Abstract
We examined whether subjectively and objectively measured sleep health composites have a relationship with heart disease. 6,820 adults (Mage = 53.4 years) from the Midlife in the United States study provided self-reported sleep characteristics and heart disease history. A smaller sample (n = 663) provided actigraphy sleep data. We tested two sleep health composites, based on self-report only and both self-report and actigraphy, across multiple sleep dimensions. We used a weighted sum approach, where higher scores indicated more sleep health problems. Modified Poisson regressions adjusted for sociodemographics and known risk factors. Having more sleep health problems was associated with a higher risk of heart disease using the self-report sleep health composite (aRR = 54%, P < .001) and the actigraphy/self-report composite (aRR = 141%, P < .001). Individual sleep dimensions of satisfaction, alertness, and efficiency (from the self-report composite) and regularity, satisfaction, and timing (from the actigraphy/self-report composite) were associated with the risk of heart disease. The effect size of each sleep health composite was larger than the individual sleep dimensions. Race moderated the association between the actigraphy/self-report sleep health composite and heart disease. There was no significant moderation by sex. Findings suggest poorer sleep health across multiple dimensions may contribute to heart disease risk among middle-aged adults.
Highlights
We examined whether subjectively and objectively measured sleep health composites have a relationship with heart disease. 6,820 adults (Mage = 53.4 years) from the Midlife in the United States study provided self-reported sleep characteristics and heart disease history
Each unit increase in poor sleep health was associated with 54% higher risk of heart disease (B = 0.43, SE = 0.09, 95% CI [0.26, 0.60], aRR = 1.54, P < .001) (Fig. 2, Panel 1)
For the actigraphy/self-report sleep health composite, each unit increase in poor sleep health was associated with 141% higher risk of heart disease (B = 0.88, SE = 0.22, 95% CI [0.44, 1.32], aRR = 2.41, P < .001), after adjusting for all covariates (Fig. 2, Panel 2)
Summary
Examining the degree of multidimensional sleep health and its association with the risk of heart disease is important in research on middle-aged adults, as multiple sleep problems may be prevalent in this p opulation[8]. (based on both self-report and actigraphy) in middle adulthood has been studied in relation to cardiometabolic outcomes, such that poorer sleep health is associated with higher odds of hypertension and diabetes[6]. Previous research has used different sleep measures to understand “sleep health” (e.g.25), making it difficult to provide a consistent guideline for research and practical settings To address these gaps, we operationalize two different sleep health composites in middle-aged adults and link them to the risk of physician-diagnosed heart disease. If results are consistent between two measures, it may suggest that, rather than specific sleep measures, the combination of multiple sleep measures is more important for the risk of heart disease
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