Risk of napping: excessive daytime sleepiness and mortality in an older community population

J Am Geriatr Soc. 1996 Jun;44(6):693-8. doi: 10.1111/j.1532-5415.1996.tb01834.x.


Objective: To describe the demographic and health-related factors related to excessive daytime sleepiness. To estimate the risk of mortality associated with excessive daytime sleepiness independent of nightime sleep problems and other factors that limit survival.

Design: Four-year prospective cohort study with annual interviews.

Setting: One urban and four rural counties in north-central North Carolina.

Participants: Adults 65 years and older (n = 3962) living in the community.

Main outcome measures: Excessive daytime sleepiness was measured as, "How often do you get so sleepy during the day or evening that you have to take a nap?" Mortality was based on continuous surveillance of the population by field investigators and abstraction of death certificates.

Results: Point prevalence of excessive daytime sleepiness in this population was 25.2%. Frequent daytime nappers were more likely than infrequent nappers to report nighttime sleep complaints and were more likely to be male and urban-dwellers, to report more depressive symptoms, more limited physical activity, and more functional impairment, and were more likely to be overweight. Of the frequent nappers, 23.9% died, compared with 15.4% of infrequent nappers. In an adjusted Cox proportional hazard model, the 4-year mortality rate was accelerated 1.73 times among older people who nap most of the time and make two or more errors on a cognitive status examination.

Conclusion: Excessive napping is associated with impaired sleep hygiene as well as with a broad range of activity-related health deficits among community-dwelling older adults. Frequent napping was associated with impaired sleep hygiene, male gender, urban-dwelling, depressive symptoms, physical activity deficits, functional impairment, and excess weight. Mortality risk was elevated selectively among the most cognitively impaired subjects.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Circadian Rhythm*
  • Disorders of Excessive Somnolence / etiology*
  • Disorders of Excessive Somnolence / mortality*
  • Female
  • Humans
  • Male
  • North Carolina / epidemiology
  • Prevalence
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Rural Health
  • Survival Analysis
  • Urban Health