0757 Association of Insomnia with Objective Short Sleep Duration and Other Phenotypes with Mortality in Older Persons

Abstract Introduction The association of insomnia with objective short sleep duration (ISSD) and mortality has not been studied in older persons. Methods In 3,601 men from the Osteoporotic Fractures in Men Sleep Study (average age 76±6 years) and 3,295 women from the Study of Osteoporotic Fractures (average age 84±4 years), we used Cox proportional hazards models to examine the association of ISSD (trouble getting to sleep within 30 minutes, waking up in the middle of the night or early morning, and/or taking a medication to help with sleep ≥3 times/week and actigraphy-estimated sleep duration 6h) with mortality. We also examined whether other sleep phenotypes (insomnia with normal sleep duration INSD; insomnia and sleep duration 6-9h, asymptomatic short sleep AS; no insomnia and sleep duration 6h, long sleep LS; self-reported or actigraphic sleep duration9h) were associated with mortality. Persons with normal sleep (no insomnia and actigraphic sleep duration 6-9h) served as the reference group. Follow-up times were 6,538 and 2,953 days in men and women, respectively. Adjusted models included age, race, education, obesity, depression, diabetes, COPD, stroke, hypertension, myocardial infarction, and heart failure. In analyses for men, we also adjusted for severe sleep disordered breathing (apnea-hypopnea index =30). Results Prevalence rates in men/women for ISSD, INSD, AS, and LS were 19.9%/11.5%, 41%/34.8%, 10.6%/10.4%, and 7.7%/17.9%, respectively. Mortality rates for men and women were 65.2% and 35.7%. Compared to men with normal sleep, ISSD (OR 1.32 1.16, 1.52) and LS (OR 2.22 1.58, 3.12) in men were associated with increased mortality risk in unadjusted models. In adjusted models, only LS vs. normal sleep conferred higher mortality risk (adjOR 1.49 1.03, 2.14). Similarly, ISSD (OR 1.32 1.07, 1.62) and LS (OR 4.65 3.49, 6.19) in women were associated with increased mortality risk in unadjusted analyses, but only women with LS had a higher mortality risk in adjusted models (adjOR 2.30 1.60, 3.31). Compared to normal sleepers, neither INSD nor AS in older men or women were related to mortality risk. Conclusion ISSD and LS represent high risk phenotypes in older persons. Future work should examine causal pathways and determine whether sleep improvements decrease mortality risk. Support (if any) AASM Foundation, NIA