Can an improvement in sleep positively impact on health?

doi:10.1016/j.smrv.2010.02.001

Sleep Medicine Reviews

Volume 14, Issue 6, December 2010, Pages 405-410

https://doi.org/10.1016/j.smrv.2010.02.001 Get rights and content

Summary

Reports from a large number of studies document significant associations between sleep duration and various health problems such as cardiovascular events, risk of stroke, incident artery calcification, changes in inflammatory markers and many more. Furthermore, some sleep duration studies have shown that shorter sleep precedes some adverse health outcomes, although a causal relationship has yet to be demonstrated.

Whilst clinical studies have shown that de-fragmenting (reducing awakenings and improving sleep continuity) sleep can reverse the harmful consequences of sleep apnea, and other studies have demonstrated that adjunctive treatment of insomnia improves depression, evidence that treatment of insomnia results in health benefit is more controversial.

This article documents the debate session from the 6th International Sleep Disorders Forum – The Art of Good Sleep, held in Toronto, Canada in September 2008; the topic of which was “Does an improvement in sleep positively impact on health?”

Introduction

The 6th International Sleep Disorders Forum – The Art of Good Sleep was held in Toronto, Canada in September 2008 and was attended by an international mix of sleep specialists. The meeting was held under the theme of Sleep & Society and focused on increasing the awareness of sleep disorders as an important health issue for society, and the relationship between sleep disorders and other common comorbid conditions. As part of the program a debate session was conducted on the topic “Does an improvement in sleep positively impact on health?”: the PRO argument was provided by Drs Ron Grunstein and Peretz Lavie, and the CON argument was presented by Drs Jim Horne and Daniel Buysse. Each author presented their arguments in the sequence PRO, CON, PRO, CON, followed by rebuttals, and the session was concluded with a general audience discussion. The following article summarizes the discussions that took place.

Section snippets

Ron Grunstein

The specifics of the debate topic were clarified from the perspective of the ‘PRO’ argument: an “improvement in sleep” was defined as increasing sleep length (for instance by decreasing sleep latency), reducing arousals and sleep fragmentation, and improved perception of sleep quality; “positively impacts on health” was defined as an improvement of markers or endpoints of good health, a decrease in markers or endpoints of ill health, and better quality-of-life (QOL) or work productivity.

Jim Horne

If poor sleep is defined in terms of excessive daytime sleepiness (EDS), then an improvement in sleep will certainly impact on health as, for example, the greatest danger with EDS is probably falling asleep while driving. However, if a person complains about poor sleep without EDS, is this sleep really poor?

While fragmented sleep is unhealthy, the argument should concentrate on whether shorter or longer sleep length is unhealthy. Approximately 7 h of sleep appears to be enough for most adults

Replies to the statements – PRO

Ron Grunstein: the debate highlighted that, whilst the evidence is clearer that lack of sleep is quite harmful in children (although children were not mentioned in the debate), there is a need for trials comparing the outcomes related to individuals randomized to different sleep lengths before this question can be definitively answered in adults.

Peretz Lavie: there is evidence that if you ask people how they feel then follow-up with them over a long period, 20 years later you will find that

Replies to the statements – CON

Daniel Buysse: while acute sleep deprivation has a negative impact on mood and other health outcomes, this is beside the point of the current discussion. This debate should not focus on the short-term symptoms because long-term data provide the most important, consequential results. What we need to know is whether increasing a person's duration of sleep over the long term actually positively impacts on a person's health.

Jim Horne: I'd like to re-iterate that whilst the acid test for

Audience perspective

During the course of the debate, the audience – an international mix of sleep specialists – contributed their opinion to the debate via interactive keypads. When asked the question “Does an improvement in sleep positively impact on health?” immediately before the debate, 89% answered ‘Yes’ and 11% answered ‘No’. When asked the same question immediately after the presentations (but before the rebuttals), audience opinion had shifted: 66% supporting the affirmative statement, while 34% didn't. At

Conclusions/summary

Whilst results from a large number of studies document significant associations between sleep duration and various health problems, a causal relationship remains to be demonstrated, and convincing evidence that treatment of ‘insufficient’ sleep results in health benefits is lacking. Before the question of whether an improvement in sleep positively impacts on health can be definitively answered in adults, there is a need for more detailed investigation into long-term outcomes and the potential

Acknowledgements

Medical writing assistance for the preparation of this manuscript was provided by Wolters Kluwer Health Medical Communications. This assistance was funded by Sanofi-aventis.

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^e: Tel.: +1 412 246 6413; fax: +1 412 246 5300.

^f: Tel.: +61 2 9515 8630; fax: +61 2 9515 7070.

^g: Tel.: +972 4 8295234; fax: +972 4 8343934.

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CommentaryCan an improvement in sleep positively impact on health?

Summary

Introduction

Section snippets

Ron Grunstein

Jim Horne

Replies to the statements – PRO

Replies to the statements – CON

Audience perspective

Conclusions/summary

Acknowledgements

Prim Care

Sleep Med Rev

Jt Comm J Qual Patient Saf

Lancet

Sleep Med Rev

Lancet

Lancet

Sleep Med

Sleep Med

Biol Psychiatry

Sleep Med

Sleep Med

Neurosci Biobehav Rev

Biol Psychol

Sleep Med Rev

Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 hours per night

Sleep

The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

Sleep

How sleep and mental disorders are related to complaints of daytime sleepiness

Arch Intern Med

Work patterns and fatigue-related risk among junior doctors

Occup Environ Med

PVT performance as a function of total sleep time in a dose response sleep restriction experiment with and without naps

Sleep

Associations between sleep loss and increased risk of obesity and diabetes

Ann N Y Acad Sci

Effect of reducing interns' weekly work hours on sleep and attentional failures

N Engl J Med

Meta-analysis of short sleep duration and obesity in children and adults

Sleep

Correlates of short and long sleep duration: a cross-cultural comparison between the United Kingdom and the United States: the Whitehall II Study and the Western New York Health Study

Am J Epidemiol

Positive pressure therapy: a perspective on evidence-based outcomes and methods of application

Proc Am Thorac Soc

Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome

Am J Respir Crit Care Med

A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea

Am J Respir Crit Care Med

Systematic review of the efficacy of nasal CPAP

Thorax

Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome

Am J Respir Crit Care Med

Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome

Thorax

Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea

QJM

A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: benefits, tolerance, compliance and quality of life

Eur Respir J

Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome

Am J Respir Crit Care Med

Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome

Eur Respir J

Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea

Thorax

Medical factors of falling asleep behind the wheel

Prague Med Rep

Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study

Neurology

Commentary
Can an improvement in sleep positively impact on health?