.8	92.9
Widowed	4.6	4.9
Separated‚ divorced‚ or never married	2.6	2.2
Family annual income, 10,000$	5.7 (4.5, 7.3)	6.0 (4.7, 7.7)
Family home value, 10,000$	12.8 (8.9, 19.5)	13.6 (9.3, 21.2)
BMI, kg/m^2	25.5 (4.4)	23.8 (3.2)
Smoking status, %
Never smoker	47.2	53.5
Past smoker	35.8	35.3
Current smoker	16.9	11.2
Alcohol intake (g/d), %
None	42.1	38.6
1–14.9	45.4	48.3
≥15	12.6	13.1
AHEI (no alcohol)	48.9 (10.7)	51.3 (11.1)
Total calories, kcal	1757.4 (520.2)	1728.4 (527.3)
Total coffee, cup/d	2.5 (1.0, 2.9)	2.5 (1.0, 3.5)
Physical activity, MET-h/wk^‡	7.9 (2.9, 19.4)	11.6 (4.3, 26.2)
Standing time, h/d	4.4 (1.1, 7.2)	4.4 (1.6, 7.2)
Sitting time, h/d	4.4 (1.1, 4.4)	2.2 (1.1, 4.4)
Family history of diabetes, %	29.6	26.4
Family history of myocardial infarction, %	17.2	15.5
Family history of cancer, %	18.3	16.0
History of hypertension, %	21.0	13.3
History of high cholesterol, %	10.4	7.5
Use of multivitamin, %	43.8	41.3
Menopausal status and hormone use, %
Pre-menopausal	1.3	1.0
Post and never used	73.2	73.8
Post and past user	3.6	4.0
Post and current user	22.0	21.2
Regular aspirin use (≥ 2 tabs/wk), %	38.0	26.6
Sleep habits
Sleep duration, h/d	7.0 (1.0)	6.9 (0.9)
Regular snorer, %	10.8	6.0
Night shift work >5 years, %	21.4	16.0
Sleep position, %
On back	6.2	6.6
On side	84.4	82.6
On front	9.4	10.8

Notes: *Values are mean (SD) or median (P₂₅, P₇₅) for continuous variables and percentages for categorical variables and are standardized to the age distribution of the study population. ^†Value was not age adjusted. ^‡MET-h/wk = sum of the average time/week spent in each activity × MET value of each activity.

Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by the square of height in meters); MET, metabolic-equivalent; AHEI, Alternate-Healthy Eating Index.

Table 2 Odds Ratios of Healthy Aging by Sleep Duration, Snoring at Midlife in the Nurses’ Health Study*

	Number of Participants	Healthy Aging, n (%)	Age-Adjusted	MV1-Adjusted^†	MV2-Adjusted^‡
Sleep duration, hours
≤5	506	57 (11.3)	0.91 (0.68, 1.21)	0.93 (0.69, 1.24)	0.94 (0.70, 1.27)
6	3052	326 (10.7)	0.85 (0.74, 0.98)	0.87 (0.75, 1.01)	0.88 (0.76, 1.02)
7	5061	621 (12.3)	1 (reference)	1 (reference)	1 (reference)
8	3094	310 (10.0)	0.81 (0.70, 0.93)	0.83 (0.71, 0.96)	0.83 (0.72, 0.96)
≥9	591	40 (6.8)	0.54 (0.38, 0.75)	0.59 (0.42, 0.82)	0.60 (0.43, 0.84)
Regular snoring
No	10,974	1259 (11.5)	1 (reference)	1 (reference)	1 (reference)
Yes	1254	81 (6.5)	0.53 (0.42, 0.67)	0.61 (0.49, 0.78)	0.69 (0.54, 0.88)

Notes: *ORs <1.00 denote lower odds of healthy aging. For sleep duration, n=13,099; for snoring: n=13,018 due to 81 participants with missing snoring; we defined regular snorers as those who reported snoring regularly and non-snorers as those who only occasionally or almost never snored; ^†MV1 was adjusted for age (continuous), education (registered nurse, bachelor, or graduate), marital status (married, widowed, or separated/divorced), household income (quintiles); family history of cancer, family history of myocardial infarction and family history of diabetes (yes or no); baseline hypertension and high cholesterol (yes or no); menopausal status and hormone use (premenopausal, postmenopausal never users, postmenopausal past users, postmenopausal current users), aspirin use (regular use or not); smoking history (never, former smoker, current smoker), alcohol intake (none, 1–14.9, ≥15 g/d), total energy intake (quintiles), diet quality (Alternate Healthy Eating Index score, in quintiles), physical activity (metabolic equivalent task-hours per week, in quintiles), standing and sitting time (in quintiles); ^‡MV2: MV1+ body mass index (BMI <18.5, 18.5–24.9, 25–29.9, ≥30 kg/m²).

Figure 1 Association of sleep duration with healthy aging including 4 domains*. (A) Sleep duration and healthy aging, (B) sleep duration and free of chronic diseases, (C) sleep duration and good physical function, (D) sleep duration and good mental health, (E) sleep duration and good cognitive function.

Notes: *ORs <1.00 denote lower odds of healthy aging. All model was adjusted for age (continuous), education (registered nurse, bachelor, or graduate), marital status (married, widowed, or separated/divorced), household income (quintiles); family history of cancer, family history of myocardial infarction and family history of diabetes (yes or no); baseline hypertension and high cholesterol (yes or no); menopausal status and hormone use (premenopausal, postmenopausal never users, postmenopausal past users, postmenopausal current users), aspirin use (regular use or not); smoking history (never, former smoker, current smoker), alcohol intake (none, 1–14.9, ≥15 g/d), total energy intake (quintiles), diet quality (Alternate Healthy Eating Index score, quintiles), physical activity (MET-h/wk), standing and sitting time (all in quintiles); body mass index (BMI <18.5, 18.5–24.9, 25–29.9, ≥30 kg/m²).

Table 3 Odds Ratios of Each Domain of Healthy Aging by Sleep Duration, Snoring at Midlife in the Nurses’ Health Study*

	Free of Chronic Diseases		Good Physical Function		No Limitation of Mental Health		No Impairment of Cognitive Function
	n (%)	MV2-Adjusted	n (%)	MV2-Adjusted	n (%)	MV2-Adjusted	n (%)	MV2-Adjusted
Sleep duration, hours
≤5	342 (67.6)	1.01 (0.83, 1.23)	141 (27.9)	0.96 (0.78, 1.19)	189 (37.4)	0.73 (0.60, 0.88)	436 (86.2)	0.67 (0.51, 0.88)
6	2090 (68.5)	1.05 (0.95, 1.16)	854 (28.0)	0.94 (0.85, 1.05)	1268 (41.6)	0.87 (0.79, 0.95)	2770 (90.8)	1.04 (0.89, 1.22)
7	3440 (68.0)	1 (reference)	1516 (30.0)	1 (reference)	2283 (45.1)	1 (reference)	4592 (90.7)	1 (reference)
8	2075 (67.1)	0.98 (0.89, 1.08)	802 (25.9)	0.86 (0.77, 0.96)	1341 (43.3)	0.95 (0.86, 1.04)	2766 (89.4)	0.89 (0.77, 1.04)
≥9	374 (63.3)	0.90 (0.75, 1.08)	121 (20.5)	0.69 (0.56, 0.86)	230 (38.9)	0.83 (0.69, 0.99)	515 (87.1)	0.74 (0.57, 0.97)
Regular snoring
No	7502 (68.4)	1 (reference)	3139 (28.6)	1 (reference)	4764 (43.4)	1 (reference)	9885 (90.1)	1 (reference)
Yes	766 (61.1)	0.86 (0.76, 0.97)	270 (21.5)	0.92 (0.79, 1.07)	509 (40.6)	0.95 (0.84, 1.08)	1125 (89.7)	0.95 (0.78, 1.16)

Note: *All footnotes are same with Table 2.

Figure 2 Joint effect of sleep duration and regular snoring on healthy aging*.

Notes: *Model was adjusted for age (continuous), education (registered nurse, bachelor, or graduate), marital status (married, widowed, or separated/divorced), household income (quintiles); family history of cancer, family history of myocardial infarction and family history of diabetes (yes or no); baseline hypertension and high cholesterol (yes or no); menopausal status and hormone use (premenopausal, postmenopausal never users, postmenopausal past users, postmenopausal current users), aspirin use (regular use or not), smoking history (never, former smoker, current smoker), alcohol intake (none, 1–14.9, ≥15 g/d), total energy intake (quintiles), diet quality (Alternate Healthy Eating Index score, quintiles), physical activity (MET-h/wk), standing and sitting time (all in quintiles); body mass index (BMI <18.5, 18.5–24.9, 25–29.9, ≥30 kg/m²).