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Actigraphic sleep duration and fragmentation are related to obesity in the elderly: the Rotterdam Study

Abstract

Objective:

The epidemiological evidence for the association between sleep duration and obesity in the elderly is inconsistent and has not been investigated with objective measures. Furthermore, the role of sleep fragmentation in this relationship is unknown. Our aim was to investigate the association of sleep measures with body mass index (BMI) and obesity in a normal elderly population.

Design:

Cross-sectional study.

Subjects:

A total of 983 community-dwelling elderly (mean age 68.4±6.9 years, range, 57–97).

Measurements:

Weight and height were measured, and sleep duration and fragmentation were assessed with on average six nights of actigraphy.

Results:

A quadratic model adequately described the association between continuous measures of sleep duration and BMI. Actigraphic sleep duration had a significant U-shaped relationship with BMI (β of quadratic term=0.30, 95% confidence interval (CI): 0.08, 0.52). Both short sleepers (<5 h: OR, 2.76 (95% CI: 1.38, 5.49), 5 to <6 h: OR, 1.97 (95% CI: 1.26, 3.08)) and long sleepers (8 h: OR, 2.93 (95% CI: 1.39, 6.16)) were more likely to be obese, compared to participants who slept 7 to <8 h. BMI increased with 0.59 kg m−2 per standard deviation of sleep fragmentation (95% CI: 0.34, 0.84). After adjustment for sleep fragmentation, the association between short sleep and obesity was no longer significant. Exclusion of participants with probable sleep apnea only marginally changed these associations. Self-reported habitual sleep duration was not associated with BMI or obesity.

Conclusions:

Sleep duration, as measured with actigraphy, had a U-shaped relationship with BMI and obesity in an elderly population. A highly fragmented sleep is associated with a higher BMI and a higher risk of obesity, and may explain why short sleep is related to obesity. To preclude bias that can be introduced by self-report measures of sleep duration, using multiple measures of sleep parameters is recommended in future research.

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Acknowledgements

The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO), the Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII) and the Municipality of Rotterdam. Additional funding for the actigraphy study was provided by ZonMw grant 4200.0019. We thank the staff of the ERGO research center, and all the general practitioners of the Ommoord district, who have contributed to the data collection. The contributions of all participants to the Rotterdam Study are also gratefully acknowledged.

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Correspondence to H Tiemeier.

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van den Berg, J., Knvistingh Neven, A., Tulen, J. et al. Actigraphic sleep duration and fragmentation are related to obesity in the elderly: the Rotterdam Study. Int J Obes 32, 1083–1090 (2008). https://doi.org/10.1038/ijo.2008.57

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