Multidimensional sleep health is not cross-sectionally or longitudinally associated with adiposity in the Study of Women's Health Across the Nation (SWAN)

Sleep Health. 2020 Dec;6(6):790-796. doi: 10.1016/j.sleh.2020.04.014. Epub 2020 Jul 15.


Objectives: The association between sleep and adiposity (indexed by body mass index or waist-to-hip ratio) has typically been evaluated using a single dimension of self-reported sleep. However, other dimensions and behavioral measures of sleep may also be associated with adiposity. This study evaluated whether multidimensional sleep health calculated from actigraphy and self-report was longitudinally associated with adiposity in a sample of midlife women who have a high prevalence of sleep disturbances and adiposity.

Design: Longitudinal study with 11-14 years of follow-up time between the sleep health assessment and body mass index / waist-to-hip ratio measurements.

Participants: Two hundred and twenty-one midlife women enrolled in the Study of Women's Health Across the Nation Sleep Study.

Measurements: Multidimensional sleep health was quantified using actigraphy (M[SD] = 29.1[7.2] nights) measures of sleep efficiency, midpoint, duration, regularity, and self-report measures of alertness and satisfaction. Each component was dichotomized and summed; higher values indicated better sleep health. Height, body weight, and waist and hip circumference were measured at the sleep study and at follow-up. Linear regression models were used to assess associations between sleep health and adiposity, adjusting for demographic and menopausal covariates.

Results: There was no substantial within-person change in adiposity over time. Better sleep health was cross-sectionally and longitudinally associated with lower adiposity in unadjusted, but not in adjusted, models. Individual sleep health components were not associated with adiposity after adjustment.

Conclusion: We did not observe cross-sectional or longitudinal associations between multidimensional sleep health and adiposity. The sleep-adiposity link may be weaker in midlife adults than in other age groups.

Keywords: Actigraphy; Midlife women; Obesity; Sleep; Waist-to-hip ratio.

Publication types

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

MeSH terms

  • Actigraphy
  • Adiposity*
  • Adult
  • Body Mass Index
  • Cross-Sectional Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • Obesity / epidemiology*
  • Self Report
  • Sleep*
  • United States / epidemiology
  • Waist-Hip Ratio
  • Women's Health / statistics & numerical data*