Tuesday, May 30, 2023
| Characteristic | Unweighted, No. | Weighteda |
|---|---|---|
| Age, mean, y | 7,784 | 44.5 (43.8–45.2) |
| Sex | ||
| Male | 3,704 | 48.5 (47.3–49.7) |
| Female | 4,080 | 51.5 (50.3–52.7) |
| Race/ethnicity | ||
| Non-Hispanic white | 2,882 | 65.5 (59.9–70.6) |
| Non-Hispanic black | 1,606 | 10.9 (8.5–13.9) |
| Hispanic | 2,111 | 15.2 (11.7–19.4) |
| Non-Hispanic other | 1,185 | 8.4 (7.1–10.1) |
| Education level | ||
| High school diploma or less | 3,247 | 33.4 (30.1–36.9) |
| Some college | 2,447 | 33.3 (31.2–35.5) |
| College graduate or above | 2,090 | 33.3 (29.4–37.5) |
| Marital status | ||
| Married or coupled | 4,760 | 64.9 (62.7–67.0) |
| Widowed, divorced, or separated | 1,387 | 15.3 (13.9–16.7) |
| Never married | 1,637 | 19.8 (18.0–21.8) |
| Family income-to-poverty ratio | ||
| ≤1.3 | 2,755 | 24.4 (21.4–27.6) |
| >1.3 to ≤1.85 | 1,082 | 11.7 (10.5–13.0) |
| >1.85 | 3,947 | 64.0 (60.2–67.6) |
| Moderately severe or severe depression | 235 | 2.6 (2.2–3.1) |
| Binge drinking once a month or moreb | 1,217 | 17.8 (16.1–19.5) |
| Prescription sleep aid use | 267 | 4.3 (3.5–5.2) |
| Sleep duration, h | ||
| <6 | 862 | 9.0 (8.2–9.9) |
| 6 to <7 | 1,571 | 18.5 (17.3–19.8) |
| 7 to <8 | 2,135 | 30.4 (28.9–31.9) |
| 8 to <9 | 2,112 | 28.6 (27.5–29.7) |
| ≥9 | 1,104 | 13.5 (12.3–14.7) |
| Overall CVH score | ||
| Mean | 6,985c | 8.0 (7.9–8.1) |
| Ideal (5–7 components) | 1,156 | 17.8 (16.3–19.4) |
| Intermediate (3–4 components) | 2,947 | 42.1 (40.9–43.3) |
| Poor (0–2 components) | 3,200 | 40.1 (38.4–41.9) |
Table 1. Estimated Weighted Population Characteristics and Prevalence of Sleep and Cardiovascular Health Among US Adults Aged 20–75 (N = 7,784), National Health and Nutrition Examination Survey, 2013–2016
Abbreviations: CI, confidence interval; CVH, cardiovascular health.
a Values are percentage (95% confidence interval) unless otherwise indicated. Because of survey weighting, proportions differ from calculations based on the unweighted number. Percentages may not total to 100% because of rounding.
b Binge drinking was defined as more than 4 drinks per day for women or more than 5 drinks per day for men.
c Mean score excluded those who were missing 1 or more CVH components.
| Component | Definitiona | Weighted Sleep Duration, mean or % (95% CI) | P Valueb | ||||
|---|---|---|---|---|---|---|---|
| <6 h | 6 to <7 h | 7 to <8 h | 8 to <9 h | ≥9 h | |||
| Overall CVH scorec | |||||||
| Mean | NA | 7.4 (7.2–7.6) | 7.9 (7.8–8.0) | 8.2 (8.1–8.4) | 8.1 (7.9–8.3) | 7.7 (7.4–8.0) | <.001 |
| Ideal | 5–7 | 11.1 (8.3–14.7) | 17.9 (15.9–20.0) | 19.1 (17.1–21.3) | 20.1 (17.8–22.6) | 15.5 (12.7–18.7) | .01 |
| Intermediate | 3–4 | 41.2 (36.0–46.6) | 41.5 (38.5–44.7) | 43.6 (40.6–46.7) | 41.9 (39.3–44.7) | 41.0 (37.6–44.5) | |
| Poor | 0–2 | 47.8 (43.0–52.6) | 40.6 (37.9–43.3) | 37.3 (34.4–40.2) | 38.0 (35.1–41.0) | 43.6 (39.4–47.8) | |
| Smoking | |||||||
| Ideal | Never smoker or quit ≥12 months ago | 47.9 (41.7–54.2) | 56.0 (52.2–59.8) | 63.2 (60.5–65.7) | 60.3 (57.1–63.4) | 57.0 (52.5–61.4) | <.001 |
| Intermediate | Smoked ≥100 cigarettes and quit <12 months ago | 21.6 (17.7–25.9) | 21.6 (18.8–24.8) | 22.0 (19.4–24.7) | 23.7 (21.3–26.2) | 19.2 (16.4–22.3) | |
| Poor | Current smoker | 30.6 (25.6–36.1) | 22.4(19.4–25.7) | 14.9 (12.7–17.5) | 16.0 (13.7–18.7) | 23.8 (20.3–27.8) | |
| Body mass index (kg weight/height in m2) | |||||||
| Mean | NA | 30.6 (30.1–31.1) | 29.6 (29.0–3.2) | 29.1 (28.6–29.5) | 29.0 (38.4–29.5) | 29.0 (28.4–29.7) | <.001 |
| Ideal | <25.0 kg/m2 | 23.3 (19.3–27.8) | 27.0 (23.9–30.4) | 30.1 (27.6–32.8) | 30.4 (26.5–34.6) | 31.2 (27.3–35.3) | .03 |
| Intermediate | 25.0–29.9 kg/m2 | 30.1 (26.0–34.7) | 32.6 (29.6–35.7) | 32.9 (30.1–35.9) | 32.7 (30.2–35.3) | 30.3 (27.0–33.9) | |
| Poor | ≥30.0 kg/m2 | 46.6 (41.6–51.6) | 40.4 (37.0–43.8) | 37.0 (34.2–39.8) | 36.9 (33.2–40.8) | 38.5 (34.0–43.3) | |
| Dietd | |||||||
| Ideal | 4–5 components | 0 | 0 | 0 | 0 | 0.1 (0.0–0.6) | .10 |
| Intermediate | 2–3 components | 22.3 (17.2–28.3) | 24.4 (21.2–28.0) | 26.8 (23.9–29.9) | 25.7 (22.7–28.9) | 20.2 (17.4–23.2) | |
| Poor | 0–1 components | 77.7 (71.7–82.8) | 75.6 (72.0–78.8) | 73.2 (70.1–76.1) | 74.3 (71.1–77.3) | 79.7 (76.6–82.5) | |
| Physical activity, min/wk | |||||||
| Mean | NA | 168.9 (144.0–193.7) | 165.9 (150.8–180.9) | 165.6 (147.2–184.0) | 171.8 (154.1–189.5) | 166.6 (136.0–197.2) | .98 |
| Ideal | ≥150 min moderate and/or vigorous or ≥75 min vigorous | 34.0 (29.7–38.6) | 39.1 (35.8–42.5) | 43.1 (39.3–47.0) | 41.9 (38.4–45.5) | 37.2 (32.0–42.7) | .03 |
| Intermediate | 1–149 min moderate and/or vigorous or 1–74 min vigorous | 17.1 (14.3–20.3) | 16.7 (13.9–20.0) | 16.3 (14.2–18.7) | 19.2 (17.0–21.7) | 14.6 (11.7–18.1) | |
| Poor | None | 49.0 (45.3–52.7) | 44.2 (40.5–47.9) | 40.6 (37.5–43.8) | 38.9 (35.3–42.6) | 48.2 (42.9–53.6) | |
| Blood pressure, mm Hg | |||||||
| Systolic, mean | NA | 122.3 (120.7–123.8) | 121.3 (120.2–122.4) | 120.5 (119.6–121.4) | 121.3 (120.4–122.2) | 121.8 (120.3–123.2) | .25 |
| Diastolic, mean | NA | 71.9 (70.8–73.1) | 70.9 (70.1–71.7) | 70.6 (69.8–71.4) | 70.5 (69.6–71.3) | 70.3 (69.1–71.5) | .16 |
| Ideal | <120/<80 untreated | 43.7 (39.5–48.0) | 44.0 (40.7–47.3) | 47.1 (43.6–50.6) | 46.7 (44.2–49.2) | 42.0 (38.3–45.8) | .24 |
| Intermediate | SBP 120–139 or DBP 80–89 or treated to goal | 46.0 (41.6–50.5) | 48.3 (45.2–51.5) | 45.5 (42.1–49.0) | 45.0 (42.7–47.2) | 48.1 (43.4–52.8) | |
| Poor | SBP ≥140 or DBP ≥90 | 10.3 (7.1–14.8) | 7.7 (6.2–9.6) | 7.4 (6.3–8.7) | 8.3 (6.7–10.3) | 9.9 (7.0-13.9) | |
| Total cholesterol, mg/dl | |||||||
| Mean | NA | 191.9 (187.6–196.3) | 189.6 (186.6–192.7) | 192.1 (190.0–194.2) | 195.4 (192.1–198.7) | 193.0 (188.5–197.4) | .07 |
| Ideal | <200 untreated | 50.6 (45.3–55.9) | 55.4 (51.3–59.4) | 50.1 (46.9–53.3) | 49.0 (44.9–53.2) | 48.6 (44.7–52.5) | .02 |
| Intermediate | 200–239 or treated to goal | 39.3 (34.5–44.4) | 34.5 (30.9–38.1) | 38.5 (35.1–42.1) | 36.2 (33.0–39.5) | 36.7 (32.3–41.3) | |
| Poor | ≥240 | 10.1 (8.3–12.4) | 10.2 (8.2–12.5) | 11.4 (9.5–13.5) | 14.8 (12.7–17.1) | 14.7 (11.5–18.6) | |
| Hemoglobin A1c, % | |||||||
| Mean | NA | 5.7 (5.6–5.7) | 5.6 (5.6–5.7) | 5.5 (5.5–5.6) | 5.6 (5.5–5.6) | 5.6 (5.5–5.7) | .01 |
| Ideal | <5.7 untreated | 66.1 (61.1–70.9) | 70.8 (67.8–73.7) | 74.3 (71.6–76.8) | 72.9 (70.1–75.5) | 65.8 (59.7–71.4) | .008 |
| Intermediate | 5.7–6.4 or treated to goal | 30.2 (25.5–35.3) | 26.0 (23.1–29.1) | 23.2 (21.0–25.6) | 24.5 (22.2–26.9) | 30.8 (25.6–36.6) | |
| Poor | ≥6.5 | 3.7 (2.5–5.4) | 3.2 (2.4–4.4) | 2.5 (1.7–3.7) | 2.6 (1.9–3.5) | 3.4 (2.3–4.9) | |
Table 2. Weighted Mean and Population Prevalence of Overall CVH Score and Individual Components Stratified By Sleep Duration Among US Adults Aged 20–75 (N = 7,784), National Health and Nutrition Examination Survey, 2013–2016
Abbreviations: CI, confidence interval; CVH, cardiovascular health; DBP, diastolic blood pressure; NA, not applicable; SBP, systolic blood pressure.
a Component definitions and scoring used were those previously described by Lloyd-Jones et al. with modification of hemoglobin A1c as a proxy for fasting plasma glucose [13]. The specific definitions used in this analysis are presented.
b P value calculated from adjusted Wald or Pearson’s χ2 tests that were corrected for the survey design.
c The CVH score comprises 7 components: smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and hemoglobin A1c (used as a proxy for fasting plasma glucose) [13]. Each component was scored as ideal (2 points), intermediate (1 point), or poor (0 points) based on guidelines described by Lloyd-Jones et al [13]. The continuous overall CVH score was calculated by summing the 7 components scores. Ideal CVH was defined as meeting ideal criteria for 5 to 7 of the components.
d American Heart Association Healthy Diet Score includes ≥4.5 cups of fruits or vegetables a day; two 3.5-ounce servings of fish per week; ≥3 one-ounce equivalent servings of whole grains per day; <1,500 mg of sodium per day; ≤36 ounces of sugar-sweetened beverages per week.
| Sleep Duration, No. of Hours | Model 1a Estimate (95% CI) | Model 2b Estimate (95% CI) | Model 3c Estimate (95% CI) | Model 4d Estimate (95% CI) |
|---|---|---|---|---|
| Odds of ideal CVH | ||||
| <6 | 0.53 (0.39 to 0.72) | 0.63 (0.45 to 0.87) | 0.56 (0.41 to 0.77) | 0.65 (0.47 to 0.90) |
| 6 to <7 | 0.90 (0.76 to 1.07) | 0.97 (0.80 to 1.18) | 0.91 (0.76 to 1.09) | 0.97 (0.80 to 1.19) |
| 7 to <8 | 1 [Reference] | |||
| 8 to < 9 | 1.03 (0.82 to 1.28) | 0.95 (0.74 to 1.23) | 1.04 (0.84 to 1.30) | 0.96 (0.75 to 1.23) |
| ≥9 | 0.75 (0.58 to 0.98) | 0.70 (0.53 to 0.93) | 0.78 (0.60 to 1.02) | 0.72 (0.55 to 0.94) |
| Mean differences in CVH score, mean | ||||
| <6 | −0.80 (−1.04 to −0.55) | −0.48 (−0.69 to −0.27) | −0.69 (−0.94 to −0.45) | −0.41 (−0.61 to −0.20) |
| 6 to <7 | −0.31 (−0.45 to −0.17) | −0.21 (−0.34 to −0.08) | −0.3 (−0.44 to −0.16) | −0.2 (−0.33 to −0.06) |
| 7 to <8 | [Reference] | |||
| 8 to < 9 | −0.15 (−0.36 to 0.06) | −0.18 (−0.39 to 0.03) | −0.12 (−0.32 to 0.07) | −0.16 (−0.36 to 0.03) |
| ≥9 | −0.51 (−0.78 to −0.24) | −0.38 (−0.63 to −0.13) | −0.45 (−0.70 to −0.19) | −0.33 (−0.57 to −0.09) |
Table 3. Association Between Sleep Duration Categories and Ideal CVH in Sequential Adjusted Logistic and Linear Regression Models Among US Adults Aged 20–75 (N = 7,784), National Health and Nutrition Examination Survey, 2013–2016
Abbreviations: CI, confidence interval; CVH, cardiovascular health; OR, odds ratio.
a Model 1: Unadjusted.
b Model 2: Adjusted for demographic factors of weighted age quartiles, sex, race/ethnicity, education level, and family income-to-poverty ratio category.
c Model 3: Adjusted for social and clinical factors of depression status, binge alcohol use, and prescription sleep aid use.
d Model 4: Fully adjusted model including factors from Models 2 and 3.
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The weighted mean age of the 7,784 participants included in our analysis was 44.5 (95% confidence interval [CI], 43.8–45.2) (Table 1). Approximately half of participants were women (51.5%; 95% CI, 50.3%–52.7%), and two-thirds were of non-Hispanic white race/ethnicity (65.5%; 95% CI, 59.9%–70.6%). About two-thirds (64.0%; 95% CI, 60.2%–67.6%) had monthly family incomes that were greater than 185% of the federal poverty guidelines. The weighted prevalence of moderately severe or severe depression was 2.6% (95% CI, 2.2%–3.1%), whereas 17.8% (95% CI, 16.1%–19.5%) reported binge drinking once a month or more. The weighted prevalence of prescription sleep aid use was 4.3% (95% CI, 3.5%–5.2%).
The weighted prevalence of those who slept 7 to <8 hours was 30.4% (95% CI, 28.9%–31.9%), and the weighted prevalence of very short sleep (<6 h) was 9.0% (95% CI, 8.2%–9.9%) and very long (≥9 h) sleep was 13.5% (95% CI, 12.3%–14.7%). Ideal CVH was reported by only 17.8% (95% CI, 16.3%–19.4%) of the population, and nearly half were classified as intermediate overall CVH ( Table 1). Differences were significant in the weighted prevalence of the overall CVH score and in several of the CVH components when stratified by the reported sleep duration (Table 2). The proportion of respondents who met the ideal criteria was highest with sleep durations of 7 to <9 hours for smoking, physical activity, and hemoglobin A1c. Results were not materially different using available case analysis.
In the multivariable logistic regression models, we found a consistent association between very short sleep duration and decreased odds of ideal CVH (Table 3). In the unadjusted model, those with very short sleep duration had 0.53 times the odds of ideal CVH (95% CI, 0.39–0.72) as those who slept 7 to <8 hours. We also saw an association between very long sleep duration and decreased odds of ideal CVH (0.75; 95% CI, 0.58–0.98). We found no consistent association with ideal CVH for the other sleep durations. After adjusting the models for demographic factors and then social and clinical factors, similar associations were found. In the fully adjusted model, the effect was slightly attenuated but still significant with an adjusted odds ratio (OR) of 0.65 (95% CI, 0.47–0.90). The association between very long sleep duration and ideal CVH remained similar with an adjusted OR of 0.72 (95% CI, 0.55–0.94).
When examining the CVH score as a continuous variable, findings in the unadjusted and adjusted models were similar. In the fully adjusted model, a significant decrease was observed in the mean CVH score for participants with very short (−0.41; 95% CI, −0.61 to −0.20) and very long (−0.33; 95% CI, −0.57 to −0.09) sleep durations, compared with those with sleep duration of 7 to <9 hours. Additionally, short sleep duration (6 to <7 hours) was also associated with a significant decrease in mean CVH score; no significant association was found for those with sleep duration of 8 to <9 hours.
