Abstract Body: Background: Sleep, a key component of the American Heart Association’s Life’s Essential 8 (LE8), influences both cardiovascular and mental health. However, its relationship with stress, depression, and anxiety among women remains uncertain.
Objective: Examine associations between subjective sleep duration and mental health outcomes in adult women.
Hypothesis: We hypothesized that both short and long sleep would be linked to poorer mental health.
Methods: We conducted a cross-sectional analysis of 711 women aged ≥18 years enrolled in the SAFE HEART Study. Participants were recruited from community sites in Baltimore and Washington Counties (MD) and through the American Heart Association’s Research Goes Red registry. Sleep duration was categorized as short (<7 h), optimal (7–9 h), or long (≥9 h). Mental health was assessed using the Perceived Stress Scale (PSS-4), Patient Health Questionnaire (PHQ-2), and Generalized Anxiety Disorder scale (GAD-2). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) using optimal sleep as referent: Model A unadjusted; Model B adjusted for sociodemographic factors (age, race, education, employment, marital status); Model C further adjusted for cardiovascular risk factors (smoking, physical inactivity, hypertension, diabetes, obesity).
Results: Among 711 participants (mean age 40.2 ± 14.9 years), 29% were Black, 47.8% White, and 18.6% Hispanic. Over one-third reported short sleep (37.9%), 55.1% optimal, and 7.0% long sleep. Women with short or long sleep were more likely to have lower education, be unmarried or unemployed, and exhibit higher physical inactivity, smoking, hypertension, high cholesterol, and diabetes (all p < 0.05). Overall, 73.8% had high perceived stress, 20.0% screened positive for depression, and 25.9% for anxiety. Long sleep (≥9 h) was associated with higher odds of depression in unadjusted models (OR 3.99; 95% CI 2.16–7.37) and showed borderline, non-significant association after full adjustment (OR 2.02; p = 0.06). It was also related to greater anxiety risk in unadjusted analyses (OR 2.21, 95% CI 1.20–4.07), though this attenuated after adjustment. While not statistically significant, the consistency and magnitude of these findings suggest that longer sleep may be linked to poorer mental health. Short sleep (<7 h) was not associated with stress, depression, or anxiety.
Conclusion: Longer sleep may signal poorer mental health, emphasizing sleep's role in women's CVH.