title: Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group.
abstract: OBJECTIVE
  We hypothesize that extremes of sleep duration are associated with elevated C-reactive protein (CRP), a pro-inflammatory marker for cardiovascular disease risk.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Population-based research.
  
  
  METHODS
  Nationally representative sample of 2007-2008 National Health and Nutrition Examination Survey participants (n = 5,587 adults).
  
  
  METHODS
  None.
  
  
  RESULTS
  Associations between CRP and self-reported total sleep time (TST) were examined. Explanatory models considered contributions of sex, age, race/ethnicity, body mass index (BMI), and BMI squared (BMI2). Models also explored the role of insomnia symptoms, sleep apnea, active medical illness, and antidiabetic/antihypertensive treatment. Differential patterns among race/ethnicity groups were examined using interactions and stratified analyses. Nonlinear relationships between CRP and TST were assessed using polynomial and multinomial regression models (< 5, 5, 6, 7, 8, 9, and > 9 h). Linear and squared terms were significant in all models in the complete sample, with notable differences by sex and ethnoracial group. Overall, in models adjusted for sociodemographics and BMI, different patterns were observed for non-Hispanic white (elevated CRP for < 5 h and > 9 h), black/African-American (elevated CRP for < 5 h and 8 h), Hispanic/Latino (elevated CRP for > 9 h), and Asian/ Other (higher in 9 and > 9 h and lower in 5 h and 6 h) groups. Ethnoracial groups also demonstrated patterning by sex.
  
  
  CONCLUSIONS
  In a representative sample of American adults, elevated CRP was associated with extreme sleep durations. Sex, race/ethnicity, sleep disorders, and medical comorbidity influenced these associations. Differences in CRP along these dimensions should be considered in future research on sleep related disparities influencing cardiometabolic disease risk.
authors: Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA 19104, USA. grandner@upenn.edu
authors: Michael A
authors: MA
authors: Grandner
authors: Orfeu M
authors: OM
authors: Buxton
authors: Nicholas
authors: N
authors: Jackson
authors: Megan
authors: M
authors: Sands-Lincoln
authors: Abhishek
authors: A
authors: Pandey
authors: Girardin
authors: G
authors: Jean-Louis
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D057566:Self Report; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000097:blood* / Q000208:ethnology*; D014481:United States; D044465:White People
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; cardiovascular disease; epidemiology; inflammation; sleep duration
references: Ethn Dis. 2007 Winter;17(1):143-52
references: 17274224
references: Circulation. 2005 Mar 15;111(10):1233-41
references: 15769763
references: BMC Nephrol. 2010 Jan 15;11:1
references: 20078870
references: J Allergy Clin Immunol. 2001 Jan;107(1):165-70
references: 11150007
references: Brain Behav Immun. 2008 Aug;22(6):960-8
references: 18328671
references: Sleep Med Rev. 2005 Dec;9(6):419-36
references: 16183307
references: Circulation. 2003 Jan 7;107(1):87-92
references: 12515748
references: Sleep. 2010 Dec;33(12):1633-40
references: 21120125
references: Obesity (Silver Spring). 2012 Jun;20(6):1135
references: 22627975
references: Ann Epidemiol. 2011 Nov;21(11):799-806
references: 21889359
references: Indian J Med Res. 2010 Feb;131:206-16
references: 20308746
references: Diabetes Care. 2009 Nov;32(11):1965-71
references: 19651919
references: J Am Geriatr Soc. 2000 Feb;48(2):115-23
references: 10682939
references: Sleep. 2012 Jan 01;35(1):97-101
references: 22215923
references: Circulation. 2006 Oct 10;114(15):1591-8
references: 17015791
references: PLoS One. 2009;4(2):e4589
references: 19240794
references: Diabetes Care. 2007 May;30(5):1233-40
references: 17322482
references: Circulation. 2005 Mar 15;111(10):1332-6
references: 15769777
references: N Engl J Med. 2004 Apr 1;350(14):1387-97
references: 15070788
references: Prog Cardiovasc Dis. 2009 Jan-Feb;51(4):294-302
references: 19110131
references: Brain Behav Immun. 2010 Jan;24(1):54-7
references: 19520155
references: J Am Coll Cardiol. 2004 Feb 18;43(4):678-83
references: 14975482
references: Rheumatology (Oxford). 2008 Dec;47(12):1780-4
references: 18854346
references: Best Pract Res Clin Endocrinol Metab. 2010 Oct;24(5):775-84
references: 21112025
references: Circulation. 1999 Aug 17;100(7):713-6
references: 10449692
references: Obesity (Silver Spring). 2011 May;19(5):1083-9
references: 21372804
references: QJM. 2003 Nov;96(11):793-807
references: 14566035
references: Sleep. 2010 Dec;33(12):1649-55
references: 21120127
references: Brain Behav Immun. 2012 May;26(4):672-9
references: 22433899
references: J Rheumatol. 2002 Jan;29(1):169-73
references: 11824956
references: Circulation. 2001 Apr 3;103(13):1813-8
references: 11282915
references: Semin Arthritis Rheum. 1994 Oct;24(2):91-104
references: 7839158
references: Am J Epidemiol. 2012 Mar 1;175(5):423-31
references: 22306563
references: BMC Evol Biol. 2009 Jan 09;9:8
references: 19134176
references: Pflugers Arch. 2012 Jan;463(1):121-37
references: 22071480
references: J Clin Endocrinol Metab. 2004 May;89(5):2119-26
references: 15126529
references: Circulation. 2004 Mar 23;109(11):1349-53
references: 15023871
references: J Clin Sleep Med. 2011 Oct 15;7(5 Suppl):S31-3
references: 22003328
references: Epidemiology. 2008 Nov;19(6):838-45
references: 18854708
references: Pain Med. 2000 Jun;1(2):156-72
references: 15101904
references: Sleep. 2012 May 01;35(5):641-8
references: 22547890
references: Obesity (Silver Spring). 2008 Apr;16(4):875-80
references: 18379563
references: Am Heart J. 2005 Jun;149(6):1066-73
references: 15976790
references: Clin Chem. 2003 Apr;49(4):686-90
references: 12651834
references: Sleep. 2009 Jul;32(7):857-64
references: 19639748
references: Circulation. 2003 Dec 16;108(24):2993-9
references: 14638538
references: Brain Behav Immun. 2007 May;21(4):413-27
references: 17178209
references: Sleep. 2007 Sep;30(9):1145-52
references: 17910386
references: Cytokine. 2012 Jun;58(3):437-47
references: 22450224
references: Stroke. 2007 Jun;38(6):1774-9
references: 17446427
references: Sleep. 2009 Feb;32(2):200-4
references: 19238807
references: Open Respir Med J. 2011;5:31-43
references: 21754974
references: Circulation. 2003 Apr 22;107(15):2016-20
references: 12681999
references: Sleep. 2011 Mar 01;34(3):261-72
references: 21358843
references: Sleep. 2010 Feb;33(2):177-84
references: 20175401
references: Stroke. 2006 Jul;37(7):1720-4
references: 16741173
references: Sleep Med. 2011 Dec;12(10):997-1002
references: 22036601
references: Sleep Med Rev. 2012 Apr;16(2):137-49
references: 21835655
references: N Engl J Med. 2000 Mar 23;342(12):836-43
references: 10733371
references: Sleep. 2007 Aug;30(8):991-6
references: 17702268
references: Hypertension. 2007 Oct;50(4):693-700
references: 17785629
references: Int J Obes Relat Metab Disord. 1998 Dec;22(12):1164-71
references: 9877251
references: Circulation. 2003 Jul 15;108(2):166-70
references: 12821545
references: JAMA. 2001 Jul 18;286(3):327-34
references: 11466099
references: Kidney Int. 2003 Feb;63(2):654-61
references: 12631131