title: Onset of impaired sleep as a predictor of change in health-related behaviours; analysing observational data as a series of non-randomized pseudo-trials.
abstract: BACKGROUND
  Changes in health-related behaviour may be a key mechanism linking impaired sleep to poor health, but evidence on this is limited. In this study, we analysed observational data to determine whether onset of impaired sleep is followed by changes in health-related behaviours.
  
  
  METHODS
  We used data from 37,508 adults from the longitudinal Finnish Public Sector Study. In analysis of 59 152 person-observations on duration and quality of sleep and health-related behaviours (alcohol consumption, smoking, physical activity and weight control), data were treated as a series of non-randomized pseudo-trials with strict predefined criteria for data inclusion and temporality.
  
  
  RESULTS
  Smokers who experienced onset of short sleep were less likely to quit smoking than those with persistent normal sleep [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.97]. Onset of short sleep also predicted initiating high-risk alcohol consumption (OR = 1.17, 95% CI: 1.00-1.37). Onset of disturbed sleep was associated with changes in all assessed health-related behaviours: initiation of high-risk alcohol consumption (OR = 1.23, 95% CI: 1.05-1.45), quitting smoking (OR = 0.80, 95% CI: 0.63-1.00), becoming physically inactive (OR = 1.17, 95% CI: 1.06-1.30) and becoming overweight or obese (OR = 1.12, 95% CI: 1.01-1.23).
  
  
  CONCLUSIONS
  Findings suggest that the onset of short or disturbed sleep are risk factors for adverse changes in health-related behaviours. These findings highlight potential pathways linking impaired sleep to the development of lifestyle-related morbidity and mortality.
authors.affiliation: Section of Social Medicine, Department of Public Health, and Copenhagen Stress Research Center, University of Copenhagen, Copenhagen, Denmark, alcl@sund.ku.dk.
authors.forename: Alice Jessie
authors.initials: AJ
authors.lastname: Clark
authors.affiliation: Finnish Institute of Occupational Health, Turku, Finland, Department of Psychology, University of Turku, Turku, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Salo
authors.affiliation: Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Theis
authors.initials: T
authors.lastname: Lange
authors.affiliation: Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital, Copenhagen, Denmark, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Jennum
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.affiliation: Finnish Institute of Occupational Health, Turku, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland, Department of Epidemiology and Public Health, University College London, London, UK and.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: Finnish Institute of Occupational Health, Turku, Finland, Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.affiliation: Section of Social Medicine, Department of Public Health, and Copenhagen Stress Research Center, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Naja Hulvej
authors.initials: NH
authors.lastname: Rod
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D001835:Body Weight; D005260:Female; D005387:Finland / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016017:Odds Ratio; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology*; D012907:Smoking; D055815:Young Adult
keywords: Impaired sleep; behaviour changes; health-related behaviours; mechanisms