Perceived Home Sleep Environment: Associations of Household-level Factors and In-bed Behaviors with Actigraphy-based Sleep Duration and Continuity in the Jackson Heart Sleep Study.

Study objectives In an older African-American sample (n=231) we tested associations of the household environment and in-bed behaviors with sleep duration, efficiency, and wakefulness after sleep onset (WASO). Methods Older adult participants completed a household-level sleep environment questionnaire, a sleep questionnaire, and underwent 7-day wrist actigraphy for objective measures of sleep. Perceived household environment (self-reported) was evaluated using questions regarding safety, physical comfort, temperature, noise, and light disturbances. In-bed behaviors included: watching television, listening to radio/music, use of computer/tablet/phone, playing video games, reading books, and eating. To estimate the combined effect of the components in each domain (perceived household environment and in-bed behaviors), we calculated and standardized a weighted score per sleep outcome (e.g., duration, efficiency, WASO), with a higher score indicating worse conditions. The weights were derived from the coefficients of each component estimated from linear regression models predicting each sleep outcome while adjusting for covariates. Results A standard deviation increase in an adverse household environment score was associated with lower self-reported sleep duration (β=-13.9 minutes, 95% confidence interval: -21.6, -1.7) and actigraphy-based sleep efficiency (β=-0.7%, -1.4, 0.0). A standard deviation increase in the in-bed behaviors score was associated with lower actigraphy-based sleep duration (β=-9.7 minutes, -18.0, -1.3), sleep efficiency (β=-1.2%, -0.9, -0.6), and higher WASO (5.3 minutes, 2.1, 8.6). Conclusion Intervening on the sleep environment, including healthy sleep practices, may improve sleep duration and continuity among African-Americans.