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OBJECTIVE: The aim of the study was to assess the association of sleep disturbance with psychological characteristics, somatic symptoms and previously identified risk factors. METHODS: Data were from 148,938 postmenopausal women enrolled in The Women's Health Initiative who provided cross-sectional information about psychological characteristics, somatic symptoms and the character of their sleep. Overall sleep quality was based on the Women's Health Initiative Insomnia Rating Scale (WHI IRS), a measure that assessed five types of sleep disturbance. RESULTS: Three factors accounted for nearly 20% of the variation in the WHI IRS: a scale for somatic symptoms, daytime restlessness and either depression or emotional well-being. Other independently associated factors were night sweats, pain and worry about expressing anger. Several factors that had been linked to sleep disturbance in other studies were found to have at most a weak independent association in this analysis. These included income, education, marital status, activity level, obesity level, hot flashes, coffee drinking and smoking. CONCLUSION: Factors strongly associated with sleep disturbance in this study deserve further evaluation to determine the reasons for the association and whether the associations suggest possible treatments for sleep disturbance.

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OBJECTIVE: Previous studies found an association between hypnotic use and mortality risk. The prospective outcome data and the many baseline risk factors included in the Women's Health Initiative (WHI) provide an opportunity to better understand the reasons for this association. SETTING: The WHI is a long-term national health study that focused on strategies for preventing disease in postmenopausal women. Participants were enrolled from 1993 to 1998. DESIGN: Baseline hypnotic use was evaluated for an association with subsequent mortality or disease after adjusting for baseline risk. SUBJECTS: 148 938 postmenopausal women between the ages of 50 and 79 throughout the USA. The median follow-up was 8 years. MAIN OUTCOME MEASURES: Mortality. Secondary outcomes included myocardial infarction, stroke, diabetes and seven types of cancer. RESULTS: For persons who use hypnotic medications almost daily the age-adjusted hazard ratio (HR) for mortality was 1.62 (95% CI 1.50 to 1.74). Greater hypnotic use was associated with less healthy levels of physical function, general health and smoking at baseline. After adjustment for these factors the HR for almost daily hypnotic use was 1.14 (1.06 to 1.23) for mortality and 1.53 (1.18 to 1.99) for melanoma; it was not significantly associated with increased incidence of other diseases tested. Less frequent hypnotic use and several types of sleeping difficulties were not associated with mortality, but sleeping more than 10 h a night had a risk-adjusted HR for mortality of 1.28 (1.01 to 1.61). CONCLUSIONS: The association of hypnotic use with mortality and incident disease was greatly reduced after adjusting for baseline risk factors. These findings do not support a strong independent association of hypnotic use with most health outcomes.

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BACKGROUND: Prospective data from the Women's Health Initiative were analyzed to evaluate more than 800 possible risk factors for an association with colon cancer in postmenopausal women. METHODS: Data included 150,912 postmenopausal women between the ages of 50 and 79. The Cox proportional hazard regression analysis was used to identify risk factors independently associated with the development of colon cancer during a median follow-up time of 8 years. RESULTS: A total of 1,210 women developed colon cancer and 282 developed rectal cancer. Eleven risk factors were independently associated with an increased risk of colon cancer at the p < 0.001 level. In decreasing order of associated χ(2) values, they were age, waist girth (especially for subjects without diabetes), use of hormone therapy at baseline (protective), years smoked, arthritis (protective presumably because of medications used for treatment), relatives with colorectal cancer, lower hematocrit levels, fatigue, diabetes, less use of sleep medication, and cholecystectomy. Of the 11 factors, three were significantly associated with an increased risk of rectal cancer: age, waist, and not taking hormone therapy. CONCLUSIONS: The results provide additional support for the importance of waist girth, hormone therapy, smoking, NSAID use, diabetes, and cholecystectomy as risk factors for colon cancer. Some factors previously identified as influencing risk (exercise and black race) did not have a strong independent association with colon cancer in this analysis.

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