Background Self-reported short and/or long sleep duration have been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodological issues. Methods Adult respondents of the 2007-2008 US National Health and Nutrition Examination Survey (NHANES) were examined in a cross-sectional analysis (N=5,649). Self-reported sleep duration was categorized as very short (<5hrs), short (5-6hrs), normal (7-8hrs) or long (≥9hrs). Obesity, diabetes, hypertension, and hyperlipidemia were assessed by self-reported history and objectively. Statistical analyses included univariate comparisons across sleep duration categories for all variables. Binary logistic regression analyses, cardiometabolic factor as outcome and with sleep duration category as predictor, were assessed with and without covariates. Observed relationships were further assessed for dependence on race/ethnicity. Results In adjusted analyses, very short sleep was associated with self-reported hypertension (OR=2.02, 95%CI[1.45, 2.81], p<0.0001), self-reported hyperlipidemia (OR=1.96, 95%CI[1.43, 2.69], p<0.0001), objective hyperlipidemia (OR=1.41, 95%CI[1.04, 1.91], p=0.03), self-reported diabetes (OR=1.76, 95%CI[1.13, 2.74], p=0.01), and objective obesity (OR=1.53, 95%CI[1.13, 2.06], p=0.005). Regarding short sleep (5-6hrs), in adjusted analyses, elevated risk was seen for self-reported hypertension (OR=1.22, 95%CI[1.02, 1.45], p=0.03) self-reported obesity (OR=1.21, 95%CI[1.03, 1.43], p=0.02) and objective obesity (OR=1.17, 95%CI[1.00, 1.38], p<0.05). Regarding long sleep (≥9hrs), no elevated risk was found for any outcomes. Interactions with Race/Ethnicity were significant for all outcomes; race/ethnicity differences in patterns of risk varied by outcome studied. In particular, the relationship between very short sleep and obesity was strongest among Blacks/African-Americans and the relationship between short sleep and hypertension is strongest among non-Hispanic Whites, Blacks/African-Americans, and non-Mexican Hispanics/Latinos. Conclusions Short sleep duration is associated with self-reported and objectively-determined adverse cardiometabolic outcomes, even after adjustment for many covariates. Also, these patterns of risk depend on race/ethnicity.

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Sleep-related complaints are widely prevalent in those with alcohol dependence (AD). AD is associated not only with insomnia, but also with multiple sleep-related disorders as a growing body of literature has demonstrated. This article will review the various aspects of insomnia associated with AD. In addition, the association of AD with other sleep-related disorders will be briefly reviewed. The association of AD with insomnia is bidirectional in nature. The etiopathogenesis of insomnia has demonstrated multiple associations and is an active focus of research. Treatment with cognitive behavioral therapy for insomnia is showing promise as an optimal intervention. In addition, AD may be associated with circadian abnormalities, short sleep duration, obstructive sleep apnea, and sleep-related movement disorder. The burgeoning knowledge on insomnia associated with moderate-to-severe alcohol use disorder has expanded our understanding of its underlying neurobiology, clinical features, and treatment options.