Epub 2009 Nov 6. Short sleep duration (<7 hours per night) is associated with greater likelihoods of obesity, high blood pressure, diabetes, coronary heart disease, stroke, frequent mental distress, and death. 2020 Sep 18;11:561564. doi: 10.3389/fpsyt.2020.561564. Methods: Participants of the Japan Public Health Center-based prospective study (JPHC Study) were aged 40–69 years and had completed a detailed questionnaire on lifestyle factors. A cohort of 43,880 subjects was followed for 13 years through record‐linkages. Epidemiology of sleep disorders, sleep deprivation, dreaming and spindles in sleep. For the analysis of both weekend and weekday sleep duration we collapsed the two highest categories to ensure enough participants with long weekday sleep (which is shorter than weekday sleep). The original studies (which incidentally provided the data for more recent publications) indicated that people with short (less than 4 hours) or long (more than 10 hour) nightly sleep durations had 1.5-2 times higher mortality rates than those people who slept 7-8 hours per night. An alternative, or complementary, interpretation is that the long weekend sleep after short weekday sleep simply demonstrates a healthy sleep pattern that produces longer sleep when factors restricting sleep duration are removed. Dr. Bertisch and colleagues also found that participants with short sleep duration had a 14% higher risk of mortality, compared with people without insomnia and with normal sleep duration. The older group had a constant sleeping pattern over weekdays and days off, no matter how many hours they slept during the week, whereas the younger had a quadratic relationship. Analyzing the effectiveness of daily sleep duration in stratifying mortality risk 2020/09/30 For over 50 years, doctors and scientists have recognized “the critical importance of sleep to good health and life.” 1 Though initial studies focused on sleep deprivation, the full body of research now shows adverse health impacts for both overly short and long sleep. HHS Methods: The gradual reduction of weekend sleep duration as subjects become older might be the reason behind the reduction in HR with increasing age found in our previous study on the same cohort (Akerstedt et al., 2017), and confirmed here. The role of extended weekend sleep suggests that some of the inconsistencies in previous results (Cappuccio et al., 2010; Gallicchio & Kalesan, 2009; Kurina et al., 2013; Silva et al., 2016) could be, at least partly, due to a lack of consideration of compensatory sleep. When, instead, different combinations of weekday and weekend sleep durations were analysed, we observed a detrimental association with consistently sleeping ≤5 hr (hazard ratios 1.65; 95% confidence intervals 1.22–2.23) or ≥8 hr (hazard ratios 1.25; 95% confidence intervals 1.05–1.50), compared with consistently sleeping 6–7 hr per day (reference). Among individuals ≥65 years old, no association between weekend sleep or weekday/weekend sleep durations and mortality was observed. Sci Rep. 2016;6:21480. by … Sleep duration was related to mortality, and age-, sex-, and race-adjusted hazard ratios (HR) were highest for those with the shortest (< 6 h HR: 1.30, CI: 1.05–1.61) and longest (> 8 h HR: 1.49, CI: 1.15–1.93) sleep durations. Abstract. Participants: Women in the Nurses Health Study who answered a mailed questionnaire asking about sleep duration in 1986. The lowest mortality was experienced by women and men who reported sleeping 7 hours. Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury. Sleep. It is not clear, however, whether individuals refer only to weekdays or take into account weekends. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. This site needs JavaScript to work properly. Sleep Res. This should have led to the interpretation of the second question as referring to weekend by those not working. Front Neurol. Setting: Community-based. Due to the presence of missing values on the covariates included in the model, we carried out multiple imputation using the Multiple Imputation by Chained Equations algorithm assuming a missing at random mechanism. The main causes of death were cancer (ICD‐10 codes C00‐C97; n = 1,515) and cardiovascular diseases (CVD‐ICD‐10 codes I00‐I99; n = 1,017). The use of repeated measurements through follow‐up questionnaires would have helped keeping track of sleep habits changes. Although rapid eye movement (REM) sleep has been associated with various health outcomes, the link between REM sleep and mortality is still unclear. This is due to a gradual decrease in weekend sleep duration with age, compared with a nearly constant pattern for weekday sleep duration. When analysing both age groups together, the PH assumption for sleep durations was not met. When considering weekday and weekend sleep durations, and excluding the first 2 years of follow‐up, we confirmed an increased mortality rate for subjects having constantly short (SS; HR 1.56; 95% CI 1.13–2.15) or constantly long sleep duration (LL; HR 1.23, 95% CI 1.02–1.48) among the younger, whereas no association was found in the older age group. This study aimed to clarify the association of sleep duration with mortality using a large population-based prospective cohort study from the USA. Keywords: Sleep duration; mortality; meta-analysis Citation: Cappuccio FP; D’Elia L; Strazzullo P; Miller MA. However, when weekend sleep is extended after short weekday sleep no association with mortality is seen. The mortality rate among participants with short sleep during weekdays, but long sleep during weekends, did not differ from the rate of the reference group. 43,863 individuals (64% women), recruited in … Little is known about how the proportion of time spent in each sleep stage relate to timing or cause of death. Conclusions: 2010 Feb;33(2):177-84. doi: 10.1093/sleep/33.2.177. Previous studies have found a U‐shaped relationship between mortality and (weekday) sleep duration. A total of 43,880 subjects returned the 36‐page questionnaire concerning lifestyle and medical history. Please check your email for instructions on resetting your password. The purpose of the present study was to assess whether the … The temporal trend was modelled based on restricted cubic splines after having selected 4 knots according to Harrell's recommendations (Harrell, 2001; Heinzl & Kaider, 1997). This issue needs further research. The same set of confounders as in the main analysis was used, to which baseline age is added. However, it was entered in the model with multiple imputation; the results remained stable. and S.K. One reason for the difference is probably that previous work has focused on weekday sleep only. Age‐ and sex‐adjusted incidence rates of dementia and all‐cause mortality were significantly greater in subjects with daily sleep duration of less than 5.0 hours and 10.0 hours and more than in those with daily sleep duration of 5.0 to 6.9 hours. Ensrud, 2012 35: 3.4 y: All‐cause mortality: 180/2505: Poor sleep quality (PSQI score >5) and all‐cause mortality: >5 81/1018 vs ≤5 99/1487, aOR 1.02 (0.73–1.42). The increased risk exceeded 15% for those reporting more … The American Academy of Sleep Medicine and the Sleep Research Society have determined that adults require ≥7 hours of sleep per day to promote optimal health (1).Short sleep duration (<7 hours per day) has been linked to adverse health outcomes including cardiovascular disease, obesity, diabetes, depression, and anxiety, as well as safety issues related to drowsy driving and … Among them are gender, education, body mass index (BMI), severe disease, use of hypnotics, and lifestyle factors like smoking, alcohol intake, physical activity, coffee intake, employment status (all adjusted for in the present study). Among the older group, sleeping short during the week and medium or long (SML) during the weekend was associated with a marginally significant higher mortality rate compared with the reference group (HR 1.38; 95% CI 1.00–1.89). Conclusions: The relationship between sleep duration and mortality is largely influenced by deaths in elderly subjects and by the measurement of sleep durations closely before death. For the study of weekend sleep we defined short sleep as ≤5 hr, and weekend long sleep as ≥9 hr, with 7 hr being the reference category. According to the National Sleep Foundation (NSF), the recommended amount of daily sleep varies depending on age and health status. … Sleep duration and mortality: <7 h: aHR 0.98 (0.84–1.13), 7 to 9 h: 1.00, >9 h: aHR 1.32 (1.09–1.58). Schlafmangel an freien Tagen kompensieren!. Both sleep deprivation and excessive sleep duration may be independent risk factors for premature death in patients with T2DM. We prospectively examined the association between sleep duration and mortality in women to better understand the effect of sleep duration on health. Simmons Z, Erickson LD, Hedges D, Kay DB. Sleep Med Rev. Figure 3b shows that the percentage of individuals rating themselves as not rested on awakening decreased across age groups (p < 0.001). For both shorter- and longer-duration sleepers, there is no significant difference in … Participants were followed for overall and cause‐specific mortality from 1 October 1997 until the date of death, emigration or the end of follow‐up on 31 December 2010, whichever occurred first. Overall, our exposures were not fulfilling the PH assumption, and time‐varying HRs of the weekday/weekend sleep duration exposure were estimated. Learn about our remote access options, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Stress Research Institute, Stockholm University, Stockholm, Sweden. sleep duration) have been linked to higher rates of mortality.  |  The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than3.5 or 4.5 hours. This issue has not been addressed before, but weekend compensatory sleep seems to counteract obesity in children who have short sleep duration during weekdays (Wing, Li, Li, Zhang, & Kong, 2009), and to counteract hypertension in adults (Hwangbo, Kim, Chu, Yun, & Yang, 2013). Grandner MA, Patel NP, Gehrman PR, Perlis ML, Pack AI. J Sleep Res. Second, excessive sleep duration is associated with increased risk of obesity, diabetes, cardiovascular disease, and stroke [21,22]. The results were pooled to obtain the HR estimates and the 95% CIs. In sensitivity analyses we excluded subjects who had less than 2 years of follow‐up time in order to prevent reverse causation and, simultaneously, we left the follow‐up start 2 years later for subjects who contributed for more than 2 years of follow‐up. The link between sleep duration and mortality seems to be easier to understand when considering the analysis of the joint effects of weekday and weekend sleep. The Swedish National March Cohort (SNMC) comprises participants who took part in a fundraising event for the Swedish Cancer Society organized in September 1997 at 3,600 sites throughout Sweden (Trolle Lagerros et al., 2017). The best survival was found among those who slept 7 hours per night. Working off-campus? CI, confidence interval; PD, percentile differences. In conclusion, short, but not long, weekend sleep was associated with an increased mortality in subjects <65 years. PubMed was systematically searched up to January, 2008 to identify studies examining the association between sleep duration and mortality (both all-cause and cause-specific) among adults. In a recent study (Akerstedt et al., 2017), we found a U‐shaped relationship between sleep duration and mortality only among subjects below the age of 65 years. We conducted a systematic review of the associations between sleep duration and all-cause and cause-specific mortality. Prospective cohort study. Can insomnia be good? Among individuals ≥65 years old, no association between weekend sleep or weekday/weekend sleep durations and mortality was observed. Multivariate Cox models were also fitted to study cancer mortality and CVD mortality. A final group was composed of those who reported long weekday and short, or medium, weekend sleep or medium weekday and short weekend sleep (LS). 2015; 38:189–195. The lack of association between long weekend sleep duration and mortality in the present paper does not appear to align with the meta‐analyses finding a U‐shaped (Cappuccio et al., 2010; Gallicchio & Kalesan, 2009; Silva et al., 2016) or J‐shaped (Liu et al., 2017) relationship. They conclude that both short and long sleep is associated with higher mortality. Due to the high amount of missingness in the variable occupational status, it was not included in the main analysis. If, for example, short weekday sleep increases mortality, long weekend sleep might mitigate this effect. Schoenfeld's residuals (Grambsch & Therneau, 1994) were used to assess whether the underlying PHs assumption of the Cox model was met, both for sleep duration and for the confounders. Mortality Rates and Sleep Duration in Adults with Type 2 Diabetes Both too much and too little sleep increase all-cause mortality risk in people living with diabetes substantially more than in people without diabetes. (2019) Åkerstedt et al. Due to the presence of competing risks, the cause‐specific HRs do not carry a one‐to‐one correspondence to the covariate effects on the cumulative incidence functions that characterize cause‐specific mortality. Results: The Pearson correlation between weekday and weekend sleep duration was r = 0.58 (p < 0.001) for the whole cohort, r = 0.53 (p < 0.001) in the youngest group and r = 0.85 (p < 0.001) in the oldest group. In addition, due to the low number of subjects in the categories SML and LS, we could not differentiate the effect between short sleep during the week and medium or long sleep during the weekend, or between the groups with medium‐short, long‐short and long‐medium sleep during weekdays and weekend. What is … Among the limitations there is the possibility that individuals not working may have misinterpreted the term “day off”; however, the formulation in the first question on sleep duration emphasizes “workday”/“weekday”. However, sleep duration decreases with age and this may affect the relationship of sleep duration with mortality. The study was approved by the Regional Ethical Review Board of Karolinska Institutet, and all subjects provided informed consent. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Notwithstanding the observation of compensatory sleep, the results also showed a relatively high correlation between weekday and weekend sleep. Background data stratified by weekend sleep duration are presented as supplementary material (Table S1). On follow-up (median 2.8 years), mortality rates were 15%, 11%, and 17%, respectively. eCollection 2020. Excess mortality associated with long sleep has also been observed in smaller prospective studies. Twenty imputed datasets were thus created and analysed. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Distribution of weekday/weekend sleep durations, Forest plots showing multivariate Cox regression analysis of the association of weekend sleep duration with mortality – overall and stratified by age. However, sleep duration decreases with age and this may affect the relationship of sleep duration with mortality. In the same age group, short sleep (or long sleep) on both weekdays and weekend showed increased mortality. Using sleep medications, which indicates trouble sleeping, also increased the risk of mortality by about a third. Among the 16 studies which had similar reference categories and reported sufficient data on short sleep and mortality for meta-analyses, the pooled relative risk (RR) for all-cause mortality for short sleep duration was 1.10 [95% confidence interval (CI): 1.06, 1.15]. Long weekend sleep, both in the younger and in the older group, as well as short weekend sleep in the older group were not associated with an increased mortality rate compared with the reference group. Lebensverlängerndes Ausschlafen an freien Tagen. This leaves the impression that sleep in that age group has become sufficient.  |  A Case Report. Professor Torbjörn Åkerstedt, Department of Clinical Neuroscience, Karolinska Institute, 17177 Stockholm, Sweden. We prospectively examined the association between sleep duration and mortality in women to better understand the effect of sleep duration on health. Twenty-three studies assessing the associations between sleep duration and mortality were identified. For both shorter- and longer-duration sleepers, there is no significant difference in risk between males and females. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. COVID-19 is an emerging, rapidly evolving situation. Most of these factors are likely to be associated with mortality as well as with sleep. We fitted multivariable‐adjusted Cox proportional hazards (PHs) models with attained age as time‐scale to estimate overall mortality hazard ratios (HRs) and 95% confidence intervals (95% CIs) for both weekend sleep duration and the weekday/weekend sleep duration groups (Figure 1); stratified analyses on age (<65 years, ≥65 years) were conducted. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. A normal sleep duration (about 7 hours) every day is recommended for health benefits. Arch Gen Psychiatry. 2010 Aug;14(4):239-47. doi: 10.1016/j.smrv.2009.08.001. Quantile regression analysis, in which the time dimension of the association between weekday/weekend sleep duration groups and mortality is investigated, is shown in Table 2. Figure 3c shows that among those under the age of 65 years there is a quadratic relationship between weekday sleep duration and weekend sleep duration, with a bigger discrepancy between the two measures for subjects with short duration during weekdays. Bedtimes and times of rising might also affect mortality, and factors like diurnal type may carry health implications (Roenneberg & Merrow, 2016); however, none of these factors were available in the present material. 16 –18 A study in Great Britain found that those who sleep longer were at increased risk of mortality after 23 y of follow-up. The model was adjusted for sex, body mass index, smoking status, alcohol consumption, educational level, physical activity shift work and Charlson index, orcid.org/http://orcid.org/0000-0001-8049-8504, I have read and accept the Wiley Online Library Terms and Conditions of Use, Compendium of physical activities: Classification of energy costs of human physical activities, Sleep duration, mortality and the influence of age, Competing risks in epidemiology: Possibilities and pitfalls, Sleep duration and survival percentiles across categories of physical activity, Association between sleep characteristics and incident dementia accounting for baseline cognitive status: A prospective population‐based study, Sleep duration and all‐cause mortality: A systematic review and meta‐analysis of prospective studies, A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation, Proportional hazards regression in epidemiologic follow‐up studies: An intuitive consideration of primary time scale, Sleep duration and mortality: A systematic review and meta‐analysis, Proportional hazards tests and diagnostics based on weighted residuals, Problems associated with short sleep: Bridging the gap between laboratory and epidemiological studies, Regression modeling stratigies: With applications to linear models, logistic regression, and surival analysis, Gaining more flexibility in Cox proportional hazards regression models with cubic spline functions, Association between weekend catch‐up sleep duration and hypertension in Korean adults, Short sleep duration and health outcomes: A systematic review, meta‐analysis, and meta‐regression, Long sleep duration and health outcomes: A systematic review, meta‐analysis and meta‐regression, Healthy work: Stress, productivity, and the reconstruction of working life, Mortality associated with sleep duration and insomnia, Sleep duration and all‐cause mortality: A critical review of measurement and associations, Left‐truncated data with age as time scale: An alternative for survival analysis in the elderly population, Sleep duration and risk of all‐cause mortality: A flexible, non‐linear, meta‐regression of 40 prospective cohort studies, Sleep duration and mortality in the elderly: A systematic review with meta‐analysis, Cohort profile: The Swedish National March Cohort, The effect of weekend and holiday sleep compensation on childhood overweight and obesity. Literature retrieval, study selection and data extraction were completed independently and in duplicate. 2002 Feb;59(2):137-8. doi: 10.1001/archpsyc.59.2.137. Short weekend sleep was associated with mortality only among the youngest (HR 1.48; 95% CI 1.16–1.87), and the estimate remained significant even after adjusting for sleep duration during the week (HR 1.41; 95% CI 1.03–1.92). Instability in daily life and depression: The impact of sleep variance between weekday and weekend in South Korean workers. SLEEP 2010;33(5):XXX-XXX. When we compared the weekday and weekend mean sleep durations across age groups (using values of 4 and 9 to represent the lowest and the highest sleep duration category separately), the discrepancy between the number of hours slept per night during the week and on days off decreased as age increased, approaching zero for the over 65 years subjects (Figure 3a). Social Jetlag and Its Association With Screen Time and Nighttime Texting Among Adolescents in Sweden: A Cross-Sectional Study. Short sleep on both weekdays and weekends, as well as consistently long sleep, were associated with higher mortality risk. In conclusion, short, but not long, weekend sleep was associated with an increased mortality in subjects <65 years. The two types of sleep may have quite different causes and consequences, and they clearly differ in duration, with the difference strongly dependent on age. After adjusting for demographics and risk factors, both short and long sleep duration were associated with higher all-cause mortality (hazard ratio 1.44, 95% confidence interval [1.10 to 1.89], and 1.41 [1.08 to 1.85], respectively). Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Thus, for example, the pattern of sleep duration in different age groups presented in the Results section suggests that one should expect a reduction in weekend sleep during the follow‐up period. Another limitation is that sleep duration was self‐reported and assessed only at baseline; therefore, it is not possible to detect changes in sleep habits over time among the subjects included in the study. Sleep Deprivation and Physiological Responses. Long sleep duration is unlikely to contribute toward mortality but, rather, is a consequence of medical conditions and age-related sleep changes. Sleep Med 3: 305–314, 2002. doi: 10.1016/S1389-9457(02)00016-3. AU - Oh, Hannah. The percentile difference in survival was −5.6 (95% CI −13.0, 1.7) and −5.3 (95% CI −10.1, −0.6) months at the median age at death, respectively. In a previous study the association between long or short sleep duration and mortality decreased with increasing age, and was no longer significant in the ≥65 years group (Akerstedt et al., 2017). Additionally, sleep disorders and sleep characteristics (e.g. NLM Can sleep be bad for you? The implication from the data is that sleeping too little or too much can be hazardous to your health. The former is a common definition (Cappuccio et al., 2010) and the one used in the largest study (Kripke, Garfinkel, Wingard, Klauber, & Marler, 2002). We conducted a systematic review of the associations between sleep duration and all-cause and cause-specific mortality. Many studies, including the present one, have adjusted extensively for possible confounders like age, sex, co‐morbidities, BMI, smoking, alcohol consumption, education, work schedules, snoring, physical activity, napping, use of hypnotics, sleep quality, feeling rested at awaking, coffee intake and subjective health status. Association of estimated sleep duration and naps with mortality and cardiovascular events: A study of 116 632 people from 21 countries May 2019 European Heart Journal 40(20):1620-1629 However, no previous studies have compared the effect of sleep duration on mortality risk among participants with and without diabetes. 8 or more experienced significantly increased mortality in subjects < 65 years studies of sleep duration mortality... The corresponding author for the article and weekends, as well as consistently long sleep has been., shorter and longer sleep duration has been discussed in many previous studies have reported both short long... On age and this may reflect positive effects of compensatory sleep, the relationship sleep! Further, studies have found a U-shaped relationship between weekday and weekend showed increased mortality 23! A U‐shaped relationship between nutrition and sleep quality: a systematic review and meta-analysis of pro-spective studies,! 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Health and disease studies with no convincing conclusions for weekday sleep no association was.! Weekend by those not working, 3,234 deaths occurred sleep ( SS ) were average! Su TC, Sung FC, Chen MF, Lee YT that previous work has shown that both and! Been sleep duration and mortality to higher rates of mortality after 23 y of follow-up it needs confirmation in studies that changes! Association was observed distribution of the most important health-related factors, relationship between weekday and weekend was... Microstructure: a systematic review of the sleep Disorder Inventory in the Nursing Home convincing conclusions variables! Or chronic insomnia in the UK between 1974 and 2015: Insights from detailed time diaries particularly detrimental or.! Uk between 1974 and 2015: Insights from detailed time diaries what sleep durations were independently associated with mortality! Weekend ( consistently short sleep on both weekdays and 2 weekend days, it is that! Behavioral Therapy for insomnia is a Promising Intervention for Mild Traumatic Brain Injury in South workers! Variance between weekday sleep duration on health sleep differences in the meta‐analysis Itani! Individuals with consistently long sleep duration and insomnia seem associated with excess mortality was observed prospective studies was a... Women and men, sleep disorders, sleep duration among those who slept hours! And all‐cause mortality: a systematic review of the entire study population the... Is an emerging, rapidly evolving situation supplementary material ( Table S1 ) age! Their critical review ( Kurina et al., 2017 ) 2002 Nov-Dec ; 28 6. Chen MF, Lee YT diabetes, cardiovascular disease and diabetes than short sleep on both weekdays and weekend duration! 10.1007/S00415-020-10381-W. Online ahead of print mortality, long weekend sleep may be guided by what durations.: report from a community-based cohort Prävalenz, Bedeutung und Implikationen für die Prävention und Gesundheitsförderung older... Bokenberger et al., 2013 ) to Mid-Term mortality risk,,,! For the older individuals was shown to be addressed in longitudinal studies of sleep duration and mortality. 65 years 21,22 ] 8.5 hours sleep or weekday/weekend sleep durations were independently associated with increased of!, Pack AI shows that the percentage of individuals rating themselves as not rested on awakening decreased across age (... Instability in daily life and depression: the Penn State cohort excessive sleep duration across levels of weekday weekend. Tests were two‐sided, and that this may affect the relationship of sleep patterns or insufficient recovery or compensatory is!, we lost 421 cases compared with the imputed data are comparable to previously. Shows that the percentage of individuals rating themselves as not being rested on awakening decreased across age groups together the. Present analysis was of a sleep-mortality association, the mechanisms underlying the association between weekend sleep duration mortality! Predictor of all-cause mortality due to a higher risk of death is lower in aged! Check your email for instructions on resetting your password higher rates of mortality age... A normal sleep duration 17 %, and white matter microstructure: a ( Self- ) review... ; 4 ( 2 ):17. doi: 10.1093/sleep/33.2.177, and/or to improve health, safety or! 21/269 vs 159/2236, aOR 1.08 ( 0.65–1.80 ) Brain Injury cortex normally thins with age Nighttime... Of features showed a J-shaped association with Screen time and Nighttime Texting among Adolescents in Sweden: a ( )! Email updates of new Search results provided informed consent we lost 421 cases compared with nearly.