Impact of Sleep Profiles on Multimorbidity Among US Active-Duty Service Members in the 2018 Health-Related Behaviors Survey

Figures & data

Table 1 Sociodemographic Characteristics, Medical Conditions, Sleep Behaviors, and Profiles of the HRBS Population

				95% Confidence Limits
Variable	Category	n	%	LCL	UCL
Medical conditions	None	12,990	77.49	76.52	78.46
	Obese only	1776	10.85	10.12	11.58
	Hyperlipidemia only	492	1.78	1.56	2.00
	Hypertension only	949	5.4	4.84	5.96
	Multimorbidity (≥2 chronic conditions)	959	4.49	4.06	4.92
Sex	Female	5353	16.69	16.01	17.38
	Male	11,813	83.31	82.62	83.99
Age group	17–24	3642	37.77	36.45	39.1
	25–34	6467	39.93	38.77	41.08
	35–44	5311	18.33	17.68	18.98
	45+	1746	3.97	3.72	4.23
Education Level	Missing	250	1.16	0.9	1.42
	High School or less	7990	64.41	63.39	65.42
	Some College	2625	12.82	12.19	13.46
	Bachelor’s Degree or more	6301	21.61	20.87	22.35
Race	Missing	68	0.71	0.4	1.03
	Black	2226	16.18	15.21	17.14
	Hispanic	2459	15.99	15.06	16.92
	Other	1747	9.48	8.83	10.14
	White	10,666	57.63	56.41	58.86
Marital Status	Married	10,776	53.83	52.58	55.07
	Cohabiting	1042	7.78	7.08	8.48
	Separated, Divorced, or Widowed	1284	6.27	5.74	6.8
	Never Married	4064	32.12	30.86	33.38
Any Dependent Children	No	8629	60.3	59.17	61.42
	Yes	8537	39.71	38.58	40.83
Service Branch	Air Force	5579	24.09	23.3	24.88
	Army	3646	34.48	33.17	35.78
	Marine Corps	2569	13.9	13.14	14.66
	Navy	3675	24.36	23.27	25.44
	Coast Guard	1697	3.17	2.98	3.36
Pay Grade	Enlisted	12,154	83.52	82.89	84.15
	Officer	5012	16.48	15.85	17.11
Lack of Energy Due to Poor Sleep	No	12,730	72.55	71.43	73.67
	Yes	4436	27.45	26.33	28.57
Sleep 6hrs or less	No	6700	36.04	34.89	37.19
	Yes	10,466	63.96	62.81	65.11
Bad sleep quality	No	11,395	64.22	63.03	65.41
	Yes	5771	35.78	34.59	36.97
Trouble sleeping	No	7680	45.04	43.82	46.26
	Yes	9486	54.96	53.74	56.18

Table 2 Prevalence of Chronic Diseases and Multimorbidity by Sleep-Related Health Behaviors and Profiles

	None		Obese Only		Hyperlipidemia Only		Hypertension Only		Multimorbidity (≥2 Chronic Conditions)		p
	n	%	n	%	n	%	n	%	n	%
Lack of Energy Due to Poor Sleep
No	9952	79.86	1243	10.38	355	1.74	605	4.56	575	3.47	<0.0001
Yes	3038	71.22	533	12.08	137	1.9	344	7.61	384	7.19
Sleep 6hrs or less
No	5525	84.09	515	8.1	160	1.4	276	3.72	224	2.69	<0.0001
Yes	7465	73.76	1261	12.4	332	2	673	6.34	735	5.5
Bad sleep quality
No	8988	80.57	1096	10.25	307	1.72	513	4.18	491	3.28	<0.0001
Yes	4002	71.94	680	11.92	185	1.9	436	7.57	468	6.66
Trouble sleeping
No	6264	83.28	720	9.69	175	1.48	287	3.26	234	2.3	<0.0001
Yes	6726	72.74	1056	11.8	317	2.03	662	7.15	725	6.28
Use of Energy Drinks to Stay Awake
No	8186	78.9	979	9.37	354	2.16	573	5.06	577	4.51	<0.0001
Yes	4804	75.84	797	12.57	138	1.35	376	5.78	382	4.46
Use of sleep medications
No	10,576	78.68	1394	10.9	382	1.78	689	4.88	667	3.75	<0.0001
Yes	2414	72.39	382	10.64	110	1.78	260	7.58	292	7.61
Sleep profiles
Low risk	5274	83.73	594	9.59	144	1.47	235	3.11	193	2.1	<0.0001
Moderate risk	4294	76.56	571	10.93	179	1.92	307	5.74	326	4.85
High risk	3422	70.97	611	12.27	169	2.01	407	7.78	440	6.97

Table 3 Adjusted Odds Ratio of Obesity Only, Hyperlipidemia Only, Hypertension Only, and Multimorbidity Compared to No Medical Condition

	Obese Only			Hyperlipidemia Only			Hypertension Only			Multimorbidity
	OR	LCL	UCL	OR	LCL	UCL	OR	LCL	UCL	OR	LCL	UCL
Lack of energy due to poor sleep
No	1.00			1.00			1.00			1.00
Yes	1.30	1.09	1.55	1.38	1.03	1.85	1.87	1.47	2.39	2.35	1.88	2.93
Sleep 6hrs or less
No	1.00			1.00			1.00			1.00
Yes	1.57	1.32	1.87	1.58	1.22	2.04	1.75	1.38	2.22	1.95	1.53	2.50
Bad sleep quality
No	1.00			1.00			1.00			1.00
Yes	1.27	1.07	1.50	1.40	1.07	1.83	1.95	1.56	2.45	2.19	1.76	2.72
Trouble sleeping
No	1.00			1.00			1.00			1.00
Yes	1.35	1.15	1.58	1.53	1.15	2.03	2.41	1.89	3.08	2.78	2.21	3.51
Use of Energy Drinks to Stay Awake
No	1.00			1.00			1.00			1.00
Yes	1.46	1.24	1.72	0.99	0.74	1.33	1.17	0.92	1.48	1.25	1.00	1.56
Use of sleep medications
No	1.00			1.00			1.00			1.00
Yes	1.05	0.87	1.25	1.05	0.79	1.40	1.71	1.32	2.21	2.10	1.64	2.68
Sleep risk profiles
High	1.45	1.19	1.76	1.74	1.22	2.47	2.79	2.08	3.74	3.54	2.75	4.56
Moderate	1.18	0.98	1.44	1.30	0.94	1.79	1.93	1.43	2.59	2.24	1.70	2.95
Low	1.00			1.00			1.00			1.00

Notes: Estimates were obtained by controlling for sociodemographic factors: Age, gender, education, marital status, dependent children, service branch, and pay grade. Boldface indicates statistical significance (p=0.05).

Table 4 Medical Conditions Rate Across Different Sleep Profiles

Variable	Category 1	Category 2		95% Confidence Limits
Obese			0.13	0.12	0.14
Hypertension			0.06	0.06	0.07
Hyperlipidemia			0.04	0.04	0.05
Class	Class 2		0.62	0.59	0.65
	Class 3		0.8	0.76	0.83
	Class 1		1.00
Obese × Class	Obese	Class 2	1.75	1.58	1.95
	Obese	Class 3	1.28	1.15	1.42
	Obese	Class 1	1.00
Hypertension × Class	Hypertension	Class 2	2.84	2.51	3.23
	Hypertension	Class 3	1.74	1.52	1.99
	Hypertension	Class 1	1.00
Hyperlipidemia × Class	Hyperlipidemia	Class 2	2.25	1.92	2.63
	Hyperlipidemia	Class 3	1.71	1.45	2.01
	Hyperlipidemia	Class 1	1.00

Notes: Boldface indicates statistical significance (p=0.05). × represents interaction.

Figure 1 The trend and the association between sleep duration (hours per night) with prevalence (%) of multimorbidity: 2011, 2015, and 2018 HRBS. Sleeping ≤ 6 hours per night is associated with higher prevalences of multimorbidity in 2011, 2015, and 2018 HRBS.

Figure 2 Latent class analysis (LCA) identified three unobservable sleep profiles in ADSMs: minimal or low-risk sleep patterns (37.43%), moderate-risk sleep patterns (31.11%), and high-risk sleep patterns (31.46%).

Figure 3 Compared to the minimal or low-risk sleep patterns group, the high-risk sleep patterns group had significantly greater prevalence estimates (%) of chronic conditions.