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,  < 0.05). Lower sleep satisfaction, daytime alertness, extreme sleep durations, and fragmented RARs were associated with greater chronic disease burden.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.