Sleep duration and the risk of cancer: a systematic review and meta-analysis including dose–response relationship

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Abstract

Background

The effect of sleep duration on cancer risk remains controversial. We aimed to quantify the available evidence on this relationship using categorical and dose–response meta-analyses.

Methods

Population-based cohort studies and case-control studies with at least three categories of sleep duration were identified by searching PubMed, EMBASE, and the Cochrane Library database up to July 2017.

Results

Sixty-five studies from 25 articles were included, involving 1,550,524 participants and 86,201 cancer cases. The categorical meta-analysis revealed that neither short nor long sleep duration was associated with increased cancer risk (short: odds ratio [OR] = 1.01, 95% confidence intervals [CI] = 0.97–1.05; long: OR = 1.02, 95% CI = 0.97–1.07). Subgroup analysis revealed that short sleep duration was associated with cancer risk among Asians (OR = 1.36; 95% CI: 1.02–1.80) and long sleep duration significantly increased the risk of colorectal cancer (OR = 1.21; 95% CI: 1.08–1.34). The dose–response meta-analysis showed no significant relationship between sleep duration and cancer risk. When treated as two linear piecewise functions with a cut point of 7 h, similar nonsignificant associations were found (per 1-h reduction: OR = 1.02, 95% CI = 0.98–1.07; per 1-h increment: OR = 1.003, 95% CI = 0.97–1.03).

Conclusion

Categorical meta-analysis indicated that short sleep duration increased cancer risk in Asians and long sleep duration increased the risk of colorectal cancer, but these findings were not consistent in the dose–response meta-analysis. Long-term randomized controlled trials and well-designed prospective studies are needed to establish causality and to elucidate the mechanism underlying the association between sleep duration and cancer risk.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5025-y) contains supplementary material, which is available to authorized users.

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Most cited references 74

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The metabolic consequences of sleep deprivation.

Kristen Knutson, Karine Spiegel, Plamen Penev … (2007)

The prevalence of diabetes and obesity is increasing at an alarming rate worldwide, and the causes of this pandemic are not fully understood. Chronic sleep curtailment is a behavior that has developed over the past 2-3 decades. Laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of diabetes and/or obesity. Current data suggest the relationship between sleep restriction, weight gain and diabetes risk may involve at least three pathways: (1) alterations in glucose metabolism; (2) upregulation of appetite; and (3) decreased energy expenditure. The present article reviews the current evidence in support of these three mechanisms that might link short sleep and increased obesity and diabetes risk.

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Sleep duration and biomarkers of inflammation.

Sanjay R Patel, Xiaobei Zhu, Amy Storfer-Isser … (2009)

Extremes of sleep duration have been associated with adverse health outcomes. The mechanism is unclear but may be related to increased inflammation. We sought to assess the association between sleep duration and inflammatory biomarkers. A total of 614 individuals from the Cleveland Family Study completed questionnaires about sleep habits and underwent polysomnography. A morning fasting blood sample was assayed for 5 inflammatory cytokines. In this cohort, mean (SD) habitual sleep duration based on self-report was 7.6 (1.6) h and mean sleep duration by polysomnography (PSG) on the night prior to blood sampling was 6.2 (1.3) h. After adjusting for obesity and apnea severity, each additional hour of habitual sleep duration was associated with an 8% increase in C-reactive protein (CRP) levels (P=0.004) and 7% increase in interleukin-6 (IL-6) levels (P=0.0003). These associations were independent of self-reported sleepiness. In contrast, PSG sleep duration was inversely associated with tumor necrosis factor alpha (TNFa) levels. For each hour reduction in sleep, TNFalpha levels increased by 8% on average (P=0.02). Sleep duration was not associated with IL-1 or IL-10. Increases in habitual sleep durations are associated with elevations in CRP and IL-6 while reduced PSG sleep duration is associated with elevated TNFa levels. Activation of pro-inflammatory pathways may represent a mechanism by which extreme sleep habits affect health.

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Estrogen and cancer.

Yongfeng Shang, Jing Liang (2012)

Estrogen exhibits a broad spectrum of physiological functions ranging from regulation of the menstrual cycle and reproduction to modulation of bone density, brain function, and cholesterol mobilization. Despite the beneficial actions of endogenous estrogen, sustained exposure to exogenous estrogen is a well-established risk factor for various cancers. We summarize our current understanding of the molecular mechanisms of estrogen signaling in normal and cancer cells and discuss the major challenges to existing antiestrogen therapies.

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Author and article information

Contributors

Min Dai: +86-10-87787428 , daimin2002@hotmail.com

Ni Li: +86-10-87788662 , nli@cicams.ac.cn

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 21 November 2018

Publication date PMC-release: 21 November 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 1149

Affiliations

[1 ]ISNI 0000 0000 9889 6335, GRID grid.413106.1, Cancer Foundation of China, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, 100021 China

[2 ]ISNI 0000 0000 9889 6335, GRID grid.413106.1, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, 100021 China

[3 ]ISNI 0000 0000 9889 6335, GRID grid.413106.1, Office for Cancer Early Diagnosis and Treatment, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, 100021 China

[4 ]ISNI 0000 0004 1799 4638, GRID grid.414008.9, Henan Office for Cancer Control and Research, , the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, ; Zhengzhou, 450008 China

Article

Publisher ID: 5025

DOI: 10.1186/s12885-018-5025-y

PMC ID: 6249821

PubMed ID: 30463535

SO-VID: bd0af0f0-6811-4f9d-8238-fbd09174f4db

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 May 2018

Date accepted : 31 October 2018

Funding

Funded by: National Key R&D Program of China

Award ID: 2016YFC0905400

Award ID: 2016YFC1302500

Award ID: 2017YFC0907900

Award ID: 2018YFC1315000

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81871885

Award ID: 81673265

Funded by: Training Programme Foundation for the Talents in Beijing City

Award ID: 2017000021223TD05

Funded by: Beijing Municipal Science and Technology Project

Award ID: D171100002617001

Funded by: Special Foundation for Central Committee Health Care

Award ID: W2017BJ39

Funded by: PUMC Youth Fund

Award ID: 2017320013

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer incidence,sleep duration,categorical meta-analysis,dose–response meta-analysis

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer incidence, sleep duration, categorical meta-analysis, dose–response meta-analysis

Sleep duration and the risk of cancer: a systematic review and meta-analysis including dose–response relationship

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Abstract

Background

Methods

Results

Conclusion

Electronic supplementary material

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Karger: Oncology

Most cited references 74

The metabolic consequences of sleep deprivation.

Sleep duration and biomarkers of inflammation.

Estrogen and cancer.

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Contributors

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Affiliations

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Funding

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