Timing and Length of Nocturnal Sleep and Daytime Napping and Associations With Obesity Types in High-, Middle-, and Low-Income Countries

就寝时间 医学 肥胖 体质指数 人口学 腰围 腹部肥胖 四分位间距 优势比 人口 老年学 环境卫生 内科学 社会学
作者
Lap Ah Tse,Chuangshi Wang,Sumathy Rangarajan,Zhiguang Liu,Koon Teo,Afzalhussein Yusufali,Álvaro Avezum,Andreas Wielgosz,Annika Rosengren,Iolanthé M. Kruger,Jephat Chifamba,Burcu Çalık Tümerdem,Karen Yeates,Katarzyna Zatońska,Khalid F. AlHabib,Khalid Yusoff,Manmeet Kaur,Noor Hassim Ismail,Pamela Serón,Patricio López‐Jaramillo,Paul Poirier,Rajeev Gupta,Rasha Khatib,Roya Kelishadi,Scott A. Lear,Tarzia Choudhury,Viswanathan Mohan,Wei Li,Salim Yusuf
出处
期刊:JAMA network open [American Medical Association]
卷期号:4 (6): e2113775-e2113775 被引量:32
标识
DOI:10.1001/jamanetworkopen.2021.13775
摘要

Importance

Obesity is a growing public health threat leading to serious health consequences. Late bedtime and sleep loss are common in modern society, but their associations with specific obesity types are not well characterized.

Objective

To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length.

Design, Setting, and Participants

This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021.

Exposures

Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping.

Main Outcomes and Measures

The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs.

Results

Overall, 136 652 participants (81 652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27 195 participants (19.9%) had general obesity, and 37 024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15am (1:30 am-3:00 am). A total of 19 660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8pmand 10pm, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2amand 6am (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8pm)nor wake-up time was associated with obesity.

Conclusions and Relevance

This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic.
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