Self-reported short sleep duration among US adults by disability status and functional disability type: Results from the 2016 Behavioral Risk Factor Surveillance System

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults

OBJECTIVE

Nicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults.

METHODS

We performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18-24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use.

RESULTS

Concerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16-1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22-2.18), and dual product users (AOR = 2.03, 95%CI = 1.44-2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06-2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates.

CONCLUSIONS

Current e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.

Understanding Sleep Disturbances in Prostate Cancer-A Scientometric Analysis of Sleep Assessment, Aetiology, and Its Impact on Quality of Life

Prostate cancer is the most commonly diagnosed cancer in the United Kingdom. While androgen-deprivation therapy is the most common treatment for prostate cancer, patients undergoing this treatment typically experience side effects in terms of sleep disturbances. However, the relation between prostate cancer and sleep and the way in which sleep interventions may benefit oncological patients is underinvestigated in the literature. The current study aims to review in a data-driven approach the existing literature on the field of prostate cancer and sleep to identify impactful documents and major thematic domains. To do so, a sample of 1547 documents was downloaded from Scopus, and a document co-citation analysis was conducted on CiteSpace software. In the literature, 12 main research domains were identified as well as 26 impactful documents. Research domains were examined regarding the link between prostate cancer and sleep, by taking into account variations in hormonal levels. A major gap in the literature was identified in the lack of use of objective assessment of sleep quality in patients with prostate cancer.

Short sleep duration and interest in sleep improvement in a multi-ethnic cohort of diverse women participating in a community-based wellness intervention: an unmet need for improvement

BACKGROUND

Disparities in sleep duration are a modifiable contributor to increased risk for cardiometabolic disorders in communities of color. We examined the prevalence of short sleep duration and interest in improving sleep among a multi-ethnic sample of women participating in a culturally tailored wellness coaching program and discussed steps to engage communities in sleep health interventions.

METHODS

Secondary analysis of data from a randomized trial were used. The wellness coaching trial utilized a Community-Based Participatory Research (CBPR) approach. Data were from the baseline survey and baseline wellness coaching notes. Short sleep duration was defined as < 7 h of self-reported sleep. Participants were prompted to set a goal related to healthy eating/physical activity and had the opportunity to set another goal on any topic of interest. Those who set a goal related to improving sleep or who discussed a desire to improve sleep during coaching were classified as having an interest in sleep improvement. Analyses utilized multivariable models to evaluate factors contributing to short sleep and interest in sleep improvement. We present our process of discussing results with community leaders and health workers.

RESULTS

A total of 485 women of color participated in the study. Among these, 199 (41%) reported short sleep duration. In adjusted models, Blacks/African Americans and Native Hawaiians/Pacific Islanders had higher odds of reporting < 7 h of sleep than Hispanics/Latinas. Depression symptoms and self-reported stress management scores were significantly associated with short sleep duration. Interest in sleep improvement was noted in the wellness coaching notes of 52 women (10.7%); sleep was the most common focus of goals not related to healthy eating/physical activity. African Immigrants/Refugees and African Americans were less likely to report interest in sleep improvement. Community leaders and health workers reported lack of awareness of the role of sleep in health and discussed challenges to obtaining adequate sleep in their communities.

CONCLUSION

Despite the high prevalence of short sleep duration, interest in sleep improvement was generally low. This study highlights a discrepancy between need and interest, and our process of community engagement, which can inform intervention development for addressing sleep duration among diverse women.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Mental and Physical Health Disparities Among Sexual and Gender Minority Adolescents Based on Disability Status

Purpose: Sexual and gender minority (SGM) youth and youth with disabilities both experience health disparities. Little data exist on whether SGM youth with disabilities have worse health outcomes compared with SGM youth without disabilities. This study aimed to examine differences in health behaviors and outcomes among a sample of SGM youth by different types of disabilities. Methods: Secondary analyses were conducted with a subset (N = 9418) of the LGBTQ National Teen Survey, a comprehensive survey of risk and protective factors and health outcomes of SGM youth across the United States collected in 2017. Multiple types of disabilities (physical, cognitive, or psychiatric) and mental, behavioral, and physical health outcomes were self-reported. Results: Of the sample, 18.3% reported a disability. Significant findings included higher odds of exercise avoidance, greater depressive symptoms and sleep concerns, and lower self-esteem and overall health ratings among SGM youth who reported any form of disability compared with SGM youth who reported no disability. Youth with cognitive disabilities had lower odds of alcohol use than youth with no disability. Youth with psychiatric disabilities had higher odds of cannabis and cigarette use, and lower physical activity than youth with no disability. Youth with either psychiatric or physical disabilities reported higher body mass index than youth with no disability. Conclusion: SGM youth with disabilities experience greater health disparities than SGM youth with no reported disabilities. Results provide groundwork evidence about the impact of disability status on SGM adolescents. Disability-inclusive or -specific frameworks are needed for future interventions and studies of SGM youth.

Sleep Quality and Disability for Custodial Grandparents Caregivers in the Southern United States

Sleep quality amongst caregivers with disability may have been compounded by the COVID-19 pandemic. We evaluated differences in sleep quality amongst custodial grandparents from a southern state that were identified through state-based Kinship Care support groups coordinators and online. Participants ( N = 102) completed the Pittsburgh Sleep Quality Index and self-reported disability statuses. Gamma tests showed a strong negative relationship between disability and sleep duration indicating fewer hours of sleep, higher use of sleep medication and greater sleep disturbances. Disability is not significantly related to sleep latency, sleep efficiency, and daytime dysfunction. T-tests showed no strength of relationship between disability and overall sleep quality. During the first year of the COVID-19 pandemic, custodial grandparents with disability had greater issues with their sleep quality than those without disability. Sleep, as it pertains to its overall preponderant role in maintaining good health, should be examined amongst custodial grandparent caregivers and those with disability.

Sleep, testosterone and cortisol balance, and ageing men

Sleep serves important biological functions, and influences health and longevity through endocrine and metabolic related systems. Sleep debt, circadian misalignment and sleep disruption from obstructive sleep apnea is widespread in modern society and accumulates with life because recovery sleep is not completely restorative. Accumulated disordered sleep throughout life impacts the ageing process and the development of age-related diseases. When epidemiological and interventional studies are considered collectively, sleep loss and lower sleep duration are associated with lower morning, afternoon and 24-h testosterone; as well as higher afternoon, but not morning or 24-h cortisol. These reciprocal changes imbalances anabolic-catabolic signaling because testosterone and cortisol are respectively the main anabolic and catabolic signals in man. Fixing testosterone-cortisol balance by means of a novel dual-hormone clamp mitigates the induction of insulin resistance by sleep restriction and provided the first proof-of-concept that the metabolic harm from sleep loss can be ameliorated by approaches that do not require sleeping more. Obstructive sleep apnea is associated with lower testosterone, even after controlling for age and obesity whereas the conclusion that continuous positive airway pressure therapy has no effect on testosterone is premature because available studies are underpowered and better-quality studies suggest otherwise. High dose testosterone therapy induces OSA, but more physiological dosing may not; and this effect may be transient or may dissipate with longer term therapy. Studies investigating the origin of the diurnal testosterone rhythm, the effect of circadian misalignment on testosterone-cortisol balance, and methods to mitigate metabolic harm, are required.

24-Hour Movement Behaviors Among US Adults With Functional Disabilities

This study aimed to quantify and compare physical activity, sitting time, and sleep behaviors among US adults with and without disabilities using the 2020 Canadian 24-hour movement framework. The weighted prevalence of 24-hour movement guideline adherence was estimated among a nationally representative sample from the 2017 to 2018 National Health and Nutrition Examination Survey of US adults (18-65 years old) with (n = 1070) and without (n = 33,370) functional disabilities in vision, hearing, mobility, cognitive, and self-care domains. The adjusted odds of single and combination guideline compliance were estimated by disability type, in reference to adults without disabilities, using separate multivariable logistic regressions. After adjusting for age, sex, and income, adults with disabilities in mobility, cognitive, or self-care domains had approximately half the odds of meeting all 3 guidelines, compared with adults without disabilities (adjusted odds range: 0.49-0.77). Significantly lower adherence was observed among adults with functional disabilities, compared with no disabilities, for sleep, and moderate to vigorous physical activity, but not sedentary guidelines. This report establishes baseline prevalence estimates for guidelines compliance among US adults with functional disabilities ages 18-65 years old. Low guideline adherence, and evidence for significant differences in physical activity and sleep, signals a need to further explore combination health behaviors among adults with disabilities.

Community-dwelling adults with functional limitations are at greater risk for sleep disturbances

OBJECTIVE

To evaluate whether sleep disturbances vary along a continuum of functional limitations in a large nationally representative sample of US adults.

METHODS

Using 2014-2015 National Health Interview Survey data (n = 33,424), we considered associations between each of 5 sleep disturbance measures (duration, trouble falling asleep, trouble staying asleep, use of sleep medications, waking rested) and Functional Limitations Index score, which distinguishes among adults with little-or-no (least-limited), moderate (somewhat-limited), and high functional limitations (most-limited).

RESULTS

Somewhat-limited and most-limited respondents reported significantly worse sleep health for all sleep disturbance measures than people with little-or-no limitations, even controlling for body mass index, psychological distress, and 14 health indicators.

CONCLUSIONS

People with significant self-reported limitations in physical functioning, independent of specific disabilities or disabling condition, report more sleep disturbances. Clinicians may want to evaluate the sleep health of patients with functional limitations.

The influence of total sleep time on chronic disease in people with disabilities in South Korea: an analysis of panel data

STUDY OBJECTIVES

This study examined the relationship between total sleep time and chronic diseases among people with disabilities using data from the Panel Survey of Employment for the Disabled (PSED) to identify differences according to sex and age.

METHODS

This study analyzed secondary data analysis from the second wave of the PSED (collected 2016-2018; n = 5,092) using a generalized estimating equation (GEE) model and chi-square test.

RESULTS

The main findings were these. First, the incidence of chronic disease was 1.84 and 1.24 times higher among patients with disabilities who slept less than 5 and 6 hours per night, respectively, than those who slept 7 hours. Second, female patients experienced more sleep problems than male patients. Third, chronic disease was most prevalent among patients with the shortest sleep time, regardless of age.

CONCLUSIONS

The results suggested that patients with disabilities who slept less than 6 hours per night were more likely to experience chronic diseases than those who slept more than 6 hours, with women especially vulnerable. Future research should consider multiple variables to clarify the relationship between total sleep time and health-related outcomes associated with various disabilities and chronic diseases.

Sleep and functional capacity in adults: Cross-sectional associations among self-report and objective assessments

OBJECTIVES

This study examined the relationship between self-reported and objectively measured sleep and functional capacity in adults.

DESIGN

Cross-sectional.

PARTICIPANTS

Data were from the Midlife in the United States study. The sample consisted of men and women (n = 664) aged 25-83 who completed telephone interviews, questionnaires, and an overnight clinic stay.

MEASUREMENTS

Sleep was assessed by self-report (Pittsburgh Sleep Quality Index [PSQI]) and by objective measures (sleep latency, duration, wake after sleep onset [WASO], and midpoint/midpoint variability) from 7 consecutive days of actigraphy. Functional capacity was assessed by self-report of limitations and measured gait speed, grip strength, and chair stands.

RESULTS

In linear regression models adjusting for demographic and health factors, better self-reported sleep quality predicted fewer reported limitations, stronger grip, quicker gait, and faster chair stands (all P< .01). Greater WASO predicted more self-report limitations and slower gait speed (P< .05). Long (>8 hours) sleep duration and a more variable sleep schedule predicted lower grip strength (p < .05). Finally, after adjustment for objective sleep measures, PSQI remained a significant predictor of functional measures (P< .05) and explained a significant amount of additional variance (change in R²: 0.01-0.05).

CONCLUSIONS

The present results suggest that subjective and objective sleep measures capture distinct aspects of sleep that are independently related to functional capacity. The variance in functional measures explained by sleep variables, though small, was comparable to other risk factors for functional impairment (eg, obesity), underscoring the importance of associations between sleep and optimal function in adults.

Relationship between Sleep Duration Trajectories and Self-Rated Depressive Symptoms in South Koreans with Physical Disabilities

Physically disabled persons can have sleep problems, which affects their mental health more than those in non-disabled people. However, there are few studies on the relationship between sleep duration and mental health targeting physically disabled people in South Korea, and existing studies on the disabled have mostly used data collected from convenience rather than nationally representative samples, limiting the generalization of the results. This study used data from the second wave of the Panel Survey of Employment for the Disabled (PSED, 2016-2018, 1st-3rd year). Participants included 1851 physically disabled individuals. The Chi-square test and generalized estimating equation (GEE) were used and the Akaike information criterion (AIC) value and the AIC log Bayes factor approximation were used to select sleep trajectories. This is the first study to elucidate multiple sleep trajectories in physically disabled people in Korea, and the relationship between sleep duration trajectories and self-rated depressive symptoms. People with physical disabilities who sleep more than 9 h have the highest risk of depression and need more intensive management as a priority intervention.

Sleep and the Testis

Disordered sleep impairs neurocognitive performance, and is now recognized to cause metabolic ill-health. This review assesses the nascent relationship between insufficient, misaligned, and disrupted sleep with andrological health. High-quality cohort studies show a reduced sperm count in men with sleep disturbances. Well-designed interventional studies show a reduction in testosterone with sleep restriction. Studies of long-term shift workers show no effect of misaligned sleep on mean testosterone concentrations. Men with obstructive sleep apnea (OSA) and more severe hypoxemia have lower testosterone levels, although it is unknown if this relationship is entirely explained by concomitant obesity, or is reversible. Nevertheless, erectile dysfunction, which is common in men with OSA, is clinically improved when OSA is properly treated. Few studies manipulating sleep have been performed in older men, in whom the accumulation of sleep disturbances over decades of life may contribute to age-related illnesses. Improving sleep could ameliorate the development of these disorders.