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Overall, 33,376 participants completed the survey. After excluding 1,962 participants with diagnosed cardiovascular disease and 679 currently taking lipid-lowering agents, a total of 31,135 participants were included in the analysis. The participants aged 18 to 97 years with a median of 44 years, and about half were males. A majority were of Han ethnicity (96.01%) and in a current marriage (85.79%). Almost sixty percent (59.03%) finished college or undergraduate education, and 39.64% were professionals. The demographic characteristics of the participants were shown in Table 1.
Table 1. Demographic characteristics of the study population (n = 31,135)
Variable Median/Number IQR/(%) Age (years) 44 35–56 Male 16,507 53.02 Han ethnicity 29,892 96.01 Marital status Unmarried 3,882 12.47 In a current marriage 26,710 85.79 Divorced 336 1.08 Widowed 207 0.66 Highest finished education Primary school 474 1.52 Junior school 2,464 7.91 Senior school 4,223 13.56 College or undergraduate 18,379 59.03 Postgraduate or above 5,595 17.97 Occupation Worker 3,692 11.86 Peasant 575 1.85 Office worker 8,924 28.66 Service seller 3,043 9.77 Professional technologist 12,342 39.64 Student 94 0.30 Housekeeper 82 0.26 Retired 1,138 3.66 Others 1,245 4.00 Overall, 60.21%, 14.05%, and 25.55% of participants were at low, medium, and high predicted 10-year CVD risk, respectively. The high and medium predicted 10-year CVD risk was positively associated with older age, male sex, lower education, smoking, alcohol drinking, poor sleep quality, taking sleep medicine, higher SBP, TC and BMI, obesity, hypertension, and diabetes, but negatively associated with sedentary behaviour (P < 0.001 for all, as shown in Table 2).
Table 2. Selected factors among participants by predicted 10-year cardiovascular disease risk
Variable Predicted 10-year cardiovascular disease risk P Low (n = 18,764) Medium (n = 4,376) High (n = 7,995) Age (years) 38.67 ± 9.94a 56.09 ± 9.81b 58.01 ± 12.51b < 0.001 Men, n (%) 9,404 (50.12)a 3,023 (69.08)b 4,080 (51.03)a < 0.001 College or above education, n (%) 11,437(60.95)a 2,346 (53.61)b 4,596 (57.49)c < 0.001 Smoking, n (%) 2,598 (13.85)a 1,347 (30.78)b 2,202 (27.54)c < 0.001 Drinking, n (%) 4,266 (22.74)a 1,488 (34.00)b 2,086 (26.09)c < 0.001 Exercise, n (%) 12,619 (67.25) 2,999 (68.53) 5,335 (66.73) 0.121 Sedentary behaviour > 6 h, n (%) 9,463 (50.43)a 1,748 (39.95)b 3,346 (41.85)c < 0.001 Excellent & good sleep quality, n (%) 16,737 (89.20)a 3,828 (87.48)b 7,090 (88.68)ab < 0.002 Taking sleep medicine, n (%) 404 (2.15)a 148 (3.38)b 293 (3.66)b < 0.001 SBP (mmHg) 117.42 ± 14.49a 132.94 ± 15.98b 131.22 ± 21.50c < 0.001 TC (mg/dL) 84.62 ± 16.27a 91.44 ± 17.68b 88.98 ± 21.53c 0.001 HDL-C (mg/dL) 23.98 ± 5.86a 23.28 ± 5.73b 24.04 ± 5.88a 0.001 BMI 24.09 ± 3.82a 25.65 ± 3.48b 24.85 ± 3.42c < 0.001 Hypertension, n (%) 787 (4.19)a 1,207 (27.58)b 2,405 (30.08)c < 0.001 Diabetes, n (%) 131 (0.70)a 320 (7.31)b 1,059 (13.25)c < 0.001 Obesity, n (%) 2,720 (14.50)a 949 (21.69)b 1,324 (16.60)c < 0.001 Note. Data were reported as mean (standard deviation) and number (percentage). P-values were reported as the results of ANOVA and rank sum test. a,b,cDesignated according to post hoc analysis. SBP, systolic blood pressure. TC, total cholesterol. HDL-C, high density lipoprotein cholesterol. BMI, body mass index. The proportions of participants who reported short sleep, optimal and long sleep duration were 11.69%, 75.57%, and 12.74%, respectively (Table 3). Compared with optimal sleep duration, short sleep duration was positively associated with CVD risk factors including age, male sex, lower education, smoking, alcohol drinking, lack of exercise, sedentary behaviour, poor sleep quality, taking sleep medicine, higher SBP, TC, BMI, lower HDL-C, hypertension, diabetes, and obesity. Long sleep duration was positively associated with female sex, better sleep quality, higher HDL-C, but negatively associated with education level, smoking, alcohol drinking, sedentary behaviour, TC, BMI, and obesity. (P < 0.001 for all). The highest mean of BMI, SBP, and TC was observed in the short sleep group. The prevalence of CVD associated basic diseases, including hypertension and diabetes, among participants reporting short sleep was higher than that of participants with optimal sleep duration (P = 0.003; P = 0.014). Both the prevalence of medium-to-high (FRS ≥ 10%) and high CVD risk (FRS ≥ 20%) were higher among short sleepers than among optimal sleepers and long sleepers.
Table 3. Conventional risk factors for cardiovascular disease by sleep duration
Variable Sleep duration P ≤ 6 h (n = 3,640) 7–8 h (n = 23,528) ≥ 9 h (n = 3,967) Age (years) 47.41 ± 12.86a 45.90 ± 13.92b 45.97 ± 15.59b < 0.001 Men, n (%) 2,225 (61.13)a 12,468 (52.99)b 1,814 (45.73)c < 0.001 College or above education, n (%) 2,132 (58.57)a,b 13,989 (59.46)b 2,258 (56.92)a < 0.001 Smoking, n (%) 1,071 (29.42)a 4,511 (19.17)b 592 (14.92)c < 0.001 Drinking, n (%) 1,148 (31.54)a 5,868 (24.94)b 824 (20.77)c < 0.001 Exercise, n (%) 2,298 (63.13)a 16,024 (68.11)b 2,631 (66.32)b < 0.001 Sedentary behaviour > 6 h, n (%) 1,947 (53.49)a 11,008 (46.79)b 1,702 (42.90)c < 0.001 Excellent & good sleep quality, n (%) 3,017 (82.88)a 21,034 (89.40)b 3,604 (90.85)c < 0.001 SBP (mmHg) 124.62 ± 18.31a 122.94 ± 18.06b 122.95 ± 18.83b < 0.001 Taking sleep medicine, n (%) 150 (4.12)a 583 (2.47)b 112 (2.82)b < 0.001 TC (mg/dL) 87.67 ± 17.27a 86.66 ± 18.33b 86.05 ± 17.84c 0.001 HDL-C (mg/dL) 23.63 ± 5.86a 23.90 ± 5.73b 24.13 ± 5.88c 0.001 BMI 25.05 ± 3.80a 24.47 ± 3.70b 24.20 ± 3.72c < 0.001 Hypertension, n (%) 575 (15.80)a 3,300 (14.03)b 524 (13.21)b 0.003 Diabetes, n (%) 212 (5.82)a 1,113 (4.73)b 185 (4.66)b 0.014 Obesity, n (%) 752 (20.66)a 3,658 (15.54)b 583 (14.70)c < 0.001 FRS ≥ 10%, n (%) 633 (17.39)a 3,250 (13.81)b 493 (12.43)b < 0.001 FRS ≥ 20%, n (%) 1,040 (28.57)a 5,936 (25.23)b 1,019 (25.69)b < 0.001 Note. Data were reported as mean (standard deviation) and number (percentage). P-values were reported as the results of ANOVA and rank sum test. a,b,cDesignated according to post hoc analysis. SBP, systolic blood pressure. TC, total cholesterol. HDL-C, high density lipoprotein cholesterol. BMI, body mass index. FRS, Framingham cardiovascular risk score. Principal component analysis and maximum variance method were used to perform multivariate logistic regression after rotation (Table 4). Among the total population, after completely adjusting for potential confounding factors (including age, sex, education level, SBP, TC, HDL-C, smoking, drinking, sedentary behaviour, physical exercise, BMI, sleep quality, taking sleep medicine, hypertension, diabetes, taking antihypertensive drugs), short sleep was significantly associated with increased odds of medium to high and high risk of predicted 10-year CVD events (OR = 1.17; 95% CI: 1.07–1.28; OR = 1.16; 95% CI: 1.05–1.28), while long sleep was not associated with the predicted 10-year CVD risk. Sex subgroup analysis showed that after completely adjusting for potential confounding factors, short sleep was associated with increased odds of medium to high risk of predicted 10-year CVD among males (OR = 1.10; 95% CI: 1.01–1.19) and increased odds of medium to high and high risk of predicted 10-year CVD events among females (OR = 1.23; 95% CI: 1.08–1.40; OR = 1.27; 95% CI: 1.11–1.44). Though long sleep was associated with increased high CVD risk among males and decreased high CVD risk among females in the unadjusted model (Model 1), the associations were not statistically significant after adjusting for age (Model 2) and all selected potential confounding factors (Model 4).
Table 4. Correlations between sleep duration and predicted 10-year CVD risk
Sleep duration (h) Medium-to-high risk (n = 12,371) High risk (n = 7,995) OR 95% CI P OR 95% CI P Model 1 7–8 1 ≤ 6 1.33 1.24–1.43 < 0.01 1.28 1.20–1.36 < 0.01 ≥ 9 0.96 0.90–1.03 0.27 1.00 0.95–1.06 0.92 Model 2 7–8 1 ≤ 6 1.21 1.11–1.33 < 0.01 1.20 1.08–1.32 < 0.01 ≥ 9 0.98 0.89–1.08 0.65 0.99 0.89–1.11 0.92 Model 3 7–8 1 ≤ 6 1.18 1.09–1.29 < 0.01 1.17 1.08–1.29 < 0.01 ≥ 9 0.93 0.85–1.02 0.12 0.96 0.87–1.06 0.42 Model 4 7–8 1 ≤ 6 1.20 1.11–1.30 < 0.01 1.19 1.08–1.30 < 0.01 ≥ 9 0.96 0.89–1.04 0.36 0.99 0.91–1.09 0.88 Model 5 7–8 1 ≤ 6 1.17 1.07–1.28 < 0.01 1.16 1.05–1.28 < 0.01 ≥ 9 0.94 0.85–1.02 0.15 0.96 0.87–1.06 0.45 Men (n) 7,103 4,080 Model 1 7–8 1 ≤ 6 1.25 1.15–1.37 < 0.01 1.18 1.09–1.28 < 0.01 ≥ 9 1.03 0.93–1.14 0.55 1.12 1.02–1.22 0.01 Model 2 7–8 1 ≤ 6 1.32 1.17–1.49 < 0.01 1.36 1.17–1.59 < 0.01 ≥ 9 0.95 0.82–1.10 0.48 0.94 0.78–1.13 0.49 Model 3 7–8 1 ≤ 6 1.24 1.08–1.40 0.01 1.19 1.01–1.41 0.04 ≥ 9 0.83 0.72–0.97 0.02 0.88 0.73–1.07 0.19 Model 4 7–8 1 ≤ 6 1.14 1.02–1.27 < 0.01 1.06 0.92–1.21 0.45 ≥ 9 0.96 0.85–1.08 0.50 1.05 0.94–1.23 0.43 Model 5 7–8 1 ≤ 6 1.10 1.01–1.19 < 0.01 1.05 0.83–1.16 0.47 ≥ 9 0.95 0.82–1.09 0.61 1.03 0.91–1.21 0.51 Women (n) 5,268 3,915 Model 1 7–8 1 ≤ 6 1.38 1.23–1.54 < 0.01 1.41 1.29–1.55 < 0.01 ≥ 9 0.94 0.85–1.03 0.20 0.92 0.85–1.00 0.04 Model 2 7–8 1 ≤ 6 1.22 1.07–1.38 < 0.01 1.25 1.09–1.42 < 0.01 ≥ 9 0.98 0.87–1.10 0.69 0.98 0.87–1.10 0.73 Model 3 7–8 1 ≤ 6 1.26 1.11–1.42 < 0.01 1.29 1.13–1.47 < 0.01 ≥ 9 0.93 0.83–1.04 0.22 0.93 0.83–1.05 0.24 Model 4 7–8 1 ≤ 6 1.29 1.14–1.41 < 0.01 1.33 1.17–1.51 < 0.01 ≥ 9 0.93 0.83–1.03 0.16 0.92 0.82–1.03 0.15 Model 5 7–8 1 ≤ 6 1.23 1.08–1.40 < 0.01 1.27 1.11–1.44 < 0.01 ≥ 9 0.94 0.84–1.05 0.27 0.93 0.83–1.05 0.28 Note. Model 1 was not adjusted. Model 2 was adjusted for age and gender (except gender-specific models). Model 3 was adjusted for age, gender (except gender-specific models), education level, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol, smoking, drinking, sedentary behaviour, exercise, body mass index, history of hypertension, and diabetes. Model 4 was adjusted for sleep quality and all variables in Model 3. Model 5 was adjusted for taking sleep medicine and all variables in Model 4.
doi: 10.3967/bes2021.109
Predicted 10-year Cardiovascular Disease Risk and Its Association with Sleep Duration among Adults in Beijing-Tianjin-Hebei Region, China
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Abstract:
Objective The study aims to predict 10-year cardiovascular disease (CVD) risk and explore its association with sleep duration among Chinese urban adults. Methods We analyzed part of the baseline data of a cohort that recruited adults for health screening by cluster sampling. The simplified Pittsburgh Sleep Quality Index (PSQI) and Framingham 10-year risk score (FRS) were used to measure sleep duration and CVD risk. Demographic characteristics, personal history of chronic diseases, lifestyle factors were collected using a questionnaire. Height, weight, total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) were also measured. Multiple logistic regression models were performed to explore the association of sleep duration with the predicted CVD risk. Results We included 31, 135 participants (median age 44 years, 53.02% males) free of CVD, cerebral stroke, and not taking lipid-lowering agents. Overall, 14.05%, and 25.55% of participants were at medium and high predicted CVD risk, respectively. Short sleep was independently associated with increased odds of medium to high risk of predicted 10-year CVD among males (OR = 1.10; 95% CI: 1.01–1.19) and increased odds of medium to high and high risk of predicted 10-year CVD among females (OR = 1.23; 95% CI: 1.08–1.40; OR = 1.27; 95% CI: 1.11–1.44). In contrast, long sleep had no association with cardiovascular risk. Conclusion A substantial number of adults free of CVD were at high 10-year CVD risk. Short sleep was associated with increased odds of predicted CVD risk. -
Key words:
- Predicted 10-year CVD risk /
- Framingham risk score /
- Sleep duration
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Table 1. Demographic characteristics of the study population (n = 31,135)
Variable Median/Number IQR/(%) Age (years) 44 35–56 Male 16,507 53.02 Han ethnicity 29,892 96.01 Marital status Unmarried 3,882 12.47 In a current marriage 26,710 85.79 Divorced 336 1.08 Widowed 207 0.66 Highest finished education Primary school 474 1.52 Junior school 2,464 7.91 Senior school 4,223 13.56 College or undergraduate 18,379 59.03 Postgraduate or above 5,595 17.97 Occupation Worker 3,692 11.86 Peasant 575 1.85 Office worker 8,924 28.66 Service seller 3,043 9.77 Professional technologist 12,342 39.64 Student 94 0.30 Housekeeper 82 0.26 Retired 1,138 3.66 Others 1,245 4.00 Table 2. Selected factors among participants by predicted 10-year cardiovascular disease risk
Variable Predicted 10-year cardiovascular disease risk P Low (n = 18,764) Medium (n = 4,376) High (n = 7,995) Age (years) 38.67 ± 9.94a 56.09 ± 9.81b 58.01 ± 12.51b < 0.001 Men, n (%) 9,404 (50.12)a 3,023 (69.08)b 4,080 (51.03)a < 0.001 College or above education, n (%) 11,437(60.95)a 2,346 (53.61)b 4,596 (57.49)c < 0.001 Smoking, n (%) 2,598 (13.85)a 1,347 (30.78)b 2,202 (27.54)c < 0.001 Drinking, n (%) 4,266 (22.74)a 1,488 (34.00)b 2,086 (26.09)c < 0.001 Exercise, n (%) 12,619 (67.25) 2,999 (68.53) 5,335 (66.73) 0.121 Sedentary behaviour > 6 h, n (%) 9,463 (50.43)a 1,748 (39.95)b 3,346 (41.85)c < 0.001 Excellent & good sleep quality, n (%) 16,737 (89.20)a 3,828 (87.48)b 7,090 (88.68)ab < 0.002 Taking sleep medicine, n (%) 404 (2.15)a 148 (3.38)b 293 (3.66)b < 0.001 SBP (mmHg) 117.42 ± 14.49a 132.94 ± 15.98b 131.22 ± 21.50c < 0.001 TC (mg/dL) 84.62 ± 16.27a 91.44 ± 17.68b 88.98 ± 21.53c 0.001 HDL-C (mg/dL) 23.98 ± 5.86a 23.28 ± 5.73b 24.04 ± 5.88a 0.001 BMI 24.09 ± 3.82a 25.65 ± 3.48b 24.85 ± 3.42c < 0.001 Hypertension, n (%) 787 (4.19)a 1,207 (27.58)b 2,405 (30.08)c < 0.001 Diabetes, n (%) 131 (0.70)a 320 (7.31)b 1,059 (13.25)c < 0.001 Obesity, n (%) 2,720 (14.50)a 949 (21.69)b 1,324 (16.60)c < 0.001 Note. Data were reported as mean (standard deviation) and number (percentage). P-values were reported as the results of ANOVA and rank sum test. a,b,cDesignated according to post hoc analysis. SBP, systolic blood pressure. TC, total cholesterol. HDL-C, high density lipoprotein cholesterol. BMI, body mass index. Table 3. Conventional risk factors for cardiovascular disease by sleep duration
Variable Sleep duration P ≤ 6 h (n = 3,640) 7–8 h (n = 23,528) ≥ 9 h (n = 3,967) Age (years) 47.41 ± 12.86a 45.90 ± 13.92b 45.97 ± 15.59b < 0.001 Men, n (%) 2,225 (61.13)a 12,468 (52.99)b 1,814 (45.73)c < 0.001 College or above education, n (%) 2,132 (58.57)a,b 13,989 (59.46)b 2,258 (56.92)a < 0.001 Smoking, n (%) 1,071 (29.42)a 4,511 (19.17)b 592 (14.92)c < 0.001 Drinking, n (%) 1,148 (31.54)a 5,868 (24.94)b 824 (20.77)c < 0.001 Exercise, n (%) 2,298 (63.13)a 16,024 (68.11)b 2,631 (66.32)b < 0.001 Sedentary behaviour > 6 h, n (%) 1,947 (53.49)a 11,008 (46.79)b 1,702 (42.90)c < 0.001 Excellent & good sleep quality, n (%) 3,017 (82.88)a 21,034 (89.40)b 3,604 (90.85)c < 0.001 SBP (mmHg) 124.62 ± 18.31a 122.94 ± 18.06b 122.95 ± 18.83b < 0.001 Taking sleep medicine, n (%) 150 (4.12)a 583 (2.47)b 112 (2.82)b < 0.001 TC (mg/dL) 87.67 ± 17.27a 86.66 ± 18.33b 86.05 ± 17.84c 0.001 HDL-C (mg/dL) 23.63 ± 5.86a 23.90 ± 5.73b 24.13 ± 5.88c 0.001 BMI 25.05 ± 3.80a 24.47 ± 3.70b 24.20 ± 3.72c < 0.001 Hypertension, n (%) 575 (15.80)a 3,300 (14.03)b 524 (13.21)b 0.003 Diabetes, n (%) 212 (5.82)a 1,113 (4.73)b 185 (4.66)b 0.014 Obesity, n (%) 752 (20.66)a 3,658 (15.54)b 583 (14.70)c < 0.001 FRS ≥ 10%, n (%) 633 (17.39)a 3,250 (13.81)b 493 (12.43)b < 0.001 FRS ≥ 20%, n (%) 1,040 (28.57)a 5,936 (25.23)b 1,019 (25.69)b < 0.001 Note. Data were reported as mean (standard deviation) and number (percentage). P-values were reported as the results of ANOVA and rank sum test. a,b,cDesignated according to post hoc analysis. SBP, systolic blood pressure. TC, total cholesterol. HDL-C, high density lipoprotein cholesterol. BMI, body mass index. FRS, Framingham cardiovascular risk score. Table 4. Correlations between sleep duration and predicted 10-year CVD risk
Sleep duration (h) Medium-to-high risk (n = 12,371) High risk (n = 7,995) OR 95% CI P OR 95% CI P Model 1 7–8 1 ≤ 6 1.33 1.24–1.43 < 0.01 1.28 1.20–1.36 < 0.01 ≥ 9 0.96 0.90–1.03 0.27 1.00 0.95–1.06 0.92 Model 2 7–8 1 ≤ 6 1.21 1.11–1.33 < 0.01 1.20 1.08–1.32 < 0.01 ≥ 9 0.98 0.89–1.08 0.65 0.99 0.89–1.11 0.92 Model 3 7–8 1 ≤ 6 1.18 1.09–1.29 < 0.01 1.17 1.08–1.29 < 0.01 ≥ 9 0.93 0.85–1.02 0.12 0.96 0.87–1.06 0.42 Model 4 7–8 1 ≤ 6 1.20 1.11–1.30 < 0.01 1.19 1.08–1.30 < 0.01 ≥ 9 0.96 0.89–1.04 0.36 0.99 0.91–1.09 0.88 Model 5 7–8 1 ≤ 6 1.17 1.07–1.28 < 0.01 1.16 1.05–1.28 < 0.01 ≥ 9 0.94 0.85–1.02 0.15 0.96 0.87–1.06 0.45 Men (n) 7,103 4,080 Model 1 7–8 1 ≤ 6 1.25 1.15–1.37 < 0.01 1.18 1.09–1.28 < 0.01 ≥ 9 1.03 0.93–1.14 0.55 1.12 1.02–1.22 0.01 Model 2 7–8 1 ≤ 6 1.32 1.17–1.49 < 0.01 1.36 1.17–1.59 < 0.01 ≥ 9 0.95 0.82–1.10 0.48 0.94 0.78–1.13 0.49 Model 3 7–8 1 ≤ 6 1.24 1.08–1.40 0.01 1.19 1.01–1.41 0.04 ≥ 9 0.83 0.72–0.97 0.02 0.88 0.73–1.07 0.19 Model 4 7–8 1 ≤ 6 1.14 1.02–1.27 < 0.01 1.06 0.92–1.21 0.45 ≥ 9 0.96 0.85–1.08 0.50 1.05 0.94–1.23 0.43 Model 5 7–8 1 ≤ 6 1.10 1.01–1.19 < 0.01 1.05 0.83–1.16 0.47 ≥ 9 0.95 0.82–1.09 0.61 1.03 0.91–1.21 0.51 Women (n) 5,268 3,915 Model 1 7–8 1 ≤ 6 1.38 1.23–1.54 < 0.01 1.41 1.29–1.55 < 0.01 ≥ 9 0.94 0.85–1.03 0.20 0.92 0.85–1.00 0.04 Model 2 7–8 1 ≤ 6 1.22 1.07–1.38 < 0.01 1.25 1.09–1.42 < 0.01 ≥ 9 0.98 0.87–1.10 0.69 0.98 0.87–1.10 0.73 Model 3 7–8 1 ≤ 6 1.26 1.11–1.42 < 0.01 1.29 1.13–1.47 < 0.01 ≥ 9 0.93 0.83–1.04 0.22 0.93 0.83–1.05 0.24 Model 4 7–8 1 ≤ 6 1.29 1.14–1.41 < 0.01 1.33 1.17–1.51 < 0.01 ≥ 9 0.93 0.83–1.03 0.16 0.92 0.82–1.03 0.15 Model 5 7–8 1 ≤ 6 1.23 1.08–1.40 < 0.01 1.27 1.11–1.44 < 0.01 ≥ 9 0.94 0.84–1.05 0.27 0.93 0.83–1.05 0.28 Note. Model 1 was not adjusted. Model 2 was adjusted for age and gender (except gender-specific models). Model 3 was adjusted for age, gender (except gender-specific models), education level, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol, smoking, drinking, sedentary behaviour, exercise, body mass index, history of hypertension, and diabetes. Model 4 was adjusted for sleep quality and all variables in Model 3. Model 5 was adjusted for taking sleep medicine and all variables in Model 4. -
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