Association between sleep duration and healthy aging among older adults: evidence from the Behavioral Risk Factor Surveillance System

TL;DR

This study finds that both too little and too much sleep are linked to poorer healthy aging in older adults, especially among the unemployed and smokers.

Contribution

The study identifies an inverted U-shaped relationship between sleep duration and healthy aging in older adults using a nationally representative sample.

Findings

Short (≤5h) and long (≥9h) sleep durations were associated with lower odds of healthy aging compared to 7h of sleep.

The unemployed and smokers experienced stronger negative effects of short sleep on healthy aging.

An optimal sleep duration of 7–8 hours per day was linked to better healthy aging outcomes.

Abstract

This study aims to explore the association between sleep duration and healthy aging in the older U.S. adults, utilizing a nationally representative sample.

Participants aged 65 and older from the 2016 Behavioral Risk Factor Surveillance System were eligible for this study. Healthy aging was defined as the absence of major chronic diseases, no physical functional limitations, and good subjective cognitive function and mental health. Logistic regression and restricted cubic spline curve analysis were employed to examine the potential association between sleep duration and healthy aging. Stratified analyses were conducted to examine the interactive effects of sleep duration with smoking, employment status, and other variables on healthy aging.

35,056 older adults (mean age 73.06 ± 5.31 years, 60.5% females) were included, among whom 5,782 (16.5%) achieved healthy aging. Sleep duration exhibited an inverted U-shaped relationship with healthy aging. Compared to those who slept for 7 h, the adjusted ORs (95% CI) of healthy aging for those who slept for ≤ 5 h, 6 h, 8 h, and ≥ 9 h were 0.51 (0.43, 0.59), 0.79 (0.72, 0.87), 0.96 (0.90, 1.03), and 0.65 (0.58, 0.73), respectively. Additionally, there was an interaction between sleep duration and employment & smoking status on healthy aging (P interaction = 0.003 & 0.009). Among the unemployed, the adjusted OR (95% CI) for healthy aging among those who slept ≤ 5 h was 0.41 (0.34, 0.49) [VS the employed: 0.75 (0.56, 1.01)]; among current and former smokers, the adjusted OR (95% CI) for healthy aging among those who slept ≤ 5 h was 0.37 (0.17, 0.82) and 0.39 (0.29, 0.51) [VS never smokers: 0.60 (0.49, 0.73)].

Both short and prolonged sleep duration may adversely impact healthy aging, especially among the unemployed and smokers. Health professionals should advise older adults that 7–8 h of sleep per day may promote overall health. Future research should explore the longitudinal relationship between sleep duration and healthy aging.

The online version contains supplementary material available at 10.1186/s12877-026-07181-8.

Figures