Sex differences in the association between self-reported sleep duration, insomnia symptoms and cardiometabolic risk factors: cross-sectional findings from ELSA-Brasil

Background: The U-shaped associations between sleep durations and cardiometabolic risk factors (glycated hemoglobin levels, obesity, hypertriglyceridemia, hypertension and HDL-Cholesterol levels) are still inconclusive. Moreover, as sleep is comprised of quantitative and qualitative aspects, exploring both insomnia symptoms and sleep duration are relevant when evaluating the potential effects of sleep problems on health. The aim was to evaluate sex-specific associations between sleep problems and cardiometabolic risk factors. Methods: This cross-sectional study used data from wave two of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), including 7,491 women and 6,232 men. Questionnaires were administered to provide information about socioeconomic conditions, lifestyle, and sleep characteristics. A 12-hour fasting blood sample was drawn to measure serum cholesterol, triglycerides, and glycated hemoglobin. Blood pressure, weight and height were also measured using standard equipment. Generalized additive models were used to evaluate the curve shape of the relationship between self-reported sleep duration and the outcomes. Logistic regression was performed to investigate the magnitude of the associations of self-reported sleep duration, insomnia symptoms, and short sleep plus insomnia symptoms with cardiometabolic risk factors. Results: For women, self-reported sleep duration and insomnia symptoms (either separately or linked to short sleep duration) were associated with obesity, hypertension and glycated hemoglobin after adjusting for the confounders. The magnitudes of the associations between self-reported short sleep duration plus insomnia symptoms and the outcomes were slightly increased, considering sleep duration or insomnia symptoms separately. For men, both long sleep duration and insomnia symptoms were associated with hypertriglyceridemia after adjusted for the confounders. Conclusion: These findings suggest possible sex-specific patterns, since obesity, hypertension and high glycated hemoglobin were associated with self-reported sleep duration and insomnia symptoms in women, but not in men, and reinforce the importance of considering quantitative and qualitative aspects of sleep for the prevention and management of the outcomes.