Association between sleep duration and high blood pressure in adolescents: a systematic review and meta-analysis

Context: Sleep has been assessed as a risk factor for health consequences. Among adults, excessively longer and shorter sleep durations are associated with high blood pressure (BP), but knowledge of the association between sleep duration and high BP among adolescents is limited.

Objectives: To estimate the associations between sleep duration and high BP in adolescents.

Methods: PubMed, Web of Science, and Cochrane databases were searched for eligible publications up until 20 November 2017. This study reviewed the reference lists from retrieved articles to search for relevant studies. Pooled odds ratios (ORs) were calculated using a random-effects meta-analysis. Sub-group and sensitivity analyses were conducted to identify heterogeneity. Publication bias was evaluated using Egger’s test.

Results: Seven studies involving 21,150 participants were included, with ages ranging from 10–18 years. For primary analysis, compared with the reference sleep duration, the pooled OR for high BP was 1.51 (95% confidence interval [CI]?=?1.04–2.19) for the short sleep duration overall. For long sleep duration, the pooled OR was 1.04 (95% CI?=?0.78–1.38). Further sub-group analysis showed that short sleep duration had a higher risk of incident high BP in males (OR?=?1.55, 95% CI?=?1.24–1.93) than in females (OR?=?1.23, 95% CI?=?0.47–3.22).

Conclusions: Among adolescents, and particularly male adolescents, short sleep duration may be a risk factor for high BP. More attention should be given to this lifestyle factor.     

Trajectories of reported sleep duration associate with early childhood cognitive development

Study ObjectivesExamine how different trajectories of reported sleep duration associate with early childhood cognition.MethodsCaregiver-reported sleep duration data (n = 330) were collected using the Brief Infant Sleep Questionnaire at 3, 6, 9, 12, 18, and 24 months and Children’s Sleep Habits Questionnaire at 54 months. Multiple group-based day-, night-, and/or total sleep trajectories were derived—each differing in duration and variability. Bayley Scales of Infant and Toddler Development-III (Bayley-III) and the Kaufman Brief Intelligence Test- 2 (KBIT-2) were used to assess cognition at 24 and 54 months, respectively.ResultsCompared to short variable night sleep trajectory, long consistent night sleep trajectory was associated with higher scores on Bayley-III (cognition and language), while moderate/long consistent night sleep trajectories were associated with higher KBIT-2 (verbal and composite) scores. Children with a long consistent total sleep trajectory had higher Bayley-III (cognition and expressive language) and KBIT-2 (verbal and composite) scores compared to children with a short variable total sleep trajectory. Moderate consistent total sleep trajectory was associated with higher Bayley-III language and KBIT-2 verbal scores relative to the short variable total trajectory. Children with a long variable day sleep had lower Bayley-III (cognition and fine motor) and KBIT-2 (verbal and composite) scores compared to children with a short consistent day sleep trajectory.ConclusionsLonger and more consistent night- and total sleep trajectories, and a short day sleep trajectory in early childhood were associated with better cognition at 2 and 4.5 years.     

Association of hostility with sleep duration and sleep disturbances in an employee population

Background: Sleep disturbances are common among the general population, and hostile persons have been proposed to be at greater risk of several serious health problems and diseases. Purpose: This study examined the relationships between hostility, sleep disturbances, and sleep duration in a large non-clinical sample of 5,433 employees working in 12 Finnish hospitals. Method: Data were collected by questionnaire surveys in 1998 and 2000. Results: Higher hostility was cross-sectionally associated with increased sleep disturbances but not with sleep duration after adjustment for gender, age, marital status, education, shift work, smoking, alcohol consumption, physical activity, body mass index, psychiatric morbidity, and somatic disease. A stratified analysis distinguishing individuals with stable hostility across the two measurements and those with transient hostility (>0.5 SD difference between measurements) replicated the association with increased sleep disturbance in both groups, but among those with transient hostility, there additionally was a cross-sectional association between higher hostility and shorter sleep duration. Conclusion: Our evidence suggests that hostility is an independent risk factor for sleep disturbances and that transient hostility may also predispose shorter sleep duration. However, the effect sizes for all these associations were small, suggesting limited clinical significance for our findings.     

Continuous positive airway pressure lowers blood pressure in hypertensive patients with obstructive sleep apnea

Summary Question of the study Obstructive sleep apnea (OSA) and hypertension are frequently associated and probably causally related. We investigated the influence of continuous positive airway pressure (CPAP) on blood pressure (BP) in OSA. Patients and Methods Fourty-four patients in whom CPAP-therapy had been successfully applied for treatment of OSA (median apnea-hypopopnea-index [AHI] 57.5/h) were included. Non-invasive 24-hour BP was measured at 15  min intervals before and with CPAP. Results After 1 – 3 days of CPAP, 24-hour systolic and diastolic BP in the hypertensive patients (n = 32) decreased from a median of 141 (129 – 173, 25 % – 75 % interquartile range) mmHg to 136 (118 – 157) mmHg (p = 0.004) and from 90 (80 – 107) mmHg to 88 (77 – 99) mmHg (p = 0.001), respectively, but was unchanged in the normotensives (n = 10). After 4 – 6 months of CPAP, 24-hour systolic and diastolic BP in a hypertensive subgroup (n = 19) decreased from a median of 140 (131 – 142) mmHg to 131 (122 – 143) mmHg (p = 0.01) and from 88 (86 – 94) mmHg to 84 (80 – 87) mmHg (p = 0.02), respectively, but was unchanged in a normotensive subgroup (n = 8). After long-term CPAP, there was a small weight reduction in the hypertensive patients. Subgroup analysis of 13 hypertensives with stable weight confirmed a significant BP-reduction. Conclusions In OSA with associated hypertension, CPAP has a specific BP-lowering effect. This suggests that both disorders are causally related.     

Associations of usual sleep duration with serum lipid and lipoprotein levels

STUDY OBJECTIVES: We examined the individual association between sleep duration and a high serum triglyceride, low HDL cholesterol, or high LDL cholesterol level. DESIGN AND SETTING: The present study analyzed data from the National Health and Nutrition Survey that was conducted in November 2003 by the Japanese Ministry of Health, Labour and Welfare. This survey was conducted on residents in the districts selected randomly from all over Japan. PARTICIPANTS: The subjects included in the statistical analysis were 1,666 men and 2,329 women aged 20 years or older. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: Among women, both short and long sleep durations are associated with a high serum triglyceride level or a low HDL cholesterol level. Compared with women sleeping 6 to 7 h, the relative risk of a high triglyceride level among women sleeping <5 h was 1.51 (95% CI, 0.96-2.35), and among women sleeping > or =8 h was 1.45 (95% CI, 1.00-2.11); the relative risk of a low HDL cholesterol level among women sleeping <5 h was 5.85 (95% CI, 2.29-14.94), and among women sleeping > or =8 h was 4.27 (95% CI, 1.88-9.72). On the other hand, it was observed that the risk of a high LDL cholesterol level was lower among men sleeping > or =8 h. These analyses were adjusted for the following items: age, blood pressure, body mass index, plasma glucose level, smoking habit, alcohol consumption, dietary habits, psychological stress, and taking cholesterol-lowering medications. CONCLUSIONS: Usual sleep duration is closely associated with serum lipid and lipoprotein levels.     

Increasing sleep duration to lower beat‐to‐beat blood pressure: a pilot study

Strong evidence has accumulated over the last several years, showing that low sleep quantity and/or quality plays an important role in the elevation of blood pressure. We hypothesized that increasing sleep duration serves as an effective behavioral strategy to reduce blood pressure in prehypertension or type 1 hypertension. Twenty‐two participants with prehypertension or stage 1 hypertension, and habitual sleep durations of 7 h or less, participated in a 6‐week intervention study. Subjects were randomized to a sleep extension group (48 ± 12 years, N = 13) aiming to increase bedtime by 1 h daily over a 6‐week intervention period, or to a sleep maintenance group (47 ± 12 years, N = 9) aiming to maintain habitual bedtimes. Both groups received sleep hygiene instructions. Beat‐to‐beat blood pressure was monitored over 24 h, and 24‐h urine and a fasting blood sample were collected pre‐ and post‐intervention. Subjects in the sleep extension group increased their actigraphy‐assessed daily sleep duration by 35 ± 9 min, while subjects in the sleep maintenance condition increased slightly by 4 ± 9 min (P = 0.03 for group effect). Systolic and diastolic beat‐to‐beat blood pressure averaged across the 24‐h recording period significantly decreased from pre‐ to post‐intervention visit in the sleep extension group by 14 ± 3 and 8 ± 3 mmHg, respectively (P < 0.05). Though the reduction of 7 ± 5 and 3 ± 4 mmHg in the sleep maintenance group was not significant, it did not differ from the blood pressure reduction in the sleep extension group (P = 0.15 for interaction effect). These changes were not paralleled by pre‐ to post‐intervention changes in inflammatory or sympatho‐adrenal markers, nor by changes in caloric intake. While these preliminary findings have to be interpreted with caution due to the small sample size, they encourage future investigations to test whether behavioral interventions designed to increase sleep duration serve as an effective strategy in the treatment of hypertension.     

Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults

A growing number of studies from a range of different countries have observed an association between sleep duration and cardiovascular disease. The objective of this paper was to examine the associations between sleep duration and prevalent cardiovascular disease in a large sample of Australian adults, and identify the sociodemographic and health-related factors moderating these associations. Participants included 218,155 Australian adults aged 45years and over. The results indicated that 6h versus 7h sleep was associated with increased odds of heart disease [odds ratio (OR)=1.11 (1.06-1.17)], diabetes [OR=1.15 (1.09-1.22)], stroke [OR=1.25 (1.14-1.38)] and high blood pressure [OR=1.08 (1.04-1.11)]. Long sleep (≥9h sleep) was also related to elevated odds of heart disease [OR=1.14 (1.09-1.19)], diabetes [OR=1.25 (1.19-1.31)], stroke [OR=1.50 (1.38-1.62)] and high blood pressure [OR=1.04 (1.01-1.08)] compared to 7h sleep. Some of these relationships varied by age, and were not evident in adults aged 75years and over. The magnitude of some associations varied significantly by body mass index, smoking and physical activity. These findings provide further insight into the nature of the relationship between sleep and cardiovascular health.     

Associations between everyday discrimination and sleep quality and duration among African-Americans over time in the Jackson Heart Study

Study ObjectivesAfrican-Americans have a high burden of poor sleep, yet, psychosocial determinants (e.g. discrimination) are understudied. We investigated longitudinal associations between everyday discrimination and sleep quality and duration among African-Americans (N = 3404) in the Jackson Heart Study.MethodsAt Exam 1 (2000–2004) and Exam 3 (2008–2013), participants completed the Everyday Discrimination Scale, rated their sleep quality (1 = poor to 5 = excellent), and self-reported hours of sleep. A subset of participants (N = 762) underwent 7-day actigraphy to objectively measure sleep duration and sleep quality (Sleep Exam 2012–2016). Changes in discrimination were defined as low stable (reference), increasing, decreasing, and high stable. Within-person changes in sleep from Exam 1 to Exam 3 were regressed on change in discrimination from Exam 1 to Exam 3 while adjusting for age, sex, education, income, employment, physical activity, smoking, body mass index, social support, and stress.ResultsAt Exam 1, the mean age was 54.1 (12.0) years; 64% were female, mean sleep quality was 3.0 (1.1) and 54% were short sleepers. The distribution of the discrimination change trajectories were 54.1% low stable, 13.5% increasing, 14.6% decreasing, and 17.7% were high stable. Participants who were in the increasing (vs. low stable) discrimination group had greater decrease in sleep quality. There was no association between change in discrimination and change in sleep duration. Among Sleep Exam participants, higher discrimination was cross-sectionally associated with shorter self-reported sleep duration, independent of stress.ConclusionDiscrimination is a unique stressor for African-Americans; thus, future research should identify interventions to reduce the burden of discrimination on sleep quality.     

Sleep duration and blood pressure: a longitudinal analysis from early to late adolescence

The aim of this study was to evaluate the association between sleep duration and blood pressure using a cross‐sectional and longitudinal approach. As part of a population‐based cohort, 1403 adolescents were evaluated at 13 and 17 years old. Sleep duration was estimated by the difference between self‐reported usual bedtime and wake‐up time. Blood pressure was measured using the auscultatory method. Regression coefficients (β) and respective 95% confidence intervals were computed to evaluate the association between sleep duration and blood pressure, using linear regression models adjusted for practice of sports and body mass index at 17 years old. The mean (standard deviation) sleep duration at 13 years old was 9.0 (0.76) h per day, and on average it decreased by 46 min up to 17 years old. The median (25th–75th) systolic blood pressure at 17 years old was 110.0 (103.5–119.0) mmHg in females and 114.0 (106.0–122.0)mmHg in males (P < 0.001); for diastolic blood pressure the values were 66.0 (60.0–71.0) and 69.0 (62.0–75.0) mmHg, respectively (P < 0.001). In cross‐sectional analysis, at 17 years old, after adjustment, a positive association was found between sleep duration and blood pressure, significant only for systolic blood pressure among females [β = 0.730 (0.005; 1.455)]. In girls, no significant association was found between sleep duration at 13 years old and blood pressure at 17 years old, but in males an inverse association was found between sleep duration at 13 years old and blood pressure at 17 years old significant only for systolic blood pressure [β = ?1.938 (?3.229; ?0.647)]. This study found no association between sleep duration at 13 years old and blood pressure at 17 years old in girls, but among males an inverse association was found.     

Self-reported seasonality is associated with complaints of sleep problems and deficient sleep duration: the Hordaland Health Study

Change in sleep duration dependent on time of year is a central characteristic of seasonal affective disorder (SAD). In a community health survey, we analysed associations between seasonality, subjective sleep problems and sleep duration. Totally, 8860 subjects (3531 men and 5329 women) aged between 40 and 44 years were included in the study. Seasonal changes in mood and behaviour were measured by the Global Seasonality Score (GSS) questionnaire, and subjects were grouped in high (GSS > or = 11), moderate (GSS 8-10) or low (GSS < 8) seasonality groups. Sleep symptomatology was assessed using a modified version of the Karolinska Sleep Questionnaire. Significant sleep duration deficiency was defined as the difference between subjective sleep need and sleep duration of at least 1 h. Sleep problems suggesting insomnia as well as increased daytime sleepiness were more prevalent in the high/moderate seasonality groups compared with the low seasonality group. Seasonality was furthermore associated with shorter sleep duration and increased subjective sleep need. Significant sleep duration deficiency was more prevalent in subjects reporting high (men 20% and women 21%) and moderate (men 13% and women 19%) seasonality than subjects reporting low (men 10% and women 14%) seasonality. In conclusion, we found seasonal changes in mood and behaviour to be associated with several sleep-related complaints. Sleep duration deficiency increased with increasing seasonality, mainly due to increasing subjective sleep need.     

The duration of REM sleep epic, odes in normal sleep

SUMMARY  The distributions of the durations of the first 3 REM sleep episodes have been analysed using a total of 134 overnight sleep recordings from 10 subjects. From investigation of the length of uninterrupted episodes of stage REM, it is shown that arousals to stage 0/1 could play an important part in the process of REM exit, and that by the middle of the sleep period, these arousals probably occur according to a Poisson process. During the first and second REM episodes a more complex process appears to be at work, which could reflect increased pressure for slow wave sleep. These findings suggest that the duration of a REM episode is determined by a process that has a large stochastic element, which is not necessarily tied to REM entry.     

Association of active and passive smoking with sleep disturbances and short sleep duration among Japanese working population

Background: The relationship between passive smoking and sleep is uncertain. Purpose: To examine the association of passive/active smoking with sleep disturbances. Method: 732 women and 1,896 men, working in a suburb of Tokyo, were surveyed using a self-administered questionnaire. Information on smoking, passive smoking exposure, and sleep was elicited. Exposure levels to passive smoking were assessed separately at work and at home as no, occasional, or regular exposure. Risk of sleep disturbances according to smoking status was estimated using logistic regression with odds ratios (OR) and 95% confidence intervals (CIs) as measures of association. Results: Compared to never smokers, odds of difficulty awakening in the morning (DAM) in current smokers were significantly higher for women (OR 1.95) and men (OR 1.50), while increased difficulty initiating sleep (OR 1.88) and decreased early morning awakening (OR 0.31) were found only in women. Never smoking men occasionally exposed to passive smoking at work but not at home had increased odds (OR 1.81) of short sleep duration (SSD, <6 h) than unexposed counterparts. Conclusions: The analyses suggest that exposure to passive smoking at work is associated with SSD in men, while current smoking relates to various subtypes of sleep disturbances in both sexes.     

Weekend catch-up sleep is associated with decreased risk of being overweight among fifth-grade students with short sleep duration

Previous studies have reported a relationship between short sleep duration and childhood overweight. Although school‐aged children tend to compensate for weekday sleep deficit by increasing weekend sleep duration, the association between weekend catch‐up sleep and childhood overweight remains unclear. This study aimed to examine the relationship between weekend catch‐up sleep and being overweight in children. A total of 936 school children (48.2% boys) aged 10 or 11 years participated in this school‐based cohort study. Anthropometric measurements including height and body weight were carried out. We obtained data on sleep patterns, lifestyle and parent characteristics using questionnaires. The main outcome measure was childhood overweight. After adjusting for the relevant confounding variables (age, sex, breakfast eating, screen time and parental obesity), longer sleep on weekdays and weekends was associated with decreased odds of childhood overweight (OR: 0.68; 95% CI: 0.54–0.86; OR: 0.64; 95% CI: 0.53–0.77, respectively). Participants with increased catch‐up sleep duration during weekends also had decreased odds of being overweight (OR: 0.67; 95% CI: 0.53–0.85). There was an interaction between weekday sleep duration and weekend catch‐up sleep in relation to childhood overweight, and this effect of weekend catch‐up sleep on being overweight was stronger as the participants slept less on weekdays (P = 0.024). These results indicate that weekend catch‐up sleep is independently associated with decreased risk of being overweight in fifth‐grade students, and this effect can be varied by the weekday sleep duration. A prospective study is required to confirm this observation.     

Self-reported sleep duration in Finnish general population

Self-reported short or long sleep duration has been repeatedly found to be associated with increased mortality and health risks. However, there is still an insufficient amount of detailed knowledge available to characterize the short and long sleep duration groups in general population. Consequently, the underlying mechanisms potentially explaining the health risks associated with short and long sleep duration are unclear. In the present study, the self-reported sleep duration in a sample of Finnish general population was studied, and its possible associations with such factors as self-perceived health, sociodemographic characteristics, lifestyle, sleep difficulties and daytime concomitants were analyzed. In particular, an effort was made to define mutually statistically-independent determinants of sleep duration. In the Finnish Health 2000 Survey, a representative sample of 8,028 subjects of 30 years of age or older and a sample of 1,894 subjects of 18-29 years of age were invited to take part in the health interview and health examination. The participation rate of the study was over 80%. The most important and statistically-independent determinants of short and long sleep duration were gender, physical tiredness, sleep problems, marital status, main occupation and physical activity. However, in the multivariable model they only accounted for approximately 16% of the variance in sleep duration in short and long sleepers, suggesting multiple sources of variance. The present study also suggests a dose-response like relationship between the sleep duration and many of its determinants within both short and long sleepers. A more detailed analysis of the clinical status of the short and long sleep duration groups is needed to evaluate the possible importance of these findings for health risks associated with sleep duration.     

妊娠高血压综合征的相关心理因素分析

为了探讨妊娠高血压综合征患者的相关社会心理因素,我们采用艾森克人格问卷（EPQ）、社会支持量表（SSRS）、SCL－90,对40例妊高征和80例正常妊娠者进行测查。结果显示,妊高征组EPQN分显著高于正常对照组,发现躯体化、强迫、焦虑等因子分显著高于对照组,提示妊高征患者存在心理卫生问题需要引起关注。     

Differences in relationships among sleep apnoea, glucose level, sleep duration and sleepiness between persons with and without type 2 diabetes

Obstructive sleep apnoea is common in patients with diabetes. Recently, it was reported that short sleep duration and sleepiness had deleterious effects on glucose metabolism. Thereafter, several reports showed relationships between glucose metabolism and obstructive sleep apnoea, sleep duration or sleepiness. But the interrelationships among those factors based on recent epidemiological data have not been examined. We analysed data on 275 male employees (age, 44±8years; body mass index, 23.9±3.1kg m(-2) ) who underwent a cross-sectional health examination in Japan. We measured fasting plasma glucose, sleep duration using a sleep diary and an actigraph for 7days, and respiratory disturbance index with a type 3 portable monitor for two nights. Fifty-four subjects (19.6%) had impaired glucose metabolism, with 21 having diabetes. Of those 21 (body mass index, 25.9±3.8kgm(-2) ), 17 (81.0%) had obstructive sleep apnoea (respiratory disturbance index≥5). Regarding the severity of obstructive sleep apnoea, 10, four and three had mild, moderate and severe obstructive sleep apnoea, respectively. The prevalence of obstructive sleep apnoea was greater in those with than without diabetes (P=0.037). Multiple regression analyses showed that the respiratory disturbance index independently related to fasting plasma glucose only in the diabetic subjects. In patients with diabetes, after adjustment for age, waist circumference, etc. sleep fragmentation had a greater correlation with fasting plasma glucose than sleep duration, but without significance (P=0.10). Because the prevalence of obstructive sleep apnoea is extremely high in patients with diabetes, sufficient sleep duration with treatment for obstructive sleep apnoea, which ameliorates sleep fragmentation, might improve fasting plasma glucose.     

Lung volumes and mean apnea duration in obstructive sleep apnea

Former studies suggested that lung volumes might play a role in pathomechanisms of obstructive sleep apnea (OSA). Mean apnea duration (MAD) is a rarely investigated parameter in OSA but is possibly a surrogate of arousal threshold. The aim of this study was to evaluate the influence of lung volumes to MAD in OSA. In 69 patients with obstructive sleep apnea (51 male und 18 female, BMI 34.2 ± 6.0 kg/m², age 53.6 ± 9.7 years, AHI 43.1 ± 21.1/h) we performed a polysomnography and pulmonary function testing in daytime. There was a significant correlation between MAD and residual volume (RV) (r = 0.51; p < 0.001), which was the highest correlation we found. In linear regression analysis RV remained the only independent variable with significant influence on MAD (p < 0.001). We could show that RV seems to play a role in the mechanisms of apnea termination in terms of MAD. MAD reflects the time until a specific negative intrathoracic pressure is reached to induce an arousal. In this process dependency on RV could explain our results. Despite some limitations these results provide some new aspects in understanding pathophysiology of OSA.     

A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort

STUDY OBJECTIVES: Although sleep curtailment has become widespread in industrialised societies, little work has examined the effects on mortality of change in sleep duration. We investigated associations of sleep duration and change in sleep duration with all-cause, cardiovascular, and non-cardiovascular mortality. DESIGN: Prospective cohort study. Data are from baseline (Phase 1, 1985-88) and Phase 3 (1991-93), with mortality follow-up of 17 and 12 years respectively. SETTING: The Whitehall II study of 10,308 white-collar British civil servants aged 35-55 at baseline. PARTICIPANTS: 9781 participants with complete data were included in the analyses at Phase 1, and 7729 of the same participants were included in the analyses at Phase 3 and the analyses of change in sleep duration. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: U-shaped associations were observed between sleep (< or =5, 6, 7, 8, > or =9 hours) at Phase 1 and Phase 3 and subsequent all-cause, cardiovascular, and non-cardiovascular mortality. A decrease in sleep duration among participants sleeping 6, 7, or 8 hours at baseline was associated with cardiovascular mortality, hazard ratio 2.4 (95% confidence intervals 1.4-4.1). However, an increase in sleep duration among those sleeping 7 or 8 hours at baseline was associated with non-cardiovascular mortality, hazard ratio 2.1 (1.4-3.1). Adjustment for the socio-demographic factors, existing morbidity, and health-related behaviours measured left these associations largely unchanged. CONCLUSIONS: This is the first study to show that both a decrease in sleep duration and an increase in sleep duration are associated with an increase in mortality via effects on cardiovascular death and non-cardiovascular death respectively.     

Actigraphic sleep fragmentation,efficiency and duration associate with dietary intake in the Rotterdam Study

Short self‐reported sleep duration is associated with dietary intake and this association may partly mediate the link between short sleep and metabolic abnormalities. Subjective sleep measures, however, may be inaccurate and biased. The objective of this study was to evaluate the associations between actigraphic measures of sleep fragmentation, efficiency and duration and energy and macronutrient intakes. We used data from a subgroup of 439 participants of the population‐based cohort, Rotterdam Study. Sleep was assessed using 7‐day actigraphy and sleep diaries, and dietary data with a validated food frequency questionnaire. We assessed the associations of actigraphic sleep parameters with dietary intake using multivariable linear regression models. Higher sleep fragmentation was associated with 4.19 g lower carbohydrate intake per standard deviation of fragmentation {β [95% confidence interval (CI) = ?4.19 (?8.0, ?0.3)]; P = 0.03}. Each additional percentage increase in sleep efficiency was associated with 11.1 kcal lower energy intake [β (95% CI) = ?11.1 (?20.6, ?1.7); P = 0.02]. Furthermore, very short sleep duration (<5.5 h) was associated with 218.1 kcal higher energy intake [β (95% CI = 218.06 (33.3, 402.8), P = 0.02], relative to the reference group (≥6.5 to <7.5 h). We observed associations between higher sleep fragmentation with lower carbohydrate intake, and both lower sleep efficiency and very short sleep duration (<5 h) with higher energy intake. The association between sleep and higher energy intake could mediate, in part, the link between short sleep or sleep fragmentation index and metabolic abnormalities.