Thursday, June 8, 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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What is already known on this topic?
Short and long sleep durations are risk factors for cardiovascular disease, but limited work has assessed the association between sleep duration and cardiovascular health, a measure of the health of the cardiovascular system. Ideal cardiovascular health is associated with a reduced risk of developing cardiovascular disease.
What is added by this report?
By using a nationally representative sample of US adults from the National Health and Nutrition Examination Survey, we showed that very short (<6 h) and very long (≥9 h) sleep duration was significantly associated with decreased odds of ideal cardiovascular health and a significant decrease in mean cardiovascular health score.
What are the implications for public health practice?
Sleep may be an additional component to describe health of the cardiovascular system. Unhealthy sleep duration represents a modifiable risk factor that can be targeted for population-level intervention.
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