Faculty Bibliography

BACKGROUND:Population estimates of sleep duration and quality are inconsistent because they rely primarily on self-reported data. Passive and ubiquitous digital tracking and wearable devices may provide more accurate estimates of sleep duration and quality. OBJECTIVE:This study aimed to identify trends in sleep duration and quality in New York City based on 2 million nights of data from users of a popular mobile sleep app. METHODS:We examined sleep duration and quality using 2,161,067 nights of data captured from 2015 to 2018 by Sleep Cycle, a popular sleep-tracking app. In this analysis, we explored differences in sleep parameters based on demographic factors, including age and sex. We used graphical matrix representations of data (heat maps) and geospatial analyses to compare sleep duration (in hours) and sleep quality (based on time in bed, deep sleep time, sleep consistency, and number of times fully awake), considering potential effects of day of the week and seasonality. RESULTS:Women represented 46.43% (1,003,421/2,161,067) of the sample, and men represented 53.57% (1,157,646/2,161,067) of individuals in the sample. The average age of the sample was 31.0 years (SD 10.6). The mean sleep duration of the total sample was 7.11 hours (SD 1.4). Women slept longer on average (mean 7.27 hours, SD 1.4) than men (mean 7 hours, SD 1.3; P<.001). Trend analysis indicated longer sleep duration and higher sleep quality among older individuals than among younger (P<.001). On average, sleep duration was longer on the weekend nights (mean 7.19 hours, SD 1.5) than on weeknights (mean 7.09 hours, SD 1.3; P<.001). CONCLUSIONS:Our study of data from a commercially available sleep tracker showed that women experienced longer sleep duration and higher sleep quality in nearly every age group than men, and a low proportion of young adults obtained the recommended sleep duration. Future research may compare sleep measures obtained via wearable sleep trackers with validated research-grade measures of sleep.

(a) Background: In patients with sleep apnea, poor adherence to positive airway pressure (PAP) therapy has been associated with mortality. Regional studies have suggested that lower socioeconomic status is associated with worse PAP adherence but population-level data is lacking. (b) Methods: De-identified data from a nationally representative database of PAP devices was geo-linked to sociodemographic information. (c) Results: In 170,641 patients, those in the lowest quartile of median household income had lower PAP adherence (4.1 + 2.6 hrs/night; 39.6% adherent by Medicare criteria) than those in neighborhoods with highest quartile median household income (4.5 + 2.5 hrs/night; 47% adherent by Medicare criteria; p < 0.0001). In multivariate regression, individuals in neighborhoods with the highest income quartile were more adherent to PAP therapy than those in the lowest income quartile after adjusting for various confounders (adjusted Odds Ratio (adjOR) 1.18; 95% confidence interval (CI) 1.14, 1.21; p < 0.0001). Over the past decade, PAP adherence improved over time (adjOR 1.96; 95%CI 1.94, 2.01), but health inequities in PAP adherence remained even after the Affordable Care Act was passed. (d) Conclusion: In a nationally representative population, disparities in PAP adherence persist despite Medicaid expansion. Interventions aimed at promoting health equity in sleep apnea need to be undertaken.