Relationship between Sleep and Hypertension: Findings from the NHANES (2007–2014)

Background: To evaluate the association of sleep factors (sleep duration, self-reported trouble sleeping, diagnosed sleep disorder) and combined sleep behaviors with the risk of hypertension. Methods: We analyzed 12,166 adults aged 30–79 years who participated in the 2007–2014 National Health and Nutrition Examination Survey. Sleep duration, self-reported trouble sleeping and sleep disorders were collected using a standardized questionnaire. We included three sleep factors (sleep duration, self-reported trouble sleeping and sleep disorder) to generate an overall sleep score, ranging from 0 to 3. We then defined the sleep pattern as “healthy sleep pattern” (overall sleep score = 3), “intermediate sleep pattern” (overall sleep score = 2), and “poor sleep pattern” (0 ≤ overall sleep score ≤ 1) based on the overall sleep score. The definition of hypertension was based on self-reported antihypertensive medication use or biological measurement (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). We used weighted logistic regression models to investigate the associations between sleep and hypertension. Results: The overall prevalence of hypertension was 37.8%. A short sleep duration (OR = 1.20, 95% CI: 1.08 to 1.33, p = 0.001), self-reported trouble sleeping (OR = 1.45, 95% CI: 1.28 to 1.65, p < 0.001) and sleep disorder (OR = 1.33, 95% CI: 1.07 to 1.66, p = 0.012) were related to the risk of hypertension. Poor sleep patterns were closely correlated with the risk of hypertension (OR = 1.90, 95% CI: 1.62 to 2.24). Conclusions: Participants with poor sleep patterns were associated with an increased risk for hypertension.

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Abstract P336: The Association Between Goal-Striving Stress, Sleep Duration and Sleep Quality in the Jackson Heart Study

Circulation ◽

10.1161/circ.137.suppl_1.p336 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Loretta Cain ◽

LáShauntá Glover ◽

Dayna Johnson ◽

Mario Sims

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Poor Sleep ◽

Jackson Heart Study ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Logistic Regression Models ◽

Short Sleep ◽

Goal Striving ◽

Heart Study

Introduction: Research shows that compared to non-Hispanic whites, African Americans (AAs) have poorer sleep quality, lower mean sleep duration, and a higher prevalence of sleep-disordered breathing. AAs also report more frequent exposures to certain stressors over the life course, which may impact physiological processes that may impair sleep. Goal-striving-stress (GSS), the discrepancy between aspiration and achievement, weighted by the subjective probability of success, and the level of disappointment experienced if goals are not reached, may be an important stressor among AA’s that may influence sleep; however this has yet to be explored. The objective of this study was to assess the relationship between GSS and sleep duration and sleep quality in AAs. Hypothesis: We assessed the hypothesis that high (versus low) GSS would be associated with short or long sleep duration and poor sleep quality. Methods: We utilized data from the baseline exam of the Jackson Heart Study (JHS; n=5306), an AA sample of women and men, 35-84 years old. There were a total of 5082 participants in the sample; 63.34% female with a mean age of 55.30 (± 12.75) and mean sleep duration of 6.43 hours (±1.51). The sample was categorized into GSS tertiles: low (n=2121), moderate (n=1716), high (n=1296). Participants self-reported sleep duration (hours) and rated their sleep quality. Sleep duration was categorized as short ( < 6 hours), normal (7 or 8 hours) and long ( > 9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Logistic regression models were used to obtain odds ratios (OR, 95% confidence interval-CI) to assess the associations of GSS levels with sleep duration and sleep quality categories. Models were adjusted for sex, age, socioeconomic status, health behaviors, discrimination, and health outcomes. Results: Significant results showed that participants who reported high (versus low) GSS had a 29% increased odds [1.29 (1.10, 1.52)] of short (versus normal) sleep after full adjustment. Participants who reported high (versus low) GSS had a 42% increased odds [1.42 (1.20, 1.67)] of low (versus high) sleep quality after full adjustment. Conclusion In conclusion, the deficit between goal aspiration and achievement is associated with short sleep duration and poor sleep quality. Potential interventions should consider the extent to which GSS may contribute to the development of short sleep duration and poor sleep quality.

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The associations between different sleep patterns and osteoporosis based on the Osteoporosis Self-Assessment Tool for Asians

Archives of Osteoporosis ◽

10.1007/s11657-020-00828-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shaojun Wu ◽

Pengbo Wang ◽

Xiaofan Guo ◽

Guozhe Sun ◽

Ying Zhou ◽

...

Keyword(s):

Postmenopausal Women ◽

Sleep Duration ◽

Assessment Tool ◽

Sleep Patterns ◽

Nocturnal Sleep ◽

Short Sleep Duration ◽

Self Assessment ◽

Increased Risk ◽

Daytime Nap ◽

Osteoporosis Risk

Abstract Summary Based on the use of Osteoporosis Self-Assessment Tool for Asians (OSTA) to assess osteoporosis risk, we found that short sleep duration and taking a daytime nap had an increased risk of osteoporosis. Purpose To explore the associations between different sleep patterns with osteoporosis. Methods 3659 postmenopausal women (average age of 60 years) were divided into low, middle, and high osteoporosis risk categories based on the Osteoporosis Self-Assessment Tool for Asians (OSTA). After having collected by a standard questionnaire, total and nocturnal sleep duration was collapsed to form categories of ≤ 6 h, > 6 h and ≤ 7 h, > 7 h and ≤ 8 h, > 8 h and ≤ 9 h, > 9 h, and daytime nap duration of 0 h and > 0 h. Results As a categorical variable, the total sleep duration of ≤ 6 h per day (OR = 1.34, 95% CI 1.04–1.72), nocturnal sleep duration of ≤ 6 h per night (OR = 1.65, 95% CI 1.24–2.18), and taking a daytime nap (OR = 1.33, 95% CI 1.09–1.64) had higher osteoporosis risk after adjustment for covariates. As a continuous variable, after the adjustment for covariates, both longer total (OR = 0.86, 95% CI 0.78–0.94) and nocturnal sleep duration (OR = 0.83, 95% CI 0.76–0.91) had lower risk of osteoporosis risk while taking longer daytime nap (OR = 1.10, 95% CI 1.02–1.19) had higher osteoporosis risk. Conclusions Postmenopausal women with both short total and nocturnal sleep duration (6 h or less) and taking a daytime nap had increased osteoporosis risk as assessed by OSTA.

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Abstract P334: The Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Circulation ◽

10.1161/circ.137.suppl_1.p334 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Brooke Aggarwal ◽

Nour Makarem ◽

Riddhi Shah ◽

Memet Emin ◽

Ying Wei ◽

...

Keyword(s):

Blood Pressure ◽

Sleep Quality ◽

Sleep Duration ◽

Sleep Onset ◽

Research Network ◽

Poor Sleep ◽

Sleep Patterns ◽

Poor Sleep Quality ◽

Basic Study ◽

Endothelial Inflammation

Background: Insufficient sleep impairs blood pressure regulation. However, the effects of milder, highly prevalent but frequently neglected sleep disturbances, including poor sleep quality and insomnia, on vascular health in women are unclear. We investigated whether poor sleep patterns are associated with blood pressure and endothelial inflammation in a diverse sample of women. Methods: Women who participated in the ongoing AHA Go Red for Women Strategically Focused Research Network population project were studied (n=323, 57% minority, mean age=39 + 17 y, range=20-79 y). Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index (score > 5=poor sleep quality). Risk for obstructive sleep apnea (OSA) was evaluated using the Berlin questionnaire, and insomnia was assessed using the Insomnia Severity Index (ISI). In a subset of women who participated in the basic study (n=28), sleep duration was assessed objectively using actigraphy and endothelial inflammation was assessed directly in harvested endothelial cells by measuring nuclear translocation of nuclear factor kappa B (NFκB). Vascular reactivity was measured by brachial artery flow-mediated dilation (FMD). Systolic and diastolic blood pressure (SBP and DPB) were measured by trained personnel. Multivariate linear regressions were used to evaluate associations between sleep patterns and blood pressure, NFκB and FMD. Results: Mean sleep duration was 6.8 ± 1.3 h/night in the population study and 7.5 ± 1.1 h/night in the basic study. In the population study sample, 50% had poor sleep quality (25% in the basic study), and 37% had some level of insomnia (15% in the basic study). SBP was associated directly with poor sleep quality, and DBP with OSA risk after adjusting for confounders (p=0.04 and p=0.08, respectively). Poor sleep quality was associated with endothelial NFκB activation (β=30.6; p=0.03). Insomnia and longer time to sleep onset were also associated with endothelial NFκB activation (β=27.6; p=0.002 and β=8.26; p=0.02, respectively). Sleep patterns were not associated with FMD. Conclusions: These findings provide direct evidence that common but frequently neglected sleep disturbances such as poor sleep quality and insomnia are associated with increased blood pressure and vascular inflammation even in the absence of sleep deprivation in women.

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Abstract MP073: Sleep Patterns and Depression in a Diverse Sample of Women from the AHA Go Red for Women Strategically Focused Research Network (SFRN)

Circulation ◽

10.1161/circ.135.suppl_1.mp073 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Brooke Aggarwal ◽

Ming Liao

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Sleep Duration ◽

Minority Women ◽

Poor Sleep ◽

Sleep Patterns ◽

Short Sleep Duration ◽

Short Sleep ◽

Long Sleep ◽

Race Ethnicity

Background: Depression has been linked to increased risk of cardiovascular disease (CVD) through biological mechanisms and altered lifestyle behaviors, possibly including short and/or long sleep duration. However the relation between specific sleep components and depressive symptoms, and interaction by race/ethnicity has not been fully defined. The purpose of this study was to determine if sleep patterns including short sleep duration, poor sleep quality, and insomnia were associated with depressive symptoms in a free-living ethnically diverse population of adult women, and if they varied by racial/ethnic status. Methods: English or Spanish speaking females between the ages of 20-79 y, participating in an observational cohort study as part of the American Heart Association Go Red for Women SFRN, were included (n=50, 56% (28 of 50) non-white, mean age = 41 ±18y). Sleep patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated instrument used to measure the quality and duration of sleep in adults. Presence of insomnia was measured using the Insomnia Severity Index (ISI). Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Linear and logistic regression models were used to evaluate cross-sectional associations between sleep patterns and depression overall, and by race/ethnicity. Results: Overall, nearly one-fifth of participants had depressive symptoms (BDI II score ≤13), 18% (9 of 50) had short sleep duration (<6 hours per night), 38% (19 of 50) had poor quality sleep (PSQI score ≥5), and 40% (20 of 50) had some level of insomnia (ISI score ≥8). Mean BDI-II scores among women who slept <6 versus ≥6 hours were significantly greater (16 versus 5, p=.0003). Higher depression scores were associated with shorter sleep duration (p=.001), poorer sleep quality (p=.03), and higher insomnia severity (p<.0001) overall. There was no association between depression and long sleep (≥8 hours). When stratified by race/ethnicity, depression was significantly associated with poor sleep quality among minority women in multivariable models adjusted for demographic confounders (OR=1.42, 95% CI=1.03-1.95), but not among non-Hispanic white women. Depression was also significantly associated with insomnia severity (p<.001), and sleep duration (p=.03) among minority women only, in multivariable adjusted models stratified by race/ethnicity. Conclusions: In this diverse sample of women, sleep problems were highly prevalent. Poor sleep quality, insomnia, and short sleep duration (but not long sleep) were associated with greater depressive symptoms among minority women but not whites. These preliminary data suggest that minority women with short sleep duration may be at heightened CVD risk from depression. Future research should determine if interventions designed to improve sleep result in decreased depressive symptoms and reduced CVD risk.

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Sleep inadequacy and incident cardiovascular disease among adults in Greece

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.218 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

PN Fountoulakis ◽

A Terzoudi ◽

D Tsiptsios ◽

AS Triantafyllis ◽

A Matziridis ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Sleep Quality ◽

Sleep Duration ◽

Berlin Questionnaire ◽

Poor Sleep ◽

Short Sleep Duration ◽

Cross Sectional ◽

Obstructive Sleep ◽

Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sleep disorders are an emerging and modifiable risk factor for cardiovascular disease (CVD). Purpose The aim of our study was to investigate potential associations between sleep insufficiency and incident CVD. Methods In this cross-sectional study, 957 participants, (mean age 49.62 ± 14.79) from the region of Thrace, Greece were enrolled and classified into three groups [short (<6 h), normal (6-8 h) and long (>8 h) sleep duration]. CVD was assessed by a positive response to the following questions: "Have you been told by a doctor that you have had a heart attack or angina (chest pain or exertion that is relieved by medication)?" or "Have you been told by a doctor that you have had a stroke?". Participants’ sleep quality was estimated with the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire. Results The overall prevalence of CVD was 9.5%. The population with CVD exhibited reduced sleep duration and efficiency reduced by 33 min and 10%, respectively. After adjusting for all possible cofounders, short sleep duration was 3.07-times more frequent in patients with CVD and sleep duration of less than 5:33 hours could be a potential risk factor for CVD, especially among females. Additionally, CVD was significantly associated with excessive increased daytime sleepiness, insomnia, poor sleep quality and increased risk of obstructive sleep apnea. Conclusion(s): Our study depicts a strong correlation of sleep insufficiency with CVD and promotes early pharmacological or cognitive behavioral interventions in order to protect cardiovascular health. Abstract Figure. Results

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Associations of Diet Quality and Sleep Quality with Obesity

Nutrients ◽

10.3390/nu13093181 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3181

Author(s):

Soohee Hur ◽

Bumjo Oh ◽

Hyesook Kim ◽

Oran Kwon

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Diet Quality ◽

Underlying Mechanism ◽

Dietary Quality ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Cross Sectional ◽

Increased Risk

Short sleep duration or poor sleep quality has been associated with an increased risk of obesity. Although the underlying mechanism remains unclear, one proposed pathway is poor diet quality. This cross-sectional study investigated whether diet quality modifies the association between sleep status and obesity in Korean adults. We used the baseline data and samples of 737 men and 428 women (n = 1165) aged 19–64, who participated in the prospective Ewha–Boramae cohort study. Sleep duration was dichotomized into ≥7 h (adequate) and <7 h (insufficient). Pittsburgh Sleep Quality Index (PSQI) values, reflecting sleep quality, were dichotomized into >5 (poor quality) and ≤5 (good quality). Diet quality was evaluated by the Recommended Food Score (RFS). Obesity was associated with higher rates of insufficient sleep and poor sleep quality in women, but not in men. After adjustment for covariates, women with poor sleep quality had a higher risk of obesity than women with good sleep quality (OR = 2.198; 95% CI = 1.027–4.704); this association occurred only in the group with RFS ≤ median score. Our findings support a significant association between sleep quality and obesity, and this association has been potentially modified by dietary quality in women.

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Abstract P080: Associations of Poor Sleep Quality and Quantity and Subclinical Atherosclerosis in Older Age - The Chicago Healthy Aging Study (CHAS)

Circulation ◽

10.1161/circ.127.suppl_12.ap080 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Thanh Huyen T Vu ◽

Norrina B Allen ◽

Kathryn J Reid ◽

Kiang Liu ◽

Daniel B Garside ◽

...

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Subclinical Atherosclerosis ◽

Older Age ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Sleep Quantity ◽

Short Sleep ◽

Increased Risk

Background: Previous studies have demonstrated a link between both sleep quantity and quality and an increased risk of CVD, stroke, and diabetes. However only a few population-based studies have information on the association of sleep quantity and quality and subclinical atherosclerosis as measured by coronary artery calcium (CAC) and ankle brachial index (ABI) -- a marker for peripheral arterial disease. Methods: CHAS data were used to investigate cross-sectional associations of short sleep duration and poor sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) (see Table Footnote for definition of poor sleep quality and quantity) and prevalence of having CAC (score > 0) or low ABI (<0.99). CAC, assessed by multi-detector computed tomography, was quantified by the Agatston’s method. ABI was calculated as the ratio of Doppler recorded systolic pressures in the lower and upper extremities (ABI >1.4 was excluded). Results: The study sample consists of 1,005 men and 390 women ages 65-84 (mean age 71) in 2007-10; 9% were African American. There are no differences in CAC prevalence among participants with or without short sleep duration (11.2% vs. 11.0%). For low ABI, these figures are 20% and10.8%, respectively. With multiple adjustments (see Table Footnote), there are no significant associations of short sleep duration or poor sleep total score with prevalent CAC. However, participants with short sleep duration are more likely to have low ABI, i.e., the odds (95% confidence interval) of having ABI <0.99 with sleep duration of <6hrs was almost two fold (1.02-3.13) compared to others (see Table). Conclusion: In older age, shorter sleep duration is associated with peripheral vascular disease. Sleep may represent a modifiable risk factor for CVD.

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Sleep insufficiency and incidence of cardiovascular disease among adults in Greece

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.204 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

PN Fountoulakis ◽

A Terzoudi ◽

D Tsiptsios ◽

AS Triantafyllis ◽

A Matziridis ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Sleep Quality ◽

Sleep Duration ◽

Berlin Questionnaire ◽

Poor Sleep ◽

Short Sleep Duration ◽

Cross Sectional ◽

Obstructive Sleep ◽

Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sleep disorders are an increasing and modifiable risk factor for cardiovascular disease (CVD). Purpose The aim of our study was to investigate potential associations between sleep insufficiency and incident CVD. Methods In this cross-sectional study, 957 participants, (mean age 49.62 ± 14.79) from the region of Thrace, Greece were enrolled and classified into three groups [short (<6 h), normal (6-8 h) and long (>8 h) sleep duration]. CVD was assessed by a positive response to the following questions: "Have you been told by a doctor that you have had a heart attack or angina (chest pain or exertion that is relieved by medication)?" or "Have you been told by a doctor that you have had a stroke?". Participants’ sleep quality was estimated with the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire. Results The overall prevalence of CVD was 9.5%. The population with CVD exhibited reduced sleep duration and efficiency reduced by 33 min and 10%, respectively. After adjusting for all possible cofounders, short sleep duration was 3.07-times more frequent in patients with CVD and sleep duration of less than 5:33 hours could be a potential risk factor for CVD, especially among females. Additionally, CVD was significantly associated with excessive increased daytime sleepiness, insomnia, poor sleep quality and increased risk of obstructive sleep apnea. Conclusion(s): Our study depicts a strong correlation of sleep insufficiency with CVD and promotes early pharmacological or cognitive behavioral interventions in order to protect cardiovascular health. Abstract Figure. Results

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P1688Behavior of indices of sympathetic activity in relation to sleep time duration in untreated hypertensives

European Heart Journal ◽

10.1093/eurheartj/ehz748.0443 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Seravalle ◽

F Quarti Trevano ◽

R Dell'oro ◽

G Bertoli ◽

G Mancia ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Sleep Duration ◽

Plasma Norepinephrine ◽

Poor Sleep ◽

Short Sleep Duration ◽

Time Duration ◽

Short Sleep ◽

Obstructive Sleep ◽

Significant Difference

Abstract Background Short sleep duration and poor sleep quality has been reported to be associated with increased cardiovascular risk and increased incidence of cardiovascular events. Purpose Whether and what extent the pathophysiology of this association includes sympathetic abnormalities has never been examined via microneurography. Methods In 28 untreated mild-to moderate essential hypertensives aged 66.4±3.1 (mean±SEM) without other cardiovascular or non-cardiovascular disease (including obstructive sleep apnea) recruited from the outpatient clinic and referred for short sleep duration, we directly assessed at patients home via actigraphy (actiwatch spectrum activity monitor, Phillips) time sleep duration and efficiency. Measurements, performed during a day preceding or following the 7 day actigraphy evaluation, included microneurographic recording of efferent postganglionic sympathetic nerve traffic (MSNA), venous plasma norepinephrine (HPLC), clinic, 24 hour and beat to beat blood pressure and heart rate values. Sleep diary and a sleep questionnaire were also administered. Results Nine patients slept less than 6 hours per night (LSD), while the remaining ones between 6 to 7 (MSD, n=8) or more than 7 hours (GSD,N=11). The 3 groups showed similar age and gender distribution and a body mass index amounting to 28.1±0.8, 28.6±0.5 and 27.3±0.5 kg/m2 (P=NS). For similar mean blood pressure values LSD showed MSNA values significantly greater than GSD (53.4±4.9 vs 40.1±3.8bs/100hb, P<0.03), this being the case also for MSD (49.7±4.4, P<0.05 vs GSD but not SLD). HR was significantly elevated only in LSD group when compared to GSD, while no significant difference was found in plasma NE between the 3 groups. Conclusions The present study provides the first microneurographic direct evidence that short sleep duration is linked to a marked sympathetic activation, which may participate at the high cardiovascular risk of these subjects. The sympathetic overdrive affects both the cardiac and peripheral district but is not reflected by NE, which thus does not represent in this condition a valuable adrenergic marker.

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Dose-response Relationship between Sleep and Rheumatoid Arthritis

American Journal of Health Behavior ◽

10.5993/ajhb.44.1.5 ◽

2020 ◽

Vol 44 (1) ◽

pp. 40-53

Author(s):

Wenwen Wu ◽

Jinru Yang ◽

Yaohua Gu ◽

Xuyu Chen ◽

Xiaodong Tan

Keyword(s):

Rheumatoid Arthritis ◽

Sleep Quality ◽

Sleep Duration ◽

Low Income ◽

Rural Areas ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Short Sleep ◽

Increased Risk

Objectives: In this study, we explored the association between sleep quality, duration and prevalence of rheumatoid arthritis (RA) among low-income adults in rural areas of China. Methods: Face-to-face investigation were conducted in 2017, and completed questionnaires were obtained from 16,648 individuals. Sleep quality and duration were evaluated using the standard Pittsburgh Sleep Quality Index. RA was based on self-reported physician diagnosis. Logistic regression analysis and restricted cubic spline models were performed. Results: Sleep duration shorter than 7 hours was associated with increased odds of RA, with an odds ratio (OR) of 1.49 for 6–<7 hours and 1.70 for <6 hours. Poor sleep quality was associated with RA, with an OR of 1.68. The combination category of poor sleep quality and any group of sleep duration was associated with a significantly increased risk of developing RA. Combined groups of good sleep quality with short sleep duration (<7 hours) were also found to be related to prevalence of RA. There was a non-linear relationship between sleep quality, duration and the odds of RA. Conclusions: Poor sleep quality and short sleep duration may be trigger or risk factors for RA.

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