title: Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors.
abstract: BACKGROUND
  Self-reported short or long sleep duration has been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodologic issues.
  
  
  METHODS
  Adult respondents of the 2007-2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N=5649). Self-reported sleep duration was categorized as very short (<5 h), short (5-6 h), normal (7-8 h), or long (≥9 h). Obesity, diabetes mellitus (DM), hypertension, and hyperlipidemia were objectively assessed by self-reported history. Statistical analyses included univariate comparisons across sleep duration categories for all variables. Binary logistic regression analyses and cardiometabolic factor as outcome, with sleep duration category as predictor, were assessed with and without covariates. Observed relationships were further assessed for dependence on race/ethnicity.
  
  
  RESULTS
  In adjusted analyses, very short sleep was associated with self-reported hypertension (odds ratio [OR], 2.02, [95% confidence interval {CI},1.45-2.81]; P<0.0001), self-reported hyperlipidemia (OR, 1.96 [95% CI, 1.43-2.69]; P<0.0001), objective hyperlipidemia (OR, 1.41 [95% CI, 1.04-1.91]; P=0.03), self-reported DM (OR, 1.76 [95% CI, 1.13-2.74]; P=0.01), and objective obesity (OR, 1.53 [95% CI, 1.03-1.43]; P=0.005). Regarding short sleep (5-6 h), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR, 1.22 [95% CI, 1.02-1.45]; P=0.03) self-reported obesity (OR, 1.21 [95% CI, 1.03-1.43]; P=0.02), and objective obesity (OR, 1.17 [95% CI, 1.00-1.38]; P<0.05). Regarding long sleep (≥9 h), no elevated risk was found for any outcomes. Interactions with race/ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among blacks and the relationship between short sleep and hypertension is strongest among non-Hispanic whites, blacks, and non-Mexican Hispanics/Latinos.
  
  
  CONCLUSIONS
  Short sleep duration is associated with self-reported and objectively determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.
authors: Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: grandner@upenn.edu.
authors: Michael A
authors: MA
authors: Grandner
authors: Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States.
authors: Subhajit
authors: S
authors: Chakravorty
authors: Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States.
authors: Michael L
authors: ML
authors: Perlis
authors: Behavioral Sleep Medicine Program of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
authors: Linden
authors: L
authors: Oliver
authors: Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
authors: Indira
authors: I
authors: Gurubhagavatula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000208:ethnology*; D006973:Hypertension / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D009765:Obesity / Q000208:ethnology*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D057566:Self Report; D012890:Sleep; D012893:Sleep Wake Disorders / Q000208:ethnology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cardiovascular disease; Cholesterol; Diabetes; Epidemiology; Hypertension; Obesity; Sleep duration