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Sleep disturbances, chronotype and social jetlag (SJL) have been associated with increased risks for major chronic diseases that take decades to develop, such as obesity, metabolic syndrome and cardiovascular disease. Potential relationships between poor sleep, chronotype and SJL as they relate to metabolic risk factors for chronic disease have not been extensively investigated. This prospective study examined chronotype, SJL and poor sleep in relation to both obesity and elevated blood pressure among healthy young adults. SJL and objective sleep measures (total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency) were derived from personal rest/activity monitoring (armband actigraphy) among 390 healthy adults 21-35 years old. Participants wore the device for 6-10 days at 6-month intervals over a 2-year period (n = 1431 repeated observations). Chronotypes were categorized into morning, intermediate and evening groups using repeated measures latent class analysis. Means of SJL and sleep measures among latent chronotype groups were compared using partial F-tests in generalized linear mixed models. Generalized linear mixed models also were used to generate odds ratios (ORs) with 95% confidence intervals (CIs) examining the relationship between repeated measures of chronotype, SJL, sleep and concurrent anthropometric outcome measures (body mass index, percentage of body fat, waist-to-hip ratio, waist-to-height ratio), systolic blood pressure and diastolic blood pressure. Sleep latency ≥12 min was associated with increased odds of a high waist-to-height ratio (OR = 1.37; CI: 1.03-1.84). Neither chronotype nor SJL was independently associated with anthropometric outcomes or with blood pressure. Relationships between poor sleep and anthropometric outcomes or blood pressure varied by chronotype. Morning types with total sleep time <6 h, sleep efficiency <85% or wake after sleep onset ≥60 min were more likely to have an increased percentage of body fat, waist-to-hip ratio and waist-to-height ratio relative to those with an intermediate chronotype. Similarly, sleep latency ≥12 min was associated with increased odds of elevated systolic blood pressure (OR = 1.90; CI: 1.15-3.16, p interaction  = 0.02) among morning versus intermediate chronotypes. No relationships between poor sleep and obesity or elevated blood pressure were observed among evening chronotypes. The results from this study among healthy young adults suggest that poor sleep among morning types may be more strongly associated with obesity and elevated blood pressure relative to those with an intermediate (neutral) chronotype. Sleep-related metabolic alterations among different chronotypes warrant further investigation.

Sleep disruption has been associated with increased risks for several major chronic diseases that develop over decades. Differences in sleep/wake timing between work and free days can result in the development of social jetlag (SJL), a chronic misalignment between a person's preferred sleep/wake schedule and sleep/wake timing imposed by his/her work schedule. Only a few studies have examined the persistence of SJL or sleep disruption over time. This prospective investigation examined SJL and sleep characteristics over a 2-year period to evaluate whether SJL or poor sleep were chronic conditions during the study period. SJL and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), and sleep efficiency [SE]), were derived from armband monitoring among 390 healthy men and women 21-35 years old. Participants wore the armband for periods of 4-10 days at 6-month intervals during the follow-up period (N = 1431 repeated observations). The consistency of SJL or sleep disruption over time was analyzed using generalized linear mixed models (GLMMs) for repeated measures. Repeated measures latent class analysis (RMLCA) was then used to identify subgroups among the study participants with different sleep trajectories over time. Individuals in each latent group were compared using GLMMs to identify personal characteristics that differed among the latent groups. Minor changes in mean SJL, chronotype, or TST were observed over time, whereas no statistically significant changes in SOL, WASO, or SE were observed during the study period. The RMLCA identified two groups of SJL that remained consistent throughout the study (low SJL, mean ± SE: 0.4 ± 0.04 h, 42% of the study population; and high SJL, 1.4 ± 0.03 h, 58%). Those in the SJL group with higher values tended to be employed and have an evening chronotype. Similarly, two distinct subgroups were observed for SOL, WASO, and SE; one group with a pattern suggesting disrupted sleep over time, and another with a consistently normal sleep pattern. Analyses of TST identified three latent groups with relatively short (5.6 ± 1.0 h, 21%), intermediate (6.5 ± 1.0 h, 44%), and long (7.3 ± 1.0 h, 36%) sleep durations, all with temporally stable, linear trajectories. The results from this study suggest that sleep disturbances among young adults can persist over a 2 year period. Latent groups with poor sleep tended to be male, African American, lower income, and have an evening chronotype relative to those with more normal sleep characteristics. Characterizing the persistence of sleep disruption over time and its contributing factors could be important for understanding the role of poor sleep as a chronic disease risk factor.

Purpose: Determine if individuals with poor sleep characteristics (i.e., late sleep onset or wake times, short sleep duration, long sleep latency, low sleep efficiency, high wake after sleep onset) have greater body mass index (BMI = kg/m(2)) or body fat., Methods: Data for these cross-sectional analyses were from the Energy Balance Study (University of South Carolina). Participants were between 21 and 35 years of age and had a BMI of 20 to 35 kg/m(2). Body fat percent was measured by dual X-ray absorptiometry. Sleep and physical activity were measured by actigraphy (BodyMedia's SenseWear physical activity armband). General linear models were used to estimate mean BMI and body fat percent by sleep metric categories., Results: Greater BMI and body fat percent were associated with low sleep efficiency (BMI = 25.5 vs. 24.8 kg/m(2), P < .01; body fat = 27.7% vs. 26.5%, P = .04) and high wake after sleep onset (BMI = 25.6 vs. 25.0 kg/m(2), P = .02; body fat = 28.0% vs. 26.7%, P = .03). Elevated BMI or body fat percent also were observed for later wake times, shorter sleep duration, and longer sleep latency. Sex modified the association between wake times and body composition., Conclusions: Understanding the complex relationships between sleep and health outcomes could help reduce chronic disease burden by incorporating sleep components, measured through novel noninvasive techniques (SenseWear armband), into weight loss interventions., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This study examined associations of sleep and minutes spent in moderate-vigorous physical activity (MVPA) with C-reactive protein (CRP) and interleukin (IL)-6 among persons living with HIV. Cross-sectional analyses (n = 45) focused on associations of inflammatory outcomes (i.e., CRP and IL-6) with actigraph-derived sleep duration, latency, and efficiency; sleep onset; wake time; and wake-after-sleep-onset; as well as MVPA. Least square means for CRP and IL-6 by levels of sleep and MVPA were computed from general linear models. Individuals below the median of sleep duration, above the median for sleep onset, and below the median of MVPA minutes had higher CRP or IL-6 levels. Generally, individuals with both low MVPA and poor sleep characteristics had higher inflammation levels than those with more MVPA and worse sleep. Understanding the combined impact of multiple lifestyle/behavioral factors on inflammation could inform intervention strategies to reduce inflammation and therefore, chronic disease risk.

A descriptive, correlational design was used to examine the associations of sleep quality and stage of illness with health-related quality of life (HRQOL) in HIV-infected African-American women. Participants were recruited from 12 health clinics and AIDS service organizations (ASO) in Georgia, North Carolina, and South Carolina. The sample consisted of 144 African-American women who ranged in age from 20 to 48 years (m = 34.8, SD = 6.8). The Pittsburgh Sleep Quality Index (PSQI) and the Medical Outcomes Short-Form Health Survey (SF-36) were administered. Participants were categorized as good sleepers (PSQI global score < 7) or poor sleepers (PSQI global score > or = 7) using the median global sleep quality score. Differences in HRQOL between good and poor sleepers, as measured by the SF-36, were tested using MANOVA. Good sleepers scored significantly higher (p < 0.0001) for each SF-36 quality of life dimension and the mental and physical health summary scores. Multiple regression analysis indicated that sleep quality is associated with HRQOL, independent of the individual's stage of illness, more so with mental HRQOL than with physical HRQOL. The results suggest that treatment for poor sleep quality should be a primary concern for the treatment of HIV infection and a means for improving HRQOL.

Background: The SenseWear™ Armband (SWA) (BodyMedia, Inc. Pittsburgh, PA) is a physical activity and lifestyle monitor that objectively and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake. The real-time feedback of the SWA can improve individual self-monitoring and, therefore, enhance weight loss outcomes. Methods: We recruited 197 sedentary overweight or obese adults (age, 46.8 ± 10.8 y; body mass index (BMI), 33.3 ± 5.2 kg/m²; 81% women, 32% African-American) from the greater Columbia, South Carolina area. Participants were randomized into 1 of 4 groups, a self-directed weight loss program via an evidence-based weight loss manual (Standard Care, n = 50), a group-based behavioral weight loss program (GWL, n = 49), the armband alone (SWA-alone, n = 49), or the GWL plus the armband (GWL+SWA, n = 49), during the 9-month intervention. The primary outcome was change in body weight and waist circumference. A mixed-model repeated-measures analysis compared change in the intervention groups to the standard care group on weight and waist circumference status after adjusting for age, sex, race, education, energy expenditure, and recruitment wave. Results: Body weight was available for 62% of participants at 9 months (52% standard care, 70% intervention). There was significant weight loss in all 3 intervention groups (GWL, 1.86 kg, P = 0.05; SWA-alone, 3.55 kg, P = 0.0002; GWL+SWA, 6.59 kg, P < 0.0001) but not in the Standard Care group (0.89 kg, P = 0.39) at month 9. Only the GWL+SWA group achieved significant weight loss at month 9 compared to the Standard Care group (P = 0.04). Significant waist circumference reductions were achieved in all 4 groups at month 9 (Standard Care, 3.49 cm, P = 0.0004; GWL, 2.42 cm, P = 0.008; SWA-alone, 3.59 cm, P < 0.0001; GWL+SWA, 6.77 cm, P < 0.0001), but no intervention group had significantly reduced waist circumference compared to the Standard Care group. Conclusions: Continuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults. This strategy, combined with a group-based behavioral intervention, may yield optimal weight loss. [ABSTRACT FROM AUTHOR]

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper's integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson's r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue. [ABSTRACT FROM AUTHOR]

Introduction: Sedentary time is inversely associated with health. Capturing 24 hours of behavior (i.e., sleep, sedentary, light physical activity, and moderate-to-vigorous physical activity) is necessary to understand behavior-health associations.Methods: Healthy young adults aged 20-35 years (n=423) completed the Profile of Mood States, the Perceived Stress Scale, and dual-energy x-ray absorptiometry and anthropometric measures at baseline and 12 months. Time spent sedentary (total, in prolonged [>30 minutes] and short [≤30 minutes] bouts), in light physical activity (1.5-3.0 METs), moderate-to-vigorous physical activity (>3.0 METs), and asleep, were assessed through SenseWear armband worn 24 hours/day for 10 days at baseline. Isotemporal substitution modeling evaluated cross-sectional and longitudinal psychological and physical health associations of substituting sedentary time with sleep, light physical activity, or moderate-to-vigorous physical activity. Data were collected from 2010 to 2015 and analyzed in 2019.Results: Cross-sectional analyses revealed substituting prolonged sedentary time for sleep was associated with lower stress (standardized β= -0.11), better mood (-0.12), and lower BMI (-0.10). Substituting total or prolonged sedentary for moderate-to-vigorous physical activity was associated with lower body fat percentage (total, -0.22; prolonged, -0.23) and BMI (-0.40; -0.42). Higher BMI was associated with substituting total or prolonged sedentary for light physical activity (0.15; 0.17); lower BMI with substituting prolonged sedentary for short bouts (-0.09). Prospective analyses indicated substituting total or prolonged sedentary with light physical activity was associated with improved mood (-0.16; -0.14) and lower BMI (-0.15; -0.16); substituting with moderate-to-vigorous physical activity was associated with improved mood (-0.15; -0.15).Conclusions: Short- and long-term psychological benefits may result from transitioning sedentary time to light physical activity or sleep, whereas increasing moderate-to-vigorous physical activity may be required to influence physical health.Trial Registration: This study is registered at www.clinicaltrials.gov NCT01746186. [ABSTRACT FROM AUTHOR]