Poor sleep quality and short sleep duration were associated with higher population-level cardiometabolic risk factor burden, with difficulty staying asleep showing stronger associations among individuals with lower socioeconomic status.
Key Findings
Results
Short sleep duration was associated with a 9% higher mean count of cardiometabolic risk factors compared to the healthy reference group.
Cross-sectional analysis of 25,433 adults using 2022 National Health Interview Survey data
Sleep duration categories were defined as short (<7 hours), normal (7-9 hours), and long (>9 hours)
Poisson regression with marginal standardization for covariates was used, accounting for complex survey design
Cardiometabolic risk factors included overweight/obesity, diabetes, hypertension, and hyperlipidemia (individual range: 0-4)
Results
Poor sleep quality measures were associated with 15% to 20% higher mean cardiometabolic risk factor counts compared to healthy reference groups.
Sleep quality measures included frequency of feeling well rested, difficulty falling asleep, and difficulty staying asleep
The range of 15% to 20% higher CMRF count was observed across the three poor sleep quality measures examined
A composite sleep health indicator was also used, with those without healthy composite sleep showing 18% higher CMRF count
Associations were assessed at the population-average level using marginal standardization
Results
The association between difficulty staying asleep and mean cardiometabolic risk factor count was stronger among individuals with lower socioeconomic status.
A statistically significant interaction by socioeconomic status was observed (p-interaction ≤0.001) on the ratio scale
This interaction was specific to difficulty staying asleep among the sleep quality measures examined
Socioeconomic status was identified as a moderator of the sleep-cardiometabolic risk relationship
The interaction was assessed on the ratio scale using Poisson regression
Results
Poor sleep quality was associated with more severe cardiometabolic risk factor combinations and patterns.
The study examined patterns of cardiometabolic risk factor combinations across sleep measures
Sleep duration showed heterogeneous associations across individual cardiometabolic outcomes, in contrast to sleep quality
Poor sleep quality was associated with more severe CMRF combinations, suggesting implications for multimorbidity
The authors concluded that sleep quality may be a potential target for multimorbidity prevention
Results
Individuals without healthy composite sleep had an 18% higher population-average cardiometabolic risk factor count compared to those with healthy composite sleep.
A composite sleep health indicator combining multiple sleep dimensions was constructed and analyzed
The 18% higher CMRF count was estimated after marginal standardization for covariates
The composite measure captured both sleep duration and sleep quality components
This finding was consistent with the individual sleep measure associations observed
What This Means
This research suggests that both how long people sleep and how well they sleep are linked to higher levels of heart and metabolic health problems. Using data from over 25,000 U.S. adults surveyed in 2022, researchers found that people who sleep less than 7 hours a night have about 9% more cardiometabolic risk factors — such as obesity, diabetes, high blood pressure, and high cholesterol — compared to those who sleep a healthy 7-9 hours. People who reported poor sleep quality (such as frequently having trouble falling or staying asleep, or rarely feeling well-rested) had 15-20% more of these risk factors on average.
One particularly notable finding is that the connection between trouble staying asleep and heart-metabolic health problems was significantly stronger in people with lower socioeconomic status. This suggests that lower-income individuals may be especially vulnerable to the health consequences of disrupted sleep, possibly due to additional stressors or limited access to health resources. The study also found that poor sleep quality — more so than short sleep duration — was linked to having multiple cardiometabolic conditions at the same time, which is sometimes called multimorbidity.
This research suggests that improving sleep quality, particularly for people with lower incomes, could be an important strategy for reducing the burden of heart and metabolic diseases at a population level. Because the study was cross-sectional (meaning it captured a single point in time), it cannot prove that poor sleep directly causes these health problems, but the consistent associations across multiple sleep measures and health outcomes point to sleep health — especially sleep quality — as a potentially meaningful focus for prevention efforts.
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Vashist K, Ward L, Shah A, Vaccarino V, Johnson D. (2026). Associations of sleep duration and quality with cardiometabolic risk factors in US adults: Evidence from the 2022 National Health Interview Survey.. Sleep health. https://doi.org/10.1016/j.sleh.2026.07.005