Ask about sleep
When the data were stratified by sex, the association between decreased REM sleep and mortality was significant for women but not for men.
“Obtaining a sleep study, representative of the patient’s usual sleep, that shows reduced REM time should alert the neurologist to look for reasons for low REM,” the study’s coinvestigator, Susan Redline, MD, MPH, Peter C. Farrell Professor of Sleep Medicine at Harvard Medical School in Boston, said in an interview.
Dr. Redline added that measures to promote sleep health, such as encouraging regular, sufficient nightly sleep; offering guidance on avoiding alcohol before bedtime and on other healthy sleep practices; and treating sleep disorders may be beneficial.
Low REM time, especially interpreted with other relevant clinical information, may alert the neurologist that a patient may have risk factors for poorer health, she added.
Sleep studies are expensive and are in high demand, so “the most realistic approach is for the neurologist to be asking each and every patient about their sleep,” said Ancoli-Israel.
“By asking a few more questions in every intake, the neurologist is more likely to determine if there are any occult sleep disorders that need to be addressed. By improving sleep in general, one is more likely to also improve any REM abnormalities,” she said.
Disease indicator?
In an accompanying editorial, Michael S. Jaffee, MD, vice chair of neurology at the University of Florida in Gainesville, and colleagues noted that the study raises the question of whether REM sleep “could serve as a biomarker for general health.”
“Since the known roles of REM sleep do not easily suggest a causal link with mortality ... it seems more likely that REM sleep reduction is either a crude marker of health or specific disease states that decrease REM sleep may play an important role in contributing to mortality,” they wrote.
Neurologists should remember that certain medications affect sleep architecture, the editorialists advised. They note that serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants reduce REM sleep, and that gabapentin, prazosin, and bupropion, on the other hand, increase REM sleep. However, data regarding whether these medications have an effect on mortality are insufficient.
The editorialists wrote that the study findings are a “welcome addition to the literature and demonstrate definitively that the association between sleep and mortality extends beyond the simple measure of total sleep time.”
Funding for the MrOS and WSC studies was provided by the National Institutes of Health and the National Institute on Aging. Dr. Ancoli-Israel consults for Eisai and Merck on matters unrelated to the study. Dr. Redline has received grants and personal fees from Jazz Pharmaceuticals, consulting fees from Respicardia, and personal fees from Eisai unrelated to the study. Dr. Jaffee served on a data and safety monitoring board for Helius Medical Technologies and consulted for the National Collegiate Athletic Association and the Department of Defense.
A version of this article originally appeared on Medscape.com.