The Relationship Between Sleep Duration, Education, and Mortality

In this podcast, Sri Banerjee, MD, PhD, MPH, MAS, speaks about the role of sleep duration in the relationship between education and mortality, including how sleep stages and social factors are connected to certain chronic conditions, such as obesity. He presented on this topic at the 25th World Congress of Neurology (WCN 2021). 

Additional Resource:

Sri Banerjee, MD, PhD, MPH, MAS, is a faculty member at Walden University in the School of Health Sciences. He is a clinical biostatistician and an epidemiologist in Leola, Pennsylvania. 



Jessica Bard: Hello, everyone. Welcome to another installment of "Podcast360," your go‑to resource for medical news and clinical updates. I'm your moderator, Jessica Bard with Consultant360 Specialty Network.

There is increasing evidence that there is an association between the duration of sleep, education, and health outcomes. Dr Sri Banerjee is here to speak with us about that today. Dr Banerjee is a faculty member at the School of Health Sciences at Walden University based in Leola, Pennsylvania. He's also a clinical biostatistician and is an epidemiologist.

Thank you for joining us today. Your research is titled "The role of sleep duration in the relationship between education and mortality." Can you please tell us more about how this topic came about?

Dr Sri Banerjee: Sure. Thank you for that question, Jessica. From my years of experience in global health and related global travel, one of the phenomena that I experienced was jet lag. When you are traveling thousands of miles, this requires quite a few days of adjustment.

From this, I started thinking about sleep and how sleep affects an individual. Personally, I was also dealing with additional sleep issues and these types of issues, as I started talking about my research and my interest, I found out that many people have issues with sleep, whether it's issues with falling asleep, staying asleep, waking up too often.

Even when I was seeing patients and asking about their sleep, I found out that there were many instances where sleep was an issue. There was no way to connect that with other chronic diseases.

Jessica: Let's dive into the meat of your research here. What is the role of sleep duration in the relationship between education and mortality?

Dr Banerjee: It's a very important question. That is a question that we were trying to find out, first, by going through the literature that is there.

As we were pouring through the literature, we've found some evidence of how certain stages of sleep were more strongly connected to certain disorders. For instance, there were researchers that found that individuals that had short duration sleep had more time remaining in either stage two and or REM sleep.

This means that they were more likely to have increased appetite and also increase likelihood of obesity. These research studies informed what we needed to look into next. Now that there was a connection between sleep and chronic conditions, we needed to find out if there was any connection with social factors.

In order to do so, we used effect modification model. The data set that we looked into was the National Health and Nutrition Examination Survey between the years of 2005 and 2010. Follow‑up was conducted through December of 2015. Many variables were ascertained through the study, of course.

Sleep duration was categorized into three categories. Low, which was considered less than or equal to six hours. Medium sleep, which was considered seven to eight hours. Then high sleep duration, which was considered greater than or equal to nine hours.

What we studied was, if sleep duration modified the effect of education level or cause mortality.

Jessica: What participant characteristics played a role in your results?

Dr Banerjee: Very important and interesting question. Before conducting a thorough analysis, it's always important to look for specific patterns within the population and understand what is actually going on.

What we did is we looked at the mortality rates at each education level and try to look if there was actually a difference. What we found was that there, in fact, was a difference. Individuals that had some high school education actually had higher percentage of mortality than individuals that had some college education.

Jessica: Did your findings surprise you?

Dr Banerjee: Interesting question. The answer to that is yes, it definitely did surprise us. What was important for us to look into was, what was the combined effect of educational attainment and sleep duration? From past studies, we had already known that sleep is connected to the chronic conditions. We individually knew also that educational attainment was leading to increased mortality.

The fact that education leads to increased mortality, this was confirmed by our study independently as well. That finding is very important. The novel finding for our study is the fact that when an individual has low educational attainment combined with low sleep duration, that causes increased mortality. That was very surprising and has important implications for future research.

Jessica: My next question is actually two questions in one. What's next for research on this topic and how can this research be used in clinical practice?

Dr Banerjee: That's an interesting question. Again, this is something that is important for future researchers to understand in the context of better characterizing what types of sleep leads to better outcomes and which types of sleep leads to poor health outcomes.

Differentiating this through future longitudinal studies is important. This will allow researchers to conduct more informed studies when they are also studying social determinants. Social determinants like educational status, ethnicity, all of these are at the forefront in epidemiology.

Researchers need to further investigate those. The takeaway from this research is that, it is important to be screening for sleep disorders. Additionally, it is important to counsel your patients on sleep hygiene. Take that extra moment. Take that extra minute.

If somebody is having difficulty sleeping, to screen for good sleep practices and proper sleep hygiene. For instance, conducting activities in bed only pertaining to sleep and not having electronic devices, food, and other things. Those are the clinical and the research implications of this study.

Jessica: What are the take‑home messages of this study? Overall take‑home messages?

Dr Banerjee: Great question. Importantly, sleep is not only important for restful energy and vitality, but also important to prevent from chronic diseases. Healthcare practitioners need to have a high index of suspicion for sleep dysfunction when especially managing chronic conditions.

Researchers, when conducting social epidemiological studies, need to also keep in mind additional factors like sleep duration. Those are my three key takeaways.

Jessica: That's all really important. Is there anything else that you'd like to add today?

Dr Banerjee: No, I think that's it.

Jessica: Fantastic. Thank you so much for joining us on the podcast today.

Dr Banerjee: Thank you.