The association between sleep quality and telomere attrition: A systematic review and meta-analysis comprising 400,212 participants.

Psychosocial stressors accelerate telomere attrition, a biomarker of cell aging, whereas good sleep is hypothesized to be a mitigating factor. However, methodological aspects - particularly underpowered studies, inconsistent findings, and multiple approaches to assessing sleep - demonstrate the need for a meta-analysis. After PROSPERO registration, we conducted a systematical search of the following databases until June 2024 to identify studies examining the relationship between sleep quality and telomere length in adult humans: CINAHL, Cochrane Library, MEDLINE, PsychINFO, PubMed, Web of Science, and Google Scholar. In total, 29 studies met inclusion criteria for the systematic review according to the preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA), 19 of which provided data that was appropriate for meta-analytic calculations. We identified the Pittsburgh sleep quality index (PSQI) global score (odds ratio (OR) 1.24, CI 95 % [1.03; 1.50], p = 0.02), sleep-related daytime impairments (OR 1.01 [1.00; 1.02], p = 0.04), and wake after sleep onset (WASO) time (OR 1.28 [1.12; 1.47], p < 0.01) as to be significantly associated with telomere attrition. Thus, the subtle telomere attrition-mitigating role of sleep has been demonstrated based on a sufficiently large body of data and defined aspects of sleep quality.