Abstract
BackgroundAlthough lifestyle factors such as cigarette smoking, excessive drinking, obesity, low or no exercise, and unhealthy dietary habits have each been associated with inadequate sleep, little is known about their combined effect. The aim of this study was to quantify the overall impact of lifestyle-related factors on non-restorative sleep in the general Japanese population.Methods and FindingsA cross-sectional study of 243,767 participants (men, 39.8%) was performed using the Specific Health Check and Guidance System in Japan. A healthy lifestyle score was calculated by adding up the number of low-risk lifestyle factors for each participant. Low risk was defined as (1) not smoking, (2) body mass index<25 kg/m2, (3) moderate or less alcohol consumption, (4) regular exercise, and (5) better eating patterns. Logistic regression analysis was used to examine the relationship between the score and the prevalence of non-restorative sleep, which was determined from questionnaire responses. Among 97,062 men (mean age, 63.9 years) and 146,705 women (mean age, 63.7 years), 18,678 (19.2%) and 38,539 (26.3%) reported non-restorative sleep, respectively. The prevalence of non-restorative sleep decreased with age for both sexes. Compared to participants with a healthy lifestyle score of 5 (most healthy), those with a score of 0 (least healthy) had a higher prevalence of non-restorative sleep (odds ratio, 1.59 [95% confidence interval, 1.29–1.97] for men and 2.88 [1.74–4.76] for women), independently of hypertension, hypercholesterolemia, diabetes, and chronic kidney disease. The main limitation of the study was the cross-sectional design, which limited causal inferences for the identified associations.ConclusionsA combination of several unhealthy lifestyle factors was associated with non-restorative sleep among the general Japanese population. Further studies are needed to establish whether general lifestyle modification improves restorative sleep.
Highlights
A combination of healthy lifestyle factors, such as abstaining from smoking, maintaining a body mass index (BMI) of less than 25 kg/m2, consuming alcohol moderately, exercising regularly, and having a healthy diet, is reportedly associated with a significantly reduced risk of developing several diseases, such as coronary heart disease [1,2], type 2 diabetes mellitus [3], stroke [4], sudden cardiac death [5], chronic kidney disease [6], cancer [7,8,9], and total mortality [10]
A combination of several unhealthy lifestyle factors was associated with non-restorative sleep among the general Japanese population
Maintaining an overall healthy lifestyle throughout young adulthood was strongly associated with a low cardiovascular disease risk profile in middle age regardless of sex, race, or a parental history of myocardial infarction, suggesting that genetic factors may not be very important in determining a low risk profile [11]
Summary
A combination of healthy lifestyle factors, such as abstaining from smoking, maintaining a body mass index (BMI) of less than 25 kg/m2, consuming alcohol moderately, exercising regularly, and having a healthy diet, is reportedly associated with a significantly reduced risk of developing several diseases, such as coronary heart disease [1,2], type 2 diabetes mellitus [3], stroke [4], sudden cardiac death [5], chronic kidney disease [6], cancer [7,8,9], and total mortality [10]. Maintaining an overall healthy lifestyle throughout young adulthood was strongly associated with a low cardiovascular disease risk profile in middle age regardless of sex, race, or a parental history of myocardial infarction, suggesting that genetic factors may not be very important in determining a low risk profile [11] Most of these studies were conducted in non-Japanese populations except for a few studies [6,9]; a combination of healthy lifestyle factors may play a prominent role regardless of sex, race, or genetics. Inadequate sleep may modify eating patterns, thereby mediating or contributing to the observed relationship between sleep disturbance and obesity [13] Lifestyle factors such as cigarette smoking, excessive drinking, obesity, low or no exercise, and unhealthy dietary habits have each been associated with inadequate sleep, little is known about their combined effect. The aim of this study was to quantify the overall impact of lifestyle-related factors on non-restorative sleep in the general Japanese population
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