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Timing and Length of Nocturnal Sleep and Daytime Napping and Associations With Obesity Types in High-, Middle-, and Low-Income Countries

Tse LA 1 , Wang C 2 , Rangarajan S 3 , Liu Z 4 , Teo K 3 , Yusufali A 5 Show all authors , Avezum Á 6 , Wielgosz A 7 , Rosengren A 8 , Kruger IM 9 , Chifamba J 10 , Calik KBT 11 , Yeates K 12 , Zatonska K 13 , AlHabib KF 14 , Yusoff K 15 , Kaur M 16 , Ismail N 17 , Seron P 18 , Lopez-Jaramillo P 19 , Poirier P 20 , Gupta R 21 , Khatib R 22 , Kelishadi R 23 , Lear SA 24 , Choudhury T 25 , Mohan V 26 , Li W 2 , Yusuf S 3

Affiliations 

  • 1 Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
  • 2 Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  • 3 Population Health Research Institute, McMaster University, Hamilton, Canada
  • 4 Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
  • 5 Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  • 6 Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  • 7 Department of Medicine, University of Ottawa, Ottawa, Canada
  • 8 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
  • 9 Africa Unit for Transdisciplinary Health Research, North-West University, Potcehfstroom, South Africa
  • 10 Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  • 11 Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
  • 12 Department of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada
  • 13 Department of Social Medicine, Wroclaw Medical University, Wroclaw Poland
  • 14 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University College of Medicine, Riyadh, Saudi Arabia
  • 15 Universiti Teknologi MARA, Selayang, Malaysia
  • 16 Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 17 Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 18 Dpto Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
  • 19 FOSCAL and Medical School, Universidad de Santander, Bucaramanga, Colombia
  • 20 Faculté de pharmacie, Université Laval, Québec, Canada
  • 21 Eternal Heart Care Centre and Research Institute, Jaipur, India
  • 22 Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
  • 23 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 24 Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
  • 25 Independent University, Dhaka, Bangladesh
  • 26 Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, Chennai, India
JAMA Netw Open, 2021 06 01;4(6):e2113775.
PMID: 34190997 DOI: 10.1001/jamanetworkopen.2021.13775

Abstract

Importance: Obesity is a growing public health threat leading to serious health consequences. Late bedtime and sleep loss are common in modern society, but their associations with specific obesity types are not well characterized.

Objective: To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length.

Design, Setting, and Participants: This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021.

Exposures: Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping.

Main Outcomes and Measures: The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs.

Results: Overall, 136 652 participants (81 652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27 195 participants (19.9%) had general obesity, and 37 024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15 am (1:30 am-3:00 am). A total of 19 660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8 pm and 10 pm, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2 am and 6 am (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8pm) nor wake-up time was associated with obesity.

Conclusions and Relevance: This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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