Perceived home sleep environment: associations of household-level factors and in-bed behaviors with actigraphy-based sleep duration and continuity in the Jackson Heart Sleep Study

Study Objectives: In an older African-American sample (n = 231) we tested associations of the household environment and in-bed behaviors with sleep duration, efficiency, and wakefulness after sleep onset (WASO). Methods: Older adult participants completed a household-level sleep environment questionnaire, a sleep questionnaire, and underwent 7-day wrist actigraphy for objective measures of sleep. Perceived household environment (self-reported) was evaluated using questions regarding safety, physical comfort, temperature, noise, and light disturbances. In-bed behaviors included watching television, listening to radio/music, use of computer/tablet/phone, playing video games, reading books, and eating.To estimate the combined effect of the components in each domain (perceived household environment and in-bed behaviors), we calculated and standardized a weighted score per sleep outcome (e.g. duration, efficiency, WASO), with a higher score indicating worse conditions. The weights were derived from the coefficients of each component estimated from linear regression models predicting each sleep outcome while adjusting for covariates. Results: A standard deviation increase in an adverse household environment score was associated with lower self-reported sleep duration (beta = -13.9 min, 95% confidence interval: -26.1, -1.7) and actigraphy-based sleep efficiency (beta = -0.7%, -1.4, 0.0). A standard deviation increase in the in-bed behaviors score was associated with lower actigraphy-based sleep duration (beta = -9.7 min, -18.0, -1.3), sleep efficiency (beta = -1.9, -0.6), and higher WASO (5.3 min, 2.1, 8.6). Conclusion: Intervening on the sleep environment, including healthy sleep practices, may improve sleep duration and continuity among African-Americans.