Relationship Between Body Mass Index and Perceived Insufficient Sleep Among U.S. Adults

An Analysis of 2008 BRFSS Data

Anne G Wheaton; Geraldine S Perry; Daniel P Chapman; Lela R McKnight-Eily; Letitia R Presley-Cantrell; Janet B Croft

Disclosures

BMC Public Health. 2011;11 

In This Article

3. Results

The median response rate to the 2008 BRFSS survey among all 50 states and the District of Columbia was 53.3% (35.8%-65.9%), based on Council of American Survey and Research Organizations (CASRO) guidelines, and the median cooperation rate was 75.0% (59.3%-87.8%). There were 414,509 respondents to the 2008 BRFSS survey. We excluded from our analysis those with missing data for age (n = 3,653), BMI (n = 18,677), or days of inadequate sleep (n = 7,060), as well as women who indicated they were pregnant, weren't sure, or did not respond to a question about their pregnancy status (n = 3,237). After these exclusions, our study sample consisted of 384,541 U.S. adults (92.8% of all 2008 BRFSS survey respondents).

Weighted population characteristics are shown in Table 1. Nearly one-fifth of people were current smokers, and one-quarter reported no leisure-time physical activity in the previous month. Approximately one-tenth reported frequent mental distress. Only 1.8% of the population was underweight, 35.1% was normal weight, 36.4% was overweight, 17.1% was obese class I, 6.1% was obese class II, and 3.5% was obese class III. Approximately 30% reported 0 days of insufficient sleep or rest, and 11.1% reported getting insufficient rest or sleep all of the previous 30 days.

Among all adults, the adjusted mean number of insufficient days of sleep in the previous 30 days was 8.6 (95% CI: 8.5, 8.6) (Table 2). The mean number of days was higher among women than among men (9.1 and 8.0, respectively [p < 0.05]) and lower among Hispanics than among members of other racial/ethnic groups. In general, age was inversely associated with days of insufficient sleep, with adults aged 18–34 reporting the most days of insufficient sleep, and those aged 65 or older reporting the fewest. The mean number of days of insufficient sleep ranged from 8.3 days among individuals without a high school diploma to 8.8 days among those with some college; was higher among current smokers than among nonsmokers; and higher among people who reported no leisure-time physical activity in the previous month than among those who reported at least some such activity. The mean number of days of insufficient sleep was 15.6 days among adults who reported frequent mental distress, compared to 7.8 days for adults without frequent mental distress.

Overall, 27.9% of adults reported ≥14 days of insufficient sleep in the previous 30 days (Table 2). The percentage who did so was higher among women than among men (29.9% vs. 25.9%, p < 0.05); lower among Hispanics than among members of the other racial/ethnic groups; lower among those aged 65 or older (15.4%) than among those aged 25–34 (35.1%); higher among those with some college education; lower among never smokers than among former smokers and current smokers (26.0% vs. 28.3% and 32.7%, respectively, p < 0.05); and higher among those who reported no leisure-time physical activity in the previous month than among those who reported some such activity (32.2% vs. 26.4%, p < 0.05). More than half of adults who reported frequent mental distress also reported ≥14 days of insufficient sleep in the previous 30 days, compared to about a quarter of adults without frequent mental distress.

When adjusted for sociodemographic characteristics, smoking status, recent physical activity, and frequent mental distress, the mean number of days of insufficient sleep ranged from 7.9 (95% CI, 7.8, 8.0) for people in the normal-weight category to 10.5 (95% CI, 10.2, 10.9) for those in the obese class III category. The mean number was also higher for people who were underweight (8.6 [95% CI, 8.0, 9.2]) than for those of normal weight. A quarter of normal-weight people reported ≥14 days of insufficient sleep in the previous month, compared with 34.9% of those in the obese class III category.

We observed a clear, positive gradient relationship between days of insufficient sleep and BMI-based weight categories from normal weight through obese class III among both men and women (Figure 1), all racial/ethnic groups (Figure 2), and all age groups (Figure 3). Although the number of days of insufficient sleep was generally higher among people in the underweight category than among those in the normal-weight category, the difference was not always statistically significant.

Figure 1.

Mean (±95% confidence intervals) days of perceived insufficient sleep in previous 30 days by BMI category and sex. Means adjusted for race, age, education, smoking, recent physical activity, and frequent mental distress.

Figure 2.

Mean (±95% confidence intervals) days of perceived insufficient sleep in previous 30 days by BMI category and race/ethnicity. Means adjusted for sex, age, education, smoking, recent physical activity, and frequent mental distress.

Figure 3.

Mean (±95% confidence intervals) days of perceived insufficient sleep in previous 30 days by BMI category and age. Means adjusted for sex, race, education, smoking, recent physical activity, and frequent mental distress.

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