Multidimensional Sleep Health in a Diverse, Aging Adult Cohort: Concepts, Advances, and Implications for Research and Intervention

Purpose: To illustrate 2 frameshifts of multidimensional sleep health: i) use of composite sleep metrics; and ii) the correlations among sleep dimensions.

Participants: 735 adults of diverse backgrounds aged <65 years who participated in the Multi-Ethnic Study of Atherosclerosis.

Measures: In-home polysomnography, 7-day wrist actigraphy, and validated questionnaires.

Methods: The Buysse Ru SATED model-sleep regularity, satisfaction, alertness, timing, efficiency, duration-was operationalized, then extended by including additional measures of sleep architecture and sleep apnea from polysomnography and difficulties initiating sleep from questionnaire and sleep onset latency and duration [ir]regularity from actigraphy. We dichotomized sleep variables, operationalizing optimal and nonoptimal ranges as 1 and 0, respectively, summed into a sleep health score, and computed global sleep health scores via principal components analysis.

Findings: Participants showed low prevalence of sleep regularity in timing (<30 minutes standard deviation [SD]; 21.4% favorable) and duration (<60 minutes SD; 36.9%). Although 62.7% of participants demonstrated favorable sleep duration by actigraphy, few met criteria for favorable levels of % N3 (11.4%) or %R (34.1%). The average Sleep Health Score was 5.6 of 13 (higher is better). Sleep variables were variably intercorrelated (r = 0 to r = -0.72). The first principal component for each operationalization of sleep health was interpretable as a "health" score; all summary scores captured variable but systematic shifts towards more favorable sleep in each sleep variable.

Conclusions: Multidimensional sleep health can be measured by complementary composite scores as well as consideration of multiple individual dimensions.