0978 Scores Derived from a Data-Driven Sleep Health Framework Show Stronger Associations with Cardiometabolic Risk in Adolescents

Abstract Introduction Sleep is increasingly recognized as vital for cardiometabolic health, yet most research focuses on single dimensions such as duration or quality. Multidimensional sleep health (MSH) captures multiple domains, providing a more comprehensive assessment. While adult studies show strong MSH–cardiometabolic health associations, evidence in adolescents is limited. We examined associations between MSH scores and metabolic syndrome (MetS), comparing our data-driven, multivariable BEDReST framework to the established RU-SATED framework. Methods Data from 341 adolescents (16.3±2.2 yr; 47% female; 22.8% racial/ethnic minority) from the Penn State Child Cohort who completed in-lab polysomnography (PSG), ≥3 days of actigraphy (ACT), and sleep questionnaires were analyzed. Two multidimensional sleep health (MSH) scores were derived. The RU-SATED score (Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration) combined ACT-derived sleep midpoint, efficiency, and total sleep time with self-reported insomnia and daytime sleepiness. The BEDReST framework (Breathing, Efficiency, Duration, Regularity, Satisfaction, Timing) incorporated 3 to 4 PSG, ACT, and self-report indicators per domain. For both scores, indicators were dichotomized using adolescent-specific cutoffs; BEDReST domain scores were averaged before summing, whereas RU-SATED domains were summed directly. Both scores ranged from 0 to 6, with higher values indicating better sleep health. Linear regression models examined associations between MSH scores and a continuous metabolic syndrome (cMetS) score, as well as components of waist circumference (WC), mean arterial pressure (MAP), HDL cholesterol, homeostatic assessment of insulin resistance (HOMA-IR), and triglycerides. All models were adjusted for age, sex, race/ethnicity, and socioeconomic status. Results BEDReST showed stronger inverse associations with cMetS than RU-SATED (BEDReST: B = -0.43, p< 0.05; RU-SATED: B = -0.17, p>0.05) and was associated with lower WC (B = -2.01, p< 0.05), the primary driver of MetS, and marginally lower MAP (B = -1.12, p=0.05); RU-SATED associations were non-significant (WC B = -0.92, p>0.05, MAP B = -0.41, p>0.05). Conclusion The data-driven BEDReST framework demonstrated stronger and more consistent associations with adolescent cardiometabolic risk than RU-SATED, particularly for waist circumference, a primary driver of metabolic syndrome. These findings highlight the value of comprehensive, multidimensional sleep assessment for identifying early cardiometabolic risk in adolescents. Support (if any) R01HL136587, UL1TR002014, TL1TR002016