Sleep Duration and Chronic Diseases Among US Adults Age 45 Years and Older: Evidence From the 2010 Behavioral Risk Factor Surveillance System

Study Questions:

What are the effects of obesity and frequent mental distress (FMD) on the relationship of sleep duration with coronary heart disease (CHD), stroke, and diabetes?


Relationships between sleep duration and selected chronic diseases among US adults ages 45 years or older were examined in 14 states, using data from the 2010 Behavioral Risk Factor Surveillance System, and whether those relationships were attenuated by FMD and/or obesity. Chronic diseases were defined through subjects’ affirmative responses to the question of whether they had ever been told by a doctor they had diabetes mellitus or CHD, which included a heart attack, angina pectoris, and/or stroke. Sleep duration was based on response to: “On average, how many hours of sleep do you get in a 24-hour period?” Sleep duration for these analyses was defined as short (≤6 hours), optimal (7-9 hours), and long (≥10 hours). FMD was defined if respondents indicated ≥14 days to the question “...about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” Obesity was calculated based on self-reported height and weight.


The response rate varied among the 14 states and ranged from 39.0% to 68.8% (median 52.7%). A total of 54,269 respondents (95.8% of those surveyed) were included. The excluded population who were missing information for sleep duration was more likely to report having diabetes (p < 0.05) and stroke (p < 0.001) than in the included population. The prevalence of obesity, FMD, and CHD was similar in excluded and included populations. Among 54,269, 33.1% were ages 65 years and older; 52.8% were women; 76.5% were non-Hispanic white. In addition, 28.8% of respondents were obese and 9.7% had FMD. Respondents reported having CHD (10.9%), stroke (4.3%), or diabetes (13.2%). Compared with the optimal sleep duration, both short and long sleep durations were significantly associated with obesity, FMD, CHD, stroke, and diabetes after controlling for sex, age, race/ethnicity, and education. The U-shaped relationships of sleep duration with CHD, stroke, and diabetes were moderately attenuated by FMD. The relationship between sleep duration and diabetes was slightly attenuated by obesity.


The authors concluded that compared with optimal sleep duration (7-9 hours), both short (≤6 hours) and long (≥10 hours) sleep duration were significantly associated with CHD, stroke, and diabetes among adults ages 45 years or older. These associations were more pronounced with long sleep duration than with short sleep duration.


Previous work has demonstrated the association between both long and short sleep duration and obesity; however, the mechanisms for these relationships are understudied. This report appears to be the first to assess FMD as a potential mediator in the relationship between sleep duration and chronic diseases. Prospective designed studies are needed to assess whether depression is a causal intermediary or a co-founder of this association. Prospective studies should also address bias introduced with self-reported sleep, and mental and chronic disease states.

Clinical Topics: Heart Failure and Cardiomyopathies, Sleep Apnea

Keywords: Ethnic Groups, Stroke, Depressive Disorder, Body Weight, Coronary Disease, Hispanic Americans, Sleep Apnea Syndromes, Mental Disorders, Cardiology, Cardiovascular Diseases, Obesity, Behavioral Risk Factor Surveillance System, Diabetes Mellitus

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