Objective The objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time. Methods A total of N=30,934 participants from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI≥30), and history of hypertension, diabetes, hypercholesterolemia, heart attack, and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone, and (3) the combined effect of sleep duration and sleep insufficiency. Results Results indicated that, when examined alone, sleep duration <5 hours (vs 7 hours) was related to BMI (B=2.716, p<0.01), obesity (B=2.080, p<0.000001), diabetes (B=3.162, p<0.000001), hypertension (B=2.703, p<0.000001), hypercholesterolemia (B=1.922, p<0.00001), heart attack (B=4.704, p<0.000001), and stroke (B=4.558, p<0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B=0.181, p<.01), obesity (B=1.061, p<0.000001), and hypercholesterolemia (B=1.025, p<.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B=1.039, p<.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5 hours (vs 7 hours) and BMI (B=1.266, p<0.05), obesity (B=1.389, p<.05), hypertension (B=1.555, p<0.01), heart attack (B=2.513, p<0.01)and stroke (B=1.807, p<0.05). It should be noted that relationships between sleep duration >9 hours (vs 7 hours) were seen for heart attack (B=1.863, p<0.001) and stroke (B=1.816, p<0.01). In these models, sleep insufficiency was associated with hypercholesterolemia (B=1.031, p<0.01)and hypertension (B=1.027, p<0.05). Conclusions These analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects.

OBJECTIVE Sleep duration is associated with obesity and cardiometabolic disease. It is unclear, though, how these relationship differs across age groups. METHODS Data from the 2007–2008 National Health and Nutrition Examination Survey (NHANES) were used, including respondents aged 16+ with complete data (N=5,607). Sleep duration and age were evaluated by self-report and body mass index (BMI) was assessed objectively. Sleep duration was evaluated continuously and categorically [very short (≤4h), short (5–6h), and long (≥9h) versus average (7–8h)]. Age was also evaluated continuously and categorically [adolescent (16–17yrs), young adult (18–29yrs), early middle age (30–49 yrs), late middle age (50–6 4yrs), and older adult (≥65 yrs)]. RESULTS There was a significant interaction with age for both continuous (Pinteraction=0.014) and categorical (Pinteraction=0.035) sleep duration. A pseudo-linear relationship is seen among the youngest respondents, with the highest BMI associated with the shortest sleepers and the lowest BMI associated with the longest sleepers. This relationship becomes U-shaped in middle-age, and less of a relationship is seen among the oldest respondents. CONCLUSIONS These findings may provide insights for clinical recommendations and could help to guide mechanistic research regarding the sleep-obesity relationship.