Sleep duration and its associations with depressive, anxiety, PTSD symptoms, and psychotic-like experiences in young people: a household-based epidemiological study in Hong Kong.

Introduction Previous studies have shown sleep duration associated with racism, but few studies have examined population-level data and how these relationships differentiate across race/ethnicity groups. Methods Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) was used. The BRFSS is a state-based population survey conducted annually by the CDC. In 2022, 25 states collected data on perceived discrimination (N=144.267), which was assessed with the question: “Within the past 12 months, do you feel that in general you were treated worse than, the same as, or better than people of other races?” As well as the same question regarding treatment at work and when seeking healthcare, and whether individuals experienced physical symptoms due to race-based treatment. Response options were Same (reference), Better, or Worse. Habitual sleep duration was categorized as <=4h, 5h, 6h, 7h (reference), 8h, 9h, and 10+h. Sleep-by-race/ethnicity interactions were explored. Models were adjusted for age, sex, education, and depression, and were population-weighted. Results Decreased likelihood of perceived better treatment was associated with <=4h, 5h, 6h, and 8h, increased likelihood of worse treatment was associated with <=4h, 5h, and 6h, and decreased likelihood was associated with 8h and 9h. Sleep-by-race/ethnicity interaction was significant (p< 0.0001). In stratified analyses, among Non-Hispanic Whites, insufficient and excessive sleep were both associated with perceived racism. Among Blacks/African-Americans, longer sleep duration was associated with perceived better treatment and insufficient sleep was associated with worse treatment. Among Hispanics/Latinos, 9h sleep was associated with perceived better treatment, but insufficient sleep was associated with worse treatment. Among Asians, worse treatment was associated with 10+h only. Among American Indians/Alaskan Natives, worse treatment was associated with all categories of insufficient sleep. Similar sleep-by-race/ethnicity interactions were found for treatment in work (p< 0.0001) and healthcare settings (p< 0.0001). Although no sleep-by-race/ethnicity interaction was found, physical symptoms due to treatment based on race was associated with <=4h (OR=2.28), 5h (OR=1.93), and 6h (OR=1.27). Conclusion Insufficient (and in some cases excessive) sleep duration is associated with increased perceived discrimination across groups and settings, though groups differ in terms of degree of impact. Insufficient sleep is also associated with increased physical symptoms due to racism. Support (if any)

Introduction Insufficient and excessive sleep have both been linked to increased cardiovascular and all-cause mortality. Whilst the relationship between sleep duration and traditional lipid indices are well described, the connection to novel lipid and anthropometric indices remains unclear. This study examines these associations using the National Health and Nutrition Examination Survey (NHANES). Methods Data from 9847 adults from NHANES 2005-2020, excluding those with major cardiovascular disease and cancer, were analysed. Sleep duration was categorized as insufficient (<7hours), normal (7-8hours), and excessive (>8 hours). Self-reported sleep disturbance was documented. Novel indices included non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), Triglyceride to HDL-Cholesterol (TG/HDL), Triglyceride-glucose index (TyG), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Conicity Index (CI), Body-roundness index (BRI), A body shape index (ABSI), and Weight-adjusted waist index (WWI). Generalized additive models (GAM) with spline smoothing and threshold analysis assessed non-linear associations, adjusting for confounders. Weighted multivariate linear regression evaluated linear associations. Results Insufficient sleep was associated with higher TyG combined with waist-to-height ratio (TyG-WHtR) (p=.003). Excessive sleep was linked to higher TyG-WHtR, CI, BRI, ABSI, and WWI (p<.001). Sleep disturbance was associated with elevated TyG-WHtR, TyG-WC, LAP, CI, BRI, ABSI, and WWI (p<.001). Threshold analysis confirmed significant changes in several indices, emphasising the impact of both insufficient and excessive sleep. Discussion Insufficient sleep duration, excessive sleep duration, and sleep disturbance, are associated with adverse lipid and anthropometric profiles indicating increased cardiometabolic risk. Optimising sleep duration and minimising sleep disturbance could mitigate these risks.

Sleep disorders and sleep deficiency are important causes of adverse health effects and increased mortality in the United States and worldwide. Sleep deficiency can also result in myriad adverse behavioral consequences, including profound sleepiness, cognitive slowing, automatic behavior, attentional failures and performance degradation, errors, and accidents. It is important to recognize that sleepiness and sleep deficiency are not synonymous.

The aim of this study was to estimate the association between insufficient sleep and prescription opioid misuse among US high school students. Participants were 6,884 high school students who self-reported on sleep duration and prescription opioid misuse in the 2019 Youth Risk Behavior Survey. Sleep duration was categorized by the Youth Risk Behavior Survey according to the American Academy of Sleep Medicine guidelines as follows: recommended sleep duration (8-9 hours) vs insufficient sleep (< 8 hours). Participants also reported whether they had any prescription opioid misuse during their lifetime and whether they had prescription opioid misuse within the past 30 days. Most (79.4%) participants reported sleeping less than 8 hours per night. Among all youth, 12.9% reported lifetime prescription opioid misuse and 6.2% reported current prescription opioid misuse. Prevalence of both lifetime and current opioid medication misuse was higher among those also reporting insufficient sleep compared to those reporting recommended sleep duration (14.3% vs 7.7%, P < .0001 for lifetime misuse and 6.6% vs 4.3%, P = .0091 for current misuse). In multivariate models, insufficient sleep was associated with an increased odds of lifetime prescription opioid misuse (adjusted odds ratios = 1.4; 95% confidence interval, 1.1-1.2; P = .006); however, we did not find an association between sleep duration and current prescription opioid misuse in multivariate analysis. Sleep duration is associated with lifetime opioid misuse among US youth. Longitudinal studies are needed to test whether causal relationships exist, and to understand biobehavioral mechanisms that underlie associations between sleep deficiency and opioid misuse in adolescents. Groenewald CB, Rabbitts JA, Tham SW, Law EF, Palermo TM. Associations between insufficient sleep and prescription opioid misuse among high school students in the United States. J Clin Sleep Med. 2021;17(11):2205-2214.

The joint effect of electronic cigarette smoking and insufficient sleep duration on cardiovascular disease (CVD) was unclear. This cross-sectional study aimed to evaluate the association between electronic cigarettes, sleep duration, and risk of CVD among American adults. The participants who completed the survey from the behavioral risk factor surveillance system in 2020 were included in this study. The status of electronic cigarette smoking was divided into never, former, and current use. The duration of sleep was categorized into insufficient (<6 h), appropriate (6–9 h), and excessive (>9 h) groups. The CVD group was defined as a patient having any of the following conditions: heart attack, coronary heart disease, or stroke according to self-report. The multivariate logistic regression model was adopted to determine the association between electronic cigarettes, sleep duration, and the risk of CVD. Sensitivity analyses were performed to assess the joint effects on the risk of CVD subtypes, including heart attack, coronary heart disease, and strokes, respectively. Subgroup analyses were performed to estimate the joint effects within the stratum of the age group. The total number of participants included in the present study was 253,561. Of which, 22,908 patients had CVD. In total, 61,293 participants had previously or currently used electronic cigarettes and 37,429 participants had inappropriate sleep duration. Former electronic cigarette users had a 10.8% increased risk of having CVD (OR = 1.108, 95% CI: 1.001–1.227) compared to users who never had electronic cigarettes. Insufficient and excessive sleep durations are associated with increased risks of CVD (OR = 1.592, 95% CI: 1.460–1.735; OR = 1.523, 95% CI: 1.320–1.758). The participants with current vaping status and lack of sleep had a 159.6% increased risk of CVD (OR = 2.596, 95% CI: 1.810–3.723). Sensitivity analyses found similar joint effects of current vaping and insufficient sleep on the risk of heart attack, coronary heart attack, and stroke. The subgroup analyses across each age stratum found that the middle-aged group is most vulnerable to the joint effect of current vaping and insufficient sleep. This study found that both current vaping and inappropriate sleep duration were associated with CVD. Additionally, there was a significant joint effect of current vaping and insufficient sleep on the risk of CVD, especially for middle-aged participants.

Background: In 2022, the American Heart Association (AHA) updated the list of modifiable lifestyle factors most important for cardiovascular health to include sleep. Sleep disturbances, such as insomnia and sleep apnea, have been associated with an increased risk of incident cardiovascular disease (CVD). However, the relationship between sleep duration and mortality remains to be fully elucidated. Methods: We used National Health and Nutrition Examination Survey (NHANES) data linked to National Death Index records to examine the association between sleep duration and CVD and all-cause mortality. A representative sample of 37,975 adults aged ≥20 years participated in the survey, which included assessments of social, behavioral, and metabolic factors, including usual weekday sleep duration. Sleep duration was categorized as (1) ideal (6-&lt;9 hours); (2) insufficient (&lt;6 hours); and (3) excessive (≥9 hours). Cox proportional hazards regression models were used to determine the relationship between sleep duration and CVD and all-cause mortality. Models were adjusted for age, sex, and race. Results: Over an average of 7.5 years of follow-up, 2,406 CVD deaths were confirmed. In adjusted models, compared to ideal sleep duration (6-&lt;9 hours), excessive sleep (≥9 hours) was associated with a 65% increase in CVD mortality (HR = 1.65; 95% CI: 1.39, 1.96), a 53% increase in cerebrovascular disease mortality (HR = 1.53; 95% CI: 1.22, 1.92), and a 52% increase in all-cause mortality (HR = 1.52; 95% CI: 1.40, 1.66). Insufficient sleep (&lt;6 hours) was associated with a 38% increase in CVD mortality (HR = 1.38; 95% CI: 1.08, 1.75) and a 54% increase in all-cause mortality (HR = 1.54; 95% CI: 1.38, 1.71). Conclusion: We found that both insufficient and excessive sleep were associated with increased risk of CVD and all-cause mortality, and the risk was more pronounced for excessive sleep. These findings emphasize the importance of recognizing sleep as a modifiable risk factor for CVD. Further research is needed to explore the relationship between sleep and CVD, including incorporating sleep quality into risk assessments and defining clinically meaningful categorizations of sleep metrics.

Cohort studies about the sleep duration on the risk of death among Chinese older adults are still lacking. The aim of this study was to examine whether extremely long or short sleep duration was associated with mortality in Chinese adults aged 65 years or older. We included participants aged 65 years or older in 2011 at baseline in 23 provinces from the Chinese Longitudinal Healthy Longevity Survey who were followed up in 2014/2018 in China. Sleep duration was categorized as short sleep duration (< 7 hours) and long sleep duration (> 8 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and mortality. Among 9578 participants, short sleep duration was associated with an 11% higher risk of death (adjusted hazard ratio [aHR]: 1.11; 95% confidence interval [CI]: 1.02-1.20) and long sleep duration was associated with a 24% higher risk of death (aHR: 1.24; 95% CI: 1.15-1.34), after adjustment for all covariates. There was a U-shaped association between sleep duration and all-cause mortality (nonlinear, P < .0001). Stratified analyses showed that the risk was higher among older people who smoked and with a higher level of education both for short and long sleepers than for those who never smoked and were illiterate (P value for interaction < .05). There was a U-shaped association between sleep duration and all-cause mortality in Chinese older adults, especially in more educated individuals and smokers. Du M, Liu M, Liu J. The association between sleep duration and the risk of mortality in the Chinese older adults: a national cohort study. J Clin Sleep Med. 2021;17(9):1821-1829.

Associations of weekend compensatory sleep and weekday sleep duration with psychotic-like experiences among Chinese adolescents.

Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes

The study aimed to discuss the association between sleep duration and the risk of hyperhomocysteinemia (Hhcy). This cross-sectional study included 4173 adults (≥ 20 years) from the National Health and Nutrition Examination Survey 2005–2006. According to their sleep duration, participants were divided into five subgroups. Multivariate logistic regression analysis models and restrictive cubic spline regressions were used to explore the association between sleep duration and the risk of Hhcy. Compared with the participants who sleep 7 h, sleep deprivation (≤ 5 h) increased the risk of Hhcy, odds ratio (OR) 1.68 (95% confidence interval (CI) 1.06–2.68); Excessive sleep (≥ 9 h) also increased the risk of Hhcy, OR 1.86 (95% CI 1.09–3.14) after adjusting for a series of confounding factors in the entire population. The risk of Hhcy was distributed in a U-shape with sleep duration. Similar results were demonstrated in obese populations. The association between sleep duration and the risk of Hhcy is U-shaped. Both sleep deprivation and excessive sleep can increase the risk of Hhcy.

The purpose of the present study was to examine the relationship between long sleep duration and functional capacities. We conducted a cross-sectional study at the Department of Kinanthropology at the University of Quebec at Montreal. Forty eight non-frail postmenopausal women aged between 49 to 75 years were recruited using advertisements in local papers. Body weight, body mass index, fat mass, skeletal muscle mass, number of steps per day, SF-36 total (healthy questionnaire), resting metabolic rate, total energy intake, sleep duration, knee extensor strength (dynamometer), chair stand test and balance opened eyes test were measured. WE FOUND A SIGNIFICANT NEGATIVE CORRELATION BETWEEN HOURS OF SLEEP AND FUNCTIONAL CAPACITY: chair stand test (r = -0.33, p = 0.02), balance opened eyes test (r = -0.45, p = 0.001), muscle strength (r = -0.43, p = 0.002) and skeletal muscle mass (r = -0.39, p = 0.007). In addition, long sleepers (> 9 h) had significantly lower values for skeletal muscle mass (p = 0.03), muscle strength (p = 0.01), chair stand test (p = 0.03), and balance opened eyes test (p = 0.001). Finally, linear regression analysis showed that sleep duration was an independent predictor of the chair stand test (p = 0.024), balance opened eyes test (p = 0.001), and muscle strength (p = 0.035) in our cohort. Long sleepers were associated with lower functional capacities in our cohort of sedentary postmenopausal women.

Whether short or insufficient sleep are risk factors for new-onset nocturnal gastroesophageal reflux (nGER). In this 10-year longitudinal study, adult general-population women in Uppsala, Sweden, answered questionnaires on sleep, nGER, and other conditions on 2 occasions. Participants at baseline totaled 6,790, while participants at follow-up totaled 4,925. "Short sleep" was defined as sleeping < 6 hours/night and "insufficient sleep" was defined as reporting an average actual sleep duration below 80% of the self-estimated need for sleep duration but without "short sleep." nGER was defined as reporting heartburn or acid reflux after going to bed sometimes, often, or very often. The confounding factors-age, body mass index, physical activity, caffeine intake, smoking habits, alcohol dependence, depression, anxiety, and snoring-were defined from the questionnaire. At baseline, 839 participants reported short sleep and 1,079 participants were defined as having insufficient sleep. Both participants with insufficient sleep and short sleep had nGER more often than those with sufficient sleep (26% vs 17% vs 10%, respectively). At follow-up, a new onset of nGER was twice as common among those with insufficient or short sleep at baseline and follow-up, compared with those with sufficient sleep at baseline and follow-up, even after adjusting for confounding factors (odds ratio 2.0 [1.5-2.8], P < .001). Insufficient sleep and short sleep are associated with nGER. Persistent insufficient and/or short sleep independently increases the risk of developing nGER over a 10-year follow-up. Women seeking treatment for nGER should be questioned about their sleep habits to identify insufficient sleep as a possible causative factor. Emilsson OI, Al Yasiry H, Theorell-Haglöw J, Ljunggren M, Lindberg E. Insufficient sleep and new onset of nocturnal gastroesophageal reflux among women: a longitudinal cohort study. J Clin Sleep Med. 2022;18(7):1731-1737.

ObjectiveAdequate sleep is an important factor for maintaining good health among children. However, there have been few studies reporting on the association of sleep duration with breakfast intake frequency. This study examined the prevalence of nocturnal sleep duration among Saudi children and its association with breakfast intake, screen time, physical activity levels and socio-demographic variables.MethodsA multistage stratified cluster random sampling technique was used to select 1051 elementary school children in Riyadh. Weight and height were measured and body mass index was computed. The sleep duration, daily breakfast intake frequency, socio-demographic and lifestyle behaviors were assessed using a specifically designed self-reported questionnaire filled by the children’s parents.ResultsOver 71% of the Saudi school children did not attain the recommended sufficient sleep duration at night. Results of logistic regression analysis, adjusted for confounders, exhibited significant associations between longer sleep duration and younger age (aOR=1.12, p=0.046), being female (aOR=1.39, p=0.037), higher father educational levels, daily breakfast intake (aOR=1.44, p=0.049) and lower screen time (aOR for >2 hrs/day=0.69, p=0.033). However, no significant (p> 0.05) association was found for mother education, family income, number of family member in the house, overweight/obesity, or physical activity levels.ConclusionThe prevalence of insufficient nocturnal sleep among Saudi children was high. Insufficient sleep was associated with breakfast and several important socio-demographic and lifestyle behaviors. The findings of this study support the development of interventions to prevent insufficient sleep and help Saudi children improve their sleeping habits.

ObjectiveHerein, we purposed to explore the association of sleep duration with chest pain among adults in US.MethodsThis research work enrolled 13,274 subjects in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. The association of sleep duration with chest pain among adults in US was evaluated by Multivariable logistic regression.ResultsTo elucidate the association, we made adjustments for gender, BMI, diabetes, smoking status, drinking status, race, marital status, annual family income, hyperlipoidemia, Hypertension. Chest pain incidence decreased by 5% [OR = 0.95 (0.93, 0.98), p = 0.0004] for an increase in sleep duration by 1 h. A generalized additive model (GAM) was used to reseal a U-shaped relationship of sleep duration with incident chest pain. When duration of sleep was <6.5 h, chest pain incidence negatively correlated to sleep duration [OR = 0.77 (0.72, 0.82) P < 0.0001]. However, when sleep duration was ≥6.5 h, chest pain incidence rose with escalating sleep duration [OR = 1.07 (1.03, 1.11) p = 0.0014].ConclusionsDuration of sleep was established to be independently linked with an increase in the occurrence of chest pain. Excessive sleep, as much as insufficient sleep, increases the risk of chest pain. Both excessive sleep and insufficient sleep are associated with an increased risk of chest pain.

Introduction Short sleep duration is linked to increased psychiatric risks, yet the protective role of subjective sleep sufficiency in short sleepers remains unclear. This study examines how reported sleep duration and subjective sleep sufficiency influence anxiety, depression, and fatigue in a Korean adult population. Methods Data from 2,492 participants in the Korean Sleep Headache Study were analyzed (age range: 19-92, mean 47.9 ± 16.4yrs, 49.6% male). Reported sleep duration was classified as inadequate (&amp;lt; 7 hours) or adequate (≥7 hours) based on weighted weekly averages from the Korean Munich Chronotype Questionnaire. Subjective sleep sufficiency was assessed via the question, “Do you think you are getting enough sleep at night?” with responses categorized as “sufficient” or “insufficient.” Anxiety, depression, and fatigue were defined using Generalized Anxiety Disorder-7 (≥10), Patient Health Questionnaire (≥10), and Fatigue Severity Scale (≥36), respectively. Logistic regression analyses, adjusting for sociodemographic, lifestyle, and sleep quality covariates, were performed to evaluate the associations between reported sleep duration and sufficiency on anxiety, depression, and fatigue. Results Participants reported inadequate sleep in 42.87% and insufficient sleep in 56.11%. Inadequate sleep duration was significantly associated with higher odds of anxiety and fatigue (OR [95% CI], 4.13 [1.75-11.41], p=0.003, and 1.33 [1.12-1.61], p= 0.002, respectively), while insufficient sleep was significantly associated only with fatigue (1.43 [1.18-1.72], p&amp;lt; 0.001). Depression was not significantly associated with either. Participants were categorized into sufficient adequate sleep (26.67%), insufficient adequate sleep (30.46%), sufficient inadequate sleep (17.22%), and insufficient inadequate sleep (25.65%). Notably, insufficient inadequate sleepers had the highest odds of anxiety (3.92 [1.24-17.42], p=0.036) and fatigue (1.89 [1.46-2.45], p&amp;lt; 0.001) compared to sufficient adequate sleepers, followed by insufficient adequate sleepers (1.48 [1.16-1.89], p=0.002) and sufficient inadequate sleepers (1.40 [1.06-1.86], p=0.018) for fatigue. For depression, insufficient inadequate sleepers showed slightly higher odds (1.22 [0.80-1.85], p=0.354), though this was not statistically significant. Conclusion Inadequate sleep duration and insufficient subjective sleep may exacerbate on daytime symptoms such as anxiety and fatigue. While sufficient subjective sleep may mitigate the impact of short sleep, particularly on fatigue, securing adequate sleep remains essential for managing mood and fatigue. Support (if any)