Cross-sectional and Longitudinal Associations Between Objectively Measured Sleep Duration and Body Mass Index: The CARDIA Sleep Study

Department of Health Studies, University of Chicago, Chicago, IL 60637, USA.
American journal of epidemiology (Impact Factor: 5.23). 09/2009; 170(7):805-13. DOI: 10.1093/aje/kwp230
Source: PubMed


Numerous studies have found an association between shorter sleep duration and higher body mass index (BMI) in adults. Most previous studies have been cross-sectional and relied on self-reported sleep duration, which may not be very accurate. In the Coronary Artery Risk Development in Young Adults (CARDIA) Sleep Study (2000-2006), the authors examine whether objectively measured sleep is associated with BMI and change in BMI. They use several nights of wrist actigraphy to measure sleep among participants in an ongoing cohort of middle-aged adults. By use of linear regression, the authors examine whether average sleep duration or fragmentation is associated with BMI and 5-year change in BMI, adjusting for confounders. Among 612 participants, sleep duration averaged 6.1 hours and was grouped into 4 categories. Both shorter sleep and greater fragmentation were strongly associated with higher BMI in unadjusted cross-sectional analysis. After adjustment, BMI decreased by 0.78 kg/m(2) (95% confidence interval: -1.6, -0.002) for each increasing sleep category. The association was very strong in persons who reported snoring and weak in those who did not. There were no longitudinal associations between sleep measurements and change in BMI. The authors confirmed a cross-sectional association between sleep duration and BMI using objective sleep measures, but they did not find that sleep predicted change in BMI. The mechanism underlying the cross-sectional association is not clear.

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    • "Although it has been documented in previous studies that selfreported sleep deprivation is related to obesity in both adults and children [4–7,10,28,29], inconsistent evidence was found between objectively measured sleep duration and obesity [10] [11] [12] [13] [14] [15]. Two studies found significant associations [14] [15], but the majority of the studies reported a lack of association between objectively measured sleep duration and obesity [10] [11] [12] [13]. Thus, some investigators suspected that the link between short sleep duration and obesity may be overrated [30] and confounded by other factors, such as psychological profiles [9]. "
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    ABSTRACT: The objective of this study was to investigate the associations between objectively measured habitual sleep duration (HSD), habitual sleep variability (HSV), and energy and snack intake in adolescents. We used data from 324 adolescents who participated in the Penn State Child Cohort follow-up examination. Actigraphy was used over seven consecutive nights to estimate nightly sleep duration. The seven-night mean and standard deviation of sleep duration were used to represent HSD and HSV, respectively. The Youth/Adolescent Food Frequency Questionnaire was used to obtain the daily average total energy, protein, fat, and carbohydrate intake, and number of snacks consumed. Linear regression models were used to investigate the associations between habitual sleep patterns and caloric, protein, fat, and carbohydrate intake. Proportional odds models were used to associate habitual sleep patterns with snack consumption. After adjusting for age, sex, race, body mass index (BMI) percentile, and smoking status, an increased HSV was associated with a higher energy intake, particularly from fat and carbohydrate. For example, with a 1-h increase in HSV, there was a 170 (66)-kcal increase in the daily total energy intake. An increased HSV was also related to increased snack consumption, especially snacks consumed after dinner. For instance, a 1-h increase in HSV was associated with 65% and 94% higher odds of consuming more snacks after dinner during school/workdays and weekends/vacation days, respectively. Neither energy intake nor snack consumption was significantly related to HSD. High habitual sleep variability, not habitual sleep duration, is related to increased energy and food consumption in adolescents. Maintaining a regular sleep pattern may decrease the risk of obesity in adolescents. Copyright © 2015 Elsevier B.V. All rights reserved.
    Sleep Medicine 03/2015; 16(7). DOI:10.1016/j.sleep.2015.03.004 · 3.15 Impact Factor
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    • "In a metaanalysis of 18 cross-sectional studies, which included a total of >604,000 adults [35], each additional hour of sleep was found to be associated with a pooled β-coefficient for BMI of −0.35 kg/m 2 (95% CI: −0.57, −0.12). Several [6] [7], but not all [36], prospective studies have also reported inverse associations between sleep duration and weight gain. For example, in the Quebec Family Study cohort, individuals sleeping 5–6 h/day gained 1.98 (95% CI: 1.16, 2.82) kg more than those sleeping an average of 7–8 h/day, over a period of 6 years [6]. "
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    ABSTRACT: Objective To examine the association between sleep duration and cardiometabolic risk factors among individuals with recently diagnosed type 2 diabetes (n=391). Methods Sleep duration was derived using a combination of questionnaire and objective heart rate and movement sensing in the UK ADDITION-Plus study (2002-2007). Adjusted means were estimated for individual cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) by five categories of sleep duration. Results We observed a J-shaped association between sleep duration and CCMR – individuals sleeping 7-<8 hours had a significantly better CCMR profile than those sleeping ≥9 hours. Independent of physical activity and sedentary time, individuals sleeping 7-<8 hours had lower triacylglycerol (0.62 mmol/l [0.29, 1.06]) and higher HDL-cholesterol levels (0.23 mmol/l [0.16, 0.30]) compared with those sleeping ≥9 hours, and a lower waist circumference (7.87 cm [6.06, 9.68]) and BMI (3.47 kg/m2 [2.69, 4.25]) than those sleeping <6 hours. Although sleeping 7-<8 hours was associated with lower levels of systolic- and diastolic- blood pressure, HbA1c, total cholesterol and LDL-cholesterol, these associations were not statistically significant. Conclusions Sleep duration has a J-shaped association with CCMR in individuals with diabetes, independent of potential confounding. Health promotion interventions might highlight the importance of adequate sleep in this high risk population.
    Sleep Medicine 10/2014; 16(1). DOI:10.1016/j.sleep.2014.10.006 · 3.15 Impact Factor
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    • "Four longitudinal studies examining associations between sleep and obesity in adults have indicated that there is no association between sleep duration and obesity [20] [21] [22] [23]. In the study by Lauderdale et al. [21], only linear regression was used and this could have made it possible to miss a U-shaped relationship. In the studies by Stranges et al. [20], the participants' baseline age was somewhat higher compared with the present study and, in the study by Appelhans et al. [23], the number of participants was somewhat lower, which could explain the discrepancy between these studies and studies showing longitudinal associations between sleep duration and obesity. "
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    ABSTRACT: Objective: To assess how change in sleep duration is related to subsequent obesity. Methods: In this 10-year follow-up, 4903 non-pregnant participants answered a questionnaire on sleeping habits, obesity, and lifestyle factors (questions identical to baseline questionnaire). Habitual normal sleepers were defined as sleeping 6-9 h/night at both baseline and follow-up, whereas women sleeping <6 h/night or ≥9 h/night at both occasions were defined as habitual short sleepers and habitual long sleepers, respectively. Logistic regression was used to analyze associations between changes in sleep duration, general obesity (body mass index ≥30 kg/m(2)), weight gain (≥10 kg) and also, central obesity (waist circumference ≥88 cm), and increase in waist circumference (≥10 cm) at follow-up. Results: Among younger women (aged <40 years) both habitual short sleepers and habitual long sleepers had a higher prevalence of general (short: 31.3%, P < 0.0001; long: 38.1%, P = 0.01) and central obesity (short: 60.5%, P = 0.01; long: 82.4%, P = 0.01) compared with habitual normal sleepers (general obesity: 8.9%; central obesity: 35.9%) at follow-up. Younger women who were short sleepers at baseline but normal sleepers at the follow-up had a higher prevalence of both general (19.3%, P = 0.01) and central obesity (45.4%, P = 0.07) compared with habitual normal sleepers at follow-up. In adjusted analyses, both habitual short [adjusted odds ratio (aOR), 6.78; 95% confidence interval (CI), 2.71-17.0] and long (aOR, 4.64; 95% CI, 1.09-19.8) sleep durations were risk factors for general obesity in younger women. In younger women habitual long sleep duration was a risk factor also for central obesity (aOR, 6.05; 95% CI, 1.19-30.7) whereas habitual short sleep duration was not (aOR, 1.93; 95% CI, 0.87-4.81). Similar results were seen also for weight gain and increased waist circumference as dependent variables. In addition, decreased sleep duration from normal to short duration was a risk factor for both weight gain (aOR, 1.85; 95% CI, 1.14-3.02) and increased waist circumference (aOR, 1.84; 95% CI, 1.20-2.81). There were no associations between changes in sleep duration and any of the measures of obesity at the follow-up in women aged >40 years at baseline. Conclusion: In younger women, both habitual short and long sleep duration was a risk factor for obesity, whereas no such relationship was seen in older women.
    Sleep Medicine 06/2014; 15(10). DOI:10.1016/j.sleep.2014.02.014 · 3.15 Impact Factor
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