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2 Minute Medicine Rewind April 27, 2026
Objectively Measured Daytime Napping Patterns and All-Cause Mortality in Older Adults
1. Older individuals with actigraphy-assessed longer nap duration, more frequent naps, and a tendency to nap in the morning were associated with a higher all-cause mortality.
Evidence Rating Level: 2 (Good)
Excessive napping in late life is associated with adverse health outcomes, including mortality. As previous studies mainly relied on self-reported napping habits, objective measurements are needed for more reliable findings. There is also a lack of research on some daytime nap characteristics, such as timing and variability of nap duration across days. This study thus examined whether actigraphy-measured daytime nap duration, frequency, variability, and timing were associated with all-cause mortality. This prospective cohort study used data from the Rush Memory and Aging Project and included community-dwelling adults aged >56 years in the U.S., with up to 19 years of follow-up. The analytic baseline was initiated in August 2005. Participants wore the actigraphy device continuously for up to 14 days. The primary outcome was daytime napping, defined as sleep episodes between 9 am and 7 pm. Participants were categorized as morning nappers (peak window: 9 am to 12 pm or 10 am to 1 pm), early afternoon nappers (peak window: 11 am to 2 pm, 12-3 pm, 1-4 pm, or 2-5 pm), or late afternoon nappers (peak window: 3-6 pm or 4-7 pm). In total, 1,338 participants (mean [SD] age, 81.4 [7.4] years; 1018 [76.0%] female) were included over a mean (SD) follow-up of 8.3(4.78) years. At a mean (SD) of 7.54 (4.52) years after analytic baseline, 926 (69.2%) deaths were reported. Longer daytime nap duration (adjusted hazard ratio [AHR] per 1-hour increase, 1.13; 95% CI, 1.04-1.23) and higher nap frequency (AHR per additional daily nap, 1.07; 95% CI, 1.02-1.13) at baseline were associated with a 13% and 7% increased risk of mortality, respectively. The risk of mortality was higher among morning nappers compared with early afternoon nappers (AHR, 1.30; 95% CI, 1.03-1.64). There was no association between variability in daytime nap duration and mortality (AHR per 1-hour increase, 1.01; 95% CI, 0.89-1.14). Overall, this study found that older individuals with longer nap duration, more frequent naps, and a tendency to nap in the morning were associated with a higher all-cause mortality. These findings highlight the potential of wearable device-based daytime nap assessments in identifying high-risk individuals for sleep interventions to improve sleep health and longevity.
1. Incidence of early-onset metastatic adenocarcinoma increased among patients with multiple metastatic sites and those with peritoneum involvement.
2. Net survival of metastatic adenocarcinoma improved over time, except for those with peritoneal involvement.
Evidence Rating Level: 2 (Good)
The incidence of early-onset (EO) colorectal metastatic adenocarcinoma (mADC) is increasing. A detailed description of epidemiologic time trends based on population-based data in Europe is lacking. This study thus described patterns in colorectal mADC incidence and survival among patients <50 years compared with older patients in a French population. This population-based cohort study used data from the French Network of Cancer Registries (FRANCIM) and included individuals diagnosed with invasive colorectal adenocarcinoma between January 1, 2004, and December 31, 2021. Age at diagnosis was classified into 15 to 39 years, 40 to 49 years, and 50 years or older. The primary outcome was metastatic status categorized into nonmetastatic disease, metastatic disease, single-site metastases, multiple-site metastases, liver metastasis, peritoneal metastasis, and lung metastasis. Among the 37,297 individuals included in the study (mean [SD] age, 72.0 [12.2] years; 20 692 males [55.5%]), 1558 (4.2%) were diagnosed before age 50, and 9995 (26.8%) had mADC. From 2004 to 2021, the incidence of single-site metastases did not increase in any age class or sex. However, the incidence of multiple-site metastases among patients aged 15 to 39 years increased annually by 9.5% (95% CI, 2.7%-16.7%) among males and 10.3% (95% CI, 3.4%-17.6%) among females. The increase in incidence in the EO among those younger than 50 years mainly involved the peritoneum. From 2004 to 2021, the probability of presenting with peritoneal metastases was 6.2-fold higher among males and 2.4-fold higher among females aged 15 to 39 years. The net survival of mADC improved over time and was higher among patients aged 15 to 49 years than among those aged 50 to 75 years, except for those with peritoneal metastasis. Overall, this study found that an increased incidence of EO mADC mainly among patients with multiple metastatic sites and those with peritoneum involvement, and that the net survival of mADC improved over time, except for those with peritoneal involvement. These findings suggest that young patients with peritoneal involvement are a high-risk population that may require intensive treatment to increase survival.
1. COVID-19 vaccination was associated with a reduced 24-month risk of new-onset atrial fibrillation/flutter after COVID-19 infection.
Evidence Rating Level: 2 (Good)
COVID-19 infection has been linked with cardiovascular complications such as new-onset atrial fibrillation/flutter (NOAF). While there is evidence of the COVID-19 vaccine being protective against the development of long COVID, its potential protective effect against long-term NOAF risk after COVID-19 infection is unclear. This study thus examined the effect of COVID-19 vaccination on reducing the long-term risk of NOAF in patients after COVID-19 recovery. This retrospective cohort study used data from the TriNetX Research Network and included adults >18 years with a first recorded diagnosis of COVID-19 between January 1, 2022 and June 30, 2023. Patients were split into a vaccine group and a control (unvaccinated) group. The primary outcome was NOAF incidence at 24 months, and secondary outcomes were NOAF incidence at 1, 6 and 12 months. In total, 477,500 patients were included in the study, with 238,750 propensity matched into the vaccine group (mean [SD] age, 52.5 [18.6]; 148,934 [62.4%] female), and control group (52.3 [18.6], 150193 [62.9%] female). The NOAF incidence at 24-months was lower in the vaccine group compared to the control group (1.91% vs 2.18%; hazard ratio [HR]: 0.82, 95% CI: 0.78–0.85), even after excluding patients with severe or critical COVID-19 illness (1.51% vs. 1.78%; HR: 0.79, 95% CI: 0.76-0.83). A protective effect was also observed at 1 month (HR: 0.73, 95% CI: 0.67–0.79), 6 months (HR: 0.71, 95% CI: 0.66–0.75), and 12 months (HR: 0.77, 95% CI: 0.73–0.81). Overall, this study found that COVID-19 vaccination was associated with a reduced 24-month risk of NOAF after COVID-19 infection, highlighting its potential cardioprotective benefits beyond preventing acute illness.
1. Polycythemia was not associated with increased in-hospital, short-term, or long-term mortality.
Evidence Rating Level: 2 (Good)
Anemia has been consistently associated with worse outcomes in both chronic heart failure and acute decompensated HF (ADHF). Polycythemia has been linked to adverse outcomes in acute coronary syndrome (ACS), but whether a similar association exists for ADHF. This study thus examined the clinical profile and prognostic implications of polycythemia in patients hospitalized with ADHF. This retrospective cohort study included adult patients >18 years hospitalized with ADHF between 2007 and 2017. Patients were categorized by hemoglobin levels: anemic (<13 g/dL men, < 12 g/dL women), normocythemic, or polycythemic (>18.5 g/dL men, > 16.5 g/dL women). Patients were matched 1:3:3 into polycythemia, normocythemia, and anemia groups. The primary outcomes were in-hospital mortality, 30-day readmission, and long-term 1- and 5-year survival. Of the 8,332 patients included in the study, 5,615 (67.4%) had anemia (mean [SD] age = 77.3 [11.5], 2677 [47.7%] female), 2,639 (31.7%) normocythemia, (mean [SD] age = 74.4 [12.9], 1427 [54.1%] female) and 78 (0.9%) polycythemia (mean [SD] age = 67.5 [13.3], 20 [25.6%] female). In the matched cohort of 546 patients (234 anemic, 234 normocythemic, 78 polycythemic), in-hospital mortality rates were similar (5.6%, 3.8%, 7.7%; p = 0.381). One-year mortality was highest in anemia (27.4%) compared with normocythemia (17.5%) and polycythemia (19.2%) (p = 0.030). Five-year survival was poorest in anemia, while it was similar for polycythemia and normocythemia (log-rank p = 0.027). Compared with normocythemia, anemia was associated with higher long-term mortality (HR 1.30, 95% CI 1.03–1.63), whereas polycythemia was not (HR 0.90, 95% CI 0.64–1.27). The 30-day readmission rate was lower in the polycythemia group (9.6%) compared with the anemia and normocythemia groups (20.6%), although this difference was not statistically significant (p = 0.084). Overall, this study found that unlike anemia, polycythemia was not associated with increased in-hospital, short-term, or long-term mortality, suggesting that polycythemia may not serve as a negative prognostic marker in this setting.
1. Adopted individuals who experienced improved environmental conditions had better long-term psychosocial outcomes than their unadopted biological siblings, with some advantages also observed in the next generation.
Evidence Rating Level: 2 (Good)
Improving home environments during early life can benefit later cognitive, educational, and behavioural outcomes. However, the long-term protective effect of child-rearing conditions and whether benefits extend to the next generation is unclear. This study thus examined whether improved home environment conditions through early adoption reduced long-term psychosocial risks and provided intergenerational benefits. This population-based adoption-discordant sibling comparison study used a Swedish register of births between 1950 and 1980, with follow-up to 31 December 2020. Two samples of sibling pairs were included: one with full siblings and one with maternal half-siblings who were or were not adopted before age 10. Biological parent or parents of these siblings had a history of a psychiatric diagnosis, suicide (attempt or death), or criminal behaviour. Offspring of these siblings were followed to assess intergenerational spillover effects. The main outcomes were psychiatric diagnoses, long-term unemployment, receipt of social welfare, highest attained criminal convictions, and, among men, non-cognitive skills and general intelligence assessed at military conscription. In total, 4254 full siblings (2719 home-reared, 1535 adopted) and 7796 maternal half siblings (5006 home-reared, 2790 adopted) were included in the study. Compared with their biological full siblings who were raised by the biological parents, the adopted individuals showed a lower risk of psychiatric diagnosis (29.8% v 36.1%; hazard ratio [HR], 0.70; 95% CI, [0.63 to 0.78]), criminal conviction (26.1% v 34.0%; HR, 0.66; 95% CI, [0.60 to 0.74]), and receiving social welfare (37.8% v 48.5%; HR, 0.63; 95%CI [0.57 to 0.70]). Adopted individuals also showed higher non-cognitive skills scores (mean 4.8 v 3.9), general intelligence scores (mean 4.5 v 3.8), and were more likely to have attended university (26.0% v 15.2%). Results were similar in the maternal half-sibling sample. Among the offspring of adopted individuals (n=2750), psychosocial functioning was modestly higher than that of their cousins (eg, 29.6% v 32.3% with psychiatric disorders), although the hazard ratios were not significant. Overall, this study found that adopted individuals who experienced improved environmental conditions had better long-term psychosocial outcomes than their unadopted biological siblings, with some advantages also observed in the next generation. These findings support possible intergenerational benefits of improved early rearing conditions.
Image: PD
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