2018/09/22

1

Associations between self-reported sleep duration and cardiometabolic disease risk factors in

executive employees

Paula R. Pienaar, BSc. (Hons) Biokinetics, MSc.(med)

PhD candidate | Health through Physical Activity, Lifestyle and Sport Research Centre | Department of Human Biology | Faculty of Health

Sciences | University of Cape Town

Sleep Scientist | Sleep Science | Sports Science Institute of South Africa

Scientific Advisor | Life Healthcare| Employee Health Solutions

BACKGROUND

57.4%

43.1% employment rate

58% overweight or obese

31% elevated serum cholesterol

19% high blood pressure

9% elevated blood glucose

Non-communicable diseases

Strategic decision-making

Working long hours

Business travel

Stress

Anxiety

Depression

FatigueLifestyle factors

CMD risk factors

Sleep health Employees sleeping <7h

45% 35%26% 30% 56%

PP2

Slide 4

PP2

�CDC analyzed data from currently employed adults surveyed for the 2013 and 2014 Behavioral Risk Factor Surveillance System

(BRFSS) in 29 states.�Paula Pienaar, 2018/09/08

2018/09/22

2

AIM

To undertake a preliminary assessment of the self reported sleep duration of corporate employees and its associations with risk

factors for cardiometabolic diseases.

Ongoing data collection Preliminary data

METHODS

2014 - present

Blood glucose

HDL cholesterol

Triglycerides (TG)

Body mass index (BMI)

Waist circumference (WC)

Blood pressure (BP)

International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute joint consensus

3 of 5 risk factors for Metabolic

Syndrome classification

Cardiometabolic risk factors - objective�WC

� M ≥102cm

� F ≥ 88cm

�TG ≥ 1.7 mmol/l

�HDL-C� M <1mmol/l

� F <1.3 mmol/l

�BP ≥130/85 mmHg

� Diagnosed HT

�Blood glucose ≥ 5.6mmol/l

� Diagnosed diabetes

2018/09/22

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Sleep duration (h)

Fatigue risk score

Depression, Anxiety and Stress

screening (DASS) tool

• Snoring, urinary problems, high blood

pressure, diabetes, sleep disorders,

sleep medication

• ≤6h sleep/night; ≥60h work/wk; raised

alcohol intake

• Selected DASS responses

• Score: low, moderate high

• Validated tool

• 3 subdomains mental health:

depression, anxiety, stress

• 4-point Likert scale

• Higher score = poorer mental health

measure

Lifestyle risk factors – self-report

RESULTS

Age (y) 45 (39-51) 42 (37-47) <0.001

Sleep duration (h) 7 (7-7) 7 (7-7) 0.19

BMI (kg����m-2) 27.4 (25.1-30.4) 25.5 (22.5-29.6) <0.001

WC (cm) 94.0 (87.0-102.0) 88.0 (73.0-89.0) <0.001

TG (mmol����L-1) 1.2 (0.9-1.8) 0.9 (0.6-1.2) <0.001

HDL (mmol����L-1) 1.2 (1.0-1.4) 1.6 (1.3-1.9) <0.001

SBP (mmHg) 124 (120-130) 120 (110-120) <0.001

DBP (mmHg) 80 (71-84) 70 (70-80) <0.001

Glucose (mmol����L-1) 5.1 (4.8-5.5) 4.8(4.5-5.1) <0.001

P valueN=2768 N=1130

N=3898 baseline assessments

No. Obese (%) 781 (28.3) 262 (23.2) <0.05

No. high WC (%) 723 (26.4) 320 (28.7) 0.14

No. high TG (%) 810 (30.4) 131 (12.0) <0.001

No. low HDL (%) 462 (16.9) 30 (2.7) <0.001

No. high BP (%) 543 (20.3) 94 (8.5) <0.001

No. high glucose (%) 99 (3.6) 14 (1.3) <0.001

No. MetS (%) 460 (16.6) 58 (5.1) <0.001

Age group: 25-64y

7.7-19.0%Vs 28.3%

SADHS 2016

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Meeting the recommended sleep duration guideline

Sleeping <7h

16.4% 19.9%

Men (n=2768)

Women (n=1130)

2

4

6

8

10

7

9

Sle

ep

du

ratio

n (h

ou

rs)

≤6h 7h 8h ≥9h

0

25

50

75

100

Fre

qu

en

cy (

%)

WC<102cm

WC ≥102cm

68.6

31.4

68.5

31.5

74.6

25.4

73.9

26.1

Sleep duration (h)

≤6h 7h 8h ≥9h

0

25

50

75

100

Sleep duration (h)

Fre

qu

en

cy (

%)

Normal weight

Overweight

Obese

19.2

47.2

33.6

27.4

43.8

28.8

25.1

47.6

27.4

22.7

50.0

27.3

≤6h 7h 8h ≥9h

10

20

30

40

50

60

Sleep duration (h)

BM

I (k

g/m

2)

≤6h 7h 8h ≥9h

50

75

100

125

150

175

200

Sleep duration (h)

Wa

ist

cir

cu

mfe

ren

ce

(c

m)

P <0.05

Association between sleep duration obesity and waist circumference

OR: 0.86, 95%CI: 0.75-0.98

WC: OR: 0.84, 95%CI: 0.73-0.97

Change in sleep: visit 3 vs visit 1

No significant relationship between changes in BMI or WC and sleep duration between visit 1 and visit 3

Sleep duration

52 (12.2%)68 (15.9%) 308 (72.0%)

n=428

Stress

Anxiety

Depression

Fatigue

Sleep health

Self-reported short sleep duration

Strategic decision-making

Working long hours

Business travel

PP2

Slide 16

PP2

�CDC analyzed data from currently employed adults surveyed for the 2013 and 2014 Behavioral Risk Factor Surveillance System

(BRFSS) in 29 states.�Paula Pienaar, 2018/09/08

2018/09/22

5

Short sleep duration

P <0.001

Raised stress scores

Working > 60h per week vs 40-60h

OR:1.03, [95%CI 1.01-1.05]

OR:2.12, [95%CI 1.37-3.48]

OR:1.05, [95%CI 1.04-1.06]

OR:3.29, [95%CI 2.51-4.30]

Predictors at visit 1

SUMMARY

Working long hoursBusiness travel

Strategic decision-making

StressAnxiety

Depression

Fatigue

Sleep healthShort sleep duration

PP2

Thank you!

Slide 19

PP2

�CDC analyzed data from currently employed adults surveyed for the 2013 and 2014 Behavioral Risk Factor Surveillance System

(BRFSS) in 29 states.�Paula Pienaar, 2018/09/08

2018/09/22

6

References

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4. Conway, Sadie H., et al. "Dose-response relation between work hours and cardiovascular disease risk: findings from the panel study of income dynamics." Journal of occupational and environmental medicine/American College of Occupational and Environmental Medicine 58.3 (2016): 221.

5. Afonso, P., M. Fonseca, and J. F. Pires. "Impact of working hours on sleep and mental health." Occupational Medicine67.5 (2017): 377-382.

6. Hafner, Marco, et al. "Why sleep matters–the economic costs of insufficient sleep." Europe: RAND Corporation (2016).

7. Alberti, K. G. M. M., et al. "Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity." Circulation 120.16 (2009): 1640-1645.

8. Hoek, Rianne JA, et al. "Stress Prevention@ Work: A study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial." BMC Public Health18.1 (2018): 26.

9. https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf South Africa Health Survey Demographic and Health Survey, 2016