Are sleep patterns influenced by race/ethnicity - a marker of relative advantage or disadvantage? Evidence to date

Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment

AIMS

Obesity is a multifactorial disease influenced by several factors including poor diet, physical inactivity, and genetic predisposition. In recent years, the social and environmental context, along with race/ethnicity and gender, have been recognized as factors influencing obesity risk beyond traditional risk factors. This review aims to increase knowledge of these causal determinants and their implications for the treatment and management of obesity, addressing not only the individual but also the societal sphere.

DATA SYNTHESIS

A growing body of evidence emphasizes the interaction between the physical and social environments in shaping personal behaviors related to obesity. Social disparities, such as socioeconomic status (income, education, employment), racial/ethnic differences, and gender, contribute significantly to weight gain from childhood to adulthood. These factors increase the risk of obesity and related cardiovascular risk factors, independent of clinical and demographic variables, and may lead to stigma and discrimination against those affected.

CONCLUSIONS

Obesity prevention solutions, from community programs to national policies, may be more effective if they address social, gender, and ethnic barriers. Understanding obesity requires a comprehensive approach that includes social, environmental, and psychological factors, as well as biological causes, to help obesity experts develop more effective interventions tailored to obesity and related diseases.

Skin tone - a marker of bias known as colorism - in relation to sleep health among African American women

People with darker-skin tone are more likely than their lighter-skin counterparts to have less access to health-promoting resources (e.g., economic security; quality housing; favorable neighborhood environment). These adverse conditions can affect sleep and result in poor health outcomes such as cardiovascular disease and depression. However, few studies have examined associations between skin tone and sleep disparities. To address this gap, we used cross-sectional (2010-2012) and longitudinal (until 2014-2018) data from the Study of Environment, Lifestyle and Fibroids cohort of 1674 Black women aged 23-35 years and residing in the Detroit, Michigan area. Skin tone was measured using a skin reflectance instrument and categorized as light [29.3-57.6] (25%), medium [57.7-72.4] (50%), and dark [72.5-106.1] (25%) brown. Self-reported sleep dimensions were dichotomized (yes vs. no): short sleep duration, non-restorative sleep, insomnia symptoms, and sleep apnea. Adjusting for age and educational attainment, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) and applied generalized estimating equations to log binomial models to determine risk ratios (RRs) and 95% CIs between skin tone and each sleep dimension, separately. Dark vs. light skin tone was associated with marginally higher prevalence and risk of short sleep (PR = 1.04 [95% CI:1.00-1.08]; RR = 1.07 [95% CI: 0.99-1.16]) and a lower prevalence of insomnia symptoms (PR = 0.95 [95% CI: 0.91-0.99]). Insomnia symptoms were more prevalent among women with light skin tone (21.1% vs. 17.7% [medium] and 15.6% [dark]). Our findings elucidate the critical importance and need to address the differential impact of historical ideologies, systems, policies, and practices on Black women, which can manifest health-damaging social phenomena like colorism.

Greenspace proximity in relation to sleep health among a racially and ethnically diverse cohort of US women

Sleep is essential for overall health. Greenspace may contribute to sleep health through, for instance, improving mood, reducing sleep disruptors (e.g., poor air quality), and promoting physical activity. Although greenspace likely differs across populations, few studies have included diverse populations. To investigate greenspace-sleep health associations, overall and by age, race and ethnicity, and socioeconomic status, we used data collected at enrollment (2003-2009) from women in the Sister Study (n = 1612 Hispanic/Latina, n = 4421 non-Hispanic (NH)-Black, and n = 41,657 NH-White). Participants' geocoded home addresses were linked to NASA's Moderate Resolution Imaging Spectroradiometer Normalized Difference Vegetation Index data (250m resolution) to capture greenspace tertiles (further categorized as low/moderate vs. high). Participants reported seven sleep dimensions, which we assessed individually, along with a multidimensional sleep health measure (categories: favorable, moderate, poor). Adjusting for individual- and environmental/neighborhood-level characteristics, we used Poisson regression with robust variance to estimate prevalence ratios and 95 % confidence intervals (PR[CI]). We tested for interaction and estimated age-, race and ethnicity-, and educational attainment category-specific associations. Among participants (mean ± SD age = 55.7 ± 9.0 years), those with low/moderate vs. high greenspace had a lower prevalence of favorable sleep (58 % vs. 66 %). After adjustment, low/moderate vs. high greenspace was associated with a 32 % higher prevalence of moderate (PR = 1.32 [1.27-1.38]) and 12 % higher prevalence of poor (PR = 1.12 [1.07-1.16]) vs. favorable sleep health. Magnitudes of associations were higher among NH-White women vs. minoritized racial-ethnic groups and women with higher vs. lower educational attainment. Higher greenspace was associated with favorable sleep, with stronger associations among groups with more social advantages.

Association between household sleep environment and sleep health characteristics in middle-aged adults: The CARDIA sleep study

OBJECTIVES

Household environmental factors and sleep hygiene may contribute to poor sleep health. We identified associations between household sleep environment (HHSE) and sleep health characteristics in White and Black adults.

METHODS

This study included cross-sectional data from the CARDIA sleep ancillary study at Year 35 (n=711). HHSE was assessed in two domains (sleep disruptors and sleep hygiene) using a questionnaire, and higher scores indicated more sleep disruptors or poorer sleep hygiene. Sleep outcomes included (1) self-reported sleep quality and daytime sleepiness and (2) actigraphy-measured sleep duration, sleep percentage, sleep timing (midpoint sleep time), and sleep regularity. We used robust regression to estimate differences in sleep outcomes corresponding to each 1-point increment in HHSE. Racial differences in associations of interest were examined by testing for interaction.

RESULTS

Participants' mean age was 61.5 (SD=3.6) years, 63% were women, and 36.7% were Black. After multivariable adjustment (β [95% CI]), more sleep disruptors (0.145 [0.04, 0.24]) and poor sleep hygiene (0.170 [0.10, 0.23]) were associated with self-reported poor sleep quality. Poor sleep hygiene was associated with actigraphy-measured shorter sleep duration (-1.397 [-2.73, -0.01]) and sleep irregularity (0.017 [0.01, 0.02]). In stratified analysis, more sleep disruptors were associated with poor sleep quality (0.320 [0.10, 0.53]) and greater daytime sleepiness (0.330 [0.11, 0.54]) only in Black participants.

CONCLUSIONS

Poor HHSE was related to self-reported poor sleep quality and to objective shorter sleep duration and sleep irregularity. Targeted interventions to mitigate sleep disruptors and promote good sleep hygiene may help to improve sleep health.

Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association

Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.

A large-scale genome-wide study of gene-sleep duration interactions for blood pressure in 811,405 individuals from diverse populations

Although both short and long sleep duration are associated with elevated hypertension risk, our understanding of their interplay with biological pathways governing blood pressure remains limited. To address this, we carried out genome-wide cross-population gene-by-short-sleep and long-sleep duration interaction analyses for three blood pressure traits (systolic, diastolic, and pulse pressure) in 811,405 individuals from diverse population groups. We discovered 22 novel gene-sleep duration interaction loci for blood pressure, mapped to 23 genes. Investigating these genes' functional implications shed light on neurological, thyroidal, bone metabolism, and hematopoietic pathways that necessitate future investigation for blood pressure management that caters to sleep health lifestyle. Non-overlap between short sleep (12) and long sleep (10) interactions underscores the plausible nature of distinct influences of both sleep duration extremes in cardiovascular health. Several of our loci are specific towards a particular population background or sex, emphasizing the importance of addressing heterogeneity entangled in gene-environment interactions, when considering precision medicine design approaches for blood pressure management.

A community-engaged qualitative study of factors affecting sleep among Hispanic/Latinos with short sleep duration

BACKGROUND

Despite having high prevalence of short sleep duration, poor sleep quality, and sleep disorders in adult Hispanics living in the US, there is limited understanding of the underlying barriers to sleep and effective interventions in these groups. This study aimed to increase understanding of sleep duration and attitudes toward sleep interventions among Hispanic adults.

METHODS

We conducted 5 online focus group discussions with male and female participants aged 18-65 recruited from the Hispanic community who reported sleeping <7 hours per night. Interviewers utilized a semistructured interview guide to assess attitudes and beliefs about sleep and sleep interventions. Focus groups were conducted in Spanish, recorded, transcribed, and coded to elicit common themes.

RESULTS

Focus groups included 31 participants (19=women) from 12 Hispanic nationalities. Coders identified three main topics: (1) Sleep perceptions, (2) External and internal factors that affect sleep, and (3) Feedback about sleep interventions. Participants discussed the importance of sleep and factors related to stress, family, environment, and acculturation. Sleep interventions were viewed as desirable, and the group discussed a variety of topics of interest. The use of consumer sleep technology was considered a favorable intervention despite few participants having experience with consumer sleep-tracking devices.

CONCLUSION

Results demonstrated that participants were aware of the importance of sleep and sleep duration recommendations. The discussion identified unique issues affecting sleep health in Hispanics as well as enthusiasm for sleep interventions, including interventions using consumer sleep trackers.

Racial-Ethnic Residential Segregation and Sleep Health among US Adults: Associations by Race and Ethnicity, Sex/Gender, and Neighborhood-Level Poverty

INTRODUCTION

Although racial-ethnic residential segregation (RRS) is hypothesized to contribute to sleep disparities by concentrating poverty and impairing sleep among minoritized racial-ethnic groups, feelings of belonging within relatively homogenous neighborhoods may be protective against poor sleep. Yet, empirical studies are sparse.

METHODS

To investigate RRS-sleep health associations and determine potential modifiers among US adults, we linked National Health Interview Survey data (2011-2017) to 2012 and 2017 American Community Survey census tract-level data. We used the local Getis-Ord Gi* statistic to categorize RRS (high, medium, low [reference]). Using survey-weighted, Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for self-reported sleep health measures. We also performed Wald tests for interactions by race-ethnicity, sex/gender, race-ethnicity-by-sex/gender intersectional category, and neighborhood-level poverty.

RESULTS

Among 126,539 participants (mean age ± SE = 46 ± 0.1 years), high RRS was most common among non-Hispanic (NH)-Black (38%), followed by NH-Asian and non-Mexican Latine (34%), Mexican Latine (30%), and NH-White adults (17%). Across races-ethnicities and sexes/genders (both p-interaction > 0.05), high vs. low RRS was associated with a 6% lower prevalence of short sleep duration (< 7-h: PR = 0.94 [95% CI:0.91-0.97]), an 11% lower prevalence of long sleep duration (> 9-h: PR = 0.89 [0.80-0.99]), and a 2% higher prevalence of restorative sleep (PR = 1.02 [1.01-1.04]). Associations with a lower prevalence of trouble falling asleep were stronger among men vs. women. Race-ethnicity-by-sex/gender group membership and neighborhood-level poverty modified associations with sleep duration and quality without consistent patterns.

CONCLUSION

RRS was associated with more favorable sleep health among US adults with variation by key modifiers (e.g., sex). Strategies that leverage potentially protective social factors while promoting equitable resources across diverse neighborhoods may help address sleep health disparities.

Focusing on sleep health for all, not just sleep disorders

Sleep is increasingly recognized as a critical pillar of overall health, yet public health efforts have traditionally focused on treating sleep disorders rather than promoting sleep health for all. This article argues that the time has come to shift the emphasis from a disorder-centric approach to one that prioritizes sleep health for everyone. Sleep health extends beyond the absence of disorders and involves achieving optimal sleep quality, duration, and consistency. Poor sleep is linked to numerous health problems, including cardiovascular disease, type 2 diabetes, mental health disorders, and impaired cognitive function. Focusing on sleep health can help prevent these conditions and reduce healthcare costs. Moreover, addressing sleep health disparities, particularly among lower-income populations, shift workers, and racial and ethnic minorities, is crucial for achieving health equity. This article outlines strategies such as public awareness campaigns, workplace policies, school-based interventions, and policy advocacy to promote sleep health. By fostering a sleep-healthy society, we can improve individual and public health outcomes, enhance productivity, and reduce the economic burden associated with poor sleep. Ultimately, a comprehensive approach to sleep health offers significant benefits that extend beyond the treatment of sleep disorders, promoting a healthier and more equitable society.

Associations between sleep health and familial social support, intragroup marginalization, and conflict among Hispanic adults

Sleep is vital for health and well-being, and familial relationships may impact sleep health. This study investigated the associations between sleep health and familial social support, familial intragroup marginalization, familial conflict, and living environment (i.e., living with parent(s) or legal guardian(s)) among Hispanic adults. Hispanic adult college students (n = 455) completed a survey assessing demographics, sleep quality, and familial social support, intragroup marginalization, and conflict. One hierarchical multiple linear regression model assessed the associations between these familial factors, living environment, and sleep quality. Results indicated that poorer sleep quality was associated with greater familial conflict in the full hierarchical regression model (i.e., Step 6). In Step 2 though, poorer sleep quality was inversely associated with familial social support, yet this association disappeared once familial intragroup marginalization was entered. Post-hoc mediation analysis revealed that familial social support was inversely indirectly associated with sleep quality through familial intragroup marginalization and conflict serially. Living environment did not moderate any relationships between familial factors and sleep quality. That familial social support was initially associated with enhanced sleep quality until familial intragroup marginalization was considered suggests that familial negativity may have a greater impact on sleep health than familial social support. Further, familial social support may influence sleep quality through familial negativity. Familial conflict may be particularly detrimental for sleep health. Clinical implications are discussed. Longitudinal studies are warranted to assess temporality.

Objective Sleep Quality in Diverse Older Adults: the Importance of Race and Ethnicity and Sex

Background

Research on sleep disparities across different sociodemographic groups is limited and often yields inconsistent findings. We aimed to examine differences in objective sleep measures by race and ethnicity, sex, and age within a diverse cohort of community-dwelling older adults.

Methods

We analyzed cross-sectional data from 838 participants aged ≥50 years in the Dormir Study (2020-2024). Sleep metrics, including sleep duration, sleep efficiency, wake after sleep onset (WASO), and sleep fragmentation index (SFI), were derived from 7-day wrist actigraphy. Race and ethnicity (Black; Mexican American [MA]; Non-Hispanic White [NHW]), sex, and age (<65; ≥65 years) were self-reported. We compared sleep metrics across sociodemographic groups and assessed their multivariable associations using linear, logistic, and multinomial regression models.

Results

We studied 190 (22.7%) Black, 282 (33.6%) MA, and 366 (43.7%) NHW Dormir participants, with a mean age of 66.7 ±8.4 years, and 64.8% women. Compared to NHW participants, Black and MA participants had shorter mean sleep duration (Black: 7.1 ±1.2 hours; MA: 7.1 ±1.1 hours; NHW: 7.5 ±1.1 hours; p<0.0001), lower median sleep efficiency (Black: 87.2%; MA: 87.8%; NHW: 90.6%; p<0.0001), longer median WASO (Black: 61.2 minutes; MA: 56.7 minutes; NHW: 44.4 minutes; p<0.0001), and higher mean SFI (Black: 32.0 ±11.0%; MA: 27.3 ±9.7%; NHW: 24.0 ±9.0%; p<0.0001). Compared to men, women had longer mean sleep duration (women: 7.4 ±1.1 hours; men: 7.1 ±1.2 hours; p=0.0004) and lower mean SFI (women: 25.9 ±8.8%; men: 28.9 ±12.1%; p=0.0001). Older participants had longer mean sleep duration (old: 7.4 ±1.1 hours; young: 7.1 ±1.1 hours; p<0.0001), higher median sleep efficiency (old: 89.8%; young: 87.7%; p<0.0001), shorter median WASO (old: 48.5 minutes; young: 56.8 minutes; p<0.0001), and lower mean SFI (old: 26.1 ±10.2%; young: 28.1 ±10.2%; p=0.007). After adjusting for socioeconomic and behavioral factors, comorbidities, and sleep medications, findings were consistent except for age group comparisons in which differences were no longer significant.

Conclusions

Our findings demonstrate significant variations in objective sleep measures across sociodemographic groups, with non-White participants and men experiencing poorer sleep quality. These disparities may contribute to health inequalities, emphasizing the need for targeted interventions to support at-risk populations.

Identifying Risk and Protective Factors for Shift Work Sleep Disorder: Insights from UK Biobank Night Shift Workers

Shift Work Sleep Disorder (SWSD) is a significant and highly prevalent condition affecting up to 48% of individuals with irregular work schedules. The diagnostic criteria for SWSD include persistent insomnia or sleepiness in relation to shift work, not attributable to other disorders or external factors. To explore risk factors of SWSD, we conducted a cross-sectional analysis among 10,787 night shift workers in the UK Biobank. To determine correlates of SWSD using multivariable-adjusted logistic regression models, a preselection of potential risk factors was made on the basis of previous literature. Self-identifying as 'Asian or Asian British' or 'Black or Black British' (compared to being 'White'), male sex, and high scores on sociability, warmth and diligence were associated with lower odds for SWSD. We did not find significant associations of chronotype, frequency of alcohol intake, smoking, and time employed in current job with SWSD. These findings underscore the need for targeted interventions and workplace policies to mitigate the adverse effects of SWSD. Future research should aim to explore the mechanisms behind these associations and develop strategies to enhance shift work tolerance among night shift workers.

Racial and ethnic disparities in the perceived neighborhood walking environment and self-reported sleep health: A nationally representative sample of the United States

OBJECTIVES

To identify associations between perceived neighborhood walkability and sleep across racial and ethnic groups of US adults.

METHODS

Data from the 2020 National Health Interview Survey (N=27,521) were used to assess self-reported measures of walkability (pedestrian access, accessible amenities, unsafe walking conditions) and sleep (short and long duration; frequency of waking up unrested, trouble falling and staying asleep, sleep medication use). Stratified by racial and ethnic group, we calculated the age-adjusted prevalence of neighborhood walkability features and sleep measures and estimated prevalence ratios assessing associations between neighborhood walkability and sleep while adjusting for sociodemographic and health covariates.

RESULTS

The prevalence of unsafe walking conditions due to crime was lowest among non-Hispanic White adults (6.9%), and access to places to relax was lowest among non-Hispanic Black adults (72.5%). The prevalence of short sleep duration was highest among non-Hispanic Black adults (37.9%). Neighborhood environment features had differential associations with sleep when stratified by race and ethnicity. For example, walking path access was related to lower sleep medication use among non-Hispanic Asian adults (adjusted prevalence ratio (aPR): 0.42, 95% CI: 0.19-0.91) but greater use among non-Hispanic White adults (aPR: 1.24, 95% CI: 1.05-1.46). More associations were observed among non-Hispanic White adults than other groups; and the strongest magnitude of association was observed among non-Hispanic Asian adults (traffic and sleep medication aPR: 0.31, 95% CI: 0.12-0.84).

CONCLUSIONS

Associations between the neighborhood environment and sleep vary and may be inconsistent by race and ethnicity. Future research may help identify determinants.

Poor sleep quality is associated with probable sarcopenia in community-dwelling older adults: Results from the longevity check-up (lookup) 8

BACKGROUND

Poor sleep quality may contribute to sarcopenia, but evidence remains sparse. This retrospective cross-sectional study investigated the association between subjective sleep quality and probable sarcopenia in a cohort of community-dwelling older adults enrolled in the Longevity Check-Up 8+ study.

METHODS

Participants were asked about their sleep quality over the past month, with four possible options ("very good", "quite good", "quite bad", very bad"). For the analysis, participants were grouped into good or bad sleep quality categories. Probable sarcopenia was operationalized according to handgrip strength values < 27 kg for men and < 16 kg for women. Logistic regression models were used to explore the relationship between sleep quality and probable sarcopenia.

RESULTS

1971 participants were included in the analysis (mean age 73.4 ± 6.2 years, 50.0 % women). Bad sleep quality was reported by 28.3 % of participants and was more prevalent among women, physically inactive individuals, and those with dyslipidemia. Probable sarcopenia was more prevalent in participants with bad sleep quality (23.8 % vs. 18.7 %, p = 0.012). Logistic regression revealed that bad sleep quality was significantly associated with increased odds of probable sarcopenia in both unadjusted (odds ratio [OR] 1.36, 95 % confidence interval [CI] 1.07-1.72, p = 0.010) and fully adjusted models (OR 1.40, 95 % CI 1.08-1.81, p = 0.011).

CONCLUSIONS

Poor sleep quality is associated with increased likelihood of probable sarcopenia in older adults. This finding highlights the importance of addressing sleep quality in interventions aimed at preventing sarcopenia and promoting healthy aging.

Sleep as a possible mediator in the association of mental health parameters with cardiovascular health indices in women: exploratory analyses from the Heart SCORE Study

OBJECTIVE

This exploratory study aimed to determine the possible role of sleep in the relationships of depression and anxiety, with early surrogate markers of subclinical atherosclerosis, such as brachial artery (BA) diameter and carotid intima media thickness (CIMT) in women.

METHODS

We included 1,075 self-reported postmenopausal women, 45 to 75 years from the Heart Strategies Concentrating on Risk Evaluation Study. Exposure variables were depression and anxiety assessed using the Center for Epidemiologic Studies Depression Scale and the State-Trait Anxiety Inventory, respectively. Outcome variables were BA diameter and CIMT measured using ultrasonography. The mediator, sleep, was assessed with the Pittsburgh Sleep Symptom Questionnaire-Insomnia. Ordinary least squares regression was used for mediation analyses.

RESULTS

Of the 1,075 participants, 56.3% were White and 43.7% were Black. Our analyses revealed significant associations of depression and anxiety with sleep ( P < 0.001 for all). After adjusting for confounders, depression was associated with max CIMT (R 2 = 0.15, P = 0.004), but not BA diameter (R 2 = 0.09, P = 0.083). Although the mediating role of sleep in the association between anxiety and BA diameter was not statistically significant [proportion mediated (CI); 0.41 (-2.77, 4.06); P = 0.219], we observed differential results within each racial group. Sleep appeared to partially mediate the association of anxiety with BA diameter in White [0.21 (0.54, 0.80); P = 0.044] women only.

CONCLUSIONS

We found preliminary indications that sleep might mediate the association of anxiety with BA diameter in White women but does not appear to serve as a mediator in all the other relationships we examined.

Corresponding Changes in Sleep and Discrimination: A Three-year Longitudinal Study Among Ethnically/Racially Diverse Adolescents

Although research has established the immediate, detrimental impact of discrimination on sleep, how changes in experiences of discrimination may be related to changes in sleep duration over multiple years is less clear. This three-year longitudinal study investigated: (1) intercept-only and linear trajectories of sleep and everyday discrimination across three years of high school; (2) ethnic/racial differences in these trajectories; and (3) the associations between changes in sleep and changes in everyday discrimination. The sample consisted of ethnically/racially minoritized adolescents from five northeast U.S. public high schools (n = 329; 70% female, 30% male, 0% non-binary; 42% Asian, 21% Black, 37% Latiné; Mage = 14.72, SD = 0.54). Latent growth curve models found that both sleep duration and everyday discrimination declined linearly throughout the first three years of high school and varied by race/ethnicity. Asian adolescents reported longer sleep duration in the 9th grade relative to Black and Latiné adolescents but underwent a significant decline such that these differences were no longer significant in the 10th and 11th grades. In addition, Black and Latiné, but not Asian, adolescents reported a significant decline in discrimination from the 9th-11th grades. Although average sleep duration declined for the entire sample, slower declines in discrimination were associated with faster decreases in sleep duration. This was particularly salient among Black adolescents. The current study contributes to research on ethnic/racial disparities in sleep by highlighting that everyday discrimination can have both an immediate and cumulative detrimental impact on sleep duration.

A socioecological model of neighborhood disorder, religious attendance, and sleep efficiency

OBJECTIVES

Drawing on the socioecological model of sleep health, we formally examine the association between neighborhood disorder and sleep efficiency. While most studies focus on direct associations with neighborhood context, we also consider whether the relationship between religious attendance and sleep efficiency varies as a function of neighborhood disorder.

DESIGN

We use ordinary least squares regression to model cross-sectional survey data.

SETTING

The United States.

PARTICIPANTS

The All of Us Research Program is based on a nonprobability sample of 5168 adults aged 18 and over.

MEASUREMENTS

Our analyses include an index of perceived neighborhood disorder, a single-item measure of religious attendance, and an objective measure of sleep efficiency based on wrist actigraphy.

RESULTS

While perceptions of neighborhood disorder are inversely associated with sleep efficiency, religious attendance is positively associated with sleep efficiency. The association between religious attendance and sleep efficiency did not vary across levels of neighborhood disorder.

CONCLUSION

Our analyses add to a growing literature on the association of neighborhood disorder with objective indicators of sleep health. To our knowledge, we are among the first to observe any association between religious attendance and sleep efficiency. We extended the socioecological model of sleep health by framing neighborhood disorder as a moderator.

Stress across the lifecourse and adult mental and physical health outcomes

INTRODUCTION

Economic, social, and traumatic stressors have been shown to impact mental and physical health. Few studies have considered whether different domains of stressors have a differential effect on health outcomes or have considered stressors across the lifecourse. We characterize stress cumulatively (life stress) and across different domains and examine their relation to adult mental and physical health using prospectively collected data from the DISPAR study.

METHODS

At 4 timepoints (birth, age 9, 15, and 50), economic, relational, and traumatic stressors were assessed, and interviews were conducted between 1959 and 2012. Experiences of major discrimination were assessed at age 50. Life stress scores and domain-specific stress scores, (occurring in either childhood or adulthood), were created. The Kessler distress scale, self-reported health, and objective measured allostatic load (AL) were assessed at age 50.

RESULTS

Adjusting for race and sex, life stress was associated with all 3 outcomes. Domain-specific analysis showed that only SES stressors impacted all outcomes (poorer self-rated health, higher distress, and higher AL). Relational stress was associated with distress only; experiences of discrimination were associated with poor self-rated health and distress.

CONCLUSION

Stressors across the lifecourse have been proposed to affect wear and tear on multiple bodily systems and to affect multiple health outcomes. Our empirical test supported this hypothesis in a 50-year old cohort and in particular the impact of economic stress across physical and mental health outcomes.

Menopausal stage transitions and their associations with overall and individual sleep quality in middle-aged Korean women

BACKGROUND

Understanding the association between the menopausal transition and declining sleep quality can guide optimal timing for preventive interventions in transitioning women. However, studies lack representation of Asian women and sufficient data on the progression of menopausal stages and sleep quality changes over time in this population.

METHODS

This study included 3305 women in the pre-menopause stage at baseline. The sleep quality and its components were assessed using the Pittsburgh Sleep Quality Index (PSQI). Menopausal stages were classified as pre-menopause, early transition, late transition, and post-menopause according to the Stages of Reproductive Aging Workshop+10 (STRAW+10) criteria. We estimated the longitudinal association between menopausal stage changes over time and the PSQI score, and examined the effect of being overweight.

RESULTS

The trends in the PSQI scores and its components according to the menopausal stage changes over time showed that with the exception of sleep duration and habitual sleep efficiency, an overall decline was noted in sleep health during late transition and post-menopause compared to pre-menopause. These associations were independent of time-variant annual chronological aging, which was not significantly associated with sleep deterioration. Additionally, although the associations between menopausal stages and sleep quality did not significantly differ by adiposity level, the overweight group exhibited worse PSQI scores and components than did the non-overweight group.

LIMITATION

Sleep quality and menopausal stage were assessed using self-reported questionnaires without objective measures.

CONCLUSION

Our study underscores the importance of screening for sleep quality deterioration and implementing appropriate measures for women experiencing menopausal transition.

Sleep Health Disparities

Sleep is an important and potentially modifiable determinant of many severe health outcomes. Sleep health disparities exist and are exemplified by reported differential rates of prevalence, severity, and outcomes among minority groups and low-socioeconomic-status backgrounds. In this review we highlight the concept of sleep health, review the evidence for disparities in sleep health, examine risk factors and consequences of poor sleep health, and discuss policy implications.

Sleep Behaviour in Sickle Cell Disease: A Systematic Review and Meta-Analysis

Background/Objectives: There is a high prevalence of sleep behaviour disorders, as well as sleep disordered breathing (SDB), in individuals living with sickle cell disease (SCD). SDB has been systematically reviewed; therefore, this systematic review and meta-analysis focused on sleep behaviour. Methods: The comprehensive literature search, following PRISMA reporting guidelines, included all languages, conference proceedings and published theses from inception through February 2022. We identified 31 studies, with most of the research being conducted in North America, using polysomnography, actigraphy and questionnaires/diaries in paediatric SCD cohorts. Results: Total sleep time (TST) decreased, while sleep onset latency (SOL) increased with age. TST was higher on self-reported sleep diary measures and lower on polysomnography (PSG) and actigraphy assessments. SOL was lowest during PSG and highest in actigraphy. The discrepancy between sleep measures might be due to the overestimation of sleep behaviour by parents. In six studies, TST and SOL were compared between people living with SCD and healthy controls; in four, TST was longer in those living with SCD while it was shorter in two. Meta-analyses on the effect of TST and SOL were limited due to publication bias, with heterogeneity between the studies, in part related to measurement differences. No significant differences were found. Conclusions: The scarcity of case-control studies and significant heterogeneity in findings likely attributable to variations in sleep assessment methodologies. Gaps in the literature should be addressed.

Unraveling the relationship between sleep behaviors and physical activity in the United States: insights from 2015 to 2020 NHANES data

BACKGROUND

Physical activity is an important component of metabolic health. However, little is known about the impact of specific types/intensities of physical activity on sleep health, especially among ethnically diverse populations. We examined the association of various sleep behaviors with moderate to vigorous work/recreational activity.

METHODS

Self-reported data from the National Health and Nutrition Examination Survey 2015-2020 were cross-sectionally analyzed for a sample of 11,039 participants in the United States (U.S.). Weighted univariate logistic regressions determined unadjusted associations, while weighted multivariable regression models adjusting for age, sex, ethnicity, BMI categories, and socio-economic status assessed the multivariable associations with moderate and vigorous work/recreational activity. Stratified analyses were performed to determine across-group differences by ethnicity and BMI categories.

RESULTS

Of 11,039 adults (mean age 41 years), 50.7% were female, 59.8% were Non-Hispanic White, 17.8% Hispanic/Latino, 12% Non-Hispanic Black, 6.3% Non-Hispanic Asian, and 4.1% other/multiple ethnicities. Moderate work activity increased the odds of short sleep duration [aOR = 1.42; 95% CI: 1.22, 1.65], snoring [aOR = 1.45; 95% CI: 1.21, 1.73], breath cessation [aOR = 1.37; 95% CI: 1.18, 1.59], and daytime sleepiness [aOR = 1.63; 95% CI: 1.39, 1.91]. Vigorous recreational activity reduced the odds of short sleep duration [aOR = 0.81; 95% CI: 0.71, 0.94] and trouble sleeping [aOR = 0.83; 95% CI: 0.73, 0.96]. Stratified analyses indicated significant ethnicity-based differences in the odds of sleep behaviors across physical activity groups and increased odds of poor sleep behaviors among participants who were underweight, overweight or had obesity.

CONCLUSION

Work-related activity was significantly associated with suboptimal sleep behaviors while recreational activity was associated with favorable sleep behaviors. These associations were more pronounced among certain ethnic groups. Further longitudinal investigation is needed to examine the mechanism driving the relationship between sleep behaviors and physical activity.

Correlates of multidimensional sleep in premenopausal women: The BioCycle study

Purpose

To identify sleep dimensions (characteristics) that co-occur in premenopausal women. The second aim was to examine associations between multiple dimensions of sleep and a set of demographic, lifestyle, and health correlates. The overarching goal was to uncover patterns of poor-sleep correlates that might inform interventions to improve sleep health of women in this age group.

Methods

The BioCycle Study included 259 healthy women aged 18-44y recruited between 2005 and 2007 from Western New York. Participants reported sleep data through daily diaries and questionnaires that were used to create five sleep health dimensions (duration, variability, timing, latency, and continuity). We used multivariate analysis - canonical correlation methods - to identify links among dimensions of sleep health and patterns of demographic, psychological, and occupational correlates.

Results

Two distinct combinations of sleep dimensions were identified. The first - primarily determined by low variability in nightly sleep duration, low variability in bedtime (timing), greater nocturnal awakening, and less sleep onset latency - was distinguished from the second - primarily determined by sleep duration.The first combination of sleep dimensions was associated with older age and higher parity, fewer depressive symptoms, and higher stress level. The second combination of sleep dimensions was associated with perception of longer sleep duration as optimal, lower parity, not engaging in shift work, older age, lower stress level, higher prevalence of depressive symptoms, and White race.

Conclusion

Among premenopausal women, we demonstrated distinct patterns of sleep dimensions that co-occur and vary by demographic, health, and lifestyle correlates. These findings shed light on the correlates of sleep health vulnerabilities among young women.

Sleep health inequities in vulnerable populations: Beyond sleep deserts

Despite the importance of sleep to overall health and well-being, there is a high prevalence of undiagnosed sleep disorders and adverse sleep health, particularly among vulnerable populations. Such vulnerable populations include people experiencing homelessness (PEH), refugees, and incarcerated individuals. In this narrative review, we provide an overview of the literature on sleep health and disorders among key and vulnerable populations (e.g., PEH, refugees, and incarcerated individuals). The limited research among these populations indicated a high prevalence of sleep disorders, mainly insomnia, short sleep duration, and fatigue. Substance abuse and PTSD were commonly found among PEH and refugee populations, respectively, which were was related to poor sleep. Similar across the included vulnerable populations, the individuals reside in environments/facilities with inopportune light exposure, noise disruption, inadequate bedding, and forced sleep schedules. Studies also found a high prevalence of psychosocial stress and reports of threats to safety, which were associated with poor sleep health outcomes. Additionally, several studies reported environmental barriers to adherence to sleep disorder treatment. This paper highlighted the conditions in which these vulnerable populations reside, which may inform interventions within these various facilities (homeless shelters, refugee camps, prisons/jails). The improvement of these facilities with a sleep equity focus may in turn improve quality of life and daily functioning.

Neighborhood social cohesion and sleep health among sexual minoritized US adults and intersections with sex/gender, race/ethnicity, and age

OBJECTIVES

Neighborhood social cohesion or living in communities characterized by trust and social ties may mitigate sleep disparities among sexual minoritized vs. heterosexual persons; but its relation to sleep health is understudied among sexual minoritized groups. To investigate associations between perceived neighborhood social cohesion and sleep health among adult US men and women who identified as "lesbian or gay, bisexual, or something else," we used cross-sectional National Health Interview Survey data (2013-2018).

METHODS

Participants reported neighborhood social cohesion (categorized as low or medium vs. high) and sleep characteristics. Adjusting for sociodemographic, health, and residential characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals for poor sleep.

RESULTS

Among 4666 sexual minoritized adults, 44% reported low, 32% medium, and 24% high neighborhood social cohesion. Women, minoritized racial/ethnic groups, and young adults disproportionately reported low neighborhood social cohesion. Overall, low vs. high neighborhood social cohesion was associated with a higher prevalence of short sleep (PR=1.27 [95% confidence interval:1.11-1.45]) and all sleep disturbances (e.g., PRinsomnia symptoms=1.36 [1.19-1.55]). PRs were often higher as intersectionality or membership to multiple minoritized groups increased.

CONCLUSIONS

Lower perceived neighborhood social cohesion was associated with poorer sleep. Fostering community cohesiveness may mitigate sleep disparities among sexual minoritized adults.

Identifying trajectories of change in sleep disturbance during psychological treatment for depression

BACKGROUND

Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making.

METHOD

This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services.

RESULTS

Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well.

LIMITATION

Single item on sleep disturbance used, no data on treatment adherence.

CONCLUSIONS

These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.

The Bidirectional Relationship Between Sleep and Pain in Crohn's Disease: A Daily Diary Study

BACKGROUND

Pain is common in Crohn's disease (CD) even after endoscopic healing is achieved. Depression, sleep disturbances, fatigue, and worry about pain impact the pain experience. There is a bidirectional relationship between sleep and pain, though it has received minimal attention in CD. Herein, we sought to comprehensively assess this relationship in CD using daily diaries.

METHOD

Patients with active symptoms of insomnia and CD were recruited as part of an ongoing clinical trial. Participants completed 14-day diaries on sleep patterns and CD symptoms. Temporal associations between sleep and pain were assessed using cross-lagged path analysis and controlled for age, sex, and menstrual cycle.

RESULTS

Overall, 26 participants completed 14-day diaries. All assessed aspects of sleep continuity disturbance were associated with worse next-day abdominal pain (Ps < 0.01). When assessed microlongitudinally, sleep onset latency predicted next-day pain (P = 0.07) and vice versa (P = 0.03). Similarly, nightly awakenings predicted next day pain (P = 0.02) and vice versa (P = 0.04). Sleep efficiency (P = 0.003), sleep quality (P < 0.001), and total sleep time (P = 0.04) predicted next-day pain whereas models with pain as the predictor were not significant.

CONCLUSIONS

Sleep continuity and abdominal pain are closely related, with sleep efficiency, total sleep time, and sleep quality potentially driving next-day abdominal pain. As interventions for pain in IBD are limited, it may be important to capitalize on the impact of sleep disturbances on pain to optimize overall wellbeing in people with CD.

The Great Controversy of Obstructive Sleep Apnea Treatment for Cardiovascular Risk Benefit: Advancing the Science Through Expert Consensus. An Official American Thoracic Society Workshop Report

The prevalence of obstructive sleep apnea (OSA) is on the rise, driven by various factors including more sensitive diagnostic criteria, increased awareness, enhanced technology through at-home testing enabling easy and cost-effective diagnosis, and a growing incidence of comorbid conditions such as obesity. Treating symptomatic patients with OSA syndrome to enhance quality of life remains a cornerstone approach. However, there is a lack of consensus regarding treatment to improve cardiovascular disease (CVD) outcomes, particularly in light of overall negative results from several randomized controlled trials (RCT) indicating no benefit of positive airway pressure (PAP) therapy on primary and secondary CVD events. These RCTs were limited by suboptimal PAP adherence, use of composite CVD outcomes, and limited diversity and generalizability to Sleep Clinic patients. As such, this workshop assembled clinical experts, as well as researchers in basic and translational science, epidemiology, clinical trials, and population health to discuss the current state, and future research directions to guide personalized therapeutic strategies and future research directions in OSA. There was overall consensus among workshop participants that OSA represents a heterogeneous disease with variable endotypes and phenotypes, and heterogeneous responses to treatment. Future research should prioritize employing multi-modal therapeutic approaches within innovative and adaptive trial designs, focusing on specific subgroups of OSA patients hypothesized to benefit from a CVD perspective. Future work should also be inclusive of diverse populations and consider the life-course of OSA to better comprehend treatment strategies that can address the disproportionate impact of OSA on racially minoritized groups. Further, a more holistic approach to sleep must be adopted to include broader assessments of symptoms, sleep duration, and comorbid sleep and circadian disorders. Finally, it is imperative to establish a sleep research consortium dedicated to collecting raw data and biospecimens categorized by OSA subtypes. This will facilitate mechanistic determinations, foster collaborative research, and help bolster the pipeline of early-career researchers.

Neighborhood social vulnerability as a mediator of racial disparities in insomnia severity

STUDY OBJECTIVES

Recent data has indicated that Black Americans experience more severe insomnia compared to their White counterparts. Although previous studies have identified psychosocial mechanisms driving this disparity, little is known about the structural determinants of insomnia disparities. This study tested neighborhood social vulnerability as a mechanism driving Black-White disparities in insomnia severity in the United States.

METHODS

Participants with a previous diagnosis of insomnia (N = 196) reported their race and insomnia severity (Insomnia Severity Index). As a measure of the neighborhood environment Social Vulnerability Index was calculated by geocoding home address at the time of participation to the respective census tract from the 2020 US Census. A mediation analysis tested the indirect effect of the Social Vulnerability Index between race and insomnia severity.

RESULTS

Black participants reported worse insomnia severity compared to White participants. Black participants also had 3.3 times the odds of living in neighborhoods with higher social vulnerability compared to White participants, with a group median difference of 0.26 percentile points (scale 0 to 1). As hypothesized, results revealed a significant indirect effect of the Social Vulnerability Index, which accounted for 31.1% of the variance between race and insomnia severity.

CONCLUSION

Living in a socially vulnerable neighborhood environment may be a mechanism driving racial disparities in insomnia severity. Interventions that consider structural determinants of health, including community-based and policy-level interventions could have an enhanced impact on addressing insomnia and its public health consequences.

Interactions among neighborhood conditions, sleep quality, and episodic memory across the adult lifespan

OBJECTIVES

On average, adults racialized as non-Hispanic Black and Hispanic sleep more poorly than adults racialized as non-Hispanic White (hereafter, Black, Hispanic, White), but associations between factors that may moderate sleep-memory associations in these groups, such as neighborhood conditions, are unclear. Poorer neighborhood conditions (e.g. lower neighborhood cohesion) may be negatively associated with sleep quality and multiplicatively influence sleep-memory associations. We hypothesized lower ratings of neighborhood conditions would be associated with poorer sleep quality and moderate the association between sleep quality and episodic memory, especially in Black and Hispanic adults, who are disproportionately situated in poor neighborhood conditions.

DESIGN

Seven-hundred-thirty-six adults across the adult lifespan (27-89 years) were recruited from the northern Manhattan community as a part of the Offspring Study of Racial and Ethnic Disparities in Alzheimer's disease. Sleep quality was assessed using a modified version of the Pittsburgh Sleep Quality Index, and episodic memory was evaluated with the Buschke Selective Reminding Test. With multiple regression models, we measured associations between perceived neighborhood conditions and sleep quality and the interaction between sleep quality and neighborhood conditions on episodic memory stratified by racial/ethnic and gender identity groups.

RESULTS

Overall, poorer neighborhood conditions were associated with poorer sleep quality. In Black and Hispanic women, the sleep-memory association was moderated by neighborhood conditions. With more favorable neighborhood conditions, Black women showed an association between higher sleep quality and higher memory performance, and Hispanic women showed a protective effect of neighborhood (higher memory even when sleep quality was poor).

CONCLUSION

Poorer neighborhood experiences may contribute to poorer sleep quality across groups. In Black and Hispanic women, the association between sleep quality and episodic memory performance was dependent upon neighborhood conditions. These findings may inform tailored, structural level sleep interventions, aimed to improve neighborhood experiences and thereby sleep quality and episodic memory.

Perceptions of sleep health among African American mothers regarding their preschool-aged children: A qualitative study to decrease sleep health disparities

OBJECTIVES

African American children are documented as having poor sleep health due to shorter sleep duration, sleep timing, and sleep behaviors compared to White peers, contributing to child health disparities. Identifying cultural-environmental, and societal factors impacting a child's sleep among African American families is essential for developing interventions for this population. This study evaluated holistically why African American children may have poorer sleep health by examining sleep duration, timing, and behaviors. This was assessed by examining sleep-related beliefs, barriers, and facilitators to sleep schedules and routines. We also explored parental ideas for a sleep intervention.

METHODS

African American mothers of preschool-aged children (2-5years) were recruited using local partnerships and social media. Individual semistructured interviews were conducted by phone. Interviews were transcribed, coded, and analyzed thematically using grounded-theory.

RESULTS

Eighteen African American mothers completed the study. Five themes related to sleep emerged: The importance of adequate nighttime sleep, the influence of family and friends on parental sleep practices, the relationship between environmental and home dynamics on child sleep duration, the impact of acute and chronic societal-level stressors on family sleep health, and considerations for culturally tailored interventions to improve child sleep health.

CONCLUSIONS

Good sleep health was important among African American mothers. Cultural-environmental and societal factors significantly impact children's sleep health. Clinicians and researchers should be aware of financial resources and home dynamics leading to challenges with adequate sleep health when developing or adapting sleep interventions. Identifying cultural-environmental, and societal factors must be considered for targeted efforts to improve sleep health in African American children.

Sleep as a contributor to socioeconomic disparities in hypertension: The Midlife in the United States (MIDUS II) Study

STUDY OBJECTIVES

Hypertension is highly prevalent and is a major risk factor for cardiovascular disease. There is a higher burden of hypertension among individuals of lower socioeconomic status (SES), yet the role of sleep in understanding socioeconomic disparities in hypertension is unclear. We investigated whether sleep quality is a partial mediator of the association between SES and hypertension.

METHODS

We used data from the Midlife in the United States II Study, 2004-2009 (n = 426). Analyses were conducted in 2023. Participants underwent 7-day actigraphy and clinical assessments. Sleep quality measures included actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Hypertension was measured via three consecutive blood pressure readings, and SES was measured via educational attainment. Models were fit adjusting for age, gender, race, body mass index, and perceived stress.

RESULTS

Participants had a mean age of 53.5 years (SD = 12.4) and 41.0% were African American. The prevalences of poor WASO (>30 minutes), low sleep efficiency (<85%), and hypertension were 77.7%, 67.1%, and 61.0%, respectively. Education was not associated with hypertension. However, individuals with low vs. high sleep efficiency had 24% higher prevalence of hypertension (aPR = 1.24, 95% CI: 1.02 to 1.51), higher systolic blood pressure (aβ = 4.61, 95% CI: 0.69 to 8.53), and higher diastolic blood pressure (aβ = 2.50, 95% CI: 0.10 to 4.89). Education was not significantly associated with sleep after adjustment. There was no evidence of sleep mediating the SES-hypertension relation.

CONCLUSIONS

Effective interventions to lower hypertension prevalence should consider targeting sleep quality. Future research should explore the intersectionality of SES and race in hypertension.

Discrimination in Middle Eastern and North African Americans predicts Worse Mental Health as Mediated by Sleep

Discrimination is a salient stressor linked with a variety of health outcomes including depression and anxiety among Middle Eastern and North African Americans (MENA). Among other minoritized racial and ethnic groups, sleep difficulties have been identified as potential mechanisms that explain the relationship between discrimination and mental health. However, this has not been explored within MENA samples. Thus, the focus of this study is to examine if two sleep measures (e.g., sleep disturbance and sleep-related impairment) mediate the relationship between discrimination and two mental health outcomes: depression and anxiety. We recruited 126 MENA adults from across the USA through Prolific. Findings revealed that sleep-related impairment fully mediated the relationship between discrimination and mental health outcomes, whereas sleep disturbances only partially mediated these outcomes. Results suggest sleep difficulties are one pathway that could explain the relationship between discrimination and mental health among MENA. Future work should continue to explore this relationship, as well as investigate discrimination and sleep as possible places of intervention to protect the health of MENA individuals.

Factors Associated with Poor Sleep Quality in Postpartum Women: A Crossectional Study

Objective  This study aimed to analyze the factors associated with poor sleep quality in women in the postpartum period who were assisted in a municipality in central Brazil. Material and Methods  This is a cross-sectional study ( n  = 400) conducted virtually from 2020 to 2021. Sociodemographic and clinical characteristics, self-perceived sleep, and the Pittsburgh Sleep Quality Index (PSQI) were assessed. Results  It was identified that 82% of postpartum women were between 18 and 35-years-old and had an average monthly household income of R$2,339.27 ± 1,812.95. It was also found that 33.50% (95% CI: 28.7-38.0) had sleep disorders (PSQI >10); 70.25% (95%CI 65.8-74.8) had poor sleep quality (PSQI >5); 57.4% (95% CI: 52.0-63.1) had inadequate sleep on weekdays/workdays; and 64.1% (95% CI 59.3-69.2) had unsuitable sleep on weekends/days off. It was found that the factors associated with sleep disturbance were: age between <18 years and >35 years ( p  = 0.048); difficulty to think clearly ( p  = 0.043); frequent sadness ( p  = 0.046); poor sleep quality; low income ( p  = 0.030); difficulty to think clearly ( p  = 0.013); and loss of interest in things ( p  = 0.030). As for sleep on weekdays, the associated factors were: marital status without a partner ( p  = 0.008); and being a victim of physical violence ( p  = 0.003). Finally, for sleep on weekends/off: nonwhite skin-color ( p  = 0.039); and having postpartum depression ( p  = 0.029). Conclusion  The findings of the present study call attention to the impacts of changes in women's bodies, behavior, and interpersonal relationships caused by the arrival of a newborn. We also highlight the need for a multidisciplinary and comprehensive medical approach in this period.

Ethical and Policy Implications of Racial and Ethnic Healthcare Disparities in Sleep Health

Despite efforts in recent years, including in policy and research, to address health disparities in the United States, many of those disparities continue to fester in marginalized racial/ethnic populations. Understanding sleep health disparities is critical in understanding the health and wellness of these groups. Using obstructive sleep apnea (OSA) in Black populations as a focus, this paper presents the role of race and ethnicity in the clinical understanding of sleep health-related issues by medical practitioners and the implications of the lack of clear policies or best practices to guide medical practitioners' attempts to meet sleep-related needs of marginalized racial/ethnic populations. Furthermore, the knowledge gap may be further complicated by the poor understanding and integration of existing evidence with the many, complex, sleep-associated co-morbidities. Policymaking in this area ought to be based on the ethical implications of disparate sleep-related health outcomes by race and ethnicity. So, we conclude by offering recommendations for developing ethically sound policies for addressing sleep problems in marginalized racial and ethnic populations.

Heterogeneities in sleep duration and quality among U.S. immigrants from different racial and ethnic backgrounds

OBJECTIVES

Sleep plays an essential role in well-being. Although U.S. immigrants are considerably growing, few studies have examined sleep in this diverse population, particularly those from Asian backgrounds. It is also unclear how sleep differs by the length of residence across immigrant groups. In this study, we examined the relationships among race/ethnicity, length of residence, and sleep using a nationally representative cohort of U.S. immigrants.

METHODS

We analyzed data from the 2013-2018 National Health Interview Survey. The sample (N = 27,761; 14% ≥65 years old) included foreign-born adults from the following racial/ethnic backgrounds: non-Hispanic White, non-Hispanic Black, Asian (Chinese, Filipino, Asian Indian), and Hispanic/Latino. Length of residence was categorized as <5, 5-9, 10-14, and ≥15years. Sleep was assessed with self-reported sleep duration (normal, short, and long) and poor sleep quality (trouble falling asleep, trouble staying asleep, and waking up unrested).

RESULTS

Filipino and Hispanic/Latino immigrants reported the highest prevalence of short (41.8%) and long (7.0%) sleep, respectively. Non-Hispanic White immigrants had the highest prevalence rate across all three poor sleep quality measures (range 17.7-41.5%). Length of residence ≥15years was significantly associated with worse sleep, and it moderated White-Asian differences in sleep quality. Immigrants from different racial/ethnic groups showed variations in sleep patterns as they resided longer in the US.

CONCLUSIONS

Immigrants exhibited substantial heterogeneities in sleep. Future research should investigate the contributing factors to the variations in their sleep patterns, both between groups and within the same group of immigrants, in order to inform tailored interventions.

Inequities in adolescent sleep health in Aotearoa New Zealand: Cross-sectional survey findings

OBJECTIVES

To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand.

METHODS

Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism.

RESULTS

Inequities in social determinants of health were evident for Māori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Māori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Māori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Māori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes.

CONCLUSIONS

Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.

Photovoice for leveraging traditional, complementary, and integrative medicine amongst black adults to improve sleep health and overall health

Introduction

Average adults are recommended to have 7-8 h of sleep. However insufficient sleep (IS defined as <7 h/nightly) is associated with increased risk of chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Traditional, complementary, and integrative medicine (TCIM), a burgeoning area of research and practice, leverages both modern and traditional approaches to improve health. Despite TCIM's recognition as a tool to improve sleep and related outcomes, there is a gap in literature in addressing its impact among black individuals, who experience a disproportionate burden of IS and chronic disease. This qualitative study aimed to increase understanding of TCIM practices to overcome IS and overall health in black communities.

Methods

Using photovoice methodology, a qualitative tool which applies community-engaged principles to produce culturally informed results through interviews and digital media, consented participants were recruited from Miami, Florida and (1) instructed to capture images over one week that communicated their TCIM to improve sleep and overall health on their mobile device; (2) interviewed using individual, semi-structured procedures to add "voice" to the "photos" they captured for ~20 min; and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for ~1.5 h. Both individual and focus group interviews were conducted over Zoom with recordings transcribed for formal content analysis using Nvivo software.

Results

The sample included N = 25 diverse US black individuals (M = 37, SD = 13, range 21-57). Approximately a quarter of the sample were unemployed (N = 7) and majority were women (N = 21). Results highlighted five themes including: (1) natural wellness (sleep supplements, comfort beverages, aromatherapy, herbalism, outdoors); (2) self-care (self-maintenance, physical activity, spatial comfort); (3) leisure (pet support, play); (4) mental stimulation (mindfulness, reading); and (5) spiritual wellness (faith-based practices). Study results elucidate the heterogeneity of diverse US black individuals regarding sociocultural knowledge, beliefs, and behaviors.

Conclusion

Addressing IS in black communities requires a comprehensive strategy that integrates cultural sensitivity, family and community dynamics, education, mental health support, and informed policymaking. Future studies should consider how sleep health literacy, stress appraisal, and coping strategies may vary by race/ethnicity for tailored intervention.

A Large-Scale Genome-Wide Study of Gene-Sleep Duration Interactions for Blood Pressure in 811,405 Individuals from Diverse Populations

Although both short and long sleep duration are associated with elevated hypertension risk, our understanding of their interplay with biological pathways governing blood pressure remains limited. To address this, we carried out genome-wide cross-population gene-by-short-sleep and long-sleep duration interaction analyses for three blood pressure traits (systolic, diastolic, and pulse pressure) in 811,405 individuals from diverse population groups. We discover 22 novel gene-sleep duration interaction loci for blood pressure, mapped to 23 genes. Investigating these genes' functional implications shed light on neurological, thyroidal, bone metabolism, and hematopoietic pathways that necessitate future investigation for blood pressure management that caters to sleep health lifestyle. Non-overlap between short sleep (12) and long sleep (10) interactions underscores the plausible nature of distinct influences of both sleep duration extremes in cardiovascular health. Several of our loci are specific towards a particular population background or sex, emphasizing the importance of addressing heterogeneity entangled in gene-environment interactions, when considering precision medicine design approaches for blood pressure management.

An Examination of John Henryism in Adults Living with Sickle Cell Disease

BACKGROUND

John Henryism (JH) is a behavioral predisposition for high-effort coping with adversity. JH has been associated with hypertension in Black Americans with low socioeconomic status (SES) and is also found to be associated with psychological well-being. Sickle cell disease (SCD), a rare genetic disease largely affecting Black Americans in the United States, presents as a chronic condition that may benefit from a deeper understanding of the impact of JH on overall health.

PURPOSE

This study examined the association between high and low JH and diastolic blood pressure, systolic blood pressure, hypertension prevalence, and sleep function. We relied on the biopsychosocial transaction model to adjust for relevant clinical and sociodemographic variables.

METHODS

This was a cross-sectional secondary analysis of 274 adults with SCD living in the United States and recruited between 2014 and 2020. Study visits consisted of physical examinations, medical history, demographic, and psychosocial questionnaires. Adjusted linear regressions estimated associations between high and low JH and diastolic and systolic blood pressure as well as self-reported sleep function. Multivariable logistic regression was used to examine associations with hypertension prevalence.

RESULTS

High JH was significantly associated with lower diastolic blood pressure (β =  - 2.98; 95% confidence interval =  - 5.92, - 0.04) but higher sleep dysfunction (β = 2.76; 95% confidence interval = 1.45, 4.07).

CONCLUSIONS

Overall, we found positive psychological coping resources associated with high JH, with the exception of sleep.

TRIAL REGISTRATION

CLINICALTRIALS

gov Identifier: NCT02156102.

Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data

STUDY OBJECTIVES

The purpose of this study was to characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database.

METHODS

Merative MarketScan insurance claims (n = 12,394,902) were used to identify youth (6-17 years of age) newly diagnosed with narcolepsy (International Classification of Diseases, 10th revision codes). Narcolepsy diagnosis and care 1 year postdiagnosis included polysomnography with Multiple Sleep Latency Test, pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only).

RESULTS

The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black vs White youth with Medicaid. Two thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had polysomnography with Multiple Sleep Latency Test (± 1 year postdiagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have polysomnography with Multiple Sleep Latency Test.

CONCLUSIONS

Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black vs White children with Medicaid. Only half overall had evidence of a diagnostically required polysomnography with Multiple Sleep Latency Test, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management.

CITATION

Tang SH, Min J, Zhang X, et al. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med. 2024;20(7):1141-1151.

Association of Birthplace for Sleep Duration, Sleep Quality, and Sleep Disorder Symptoms, at the US-Mexico Border

OBJECTIVES

The present study investigated the roles birthplace and acculturation play in sleep estimates among Hispanic/Latino population at the US-Mexico border.

MEASURES

Data were collected in 2016, from N = 100 adults of Mexican descent from the city of Nogales, AZ, at the US-Mexico border. Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index categorized as none, mild, moderate, and severe, and Multivariable Apnea Prediction Index (MAP) categorized as never, infrequently, and frequently. Acculturation was measured with the Acculturation Rating Scale for Mexican-Americans II (ARSMA-II).

RESULTS

The sample consisted of majority Mexican-born (66%, vs. born in the USA 38.2%). Being born in the USA was associated with 55 fewer minutes of nighttime sleep (p = .011), and 1.65 greater PSQI score (p = .031). Compared to no symptoms, being born in the USA was associated with greater likelihood of severe difficulty falling asleep (OR = 8.3, p = .030) and severe difficulty staying asleep (OR = 11.2, p = .050), as well as decreased likelihood of breathing pauses during sleep (OR = 0.18, P = .020). These relationships remained significant after Mexican acculturation was entered in these models. However, greater Anglo acculturation appears to mediate one fewer hour of sleep per night, poorer sleep quality, and reporting of severe difficulty falling asleep and staying asleep.

CONCLUSIONS

Among individuals of Mexican descent, being born in the USA (vs Mexico) is associated with about 1 hour less sleep per night, worse sleep quality, more insomnia symptoms, and less mild sleep apnea symptoms. These relationships are influenced by acculturation, primarily the degree of Anglo rather than the degree of Mexican acculturation.

Associations Between Self-Reported Sleep Quality, Fatigue Severity, Factors Associated With Successful Cessation, and Cessation Beliefs Among Regular Smokers

BACKGROUND

Smokers report poorer sleep than nonsmokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Better understanding of the relationship between sleep and relapse-related outcomes could inform novel approaches to smoking cessation support. The aim of this study was to investigate same-day associations of self-reported sleep quality and fatigue severity with factors associated with successful cessation and cessation beliefs, among regular smokers.

METHODS

This cross-sectional observational study (n = 412) collected self-reported sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs among regular smokers via an online survey (60% male).

RESULTS

There was evidence of an association between sleep quality (SQ) and reduced 24-hour (β = -0.12, p = .05) and lifetime (β = -0.09, p = .04) abstinence self-efficacy. In addition, poorer SQ and higher fatigue severity (FS) were associated with increased smoking urges (SQ: β = 0.27, p < .001; FS: β = 0.32, p < .001), increased barriers to cessation (SQ: β = 0.19, p < .001; FS: β = 0.32, p < .001), and increased perceived risks to cessation (SQ: β = 0.18, p < .001; FS: β = 0.26, p < .001). Fatigue severity was weakly associated with increased perceived benefits to cessation (β = 0.12, p = .017).

CONCLUSIONS

Self-reported sleep quality and fatigue severity were associated with multiple factors associated with successful cessation and cessation beliefs. Further research is needed to extend these findings by using different methods to identify the temporal direction of associations and causality.

IMPLICATIONS

This study is the first to examine associations between sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs. Findings show that both sleep quality and fatigue severity are associated with multiple factors associated with successful cessation and could be modifiable targets for future smoking cessation interventions. Furthermore, our data suggest that fatigue severity has an independent effect on multiple factors associated with successful cessation when accounting for sleep quality. This indicates that fatigue, independent of sleep quality, could be an important factor in a quit attempt.

Revolutionizing Sleep Health: The Emergence and Impact of Personalized Sleep Medicine

Personalized sleep medicine represents a transformative shift in healthcare, emphasizing individualized approaches to optimizing sleep health, considering the bidirectional relationship between sleep and health. This field moves beyond conventional methods, tailoring care to the unique physiological and psychological needs of individuals to improve sleep quality and manage disorders. Key to this approach is the consideration of diverse factors like genetic predispositions, lifestyle habits, environmental factors, and underlying health conditions. This enables more accurate diagnoses, targeted treatments, and proactive management. Technological advancements play a pivotal role in this field: wearable devices, mobile health applications, and advanced diagnostic tools collect detailed sleep data for continuous monitoring and analysis. The integration of machine learning and artificial intelligence enhances data interpretation, offering personalized treatment plans based on individual sleep profiles. Moreover, research on circadian rhythms and sleep physiology is advancing our understanding of sleep's impact on overall health. The next generation of wearable technology will integrate more seamlessly with IoT and smart home systems, facilitating holistic sleep environment management. Telemedicine and virtual healthcare platforms will increase accessibility to specialized care, especially in remote areas. Advancements will also focus on integrating various data sources for comprehensive assessments and treatments. Genomic and molecular research could lead to breakthroughs in understanding individual sleep disorders, informing highly personalized treatment plans. Sophisticated methods for sleep stage estimation, including machine learning techniques, are improving diagnostic precision. Computational models, particularly for conditions like obstructive sleep apnea, are enabling patient-specific treatment strategies. The future of personalized sleep medicine will likely involve cross-disciplinary collaborations, integrating cognitive behavioral therapy and mental health interventions. Public awareness and education about personalized sleep approaches, alongside updated regulatory frameworks for data security and privacy, are essential. Longitudinal studies will provide insights into evolving sleep patterns, further refining treatment approaches. In conclusion, personalized sleep medicine is revolutionizing sleep disorder treatment, leveraging individual characteristics and advanced technologies for improved diagnosis, treatment, and management. This shift towards individualized care marks a significant advancement in healthcare, enhancing life quality for those with sleep disorders.

Evaluation of Sleep in Pregnant Inpatients Compared With Outpatients

OBJECTIVE

To evaluate whether antepartum hospitalization was associated with differences in sleep duration or disrupted sleep patterns.

METHODS

This was a prospective cohort study with enrollment of pregnant people aged 18-55 years with singleton gestations at 16 weeks of gestation or more between 2021 and 2022. Each enrolled antepartum patient was matched by gestational age to outpatients recruited from obstetric clinics at the same institution. Participants responded to the ISI (Insomnia Severity Index) and wore actigraph accelerometer watches for up to 7 days. The primary outcome was total sleep duration per 24 hours. Secondary outcomes included sleep efficiency (time asleep/time in bed), ISI score, clinical insomnia (ISI score higher than 15), short sleep duration (less than 300 minutes/24 hours), wakefulness after sleep onset, number of awakenings, and sleep fragmentation index. Outcomes were evaluated with multivariable generalized estimating equations adjusted for body mass index (BMI), sleep aid use, and insurance type, accounting for gestational age correlations. An interaction term assessed the joint effects of time and inpatient status.

RESULTS

Overall 58 participants were included: 18 inpatients and 40 outpatients. Inpatients had significantly lower total sleep duration than outpatients (mean 4.4 hours [SD 1.6 hours] inpatient vs 5.2 hours [SD 1.5 hours] outpatient, adjusted β=-1.1, 95% CI, -1.8 to -0.3, P =.01). Awakenings (10.1 inpatient vs 13.8, P =.01) and wakefulness after sleep onset (28.3 inpatient vs 35.5 outpatient, P =.03) were lower among inpatients. There were no differences in the other sleep outcomes, and no interaction was detected for time in the study and inpatient status. Inpatients were more likely to use sleep aids (39.9% vs 12.5%, P =.03).

CONCLUSION

Hospitalized pregnant patients slept about 1 hour/day less than outpatients. Fewer awakenings and reduced wakefulness after sleep onset among inpatients may reflect increased use of sleep aids in hospitalized patients.

Impact of COVID-related Discrimination on Psychological Distress and Sleep Disturbances across Race-Ethnicity

COVID-related discrimination towards historically marginalized racial-ethnic groups in the United States has been well-documented; however, its impact on psychological distress and sleep (overall and within specific racial-ethnic groups) is largely unknown. We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, conducted from 12/2020-2/2021. Participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Psychological distress was captured as having experienced anxiety-depression symptoms (Patient Health Questionairre-4, PHQ-4), perceived stress (modified Perceived Stress Scale), or loneliness-isolation ("How often have you felt lonely and isolated?"). Sleep disturbances were measured using the Patient-Reported Outcomes Information System Short Form Sleep Disturbance scale (PROMIS-SF 4a). Overall, 22.1% reported COVID-related discriminatory behaviors (sometimes/always: 9.7%; rarely: 12.4%). 48.4% of participants reported anxiety-depression symptoms (moderate/severe: 23.7% mild: 24.8%), 62.4% reported feeling stressed (moderate/severe: 34.3%; mild: 28,1%), 61.0% reported feeling lonely-isolated (fairly often/very often: 21.3%; almost never/sometimes: 39.7%), and 35.4% reported sleep disturbances (moderate/severe:19.8%; mild: 15.6%). Discrimination was only associated with increased psychological distress among racial-ethnic minorities. For example, COVID-related discrimination was strongly associated with anxiety-depression among Black/African American adults (mild: aOR=2.12, 95% CI=1.43-5.17; moderate/severe: aOR=5.19, 95% CI=3.35-8.05), but no association was observed among White or multiracial adults. Mitigating pandemic-related discrimination could help alleviate mental and sleep health disparities occurring among minoritized racial-ethnic groups.

Self-reported neighborhood stressors and sleep quality among Puerto Rican young adults

OBJECTIVE

To examine the association between changes in self-reported neighborhood stressors and sleep quality and determine whether this varied by sociocultural context among Puerto Rican young adults.

METHODS

Data come from the Boricua Youth Study Health Assessment, a sample of Puerto Rican young adults from San Juan, Puerto Rico, and South Bronx, New York (n = 818; mean age=22.9years). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Neighborhood social stressors (disorder, social cohesion, and safety) were parent-reported in childhood and self-reported in young adulthood and categorized into: low in childhood/young adulthood (reference group), high in childhood/low in young adulthood, low in childhood/high in young adulthood, and high in childhood/young adulthood. Sociocultural context was based on participant residence during childhood (San Juan vs. South Bronx).

RESULTS

Adjusting for sociodemographic factors, living with high neighborhood stressors in both childhood and young adulthood (prevalence ratios=1.30, 95% CI: 1.01, 1.66) was associated with overall poor sleep (PSQI score >5). Among PSQI components, living with high neighborhood stressors in young adulthood only or in both time periods was associated with worse subjective sleep quality and daytime dysfunction. Additionally, there were various associations between the neighborhood stressor measures and PSQI components. Results did not differ by sociocultural context.

CONCLUSION

Findings suggest that living with high levels of neighborhood stressors during childhood and young adulthood may have a cumulative adverse impact on sleep quality in young adulthood.

Associations of Long-term Sleep Duration Trajectories with Overall and Cause-Specific Mortality Among Middle-to-older Aged Black and White Adults

Background

Both short and long sleep durations are adversely associated with numerous chronic conditions, including cardiovascular disease (CVD), diabetes, hypertension, and mortality. The American Academy of Sleep Medicine recommends adults in the United States sleep at least 7 hours and less than 9 hours per night to maintain optimal health. It remains unclear how sleep duration trajectories over time are associated with mortality.

Methods

This observational cohort study includes 46,928 Black and White adults (mean age: 53 ± 9 years) who enrolled in the Southern Community Cohort Study between 2002-2009 and completed a follow-up survey in 2008-2013. Participants were categorized into nine sleep duration trajectory categories based on the reported average sleep duration between study enrollment and at follow-up. Participant vital status and date and cause of death were ascertained via linkage to the National Death Index through 2022. Cox regression analysis was performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between sleep duration trajectory and all-cause and cause-specific mortality (CVD, cancer, and neurodegenerative disease) after adjustment for sociodemographic characteristics, health behaviors, and clinical factors.

Results

During a median 12.6 years of follow-up, we documented 13,579 deaths, including 4,135 from CVD, 3,067 from cancer, and 544 from neurodegenerative diseases. Compared to the optimal sleep duration trajectory (maintaining 7-9 hours), all sub-optimal trajectories were associated with significant 6 to 33% greater risk of all-cause mortality in fully adjusted models. Compared to the optimal sleep trajectory, three of the sub-optimal trajectories were associated with increased CVD mortality, with HRs ranging from 1.20 to 1.34. The short-long trajectory was associated with the greatest risk of all-cause mortality (HR:1.33; 95%CI: 1.21, 1.46) and the long-short trajectory was associated with the greatest CVD mortality risk (HR:1.34; 95%CI: 1.10, 1.65). The healthy-long trajectory was associated with the greatest risk of cancer mortality (HR: 1.19; 95%CI:1.00, 1.41). None of the sub-optimal trajectories was associated with neurodegenerative disease mortality.

Conclusions

Suboptimal sleep duration trajectories were associated with increased risk of all-cause mortality as well as CVD mortality. Findings highlight the importance of maintaining healthy sleep duration throughout midlife to reduce mortality risk.