Frequent Sleep Insufficiency among Adults in Georgia: 2008-2010 BRFSS Results

Presentation to American Public Health Association (APHA)

Presented by: Viani Ramirez-Irizarry, MPH

Date: October 29, 2012Authors: Chad Dante Neilsen, MPH, Suparna Bagchi, DrPH, & Viani Ramirez-Irizarry, MPH

Presenter Disclosures

Viani Ramirez-Irizarry, MPH

• No relationships to disclose

Background• Approximately 50 to 70 million Americans suffer from

insufficient sleep-related problems1-5

– Daytime sleepiness, fatigue, impaired cognitive function, weight gain, and mood disorders

• Frequent sleep insufficiency (FSI) affects 28.5% of the U.S. population2

• FSI is most commonly defined as having ≥14 days of insufficient sleep in the preceding 30 days

• Risk factors associated with FSI are1-8:– Unhealthy lifestyle– Occupational factors – Sleep disorders

Health Impacts of FSI• FSI decreases

productivity and alertness, and increases the risk of injury and death4,7,8

• FSI has been partially responsible for human and environmental health disasters– Exxon Valdez oil tanker14

Problem• National studies have previously demonstrated

that demographic and behavioral risk factors are associated to FSI3-10

• Literature reporting on burden of FSI and associated health risk factors for the state of Georgia is scarce

Study Aim

• To determine the prevalence of FSI among adults in Georgia

• To determine the health correlates of FSI among adults in Georgia after adjusting for socio-demographic and health risk factors

Data Source

• Behavioral Risk Factor Surveillance Survey (BRFSS)

– Established in 1984– Annual, State-based, cross-sectional telephone survey– Collects information about behaviors associated with

preventable chronic diseases, injuries, and infectious diseases– Noninstitutionalized adults ≥18 with land-line telephones, from all 50 states, District of Columbia, Puerto Rico, and Virgin Islands– 2008: Added question to measure sleep insufficiency in all states, including Georgia

Covariates• Demographics: age, sex, race/ethnicity, and

education

• Dependent Variable: frequent sleep insufficiency (FSI)

• Independent variables: smoking, heavy drinking, leisure time physical activity (LTPA), and frequent mental distress (FMD)

Definitions

• Frequent sleep insufficiency (FSI): ≥14 days in response to: – “During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?”

Definitions

• Frequent mental distress (FMD): ≥14 days in response to: – “Now thinking about your mental health, which

includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

• Smoking: “Yes” responses to:– “Current Smoker”

• Heavy Drinking:– Males that had ≥2 drinks per day; females that had ≥1

drinks per day

Definitions• No Leisure Time Physical Activity (LTPA):

“No” responses to:– “Adults that report doing physical activity or

exercise during the past 30 days other than their regular job”

• Body Mass Index (BMI) Status: – Normal: 18.5 ≤ BMI < 25 – Overweight: 25 ≤ BMI < 30 – Obese: BMI ≥ 30

Data Analyses

• Combined data from 2008, 2009, and 2010 Georgia BRFSS

• Bivariate associations between FSI and demographic and health risk factors

• Multivariable logistic regression analyses to derive Adjusted Odds Ratios (AOR) and 95% Confidence Intervals of factors associated with FSI

• SAS-callable SUDAAN (v.11.0.0) was used to conduct all analyses

Study Sample • Combined study sample: 17,400 GA adults• Study sample consisted of:

– Males (49%)– Females (51%)– NH White (63%)– NH Black (26%)– Hispanic (5%)– NH Other (6%)

• Overall prevalence of FSI among adults in GA was

28.5% (95% CI: 27.4 - 29.6)

Demographic Distribution of Study Sample, GA, 2008-2010

% Prevalence 95% Confidence Intervals

Sex

Male 48.6 47.4 49.7

Female 51.4 50.2 52.6

Race/Ethnicity

White NH 63.1 62.0 64.3

Black NH 25.7 24.6 26.7

Hispanic 5.3 4.6 6.0

Other NH 5.9 5.2 6.6

Age (mean) 45.4 45.0 45.8

Education

<High School 10.4 9.7 11.1

High School Graduate 27.4 26.4 28.5

Some College 25.6 24.6 26.6

College Graduate 36.6 35.2 37.7

Distribution of Study Sample by Health Status, GA, 2008-2010

Health Status % Prevalence 95% Confidence Intervals

Frequent Sleep Insufficiency (FSI) 28.5 27.4 29.6

Frequent Mental Distress (FMD) 10.2 9.5 10.9

BMI Category

Normal 34.4 33.3 35.5

Overweight 37.1 36.0 38.2

Obese 28.5 27.5 29.6

Risk Behavior

Smoking 18.3 17.3 19.2

Heavy Drinking 3.0 2.6 3.4

No LTPA 24.1 23.2 25.1

Prevalence of Self-Reported FSI Among Adults by Demographics, GA, 2008-2010

*p<0.05 ^p<0.001

Prevalence of Self-Reported FSI Among Adults by Demographics, GA, 2008-2010

Prevalence of FSI Among Adults by Health Status, GA, 2008-2010

*p<0.0001

Statistical Model

• Full Multivariable Logistic Regression Model:– Frequent Sleep Insufficiency (FSI)

= Sex + Age + Frequent Mental Distress (FMD) + Body Mass Index (BMI) + Smoking + Leisure Time Physical Activity (LTPA) + Heavy Drinking

Multivariable Regression

DemographicsOdds Ratio

(OR)95% Confidence

Intervals

Sex

Male Ref Ref Ref

Female 1.1 1.0 1.3

Age Groups

18-24 years 2.3* 1.6 3.1

25-34 years 3.3* 2.8 3.9

35-44 years 2.8* 2.4 3.2

45-54 years 2.1* 1.8 2.4

55-64 years 1.6* 1.4 1.8

≥ 65 years Ref Ref Ref

*p<0.001

Multivariable Regression

Health StatusOdds Ratio

(OR)95% Confidence

Intervals

Frequent Mental Distress (FMD) 4.6* 3.9 5.5

BMI Category

Normal Ref Ref Ref

Obese 1.4* 1.2 1.6

Overweight 1.2* 1.04 1.4

Risk Behaviors

Smoking 1.4* 1.2 1.7

No Physical Activity 1.4* 1.2 1.6

Heavy Drinking 1.1 0.8 1.6

*p<0.001

Summary• Similar to other studies:

– the prevalence of FSI in Georgia was comparable to that for the US2

– individuals who were 25-34 years old, obese, physically inactive, smokers, and that had FMD were significantly more likely to report FSI3-6,8,12

– education level and race/ethnicity were not significantly associated with FSI5,6

• In contrast to other studies, heavy drinking and sex were not significantly associated to FSI; however, the direction of the associations were similar3-6,8-13

Public Health Implications• Interventions should be directed to promoting good mental

health, healthy weight management, smoking cessation, as well as to increasing physical activity

• Increasing awareness about negative effects of sleep loss is important to encourage sleep health and reduce FSI prevalence in Georgia

• Healthcare professionals need more training in order to effectively identify, diagnose, and treat sleep conditions among their patients

• More research is needed in order to determine specific risk factors associated to sleep insufficiency

Strengths

• FSI estimates among adults in Georgia

• Association of FSI with other health risk factors

• Population-based data from BRFSS allows results to be representative of the state of Georgia

Limitations

• Self-reported data

• Institutionalized individuals and those without landline phones not included– Results not generalizable to these populations

• Cross-sectional design does not allow determination of causality

• Only representative of Georgia

• Differences in FSI definitions in literature

References1. The American Occupational Therapy Association, Inc. (2012). Occupational Therapy’s Role in

Sleep. Available from http://www.aota.org/Consumers/Professionals/WhatIsOT/WI/Facts/Sleep.aspx?FT=.pdf

2. Centers for Disease Control and Prevention. (2009). Perceived Insufficient Rest or Sleep Among Adults – US, 2008. MMWR 58 (42);1175-1179. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5842a2.htm

3. Herrick, H. (2010). The Association of Insufficient Sleep with Smoking, Obesity, Physical Inactivity, and Poor Quality of Life: Results from the 2008 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) Survey. The State Center for Health Statistics Statistical Brief No.35. Available from http://www.schs.state.nc.us/SCHS/pdf/SB_35_WEB.pdf

4. Centers for Disease Control and Prevention. (2011). Unhealthy Sleep-Related Behaviors-12 States, 2009. MMWR 60 (8);233-238.

5. Strine, T.W. & Chapman, D.P. (2005). Associations of Frequent Sleep Insufficiency with Health-Related Quality of Life and Health Behaviors. Sleep Medicine 6(1); 23-27.

6. Wheaton, A.G., Perry, G.S., Chapman, D.P., McKnight-Eily, L.R., Presley-Cantrell, L.R., & Croft, J.B. (2011). Relationship between Body Mass Index and Perceived Insufficient Sleep Among US Adults: an Analysis of 2008 BRFSS data. BMC Public Health 11:295. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098793/

7. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. (2006). Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US). 3, Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. Available from: http://www.ncbi.nlm.nih.gov/books/NBK19961/

References8. Centers for Disease Control and Prevention. (2011). Effect of Short Sleep Duration on

Daily Activities – US, 2005-2008. MMWR 60(8);239-242.

9. Chaput, J.P., McNeil, J., Despres, J.P., Bouchard, C., & Tremblay, A. (2012). Short Sleep Duration is Associated with Greater Alcohol Consumption in Adults. Appetite 59(3); 650-655.

10. Haario, P., Rahkonen, O., Laaksonen, M., Lahelma, E., & Lallukka, T. (2012). Bidirectional Associations Between Insomnia Symptoms and Unhealthy Behaviours. J Sleep Res doi: 10.1111/j.1365-2869.2012.01043.x .

11. Krueger, P.M. & Friedman, E.M. (2009). Sleep Duration in the United States: a Cross-Sectional Population-Based Study. Am J Epidemiol 169(9); 1052-1063.

12. Centers for Disease Control and Preventio. (2011). Insufficient Sleep Among Georgia Adults. In: Sleep and Sleep Disorders. Available from http://www.cdc.gov/sleep/pdf/states/Insufficient_Sleep_Fact_Sheet_2011_GA.pdf

13. Roehrs, T. & Roth, T. (2001). Sleep, sleepiness, sleep disorders and alcohol use and abuse. Sleep Med 5(4):287-297.

14. Exxon Valdez Oil Spill Trustee Council. (n.d.). Oil Spill Facts. Available from http://www.evostc.state.ak.us/facts/index.cfm

Thank You

Questions?