Psychosocial Factors Are Strongly Associated With Sleep Disturbances and Evening Chronotype Among Diverse Women: Evidence From the AHA Go Red for Women Strategically Focused Research Network

Background: Psychosocial factors have been linked to increased CVD risk through biological and behavioral mechanisms, possibly including short and/or long sleep duration. However, relations between specific aspects of sleep, chronotype, and psychosocial factors have not been fully characterized, particularly among women, who are more prone to poor sleep and psychosocial distress. Hypothesis: Depression, low social support, and caregiver responsibilities and strain will be associated with poor sleep patterns and having an evening chronotype among free-living ethnically diverse women. Methods: Women ages 20-76 y participating in the AHA Go Red for Women SFRN were included (N=506, 61% racial/ethnic minority, mean age = 37 ±16y). Assessments included: 1) sleep duration and quality, [Pittsburgh Sleep Quality Index (PSQI)]; 2) presence of insomnia, [Insomnia Severity Index (ISI)]; 3) obstructive sleep apnea (OSA) [Berlin Questionnaire], and 4) chronotype [Morningness-Eveningness Questionnaire]. Depression was assessed using the Beck Depression Inventory-II, low social support using the ENRICHD Social Support Instrument, and caregiver strain using the Caregiver Strain Index. Logistic regression models were used to evaluate cross-sectional associations between psychosocial factors and sleep, adjusted for age, race, ethnicity, education, and insurance. Results: Nearly 1 in 5 participants had depressive symptoms, 27% had low social support, 21% were caregivers, and 29% of caregivers experienced high strain. Half of women had short sleep duration (<7h/night), 39% had poor quality sleep (PSQI score >5), and 38% had some level of insomnia (ISI score ≥8). After adjusting for confounders, women who were depressed had ~3-fold higher odds of short sleep (<7h/night), 2-fold higher odds of poor sleep quality and having a high OSA risk (95%CI=1.69-4.61, 1.42-3.70, and 1.34-4.24, respectively), and 4-fold higher odds of insomnia (95%CI=2.42-6.59). Women with depressive symptoms were more likely to have an evening vs morning or intermediate chronotype (OR: 2.62, 95%CI=1.41-4.89). Low social support was associated with insomnia (OR: 1.79, 95%CI=1.18-2.71) and evening chronotype (OR: 2.38, 95%CI=1.35-4.19). Being a primary caregiver was associated with sleeping <7h/night (OR: 1.73, 95%CI=1.09-2.77) and high risk for OSA (OR: 2.46, 95%CI=1.43-4.22). There was no association between depression and long sleep (>8 h/night). Conclusions: In this diverse sample of women, sleep problems were highly prevalent and associated with psychosocial risk factors for CVD including depression, low social support, and caregiving. Low social support and depression were also associated with evening chronotype. These findings suggest that sleep may be a potential mechanism linking psychosocial factors to CVD risk but associations may be bidirectional and warrant confirmation prospectively.