The effects of social jetlag and sleep variability on sleepiness in a population-based study: The mediating role of sleep debt
Guilherme Luiz Fernandes
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Software, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorJulia Ribeiro da Silva Vallim
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Software, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorVânia D'Almeida
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorSergio Tufik
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Funding acquisition, Project administration, Resources, Supervision
Search for more papers by this authorCorresponding Author
Monica Levy Andersen
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Correspondence
Monica Levy Andersen, Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, 04024-002, Brazil.
Email: [email protected]
Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorGuilherme Luiz Fernandes
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Software, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorJulia Ribeiro da Silva Vallim
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Software, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorVânia D'Almeida
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorSergio Tufik
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Contribution: Conceptualization, Funding acquisition, Project administration, Resources, Supervision
Search for more papers by this authorCorresponding Author
Monica Levy Andersen
Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
Correspondence
Monica Levy Andersen, Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, 04024-002, Brazil.
Email: [email protected]
Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorSummary
Sleepiness is a multicausal condition, and previous research has highlighted associations between this symptom and the circadian timing system, specifically concerning social jetlag and sleep variability. Recent inquiries have shown that the effects of social jetlag on sleepiness can be confounded with the consequences of sleep debt. In light of the current evidence, we aimed to assess the effects of social jetlag and sleep variability on sleepiness and the potential mediating role of sleep debt. We used data from the EPISONO study, a cross-sectional population-based study with a sample size of 1042 participants, representative of the city of Sao Paulo, Brazil. Participants completed the UNIFESP Sleep Questionnaire (self-reported bedtime and get-up time) and the Epworth Sleepiness Scale (subjective daytime sleepiness). Subsequently, sleep-corrected mid-sleep time (chronotype), total sleep time, social jetlag (absolute difference between the mid-sleep time on workdays and mid-sleep time on free days), sleep variability (standard deviation of mid-sleep time), and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalised linear models were used to test whether social jetlag and sleep variability affected sleepiness. Mediation models were used to determine if any observed significant effects were mediated by sleep debt. The prevalence of social jetlag was 23% for >1 h and 12% for >2 h. The mean sleep variability was 41 ± 30 min. Social jetlag had a significant effect on the Epworth Sleepiness Scale scores. This association was no longer statistically significant after controlling for age, sex, body mass index, work schedule, and chronotype. A significant indirect effect of social jetlag on sleep debt and subsequently on the Epworth Sleepiness Scale scores was found. No effect of sleep variability on sleepiness could be identified. In conclusion, the association between social jetlag and sleepiness was mediated by sleep debt but was not independent of demographic, work, and chronotype variables. This study provides new evidence on the importance of circadian misalignment and sleep debt for sleep health on a population level.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Open Research
DATA AVAILABILITY STATEMENT
Research data are not shared.
Supporting Information
Filename | Description |
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jsr14043-sup-0001-FigureS1.pngPNG image, 74.1 KB | Figure S1. Polar histograms depicting the distribution of mid-sleep time at each datapoint collected in this study |
jsr14043-sup-0002-TableS1.docxWord 2007 document , 16.4 KB | Table S1. Generalised linear models testing the simple effects of social jet lag and mid-sleep time variability on Epworth Sleepiness Scale score as a normal variable |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- Åkerstedt, T., Hallvig, D., & Kecklund, G. (2017). Normative data on the diurnal pattern of the Karolinska sleepiness scale ratings and its relation to age, sex, work, stress, sleep quality and sickness absence/illness in a large sample of daytime workers. Journal of Sleep Research, 26(5), 559–566. https://doi.org/10.1111/jsr.12528
- American Academy of Sleep Medicine. (2014). International classification of sleep disorders ( 3rd ed.). American Acad. of Sleep Medicine.
- Bei, B., Wiley, J. F., Trinder, J., & Manber, R. (2016). Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. Sleep Medicine Reviews, 28, 108–124. https://doi.org/10.1016/j.smrv.2015.06.003
- Berger, M., Hirotsu, C., Haba-Rubio, J., Betta, M., Bernardi, G., Siclari, F., Waeber, G., Vollenweider, P., Marques-Vidal, P., & Heinzer, R. (2021). Risk factors of excessive daytime sleepiness in a prospective population-based cohort. Journal of Sleep Research, 30(2), e13069. https://doi.org/10.1111/jsr.13069
- Bertolazi, A. N., Fagondes, S. C., Hoff, L. S., Pedro, V. D., Menna Barreto, S. S., & Johns, M. W. (2009). Portuguese-language version of the Epworth sleepiness scale: Validation for use in Brazil. Jornal Brasileiro de Pneumologia, 35(9), 877–883. https://doi.org/10.1590/S1806-37132009000900009
- Braz, S., Neumann, B. R., & Tufik, S. (1987). Evaluation of sleep disorders: Elaboration and validation of a questionnaire. Revista ABP-APAL, 9(1), 9–14.
- Caliandro, R., Streng, A. A., van Kerkhof, L. W. M., van der Horst, G. T. J., & Chaves, I. (2021). Social jetlag and related risks for human health: A timely review. Nutrients, 13(12), 4543. https://doi.org/10.3390/nu13124543
- Carter, B., Rees, P., Hale, L., Bhattacharjee, D., & Paradkar, M. S. (2016). Association between portable screen-based media device access or use and sleep outcomes: A systematic review and meta-analysis. JAMA Pediatrics, 170(12), 1202–1208. https://doi.org/10.1001/jamapediatrics.2016.2341
- Di, H., Guo, Y., Daghlas, I., Wang, L., Liu, G., Pan, A., Liu, L., & Shan, Z. (2022). Evaluation of sleep habits and disturbances among US adults, 2017-2020. JAMA Network Open, 5(11), e2240788. https://doi.org/10.1001/jamanetworkopen.2022.40788
- Facer-Childs, E. R., Campos, B. M., Middleton, B., Skene, D. J., & Bagshaw, A. P. (2019). Circadian phenotype impacts the brains resting-state functional connectivity, attentional performance, and sleepiness. Sleep, 42(5), zsz033. https://doi.org/10.1093/sleep/zsz033
- Fischer, D., Klerman, E. B., & Phillips, A. J. K. (2021). Measuring sleep regularity: Theoretical properties and practical usage of existing metrics. Sleep, 44(10), zsab103. https://doi.org/10.1093/sleep/zsab103
- Fischer, D., McHill, A. W., Sano, A., Picard, R. W., Barger, L. K., Czeisler, C. A., Klerman, E. B., & Phillips, A. J. K. (2020). Irregular sleep and event schedules are associated with poorer self-reported well-being in US college students. Sleep, 43(6), zsz300. https://doi.org/10.1093/sleep/zsz300
- Goto, Y., Fujiwara, K., Sumi, Y., Matsuo, M., Kano, M., & Kadotani, H. (2021). Work habit-related sleep debt; insights from factor identification analysis of actigraphy data. Frontiers in Public Health, 9, 630640. https://doi.org/10.3389/fpubh.2021.630640
- Horne, J. (2010). Sleepiness as a need for sleep: When is enough, enough? Neuroscience & Biobehavioral Reviews, 34(1), 108–118. https://doi.org/10.1016/j.neubiorev.2009.07.009
- Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22, 23–36. https://doi.org/10.1016/j.smrv.2014.10.001
- Islam, Z., Hu, H., Akter, S., Kuwahara, K., Kochi, T., Eguchi, M., Kurotani, K., Nanri, A., Kabe, I., & Mizoue, T. (2020). Social jetlag is associated with an increased likelihood of having depressive symptoms among the Japanese working population: The Furukawa nutrition and health study. Sleep, 43(1), zsz204. https://doi.org/10.1093/sleep/zsz204
- Jaussent, I., Morin, C. M., Ivers, H., & Dauvilliers, Y. (2017). Incidence, worsening and risk factors of daytime sleepiness in a population-based 5-year longitudinal study. Scientific Reports, 7(1), 1372. https://doi.org/10.1038/s41598-017-01547-0
- Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14(6), 540–545. https://doi.org/10.1093/sleep/14.6.540
- Kim, H., & Young, T. (2005). Subjective daytime sleepiness: Dimensions and correlates in the general population. Sleep, 28(5), 625–634. https://doi.org/10.1093/sleep/28.5.625
- Kim, L. J., Coelho, F. M., Hirotsu, C., Araujo, P., Bittencourt, L., Tufik, S., & Andersen, M. L. (2015). Frequencies and associations of narcolepsy-related symptoms: A cross-sectional study. Journal of Clinical Sleep Medicine, 11(12), 1377–1384. https://doi.org/10.5664/jcsm.5268
- Kitamura, S., Katayose, Y., Nakazaki, K., Motomura, Y., Oba, K., Katsunuma, R., Terasawa, Y., Enomoto, M., Moriguchi, Y., Hida, A., & Mishima, K. (2016). Estimating individual optimal sleep duration and potential sleep debt. Scientific Reports, 6(1), 35812. https://doi.org/10.1038/srep35812
- Kolla, B. P., He, J. P., Mansukhani, M. P., Frye, M. A., & Merikangas, K. (2020). Excessive sleepiness and associated symptoms in the U.S. adult population: Prevalence, correlates, and comorbidity. Sleep Health, 6(1), 79–87. https://doi.org/10.1016/j.sleh.2019.09.004
- Lang, C. J., Reynolds, A. C., Appleton, S. L., Taylor, A. W., Gill, T. K., McEvoy, R. D., Ferguson, S. A., & Adams, R. A. (2018). Sociodemographic and behavioural correlates of social jetlag in Australian adults: Results from the 2016 National Sleep Health Foundation Study. Sleep Medicine, 51, 133–139. https://doi.org/10.1016/j.sleep.2018.06.014
- Lopes, X., Araújo, M. F. S., Lira, N. C. C., de Sousa Dantas, D., & de Souza, J. C. (2022). Social, biological and behavioral factors associated with social jet lag and sleep duration in university students from a low urbanized city. Journal of Multidisciplinary Healthcare, 15, 11–20. https://doi.org/10.2147/JMDH.S337361
- Lunsford-Avery, J. R., Engelhard, M. M., Navar, A. M., & Kollins, S. H. (2018). Validation of the sleep regularity index in older adults and associations with cardiometabolic risk. Scientific Reports, 8(1), 14158. https://doi.org/10.1038/s41598-018-32402-5
- Manber, R., Bootzin, R. R., Acebo, C., & Carskadon, M. A. (1996). The effects of regularizing sleep-wake schedules on daytime sleepiness. Sleep, 19(5), 432–441. https://doi.org/10.1093/sleep/19.5.432
- Okajima, I., Komada, Y., Ito, W., & Inoue, Y. (2021). Sleep debt and social jetlag associated with sleepiness, mood, and work performance among workers in Japan. International Journal of Environmental Research and Public Health, 18(6), 2908. https://doi.org/10.3390/ijerph18062908
- Pérez-Carbonell, L., Mignot, E., Leschziner, G., & Dauvilliers, Y. (2022). Understanding and approaching excessive daytime sleepiness. The Lancet, 400(10357), 1033–1046. https://doi.org/10.1016/S0140-6736(22)01018-2
- Pewsey, A., Neuhäuser, M., & Ruxton, G. D. (2013). Circular statistics in R ( 1st ed.). Oxford University Press.
- Raman, S., & Coogan, A. N. (2019). A cross-sectional study of the associations between Chronotype, social jetlag and subjective sleep quality in healthy adults. Clocks & Sleep, 2(1), 1–6. https://doi.org/10.3390/clockssleep2010001
- Roenneberg, T., Pilz, L. K., Zerbini, G., & Winnebeck, E. C. (2019). Chronotype and social jetlag: A (self-) critical review. Biology, 8(3), 54. https://doi.org/10.3390/biology8030054
- Roenneberg, T., Allebrandt, K. V., Merrow, M., & Vetter, C. (2012). Social jetlag and obesity. Current Biology, 22(10), 939–943. https://doi.org/10.1016/j.cub.2012.03.038
- Roenneberg, T., Kuehnle, T., Pramstaller, P. P., Ricken, J., Havel, M., Guth, A., & Merrow, M. (2004). A marker for the end of adolescence. Current Biology, 14(24), R1038–R1039. https://doi.org/10.1016/j.cub.2004.11.039
- Santos-Silva, R., Bittencourt, L. R. A., Pires, M. L. N., de Mello, M. T., Taddei, J. A., Benedito-Silva, A. A., Pompeia, C., & Tufik, S. (2010). Increasing trends of sleep complaints in the city of Sao Paulo, Brazil. Sleep Medicine, 11(6), 520–524. https://doi.org/10.1016/j.sleep.2009.12.011
- Santos-Silva, R., Tufik, S., Conway, S. G., Taddei, J. A., & Bittencourt, L. R. A. (2009). Sao Paulo epidemiologic sleep study: Rationale, design, sampling, and procedures. Sleep Medicine, 10(6), 679–685. https://doi.org/10.1016/j.sleep.2008.11.001
- Silva, C. M., Mota, M. C., Miranda, M. T., Paim, S. L., Waterhouse, J., & Crispim, C. A. (2016). Chronotype, social jetlag and sleep debt are associated with dietary intake among Brazilian undergraduate students. Chronobiology International, 33(6), 740–748. https://doi.org/10.3109/07420528.2016.1167712
- Soehner, A. M., Kennedy, K. S., & Monk, T. H. (2011). Circadian preference and sleep-wake regularity: Associations with self-report sleep parameters in daytime-working adults. Chronobiology International, 28(9), 802–809. https://doi.org/10.3109/07420528.2011.613137
- Suikki, T., Maukonen, M., Partonen, T., Jousilahti, P., Kanerva, N., & Männistö, S. (2021). Association between social jet lag, quality of diet and obesity by diurnal preference in Finnish adult population. Chronobiology International, 38(5), 720–731. https://doi.org/10.1080/07420528.2021.1876721
- Taillard, J., Philip, P., Claustrat, B., Capelli, A., Coste, O., Chaumet, G., & Sagaspe, P. (2011). Time course of neurobehavioral alertness during extended wakefulness in morning- and evening-type healthy sleepers. Chronobiology International, 28(6), 520–527. https://doi.org/10.3109/07420528.2011.590623
- Tamura, N., Komada, Y., Inoue, Y., & Tanaka, H. (2022). Social jetlag among Japanese adolescents: Association with irritable mood, daytime sleepiness, fatigue, and poor academic performance. Chronobiology International, 39(3), 311–322. https://doi.org/10.1080/07420528.2021.1996388
- Wittmann, M., Dinich, J., Merrow, M., & Roenneberg, T. (2006). Social jetlag: Misalignment of biological and social time. Chronobiology International, 23(1–2), 497–509. https://doi.org/10.1080/07420520500545979