自我报告的睡眠时长和睡眠质量与癌症风险的关联：6项前瞻性队列的汇总分析

A third of adults report poor sleep health which may be from short sleep (<7 hours/day), long sleep (>9 hours/day), or poor quality of sleep. Sleep health involves getting the right amount of restful sleep each day and poor sleep health is associated with increased morbidity and mortality, including certain types of cancer. There is evidence linking more common cancers, such as breast, colon, and lung, to both short and long sleep duration, but less is known about sleep quality and other cancer types. We sought to evaluate the association between sleep duration and quality with risk from 29 types of cancer. We conducted a pooled random-effects meta-analysis of 6 prospective United States and Asian cohorts in the National Cancer Institute Cohort Consortium with self-reported sleep duration and quality. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for associations with incidence of overall cancer as well as 29 types of cancer; adjusted for age, sex, race/ethnicity, education, body mass index, alcohol consumption, and smoking status. Sleep duration (hours) was modeled as a 5:2 weekday:weekend weighted average and quality was based on reported trouble sleeping or restless sleep (<1 night/week or rarely/never vs 1+ nights/week). A total of 643,860 participants (median [range] age, 62 [34-99] years, 58% female) were included in the analysis. Over a median of 12 years of follow-up, there were 138,606 cancer diagnoses. Compared to National Sleep Foundation's recommended sleep duration of 7-9 hours/day in adults, short sleep duration was associated with reduced risk of overall cancers (HR 0.98; 95% CI 0.97, 0.99), as well as breast (n = 24,386; HR 0.95; 95% CI 0.92, 0.97) and prostate cancer (n = 24,593; HR 0.97; 95% CI 0.94, 1.00); and increased risk of small intestine (n = 510; HR 1.26; 95% CI 1.05, 1.52) and head and neck cancers (n = 3,433; HR 1.09; 95% CI 1.02, 1.18). Long sleep duration was associated with increased risk of head and neck cancers (HR 1.19; 95% CI 1.03, 1.39). Restless sleep was associated with decreased risk of breast cancer (n = 12,515; HR 0.95; 95% CI 0.90, 0.99) and increased risk of hepatocellular carcinoma (n = 352; HR 1.31; 95% CI 1.03, 1.67). We did not observe any associations with trouble sleeping. Short sleep duration appeared to be protective against overall cancer risk, potentially due to the association with lower risks of breast and prostate cancer. However, short sleep was associated with higher risks of small intestine and head and neck cancers. Long sleep duration was also associated with increased risk of head and neck cancers. While we observed associations between restless sleep and breast cancer and hepatocellular carcinoma, only 2 cohorts asked about restless sleep. These results highlight the complex relationship between sleep and cancer risk and the importance of assessing individual cancer types.