Cytokines disease-associated, measurement

We are not certain which comorbid risk factors cause mortality independent of sleep effects, and therefore, we cannot be certain whether we controlled too much or too little for comorbidities. For example, since short sleep or long sleep may cause a person to be sick at present or to get little exercise or to have heart disease (17), diabetes (18), etc., controlling for these possible mediating variables may have incorrectly minimized the hazards associated with sleep durations. This would be overcontrol. The hazard ratios for participants who were rather healthy at the time of the initial questionnaires were unlikely to be overcontrolled for initial illness. Since the 32-covariate models and the hazard ratios for initially healthy participants were similar, this similarity reduced concern that the 32-covariate models were overcontrolled. On the other hand, there may have been residual confounding processes that caused both short or long sleep and early death that we could not adequately control in the CPSII data set, either because available control variables did not adequately measure the confound or because the disease did not yet manifest itself. Depression, sleep apnea, and dysregulation of cytokines are plausible confounders that were not adequately controlled. It may be impossible to be confident that all conceivable confounds are adequately controlled in epidemiological studies of sleep. 

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