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Objectives<\/jats:title>\n                    <jats:p>Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010\u20132013). 1726 participants were followed for a median of 6.9 years (Q1\u2013Q3, 6.4\u20137.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsad048","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T04:33:11Z","timestamp":1686112391000},"source":"Crossref","is-referenced-by-count":32,"title":["Multi-dimensional sleep and mortality: The Multi-Ethnic Study of Atherosclerosis"],"prefix":"10.1093","volume":"46","author":[{"given":"Joon","family":"Chung","sequence":"first","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital , Boston, MA , USA"},{"name":"Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-7940","authenticated-orcid":false,"given":"Matthew","family":"Goodman","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital , Boston, MA , USA"},{"name":"Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8420-9167","authenticated-orcid":false,"given":"Tianyi","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital , Boston, MA , USA"},{"name":"Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-890X","authenticated-orcid":false,"given":"Meredith L","family":"Wallace","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh , Pittsburgh, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1572-1340","authenticated-orcid":false,"given":"Pamela L","family":"Lutsey","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health, the University of Minnesota , Minneapolis, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarvis T","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Castro-Diehl","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Bertisch","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital , Boston, MA , USA"},{"name":"Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6585-1610","authenticated-orcid":false,"given":"Susan","family":"Redline","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital , Boston, MA , USA"},{"name":"Harvard Medical School , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,31]]},"reference":[{"issue":"6","key":"2024022609021527100_CIT0001","doi-asserted-by":"crossref","first-page":"zsy047","DOI":"10.1093\/sleep\/zsy047","article-title":"Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: Sleep Heart Health Study","volume":"41","author":"Bertisch","year":"2018","journal-title":"Sleep."},{"issue":"5","key":"2024022609021527100_CIT0002","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1093\/sleep\/33.5.585","article-title":"Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies","volume":"33","author":"Cappuccio","year":"2010","journal-title":"Sleep."},{"issue":"14","key":"2024022609021527100_CIT0003","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/eurheartj\/ehy624","article-title":"The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study","volume":"40","author":"Azarbarzin","year":"2019","journal-title":"Eur Heart J."},{"issue":"1","key":"2024022609021527100_CIT0004","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/01.PSY.0000039756.23250.7C","article-title":"Healthy older adults\u2019 sleep predicts all-cause mortality at 4 to 19 years of follow-up","volume":"65","author":"Dew","year":"2003","journal-title":"Psychosom Med."},{"issue":"2","key":"2024022609021527100_CIT0005","doi-asserted-by":"crossref","first-page":"87","DOI":"10.2188\/jea.10.87","article-title":"Sleep patterns and total mortality: a 12-year follow-up study in Japan","volume":"10","author":"Kojima","year":"2000","journal-title":"J Epidemiol."},{"issue":"1","key":"2024022609021527100_CIT0006","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.sleep.2010.04.016","article-title":"Mortality related to actigraphic long and short sleep","volume":"12","author":"Kripke","year":"2011","journal-title":"Sleep Med."},{"issue":"3","key":"2024022609021527100_CIT0007","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1046\/j.1365-2796.2002.00941.x","article-title":"Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population","volume":"251","author":"Mallon","year":"2002","journal-title":"J Intern Med."},{"issue":"4","key":"2024022609021527100_CIT0008","doi-asserted-by":"crossref","first-page":"e91965","DOI":"10.1371\/journal.pone.0091965","article-title":"The joint effect of sleep duration and disturbed sleep on cause-specific mortality: results from the Whitehall II cohort study","volume":"9","author":"Rod","year":"2014","journal-title":"PLoS One."},{"issue":"3","key":"2024022609021527100_CIT0009","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1093\/aje\/kwq371","article-title":"Sleep disturbances and cause-specific mortality: results from the GAZEL cohort study","volume":"173","author":"Rod","year":"2011","journal-title":"Am J Epidemiol."},{"issue":"6","key":"2024022609021527100_CIT0010","doi-asserted-by":"crossref","first-page":"e13386","DOI":"10.1111\/jsr.13386","article-title":"Physiological sleep measures predict time to 15-year mortality in community adults: application of a novel machine learning framework","volume":"30","author":"Wallace","year":"2021","journal-title":"J Sleep Res."},{"issue":"4","key":"2024022609021527100_CIT0011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/sleep\/zsac015","article-title":"Actigraphy-derived sleep health profiles and mortality in older men and women","volume":"45","author":"Wallace","year":"2022","journal-title":"Sleep."},{"issue":"1","key":"2024022609021527100_CIT0012","doi-asserted-by":"crossref","first-page":"zsx189","DOI":"10.1093\/sleep\/zsx189","article-title":"Which sleep health characteristics predict all-cause mortality in older men? 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