Abstract MP27: The Association Between Psychosocial Factors and Sleep Among African-American Men and Women, the Jackson Heart Sleep Study

Abstract

Background: Emerging evidence suggests that sleep traits and disorders are strong predictors of cardiovascular disease (CVD), particularly among African-Americans. Identifying determinants of insufficient sleep among African-Americans may help to target interventions and potentially reduce CVD burden. Psychosocial factors may be particularly relevant to sleep health among African-Americans; however, more research is needed using objective and well-validated sleep assessments. We investigated associations of individual and aggregate psychosocial factors (e.g. stress, depression, anxiety) with objectively-measured sleep traits and insomnia; and examined differences by sex among African-Americans. Methods: Between 2012 and 2016, Jackson Heart Sleep Study (JHSS) participants (N=913) underwent 7-day wrist actigraphy, had a clinic visit and completed questionnaires. Actigraphy-based measures included short sleep duration (<6 hours), low sleep efficiency (< 85%), and wake after sleep onset (WASO). Insomnia was assessed by the Women’s Health Initiative Insomnia Rating Scale (WHIIRS ≥10). A composite psychosocial factors variable was created based on the number of high-level factors that the participant reported: top quintile of stress (Perceived Stress Scale ≥ 18), high depressive symptoms (Center for Epidemiologic Studies Depression Scale-20, excluding restless sleep, ≥ 16), and top quintile of anxiety (State-Trait Anxiety Inventory score ≥ 38). Linear and logistic regression models were fit to test associations between psychosocial factors and sleep outcomes, adjusted for demographics, socioeconomic status, body mass index (BMI), and physical activity. Psychosocial factors and sex interactions were tested in adjusted models. Results: JHSS participants had a mean age of 63.4 years (standard deviation: 10.7), 33.6% were male, 53.6% had a college degree and the mean BMI was 31.9 kg/m 2 (6.9). Short sleep and low sleep efficiency were common, 26.1% and 30.0%, respectively. The average WASO was 54.5 (23.5) minutes. Psychosocial factors (composite and individually) were associated with insomnia. Adverse psychosocial factors were associated with a higher odds of insomnia, adjusted odds ratio (aOR)=1.65 (95% confidence interval: 1.39, 1.95). High anxiety, but not stress or depressive symptoms were associated with a short sleep duration, aOR=2.00 (1.34, 2.98). There was no evidence of associations between psychosocial factors and sleep efficiency or WASO in the overall sample. However, in males only, high anxiety and stress were associated with lower sleep efficiency, P ≤0.05 for all. Conclusion: Stress and negative emotional state, anxiety and depressive symptoms were associated with insomnia. Short sleep duration was specifically associated with anxiety. Psychosocial factors may be a point of intervention for improving sleep health, particularly among men.