This study examined the relationships between long sleep duration, emotional distress, BMI, physical activity, and medical comorbidities using data from over 900,000 US adults. The results showed that both higher BMI and greater emotional distress significantly mediated the relationship between long sleep and increased risk of medical comorbidities. However, physical activity did not have a significant mediating effect. The findings suggest that interventions aiming to address medical comorbidities related to long sleep should target reducing BMI and emotional distress.

1. Relationships between Long Sleep and Chronic Diseases: the Mediating Roles of
Emotional Distress, BMI, and Physical Activity
Bradley, C.; Addison, D.; Auguste, E.; Camille, P.; Zizi, F.; Rogers A; Williams, NJ; Seixas, A.; Jean-Louis, G.
Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, NY, NY
Introduction
Methods
• BMI and emotional distress are shown to have a
significant, indirect effect on the relationship
between long sleep and medical comorbidity.
• The present analysis reveals a novel
relationship between long sleep and medical
comorbidity as mediated by BMI, physical
activity, and emotional distress.
• In addition to sleep duration, intervention
methods should target BMI and emotional
distress in efforts to address medical
comorbidities.
Conclusions
References
This research was supported by funding from the NIH (R01MD004113, 01MD007716-01A1, R25HL105444, R01HL78566, R01HL095799 and K24HL2222315-01)
• The study utilized data from the National Health
Interview Survey; an ongoing, nationally
representative, cross-sectional study of non-
institutionalized U.S. adults (≥18 years) between
2004 and 2013 (n = 911,773).
• Structural equation modeling was employed to
assess mediation of observed and latent factors
by Path Coefficient Estimate (PCE). Statistical
analyses were conducted with Mplus 7 and
SPSS V.20. Physical activity was defined as 10+
minutes of either moderate or vigorous leisurely
activity. Emotional distress was measured with
the Kessler-6 scale.
• Medical comorbidity was self-reported and
included: hypertension, coronary heart disease,
diabetes, heart attack, stroke, kidney disease,
and cancer. Covariates included: age, sex,
education, income, race, and marital status.
• Studies have shown a significant association
between long sleep (>8 hours) and various
chronic diseases such as: cardiovascular
disease, obesity, cancer, and stroke.
• The purpose of this study is to determine the
mediating roles of body mass index (BMI),
physical activity, and emotional distress on the
relationship between long sleep and medical
comorbidity.
Results
Frequency of Comorbidities in Long Sleepers
vs. Average Sleepers
• Of the sample, 55% were women, 45% were
men, and 80% were white. The mean age was
47 and the mean BMI was 26.99 kg/m2.
• BMI significantly, positively mediated the
relationship between long sleep and medical
comorbidity (indirect effect= 0.010, p<0.001).
• Emotional distress significantly, positively
mediated the relationship between long sleep
and medical comorbidity (indirect effect= 0.065,
p<0.001).
• Physical activity did not significantly mediate the
relationship between long sleep and medical
comorbidity (indirect effect= 0.000, p=0.0642).
• Yue Leng, Cappuccio F.P., Wainwright N.WJ., Surtees P.G., Luben R, Brayne C.,
Khaw K. Sleep duration and risk of fatal and nonfatal stroke. Neurology 2015 (84)
• Ramos, A. R., & Gangwisch, J. E. (2015). Is sleep duration a risk factor for
stroke?. Neurology, 84(11), 1066-1067.
Direct and Indirect Pathways between Long
Sleep and Medical Comorbidities