Sleep Disorder Symptoms Among Adults in 8 States and the District of Columbia, 2017

Yong Liu, MD; Susan A. Carlson, PhD; Anne G. Wheaton, PhD; Kurt J. Greenlund, PhD; Janet B. Croft, PhD

Prev Chronic Dis. 2021;18(12):e105

Abstract and Introduction

Abstract

Sleep disorder symptoms (trouble falling asleep or staying asleep, unintentionally falling asleep, snoring loudly, and episodes of having stopped breathing) among US adults (N = 59,108) from 8 states and the District of Columbia were analyzed by using data from the 2017 Behavioral Risk Factor Surveillance System. We conducted a multivariable logistic regression to assess the association between the 4 symptoms and sociodemographic characteristics, risk behaviors, and chronic conditions. The 4 symptoms were prevalent and more likely to be reported among adults with any chronic condition(s) than their counterparts without symptoms and among those who slept fewer than 7 hours compared with those who slept 7 to 9 hours.

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Abstract and Introduction
Objective
Methods
Results
Discussion
References
Sidebar

Table 1. Age-Adjusted Prevalence ^a and Adjusted Prevalence Ratio ^b of Sleep Disorder Symptoms Among Adults in 8 States ^c and the District of Columbia, 2017 Behavioral Risk Factor Surveillance System
Characteristic	Number of respondents	Trouble falling asleep or staying asleep^d		Unintentionally falling asleep^e
Characteristic	Unweighted, n	Prevalence (95% CI)^a	Prevalence ratio (95% CI)^b	Prevalence (95% CI)^a	Prevalence ratio (95% CI)^b
Crude percentage	59,108	49.1 (48.4–49.8)	NA	24.0 (23.4–24.5)	NA
Age-adjusted percentage	59,108	49.5 (48.8–50.2)	NA	23.1 (22.5–23.7)	NA
Sex
Male	27,657	43.8 (42.8–44.8)	0.80 (0.78–0.83)	23.0 (22.2–23.8)	1.05 (0.99–1.10)
Female	31,451	55.3 (54.3–56.3)	1.0 [Reference]	23.4 (22.5–24.2)	1.0 [Reference]
Age group, y
18–44	16,150	52.0 (50.8–53.1)	1.0 [Reference]	21.2 (20.2–22.1)	1.0 [Reference]
45–64	21,861	50.4 (49.3–51.4)	0.94 (0.91–0.98)	21.3 (20.4–22.2)	0.98 (0.92–1.05)
≥65	21,097	41.6 (40.5–42.6)	0.76 (0.73–0.80)	33.4 (32.4–34.4)	1.60 (1.49–1.72)
Race and ethnicity
Non-Hispanic White	48,909	51.2 (50.4–52.0)	1.0 [Reference]	21.1 (20.5–21.7)	1.0 [Reference]
Non-Hispanic Black	3,426	44.6 (41.3–47.8)	0.78 (0.72–0.85)	32.8 (29.9–35.9)	1.40 (1.26–1.56)
Hispanic	3,612	41.9 (39.8–44.1)	0.86 (0.81–0.91)	23.8 (22.0–25.6)	1.20 (1.11–1.31)
Other non-Hispanic^f	3,161	49.6 (46.7–52.4)	0.93 (0.87–1.00)	28.7 (26.2–31.4)	1.36 (1.23–1.51)
Marital status
Married or member of an unmarried couple	33,627	47.0 (45.9–48.1)	1.0 [Reference]	20.3 (19.4–21.2)	1.0 [Reference]
Divorced, widowed, or separated	15,889	52.1 (48.8–55.4)	1.04 (1.01–1.08)	26.6 (24.1–29.2)	1.19 (1.12–1.26)
Never married	9,592	53.8 (52.0–55.6)	1.21 (1.17–1.26)	27.0 (25.4–28.7)	1.43 (1.33–1.53)
Body mass index (kg/m²)
Underweight or normal weight (<25.0)	19,034	49.7 (48.5–50.9)	1.0 [Reference]	19.8 (18.9–20.8)	1.0 [Reference]
Overweight (25.0–29.9)	21,549	47.0 (45.8–48.3)	0.97 (0.93–1.00)	21.3 (20.4–22.4)	1.02 (0.96–1.09)
Obese (≥30.0)	18,525	52.5 (51.2–53.8)	0.97 (0.94–1.01)	28.4 (27.2–29.5)	1.23 (1.15–1.31)
Selected chronic disease^g
Yes	31,010	58.3 (57.0–59.5)	1.19 (1.15–1.23)	29.0 (27.9–30.2)	1.40 (1.33–1.48)
No	28,098	43.3 (42.4–44.1)	1.0 [Reference]	18.2 (17.5–18.9)	1.0 [Reference]
High blood pressure
Yes	22,946	57.2 (55.3–59.0)	1.09 (1.06–1.13)	29.2 (27.4–31.0)	1.16 (1.09–1.22)
No	36,037	47.2 (46.4–48.0)	1.0 [Reference]	20.6 (19.9–21.2)	1.0 [Reference]
Depression
Yes	11,704	72.2 (70.9–73.5)	1.54 (1.50–1.58)	31.5 (30.2–32.9)	1.35 (1.28–1.43)
No	47,187	43.3 (42.5–44.1)	1.0 [Reference]	20.8 (20.1–21.4)	1.0 [Reference]
Average sleep duration in a 24-hour period, h
<7	18,054	62.1 (60.9–63.3)	1.44 (1.40–1.48)	29.1 (28.0–30.2)	1.39 (1.32–1.46)
7–9	39,012	42.7 (41.8–43.6)	1.0 [Reference]	19.3 (18.6–20.0)	1.0 [Reference]
>9	2,042	50.1 (45.4–54.8)	1.01 (0.92–1.11)	32.1 (28.0–36.5)	1.32 (1.15–1.50)

Abbreviation: NA, not applicable.
^aAge-adjusted prevalence and 95% CIs were standardized to the 2000 projected US population for all selected characteristics except for age group.
^bAdjusted prevalence ratio was obtained from multivariable logistic regression models with all covariates in the table.
^cEight states are Arizona, Kansas, Minnesota, Nebraska, Nevada, North Dakota, Oregon, and Tennessee.
^dTrouble falling asleep or staying asleep was defined as a respondent reporting ≥1 day of trouble falling asleep or staying asleep or sleeping too much in the past 14 days.
^eUnintentionally falling asleep was defined as a respondent reporting ≥1 day of unintentionally falling asleep in the past 14 days.
^fOther, non-Hispanic includes non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Native Hawaiian or Pacific Islander, non-Hispanic other race, and non-Hispanic multiracial.
^gChronic diseases include heart disease (coronary heart disease/angina, myocardial infarction/heart attack), stroke, diabetes, arthritis, history of asthma, chronic obstructive pulmonary disease, cancer (not including skin cancer), and chronic kidney disease.

Table 2. Age-Adjusted Prevalence ^a and Adjusted Prevalence Ratio ^b of Sleep Disordered Breathing Symptoms Among Adults in 8 States ^c and the District of Columbia, 2017 Behavioral Risk Factor Surveillance System
Characteristic	Number of respondents	Snoring loudly^d		Observed breathing stopped^e
Characteristic	Unweighted, n	Prevalence (95% CI)^a	Prevalence ratio (95% CI)^b	Prevalence (95% CI)^a	Prevalence ratio (95% CI)^b
Crude percentage	59,108	41.8 (41.1–42.4)	NA	14.2 (13.7–14.6)	NA
Age-adjusted percentage	59,108	41.1 (40.4–41.7)	NA	13.6 (13.1–14.0)	NA
Sex
Male	27,657	50.3 (49.3–51.3)	1.61 (1.56–1.67)	17.8 (17.1–18.5)	2.23 (2.07–2.41)
Female	31,451	31.6 (30.7–32.5)	1.0 [Reference]	9.4 (8.9–10.0)	1.0 [Reference]
Age group, y
18–44	16,150	34.4 (33.3–35.5)	1.0 [Reference]	9.5 (8.9–10.2)	1.0 [Reference]
45–64	21,861	50.6 (49.6–51.7)	1.27 (1.22–1.33)	18.2 (17.4–19.0)	1.34 (1.21–1.48)
≥65	21,097	43.0 (42.0–44.1)	1.07 (1.02–1.13)	17.1 (16.3–17.9)	1.22 (1.09–1.37)
Race and ethnicity
Non-Hispanic White	48,909	40.7 (40.0–41.5)	1.0 [Reference]	13.7 (13.2–14.3)	1.0 [Reference]
Non-Hispanic Black	3,426	42.5 (39.3–45.7)	1.06 (0.97–1.15)	13.3 (11.4–15.5)	0.90 (0.75–1.08)
Hispanic	3,612	42.5 (40.3–44.6)	1.01 (0.95–1.07)	11.8 (10.4–13.3)	0.84 (0.74–0.97)
Other, non-Hispanic^f	3,161	39.8 (37.0–42.6)	0.99 (0.91–1.07)	14.6 (12.7–16.8)	1.06 (0.90–1.25)
Marital status
Married or member of an unmarried couple	33,627	43.5 (42.4–44.5)	1.0 [Reference]	13.6 (13.0–14.2)	1.0 [Reference]
Divorced, widowed, or separated	15,889	38.3 (35.7–41.0)	0.85 (0.81–0.88)	15.8 (14.3–17.5)	1.01 (0.93–1.10)
Never married	9,592	37.2 (35.4–39.0)	0.72 (0.67–0.76)	12.5 (11.3–13.8)	0.72 (0.64–0.81)
Body mass index (kg/m²)
Underweight or normal weight (<25.0)	19,034	26.4 (25.3–27.4)	1.0 [Reference]	6.7 (6.1–7.3)	1.0 [Reference]
Overweight (25.0–29.9)	21,549	41.4 (40.3–42.6)	1.42 (1.36–1.49)	10.7 (10.1–11.4)	1.39 (1.25–1.55)
Obese (≥30.0)	18,525	55.9 (54.6–57.1)	1.96 (1.87–2.05)	23.3 (22.3–24.3)	2.92 (2.63–3.23)
Selected chronic disease^g
Yes	31,010	46.0 (44.7–47.2)	1.12 (1.08–1.16)	18.9 (18.0–19.9)	1.61 (1.49–1.75)
No	28,098	37.3 (36.5–38.2)	1.0 [Reference]	9.1 (8.6–9.7)	1.0 [Reference]
High blood pressure
Yes	22,946	51.9 (50.2–53.7)	1.19 (1.15–1.24)	22.3 (20.9–23.7)	1.55 (1.43–1.67)
No	36,037	36.7 (36.0–37.5)	1.0 [Reference]	9.9 (9.4–10.3)	1.0 [Reference]
Depression
Yes	11,704	46.8 (45.3–48.2)	1.22 (1.17–1.27)	21.9 (20.7–23.1)	1.87 (1.73–2.02)
No	47,187	39.5 (38.7–40.3)	1.0 [Reference]	11.3 (10.8–11.8)	1.0 [Reference]
Average sleep duration in a 24-hour period, h
<7	18,054	44.4 (43.2–45.6)	1.09 (1.05–1.13)	16.9 (16.1–17.8)	1.32 (1.22–1.42)
7–9	39,012	38.9 (38.1–39.8)	1.0 [Reference]	11.5 (10.9–12.0)	1.0 [Reference]
>9	2,042	42.2 (38.1–46.5)	1.03 (0.93–1.14)	16.2 (13.5–19.4)	1.11 (0.90–1.37)

Abbreviation: NA, not applicable.
^aAge-adjusted prevalence and 95% CIs were standardized to the 2000 projected US population for all selected characteristics except for age group.
^bAdjusted prevalence ratio was obtained from multivariable logistic regression models with all covariates in the table.
^cEight states are Arizona, Kansas, Minnesota, Nebraska, Nevada, North Dakota, Oregon, and Tennessee.
^dSnoring loudly was defined as an affirmative response to "Have you ever been told that you snore loudly?"
^eObserved breathing stopped was defined as an affirmative response to "Has anyone ever observed that you stop breathing during your sleep?"
^fOther, non-Hispanic includes non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Native Hawaiian or Pacific Islander, non-Hispanic other race, and non-Hispanic multiracial.
^gChronic diseases include heart disease (coronary heart disease/angina, myocardial infarction/heart attack), stroke, diabetes, arthritis, history of asthma, chronic obstructive pulmonary disease, cancer (not including skin cancer), and chronic kidney disease.