Unhealthy Sleep-Related Behaviors --- 12 States, 2009

Unhealthy Sleep-Related Behaviors --- 12 States, 2009
Weekly
March 4, 2011 / 60(08);233-238




An estimated 50--70 million adults in the United States have chronic sleep and wakefulness disorders (1). Sleep difficulties, some of which are preventable, are associated with chronic diseases, mental disorders, health-risk behaviors, limitations of daily functioning, injury, and mortality (1,2). The National Sleep Foundation suggests that most adults need 7--9 hours of sleep per night, although individual variations exist. To assess the prevalence and distribution of selected sleep difficulties and behaviors, CDC analyzed data from a new sleep module added to the Behavioral Risk Factor Surveillance System (BRFSS) in 2009. This report summarizes the results of that analysis, which determined that, among 74,571 adult respondents in 12 states, 35.3% reported having <7 hours of sleep on average during a 24-hour period, 48.0% reported snoring, 37.9% reported unintentionally falling asleep during the day at least 1 day in the preceding 30 days, and 4.7% reported nodding off or falling asleep while driving in the preceding 30 days. Continued public health surveillance of sleep quality, duration, behaviors, and disorders is needed to understand and address sleep difficulties and their impact on health. As a first step, a multifaceted approach that includes increased public awareness and education and training in sleep medicine for appropriate health-care professionals is needed; however, broad societal factors, including technology use and work policies, also must be considered.

BRFSS is a state-based, random-digit--dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years, conducted by state health departments in collaboration with CDC (3). Based on Council of American Survey and Research Organizations (CASRO) guidelines, response rates* for 12 states† that used the optional sleep module in 2009§ ranged from 40.0% (Maryland) to 66.9% (Nebraska). Cooperation rates¶ ranged from 55.5% (California) to 83.9% (Georgia).

The following questions from the sleep module were asked: "On average, how many hours of sleep do you get in a 24-hour period? Think about the time you actually spend sleeping or napping, not just the amount of sleep you think you should get (categorized as <7 hours and ≥7 hours**)." "Do you snore? (can have been told by spouse or someone else; categorized as yes or no)?" "During the past 30 days, for about how many days did you find yourself unintentionally falling asleep during the day (categorized as none or at least 1 day reported)?" and "During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving (categorized as yes or no)?" Age-standardized (to the projected U.S. 2000 population) prevalence estimates were calculated by state and by selected characteristics; 95% confidence intervals were calculated, and statistical significance (at p<0.05) was determined by t-test.

Among respondents, 35.3% reported sleeping <7 hours on average during a 24-hour period (Table). Adults aged ≥65 years were significantly less likely to report sleeping <7 hours (24.5%) than persons in all other age categories. Non-Hispanic blacks (48.3%) and non-Hispanic persons of other races (38.7%) were more likely to report sleeping <7 hours than non-Hispanic whites (34.9%). No significant differences were observed by sex. Compared with employed adults (37.4%), those unable to work (46.4%) were significantly more likely to report <7 hours of sleep, but retired adults (25.0%) and homemakers and students (30.8%) were less likely. Adults with at least some college education (35.8%) were significantly more likely to report <7 hours of sleep than those with less than a high school diploma (32.0%) as were divorced, widowed, or separated (39.1%) and never married adults (37.9%), compared with married adults (35.1%).

Snoring was reported by 48.0% of respondents (Table). Persons aged 18--24 years were least likely (25.6%) to report snoring. Hispanics (50.6%) were more likely to report snoring than non-Hispanic whites (46.8%), as were men (56.5%) compared with women (39.6%). Compared with employed persons (50.5%), retired adults (37.9%) and homemakers/students (37.0%) were significantly less likely to report snoring. Persons with less than a high school diploma (51.2%) and with a high school diploma or General Educational Development certificate (GED) (49.9%) were significantly more likely to report snoring than those with at least some college or a college degree (47.0%), as were married persons (49.5%) compared with never married (43.5%) persons.

An estimated 37.9% of adults reported unintentionally falling asleep during the day at least 1 day in the preceding 30 days (Table). Adults aged 18--24 years (43.7%) and ≥65 years (44.6%) were significantly more likely to report this behavior than all other age groups, as were persons from all other racial/ethnic categories compared with non-Hispanic whites (33.4%). No significant difference was observed by sex. Compared with employed persons (33.5%), those who were unemployed (44.0%), unable to work (57.3%), and homemakers/students (39.3%) were significantly more likely to report unintentionally falling asleep during the day. Persons with at least some college education (35.9%) were significantly less likely to report unintentionally falling asleep than those with a high school diploma or GED (39.6%) or less education (43.4%). Never married adults (42.9%) were significantly more likely to report unintentionally falling asleep during the day than married adults (35.9%).

Nodding off or falling asleep while driving in the preceding 30 days was reported by 4.7% of adults (Table). Persons aged ≥65 years (2.0%) were significantly less likely to report this behavior than persons aged 25--34 years (7.2%), 35--44 years (5.7%), 18--24 years (4.5%), 45--54 years (3.9%), and 55--64 years (3.1%). Hispanics (6.3%), non-Hispanic blacks (6.5%), and non-Hispanics of other races (7.2%) all were significantly more likely to report this behavior than non-Hispanic whites (3.2%). Men were more likely (5.8%) to report this behavior, compared with women (3.5%), and employed persons were more likely (5.4%), compared with homemakers and students (2.2%). No significant differences were observed by educational level or marital status.

Persons who reported sleeping <7 hours on average during a 24-hour period were more likely to report unintentionally falling asleep during the day at least 1 day in the preceding 30 days (46.2% versus 33.2%) and nodding off or falling asleep while driving in the preceding 30 days (7.3% versus 3.0%) (Figure). They also were more likely to report snoring (51.4% versus 46.0%).

Among adults in the 12 states surveyed, reports of <7 hours of sleep ranged from 27.6% in Minnesota to 44.6% in Hawaii. Snoring estimates ranged from 44.8% in California to 54.0% in Hawaii. Estimates of unintentionally falling asleep during the day in the preceding 30 days ranged from 33.0% in Wyoming to 42.8% in Hawaii. Finally, estimates of nodding off or falling asleep while driving in the preceding 30 days ranged from 3.0% in Illinois to 6.4% in Hawaii and Texas.

Reported by
LR McKnight-Eily, PhD, Y Liu, MS, MPH, AG Wheaton, PhD, JB Croft, PhD, GS Perry, DrPH, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Heath Promotion; CA Okoro, MS, T Strine, PhD, Public Health Surveillance Program Office, Office of Surveillance, Epidemiology, and Laboratory Science, CDC.

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Unhealthy Sleep-Related Behaviors --- 12 States, 2009