Sleep, rest-activity rhythms, and the Charlson Comorbidity Index in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sueño

This study aimed to investigate the role of sleep and circadian health on disparities in overall disease burden among individuals of Hispanic/Latino heritage with differing nativity backgrounds. This study evaluated associations between self-reported sleep (from HCHS/SOL baseline, 2008-2011) and actigraphy-derived sleep/circadian measures (from Sueño, 2010-2013) with multimorbidity at follow-up (2011-2017). Zero-inflated Poisson regression modeled associations between categorical sleep metrics (e.g. standard cut-off values or tertiles) with a modified Charlson Comorbidity Index (CCI) after accounting for the complex sampling design. This study explored effect modification of sleep-CCI associations to understand potential health disparities by age group, gender, and nativity (non-US-born <10 yrs. 10-20 yrs. +20 yrs. and US-born). Actigraphy-assessed short (short-sleep, IRR:1.48 (95%CI:0.99-2.20)) and long sleep duration (long-sleep, IRR:1.52 (95%CI:0.95-2.43)), and sleep regularity index (T3vs.T1, IRR: 1.43 (95%CI:1.14-1.79)) were individually associated with higher overall multimorbidity 5-6 years later; similar associations were seen utilizing self-reported insomnia symptoms (WHI insomnia score ≥ 9 vs. < 9, IRR:1.23 (95%CI:1.13-1.34)) and excessive daytime sleepiness (ESS score ≥ 11 vs. < 11, IRR:1.10 (0.99-1.21). Tests for the interaction showed differences by nativity (two-sided, <i>p</i> < 0.05). Lower sleep satisfaction, daytime alertness, extreme sleep durations, and fragmented RARs were associated with greater chronic disease burden.<b>STATEMENT OF SIGNIFICANCE</b>Lower sleep satisfaction, extreme sleep durations, and decreased sleep regularity were associated with greater chronic disease burden. Our study expands on previous work in HCHS/SOL and Sueño by investigating a composite measure of disease burden in association with sleep, whereas prior studies in this cohort focused on individual associations between sleep and these chronic diseases.