Association of device-based measured sleep duration, sleep efficiency and sleep regularity with cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium

BackgroundSleep is critical for cardiometabolic health, yet evidence on the independent and combined associations of device-measured sleep parameters remains limited. The aim of this study is to examine the independent and joint associations of sleep duration, regularity, and efficiency with cardiometabolic health outcomes in adults. MethodsCross-sectional data from six cohorts (n=14,085 participants; five countries, [&ge;]4-day wear time) from the Prospective Physical Activity, Sitting and Sleep (ProPASS) consortium were used. Sleep duration (short: <7 h/day; adequate: 7-8 h/day; long: >8 h/day), sleep regularity index as a measure of day-to-day variability in sleep-wake patterns (regular: >87.3%; slightly irregular: 71.6-87.3%; irregular: <71.6%), and sleep efficiency as the ratio of total sleep time to total time in bed (high: >91.8%), medium: 85.3-91.8%, low: <85.3%; based on tertiles) were derived from thigh-worn accelerometer data. Cardiometabolic health markers included body mass index, waist circumference, HDL and LDL cholesterol, glycated haemoglobin, systolic and diastolic blood pressure, and a composite cardiometabolic risk z-score was computed. Generalized linear regression was used to examine individual and joint associations of sleep parameters with cardiometabolic health, adjusted for age, sex, cohort, smoking, alcohol consumption, medication use, prevalent cardiovascular disease and moderate-to-vigorous intensity physical activity. ResultsShort sleep duration ({beta}: 0.05, 95%CI: 0.03-0.07), an irregular sleep pattern ({beta}:0.14, 95%CI:0.11-0.18), and low sleep efficiency ({beta}:0.10, 95%CI:0.07-0.13) were associated with a higher cardiometabolic risk z-score compared to adequate sleep duration, regular sleep patterns, and high sleep efficiency, respectively. A long sleep duration was not associated with cardiometabolic risk score ({beta}:0.01, 95%CI:-0.03-0.03). The joint analysis of all three sleep parameters shows that individuals with an irregular and low sleep efficiency, regardless of sleep duration, had worse cardiometabolic health (in long sleepers: {beta}:0.21, 95%CI: 0.15-0.28; in adequate sleepers: {beta}:0.23, 95%CI: 0.16-0.30; in short sleepers: {beta}:0.28, 95%CI: 0.22-0.35) compared to adequate, regular and highly efficient sleepers. ConclusionOur study suggests that sleep regularity and efficiency are important for cardiometabolic health beyond sleep duration. Future longitudinal studies and trials should evaluate multidimensional sleep indices that incorporate duration, regularity, and efficiency across diverse populations.