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J Am Geriatr Soc. 1996 Jun;44(6):693-8.

Risk of napping: excessive daytime sleepiness and mortality in an older community population.

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Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27710, USA.



To describe the demographic and health-related factors related to excessive daytime sleepiness. To estimate the risk of mortality associated with excessive daytime sleepiness independent of nightime sleep problems and other factors that limit survival.


Four-year prospective cohort study with annual interviews.


One urban and four rural counties in north-central North Carolina.


Adults 65 years and older (n = 3962) living in the community.


Excessive daytime sleepiness was measured as, "How often do you get so sleepy during the day or evening that you have to take a nap?" Mortality was based on continuous surveillance of the population by field investigators and abstraction of death certificates.


Point prevalence of excessive daytime sleepiness in this population was 25.2%. Frequent daytime nappers were more likely than infrequent nappers to report nighttime sleep complaints and were more likely to be male and urban-dwellers, to report more depressive symptoms, more limited physical activity, and more functional impairment, and were more likely to be overweight. Of the frequent nappers, 23.9% died, compared with 15.4% of infrequent nappers. In an adjusted Cox proportional hazard model, the 4-year mortality rate was accelerated 1.73 times among older people who nap most of the time and make two or more errors on a cognitive status examination.


Excessive napping is associated with impaired sleep hygiene as well as with a broad range of activity-related health deficits among community-dwelling older adults. Frequent napping was associated with impaired sleep hygiene, male gender, urban-dwelling, depressive symptoms, physical activity deficits, functional impairment, and excess weight. Mortality risk was elevated selectively among the most cognitively impaired subjects.

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