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Habitual sleep duration associated with self-reported and objectively determined cardiometabolic risk factors
Open accessAbstract
Background Self-reported short and/or long sleep duration have been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodological issues. Methods Adult respondents of the 2007-2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N=5,649). Self-reported sleep duration was categorized as very short (<5hrs), short (5-6hrs), normal (7-8hrs) or long (≥9hrs). Obesity, diabetes, hypertension, and hyperlipidemia were assessed by self-reported history and objectively. Statistical analyses included univariate comparisons across sleep duration categories for all variables. Binary logistic regression analyses, cardiometabolic factor as outcome and with sleep duration category as predictor, were assessed with and without covariates. Observed relationships were further assessed for dependence on race/ethnicity. Results In adjusted analyses, very short sleep was associated with self-reported hypertension (OR=2.02, 95%CI[1.45, 2.81], p<0.0001), self-reported hyperlipidemia (OR=1.96, 95%CI[1.43, 2.69], p<0.0001), objective hyperlipidemia (OR=1.41, 95%CI[1.04, 1.91], p=0.03), self-reported diabetes (OR=1.76, 95%CI[1.13, 2.74], p=0.01), and objective obesity (OR=1.53, 95%CI[1.13, 2.06], p=0.005). Regarding short sleep (5-6hrs), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR=1.22, 95%CI[1.02, 1.45], p=0.03) self-reported obesity (OR=1.21, 95%CI[1.03, 1.43], p=0.02) and objective obesity (OR=1.17, 95%CI[1.00, 1.38], p<0.05). Regarding long sleep (≥9hrs), no elevated risk was found for any outcomes. Interactions with Race/Ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among Blacks/African-Americans and the relationship between short sleep and hypertension is strongest among non-Hispanic Whites, Blacks/African-Americans, and non-Mexican Hispanics/Latinos. Conclusions Short sleep duration is associated with self-reported and objectively-determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.
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TL;DR
In 2007–2008 NHANES adults, very short sleep (<5 h) was associated with several self-reported and objectively determined cardiometabolic risk factors after adjustment, while long sleep (≥9 h) showed no elevated risk. These patterns varied by race/ethnicity.
Key findings
- Very short sleep (<5 h) was associated in adjusted analyses with self-reported hypertension (OR=2.02, 95%CI[1.45, 2.81]), self-reported hyperlipidemia (OR=1.96, 95%CI[1.43, 2.69]), objective hyperlipidemia (OR=1.41, 95%CI[1.04, 1.91]), self-reported diabetes (OR=1.76, 95%CI[1.13, 2.74]), and objective obesity (OR=1.53, 95%CI[1.13, 2.06]).
- Short sleep (5–6 h) was associated in adjusted analyses with self-reported hypertension (OR=1.22, 95%CI[1.02, 1.45]), self-reported obesity (OR=1.21, 95%CI[1.03, 1.43]), and objective obesity (OR=1.17, 95%CI[1.00, 1.38]).
- Long sleep (≥9 h) showed no elevated risk for any outcomes after adjustment; elevated risk was found only for objective diabetes in unadjusted analyses.
- Race/ethnicity interactions were significant for self-reported and objective hypertension, hyperlipidemia, diabetes, and obesity (p-values from <0.0001 to 0.007); for example, the very-short-sleep–obesity relationship was strongest among Blacks/African-Americans, and the short-sleep–hypertension relationship was strongest among non-Hispanic Whites, Blacks/African-Americans, and non-Mexican Hispanics/Latinos.
Methods
- Cross-sectional analysis of 2007–2008 US National Health and Nutrition Examination Survey (NHANES) adult respondents ages 18–80+ years with complete data (N=5,649), using census-weighted, nationally representative data.
- Self-reported sleep duration was categorized as very short (<5 h), short (5–6 h), normal (7–8 h; reference), or long (≥9 h).
- Outcomes were self-reported and objective hypertension, hyperlipidemia, diabetes, and obesity; analyses used chi-square tests and binary logistic regression with and without covariates, plus race/ethnicity interaction and stratified analyses in STATA/SE 12.
Limitations
- The paper states that the cross-sectional design cannot infer causality; self-reported integer sleep duration may cause misclassification and attenuate associations; prospective diary and actigraphy would be better; extreme sleepers represent a small population subset; BMI does not capture central adiposity or some relevant factors, and residual confounding may exist.
- The paper notes that race/ethnicity stratified analyses reduce statistical power, especially in less populous groups.
- The text makes evident that self-reported versus objective outcome discrepancies may reflect recall bias, social desirability, state-dependent factors, or measurement error in the sleep duration item.
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In the paper
“Among Asian/other respondents, elevated risk for self-reported and objective hyperlipidemia were found for very short sleep.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Race/Ethnicity Interactions
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In the paper
“objective hyperlipidemia among long sleepers”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Race/Ethnicity Interactions
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In the paper
“Regarding long sleep (≥9hrs), elevated risk was found only for objective diabetes, in unadjusted analyses only.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Characteristics of the Sample
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In the paper
“elevated risk was seen for self-reported hypertension (OR=1.22, 95%CI[1.02, 1.45], p=0.03)”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > Abstract > Results
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In the paper
“the relationship between short sleep and hypertension is strongest among non-Hispanic Whites, Blacks/African-Americans, and non-Mexican Hispanics/Latinos.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > Abstract > Results
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In the paper
“Interactions with Race/Ethnicity were significant for all outcomes”
- Also stated in: § Race/Ethnicity Interactions · plain
“In adjusted models, significant interactions between sleep duration category and race/ethnicity were found for self-reported hypertension (p<0.0001), objective hypertension (p<0.0001), self-reported hyperlipidemia (p=0.007), objective hyperlipidemia (p=0.005), self-reported diabetes (p=0.001), objective diabetes (p=0.0003), self-reported obesity (p<0.0001), and objective obesity (p=0.0001).”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > Abstract > Results
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In the paper
“Regarding diabetes, associations with very short sleep were seen most clearly among non-Hispanic Whites, and not other groups.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Interactions by Race/Ethnicity
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In the paper
“Long sleep was not found to be associated with risk factors., especially after adjustment.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION
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In the paper
“self-reported obesity (OR=1.21, 95%CI[1.03, 1.43], p=0.02)”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > Abstract > Results
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In the paper
“Short sleep duration is associated with obesity.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Sleep Duration and Obesity
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- It may state two separate claims as one. 17
- The quote only partly states this claim. 1
- Probably not a substantial claim. 11
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“for non-Hispanic white respondents, elevated risk was found for self-reported hypertension, self-reported hyperlipidemia, objective hyperlipidemia, and self-reported diabetes among very short sleepers”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Race/Ethnicity Interactions
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In adjusted analyses, all relationships except objective hypertension persisted.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Characteristics of the Sample
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For Mexican-Americans, elevated risk of self-reported hypertension and self-reported obesity were found for short sleep and decreased self-reported hyperlipidemia was seen in long sleep.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Race/Ethnicity Interactions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For black/African-American respondents, elevated risk of self-reported hypertension, self-reported obesity, and objective obesity were found for very short sleep.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Race/Ethnicity Interactions
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In the paper
“For other Hispanic/Latino respondents, elevated risk of self-reported hypertension was found for very short sleep and objective diabetes for short sleep.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Race/Ethnicity Interactions
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In the paper
“The present study found that only very short sleep associated with elevated diabetes risk when measured using the standard survey question. When an objective determination was used, elevations were not found.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Sleep Duration and Diabetes
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In the paper
“The results of the present study extend the later findings; for all outcomes except objective diabetes, the relationship between sleep duration and cardiometabolic disease differed by race/ethnicity.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Interactions by Race/Ethnicity
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In unadjusted analyses, short sleep (5-6hrs) was associated with elevated risk was seen for self-reported and objective hypertension and self-reported and objective obesity.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Characteristics of the Sample
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After adjustment for covariates, significant relationships remained for self-reported hypertension, self-reported and objective hyperlipidemia, self-reported diabetes, and objective obesity. All other variables were attenuated to trends (p<0.10).”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > RESULTS > Characteristics of the Sample
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In the paper
“the relationship between very short sleep and self-reported hypertension was seen for all groups except Mexican-Americans and Asians/Others, with the strongest effect seen among Other Hispanics/Latinos.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Interactions by Race/Ethnicity
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In the paper
“Very short sleep (<5hrs) was most strongly associated with the widest range of adverse outcomes, followed by short sleep (5-6hrs).”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION
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In the paper
“statistical controls for differential effects of race/ethnicity”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > INTRODUCTION
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In the paper
“Our distribution of sleep duration values is consistent with that reported by other cohorts.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Study Limitations
What the sources say
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Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Small-scale experimental studies have shown that short-term sleep deprivation may lead to metabolic dysregulation[29-34], elevated inflammation[35, 36], and elevated blood pressure[37].”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > INTRODUCTION
What the sources say
- Not checked yetcites [29] Schmid SM Hallschmid M Jauch-Chara K Wilms B Lehnert H Born J Disturbed glucoregulatory response to food intake after moderate sleep restriction. Sleep 2011 34 371 7 21358855 PMC3041714 source
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- Not checked yetcites [35] Faraut B Boudjeltia KZ Vanhamme L Kerkhofs M Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery. Sleep Med Rev 2012 16 137 49 21835655 source
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Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“hypertension[2, 13, 14]”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > INTRODUCTION
What the sources say
- Not checked yetcites [2] Altman NG Izci-Balserak B Schopfer E Jackson N Rattanaumpawan P Gehrman PR Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes. Sleep Med 2012 13 1261 70 23141932 PMC3527631 source
- Not checked yetcites [13] Mezick EJ Hall M Matthews KA Sleep duration and ambulatory blood pressure in black and white adolescents. Hypertension 2012 59 747 52 22275538 PMC3314491 source
- Not checked yetcites [14] Kim SJ Lee SK Kim SH Yun CH Kim JH Thomas RJ Genetic association of short sleep duration with hypertension incidence. Circ J 2012 76 907 13 22322875 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This suggests that although these relationships are likely to exist within the population, they are most relevant for only a small subset of the general population.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Study Limitations
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None of the sources cited for this claim have been checked yet.
In the paper
“Epidemiologic studies, while typically more generalizable, carry methodological limitations such as inconsistent definitions of ‘short’ and ‘long’ sleep duration categories, inconsistent assessments (e.g., differently-worded survey items)[17], variable measurement techniques (e.g., diaries, actigraphy, polysomnography)[38], and occasionally non-representative samples”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > INTRODUCTION
What the sources say
- Not checked yetcites [17] Grandner MA Patel NP Gehrman PR Perlis ML Pack AI Problems associated with short sleep: Bridging the gap between laboratory and epidemiological studies. Sleep Med Rev 2010 14 239 47 19896872 PMC2888649 source
- Not checked yetcites [38] Lauderdale DS Knutson KL Yan LL Liu K Rathouz PJ Self-reported and measured sleep duration: how similar are they? Epidemiology 2008 19 838 45 18854708 PMC2785092 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“the data used in the following analyses were also weighted to control for representativeness, by following the procedures outlined in the current NHANES Analytic and Reporting Guidelines[52].”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > METHODS > Data Source
What the sources say
- Not checked yetcites [52] Centers for Disease Control and Prevention Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES) 2006 National Center for Health Statistics Hyattsville, MD
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These data were not collected for NHANES, and nor were data regarding menopausal status, menstrual cycle phase or use of hormone replacement therapy.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Study Limitations
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In the paper
“the number of covariates entered into the analyses was limited to mitigate reporting bias and to avoid the creation of models that were over-controlled.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > METHODS > Data Source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“The present study is limited to a cross-sectional analysis on prevalent subclinical disease and cannot make inferences of causality.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Study Limitations
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None of the sources cited for this claim have been checked yet.
In the paper
“previously established categories of self-reported sleep duration[2, 17, 47, 48]”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > INTRODUCTION
What the sources say
- Not checked yetcites [2] Altman NG Izci-Balserak B Schopfer E Jackson N Rattanaumpawan P Gehrman PR Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes. Sleep Med 2012 13 1261 70 23141932 PMC3527631 source
- Not checked yetcites [17] Grandner MA Patel NP Gehrman PR Perlis ML Pack AI Problems associated with short sleep: Bridging the gap between laboratory and epidemiological studies. Sleep Med Rev 2010 14 239 47 19896872 PMC2888649 source
- Not checked yetcites [47] Grandner MA Jackson N Gerstner JR Knutson KL Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample. Appetite 2013 64 71 80 23339991 PMC3703747 source
- Not checked yetcites [48] Grandner MA Buxton OM Jackson N Sands-Lincoln M Pandey A Jean-Louis G Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group. Sleep 2013 36 769 79 23633760 PMC3624831 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Since NHANES limits self-reports of sleep duration to integer values, which likely reflect usual habits in recent times, some misclassification bias may have occurred, which would have mitigated the strength of the associations that were found in the present analysis.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Study Limitations
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- Rests on an assumption: NHANES self-reports of sleep duration, limited to integer values, likely reflect usual habits in recent times.
In the paper
“It is also important to note that race/ethnicity can be recognized as a risk factor for cardiometabolic disease[87].”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Interactions by Race/Ethnicity
What the sources say
- Not checked yetcites [87] Truman BI Smith CK Roy K Chen Z Moonesinghe R Zhu J Rationale for regular reporting on health disparities and inequalities - United States. MMWR Morb Mortal Wkly Rep 2011 60 3 10 21430613
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Since NHANES limits self-reports of sleep duration to integer values, which likely reflect usual habits in recent times, some misclassification bias may have occurred, which would have mitigated the strength of the associations that were found in the present analysis.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > DISCUSSION > Study Limitations
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The NHANES is designed to ensure generalizability to the entire population across all ages.”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > METHODS > Data Source
What the sources say
- Not checked yetcites [51] Centers for Disease Control and Prevention National Health and Nutrition Examination Survey Phone Follow-Up Dietary Interviewer Procedures Manual 2008 U.S. Department of Health and Human Services Hyattsville, MD
- Not checked yetcites [52] Centers for Disease Control and Prevention Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES) 2006 National Center for Health Statistics Hyattsville, MD
- Not checked yetcites [53] Centers for Disease Control and Prevention U.S. Department of Health and Human Services National Health and Nutrition Examination Survey Data 2008 National Center for Health Statistics Hyattsville, MD
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“diabetes[4, 11, 12]”
§ Habitual Sleep Duration Associated with Self-Reported and Objectively-Determined Cardiometabolic Risk Factors > INTRODUCTION
What the sources say
- Not checked yetcites [4] Morselli LL Guyon A Spiegel K Sleep and metabolic function. Pflugers Arch 2012 463 139 60 22101912 PMC3289068 source
- Not checked yetcites [11] Zizi F Pandey A Murrray-Bachmann R Vincent M McFarlane S Ogedegbe G Race/ethnicity, sleep duration, and diabetes mellitus: analysis of the National Health Interview Survey. Am J Med 2012 125 162 7 22269619 PMC3266551 source
- Not checked yetcites [12] Kachi Y Ohwaki K Yano E Association of sleep duration with untreated diabetes in Japanese men. Sleep Med 2012 13 307 9 22305609 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
NHANES self-reports of sleep duration, limited to integer values, likely reflect usual habits in recent times.
“Since NHANES limits self-reports of sleep duration to integer values, which likely reflect usual habits in recent times”
The paper relies on this without support.
Residual confounding from unmeasured variables would likely attenuate the association between sleep duration and cardiometabolic disease towards the null.
“However, this would likely attenuate the association between sleep duration and cardiometabolic disease towards the null”
The paper relies on this without support.
BMI is a useful measure of central obesity and cardiovascular risk.
“while many studies have shown BMI to be a useful measure of central obesity and cardiovascular risk”
The paper relies on this without support.
BMI does not account for muscle mass, gender- or age-related differences in body fat distribution, or differences in relationships between adiposity and cardiometabolic disease among ethnoracial subgroups.
“BMI does not account for muscle mass, gender-or age-related differences in body fat distribution, or differences in relationships between adiposity and cardiometabolic disease among ethnoracial subgroups.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“This was followed up by another analysis that showed that the relationship between sleep duration and obesity, diabetes, hypertension and hyperlipidemia depended on self-identified race/ethnicity(20).”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [20]
In the citing paper
“Although this has not yet been directly tested, several studies have shown that the relationship between sleep and cardiometabolic disease risk does depend on race/ethnicity.”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [20]
In the citing paper
“Also, this relationship may be moderated by race/ethnicity, with stronger relationships between sleep and obesity among non-Hispanic white and black/African American adults.24”
From Sleep, Health, and Society (2017) · cites this paper as [24]
In the citing paper
“based on previous data linking sleep duration to cardiometabolic disease risk in a US population sample [44].”
From Smoking, screen-based sedentary behavior, and diet associated with habitual sleep duration and chronotype: data from the UK Biobank (2016) · cites this paper as [44]
In the citing paper
“Analysis of NHANES did find that self-reported short sleep duration was associated with both self-reported chronic disease (e.g. obesity and hypertension) as well as objectively-measured markers of chronic disease (e.g. obesity and hyperlipidemia) [204].”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [204]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Race-specific short-sleep hypertension result conflicts with the abstract
MajorThe abstract says the association between short sleep and hypertension is strongest among non-Hispanic Whites, Blacks/African-Americans, and non-Mexican Hispanics/Latinos. The stratified results report no elevated outcomes among short sleepers in the first two groups and identify short-sleep hypertension among Mexican-Americans instead.
“the relationship between short sleep and hypertension is strongest among non-Hispanic Whites, Blacks/African-Americans, and non-Mexican Hispanics/Latinos.”
“Overall, for non-Hispanic white respondents, elevated risk was found for self-reported hypertension, self-reported hyperlipidemia, objective hyperlipidemia, and self-reported diabetes among very short sleepers, no outcomes among short sleepers, and objective hyperlipidemia among long sleepers. For black/African-American respondents, elevated risk of self-reported hypertension, self-reported obesity, and objective obesity were found for very short sleep.”
Objective-diabetes interaction is both significant and excluded
MinorThe results report a significant sleep-duration-by-race/ethnicity interaction for objective diabetes (p=0.0003), but the discussion says objective diabetes is the exception to race/ethnicity differences.
“objective diabetes (p=0.0003)”
“for all outcomes except objective diabetes, the relationship between sleep duration and cardiometabolic disease differed by race/ethnicity.”
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Research works printed but not linked: 3
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Nivel de consumo máximo de oxígeno y calidad del sueño en estudiantes universitarios
Luna, J. A. M., Castro, G. L., & Guerrero, D. A. G. (2024) · Movimiento Científico · doi:10.33881/2011-7191.mct.17208 · Cited by 1
Thirty-Year Trends in Sleep Disorders and Cardiovascular Disease Risk
Гафаров, В. В., Громова, Е. А., Tripelgorn, A. N., Gagulin, I. V., & Гафарова, А. В. (2024) · IntechOpen eBooks · doi:10.5772/intechopen.1005010 · Cited by 1
Moradzadeh, R., Sadeghniiat‐Haghighi, K., Najafi, A., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-19368-y
“Researchers have indicated a relationship between poor sleep quality and high levels of food insecurity [18].”
BackgroundAssociation of inadequate sleep with mortality among persons who inject drugs
Sun, J., Hsu, H.-Y., Rabinowitz, J. A., Sosnowski, D. W., Piggott, D. A., Mehta, S. H., Maher, B. S., Spira, A. P., & Kirk, G. D. (2024) · Sleep Health · doi:10.1016/j.sleh.2024.07.008
Sleeping and thinking: An examination of insomnia symptoms, global sleep health and sleep regularity
Nielson, S. A., Dautovich, N. D., & Dzierzewski, J. M. (2025) · Research Directions Sleep Psychology · doi:10.1017/slp.2025.1
Child Abuse Exposure and Adult Sleep Continuity Disturbance, Sleep Duration, and Bedroom Safety
Alfonso‐Miller, P., Ellis, J. G., Bastien, C., Hale, L. E., Branas, C. C., Perlis, M. L., Rasmussen, E. F., Gorovoy, S. B., & Grandner, M. A. (2025) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2529871
“This item has been used in a number of previous studies and has been demonstrated to be associated with health outcomes such as cardiometabolic disease risk (Grandner et al., 2014) and socioeconomic status (Whinnery et al., 2014).”
Self-citationZarghami, F., Karimi, K., Salehi, S., Akbarpour, S., & Azizpour, Y. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103294 · Cited by 1
“Previous studies have reported stronger associations between sleep disturbances and conditions such as hypertension, diabetes, and dyslipidemia (Grandner et al., 2013; Medic et al., 2017).”
Sleep and healthy decision-making
Baron, K. G., & Culnan, E. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-13954-3.00026-7
Insufficient sleep and obesity
Spaeth, A. M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-13954-3.00033-4
Sleep deprivation enhances self-protective behavior after negative social feedback
Zou, F., Yang, X., Luo, Y., Zhang, X., Feng, S., Du, M., Zhang, R., Peng, Y., Sima, J., Wang, Y., et al. (2025) · Current Psychology · doi:10.1007/s12144-025-08834-4
“…& Tai, 2023 ; Walker, 2008 ), emotional disturbances (Zohar, 2005; Killgore et al., 2017; Palmer et al., 2024), weight gain (Cha - put et al., 2023; Grandner et al., 2014; Cain et al., 2015 ), inflammation (Besedovsky et al., 2019; Garbarino et al., 2021 ), and an increased risk of all-cause…”
Li, C.-I., Lin, C., Liu, C.-S., Lin, C.-H., Yang, S.-Y., & Li, T.-C. (2022) · Figshare · doi:10.6084/m9.figshare.19670321
Zhuang, Z., Gao, M., Yang, R., Li, N., Liu, Z., Cao, W., & Huang, T. (2020) · Figshare · doi:10.6084/m9.figshare.12276971
Rizk, R., Haddad, C., Sacre, H., Malaeb, D., Wachten, H., Strahler, J., & Salameh, P. (2024) · Figshare · doi:10.6084/m9.figshare.26586456
Additional file 1 of Sleep deprivation and suicide risk among minoritized US adolescents
Joseph, V. A., Kreski, N. T., & Keyes, K. M. (2024) · Figshare · doi:10.6084/m9.figshare.26614210
Li, C.-I., Lin, C., Liu, C.-S., Lin, C.-H., Yang, S.-Y., & Li, T.-C. (2022) · Figshare · doi:10.6084/m9.figshare.19670318
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“In turn, poor sleep quality elevates the risk for NCDs, underscoring the broader health implications of occupational stressors in healthcare settings 17,24 .”
Correlates of interindividual variability in sleep in the United States
Smith, M. D., & Wesselbaum, D. (2026) · Sleep Health · doi:10.1016/j.sleh.2026.05.004
Wang, Q., Gong, Y., Ji, J., Zhang, Y., Lu, M., Song, M., Zhang, X., Zhao, Y. J., & Miao, Q. (2026) · ALPHA PSYCHIATRY · doi:10.31083/ap50350
“Sleep duration has been linked to an increased risk of dyslipidemia, including hyperc-holesterolemia [26], hyperlipidemia [27], and elevated low-density lipoprotein cholesterol (LDL-C) and reduced high-density lipoprotein cholesterol (HDL-C) levels [28,29].”
Die Rolle des Schlafes in der Schlaganfallprävention
Thaller, A., & Mayer‐Suess, L. (2026) · psychopraxis neuropraxis · doi:10.1007/s00739-026-01189-w
Insomnia Symptoms are Common Among Community Dwelling African Americans Who Report Poor Sleep
Peyrel, P., Viverito, M., Eliser, D. D., Griffith, I., Tanksley, M., Greenway, F. L., Carmichael, O. T., Newton, R. L., Beyl, R. A., Baron, K. G., et al. (2026) · Behavioral Sleep Medicine · doi:10.1080/15402002.2026.2715443
Sleep Health Disparities: Are Black Women Disadvantaged?
Oladimeji, A. (2026) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-026-03191-9
Metadata
- Authors
- Grandner, M. A., Chakravorty, S., Perlis, M. L., Oliver, L., & Gurubhagavatula, I.
- Affiliations
- University of Pennsylvania (US)
- Philadelphia VA Medical Center (US)
- Corresponding author
- Grandner, Michael A.
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 15
- Issue
- 1
- Pages
- 42-50
- ISSN
- 1389-9457 (ISSN-L)
- PMC
- PMC3947242
- OpenAlex
- W2038542855
- Semantic Scholar
- 5485cfc73eb7b576de649913112b5fa90a1be2a4
- Cited by
- 300
- References
- 135
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 22 · 2023: 22 · 2022: 29 · 2021: 26 · 2020: 34 · 2019: 31 · 2018: 17 · 2017: 28 · 2016: 21 · 2015: 31 · 2014: 12
- FWCI
- 29.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association (12SDG9180007)
- National Heart, Lung and Blood Institute (K23HL110216)
- National Institute of Environmental Health Sciences (R21ES022931)
- University of Pennsylvania CTSA (UL1RR024134)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- habitual sleep duration, short sleep duration, long sleep, cardiometabolic risk factors, hypertension, obesity, diabetes mellitus, hyperlipidemia, self-reported sleep duration, racial and ethnic differences, NHANES adults
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Hyperlipidemias, Hypertension, Male, Middle Aged, Nutrition Surveys, Obesity, Surveys and Questionnaires, Risk Factors, Sleep, Sleep Wake Disorders, Racial Groups, Young Adult, Self Report
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