Abstract Body (Do not enter title and authors here): Introduction: Insufficient sleep has been recognized as part of Life’s Essential 8 in the prevention of cardiovascular disease (CVD). While sleep is a multidimensional phenomenon comprised of duration, efficiency, quality, timing, and regularity, prior epidemiological research in youth has predominantly focused on sleep duration. It is important to disentangle which sleep dimensions most associate with other health behaviors and biomarkers for CVD risk in adolescents.
Methods: We analyzed data from 421 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 5-nights at-home actigraphy (ACT), 1-night in-lab 9-h polysomnography (PSG), self-reported insomnia symptoms, daytimes sleepiness, sleep schedule, circadian preference, and dietary assessment, as well as fasting blood draw assayed for C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα). Linear regression models tested the independent association of each sleep dimension with caloric intake, ACT-derived sedentary behavior, and blood-based inflammatory biomarkers, while accounting for sex, age, race/ethnicity, and body mass index.
Results: Higher ACT-measured night-to-night variability in sleep duration was most strongly associated with increased caloric intake, particularly carbohydrates (B=0.203,p<0.001), while shorter PSG-measured sleep duration was also associated with carbohydrates but to a lesser extent (B=-0.150,p=0.002). Later bedtime on weekdays was most strongly associated with higher bouts of sedentary behavior (B=0.216,p<0.001), while shorter ACT-measured sleep duration was most strongly associated with time spent sedentary (B=-0.226,p<0.001). PSG-measured sleep apnea was most strongly associated with higher CRP (B=0.287,p<0.001) and IL-6 levels (B=0.260,p<0.001), while later bedtime on weekdays (B=0.136,p=0.025) and evening circadian preference (B=-0.124,p=0.017) were also associated with inflammation but to a lesser extent.
Conclusions: The association of inadequate sleep with health behaviors and cardiometabolic risk in adolescents is in itself multidimensional. These data support that AHA guidelines should be updated to include insufficient, disturbed, and misaligned sleep as contributors to CVD risk.