Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults

Sleep Health. 2021 Jun;7(3):332-338. doi: 10.1016/j.sleh.2021.01.007. Epub 2021 Mar 8.


Objective: To document sleep duration and sleep quality among a sample of Marshallese adults and to examine if sleep duration and quality are associated with type 2 diabetes, body mass index (BMI), and self-reported health in the Marshallese population.

Design: Cross-sectional analysis of a staff-administered survey.

Setting: Thirty Marshallese churches in Arkansas and Oklahoma.

Participants: The study includes 378 Marshallese participants, 56.6% female, with a mean age of 42.4 years (±11.6). Recruitment was limited to participants who were considered overweight, with a BMI >25 kg/m2.

Measures: Staff-administered surveys were used to collect data on sleep duration, sleep quality, and self-reported health. Clinical measures were collected by trained research personnel using standard tools and protocols. Kruskal-Wallis tests, Spearman's correlations, and nonparametric tests of trends were used to evaluate differences in HbA1c, BMIc, and self-reported health by sleep duration and quality. Multivariable analyses were used to test the associations, controlling for sociodemographic factors.

Results: Fifty-four percent of the participants reported something other than normal sleep duration and 52.4% reported at least 1 night of difficult or interrupted sleep in the previous 2-week period. Longer sleep duration was associated with lower HbA1c and poorer sleep quality was associated with higher HbA1c. Poor sleep quality was associated with lower self-reported health. However, neither sleep duration nor quality was associated with BMI. The associations were found independent of sociodemographic factors.

Conclusion: This is the first study to document sleep duration and sleep quality, as well as the first study to examine the relationship between sleep and HbA1c, BMI, and self-reported health in Marshallese adults with a BMI >25 kg/m2. This research will be used to help develop sleep interventions to address type 2 diabetes health disparities in the Marshallese community.

Keywords: Body mass index; HbA1c; Marshallese; Sleep duration; Sleep quality; Type 2 diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Male
  • Self Report
  • Sleep


  • Glycated Hemoglobin A