Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group

Sleep. 2013 May 1;36(5):769-779E. doi: 10.5665/sleep.2646.


Study objectives: We hypothesize that extremes of sleep duration are associated with elevated C-reactive protein (CRP), a pro-inflammatory marker for cardiovascular disease risk.

Design: Cross-sectional.

Setting: Population-based research.

Participants: Nationally representative sample of 2007-2008 National Health and Nutrition Examination Survey participants (n = 5,587 adults).

Interventions: None.

Measurements and results: Associations between CRP and self-reported total sleep time (TST) were examined. Explanatory models considered contributions of sex, age, race/ethnicity, body mass index (BMI), and BMI squared (BMI2). Models also explored the role of insomnia symptoms, sleep apnea, active medical illness, and antidiabetic/antihypertensive treatment. Differential patterns among race/ethnicity groups were examined using interactions and stratified analyses. Nonlinear relationships between CRP and TST were assessed using polynomial and multinomial regression models (< 5, 5, 6, 7, 8, 9, and > 9 h). Linear and squared terms were significant in all models in the complete sample, with notable differences by sex and ethnoracial group. Overall, in models adjusted for sociodemographics and BMI, different patterns were observed for non-Hispanic white (elevated CRP for < 5 h and > 9 h), black/African-American (elevated CRP for < 5 h and 8 h), Hispanic/Latino (elevated CRP for > 9 h), and Asian/ Other (higher in 9 and > 9 h and lower in 5 h and 6 h) groups. Ethnoracial groups also demonstrated patterning by sex.

Conclusion: In a representative sample of American adults, elevated CRP was associated with extreme sleep durations. Sex, race/ethnicity, sleep disorders, and medical comorbidity influenced these associations. Differences in CRP along these dimensions should be considered in future research on sleep related disparities influencing cardiometabolic disease risk.

Keywords: C-reactive protein; cardiovascular disease; epidemiology; inflammation; sleep duration.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Cross-Sectional Studies
  • Ethnicity*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Self Report
  • Sex Factors
  • Sleep Wake Disorders / blood*
  • Sleep Wake Disorders / ethnology*
  • United States
  • White People*


  • Biomarkers
  • C-Reactive Protein