State and Regional Prevalence of Sleep Disturbance and Daytime Fatigue
1Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA; Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA; 2Sleep & Neurophysiology Research Laboratory, University of Rochester Medical Center, Rochester, NY; 3Center of Excellence for Suicide Prevention, Canandiagua VA Medical Center & Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY; 4Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA; Division of Geriatric Medicine, University of Pennsylvania, Philadelphia, PA; 5Respiratory Specialists and Reading Hospital and Medical Center, Reading, PA
Social and demographic influences are important for sleep attainment. Geographic location has not been previously explored.
Data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) were used (N = 157,319). Participants answered a question on Sleep Disturbance and Daytime Fatigue. Thirty-six states/regions provided data on these items. Prevalence estimates were adjusted for age, sex, ethnoracial group, education, income, employment, general health, healthcare access, and depression. Chi-squared tests were conducted across states and census regions, and pseudo-R2 values were computed for the effect of state, relative to other predictors. To evaluate potential mediators of census region differences, an analysis of p value change associated with specific covariates and covariate groups was undertaken.
Adjusted prevalence rates of Sleep Disturbance differed across states/regions overall (χ2 = 412.3, p < 0.0001), as well as separately for men (χ2 = 139.5, p < 0.0001) and women (χ2 = 350.0, p < 0.0001), as did rates of Daytime Fatigue overall (χ2 = 245.7, p < 0.0001), and separately for men (χ2 = 117.5, p < 0.0001) and women (χ2 = 181.2, p < 0.0001). Analysis of pseudo-R2 values revealed that despite these significant findings, state differences were an overall weak predictor, representing 1.30% to 1.73% of the magnitude of the effect of the best predictor (mental health). When Census regions were compared, significant differences were found for Sleep Disturbance (p = 0.002), but after adjustment for covariates, these were no longer significant. Differences existed for Daytime Fatigue in adjusted analyses overall (p < 0.0001), with the West reporting the fewest complaints and the South reporting the most.
These results demonstrate that reports of sleep related complaints vary across states, independent (at least partially) of factors that influence circadian rhythms (e.g., latitude).
Grandner MA; Jackson NJ; Pigeon WR; Gooneratne NS; Patel NP. State and regional prevalence of sleep disturbance and daytime fatigue. J Clin Sleep Med 2012;8(1):77-86.
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