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Background To investigate the relationship between objectively-measured, free-living sleep patterns, and cardiometabolic health, in a rural South African health and demographic surveillance site. Methods Wrist-mounted actigraphy data was collected over nine days from 167 adults (≥ 40 years). Sleep patterns were constructed from tertiles of sleep quantity and quality parameters (TST: total sleep time, AC: activity counts during sleep) from valid minute-by-minute data. The reference category was Moderate TST/Low-to-Moderate AC. Self-reported data included behavioural, health and socio-demographic variables. Biological data included anthropometry, resting blood pressure and fasting blood glucose, insulin and lipids. Binary and ordinal logistic regression models were constructed to determine the association between TST and AC, the factors associated with sleeping patterns, and the association between sleeping patterns and Insulin resistance (HOMA-IR) and Metabolic Syndrome (MetS). HOMA-IR and MetS were also examined across sleep patterns using analysis of variance models. Results A total of 139 adults (71.2% female) had a complete dataset. In unadjusted analyses, females had poorer sleep quality, were more physically active, and displayed poorer cardiometabolc health and greater adiposity than males ( p  ≤ 0.017). There were no sex differences in TST or sleep pattern distribution ( p  ≤ 0.901). Not being classified as Low TST/High AC or exposed to ≥ 1 bout of Low TST/High AC sleep was associated with lower physical activity, longer sleep duration, better sleep quality and lower IR ( p  ≤ 0.0452). In multivariate analyses, there was no association between TST and AC ( p  = 0.921), while increasing age and people-to-bedroom density, and lower physical activity where significantly associated with increasing TST ( p  ≤ 0.027). Participants classified as Low TST/High AC had significantly higher HOMA-IR, but not MetS, compared with Moderate TST/Low AC ( p  = 0.021). Being exposed to ≥ 1 bout of Low TST/High AC sleep was significantly associated with hypertension (OR = 2.31, 95%CI: 1.00, 5.34), but not for HOMA-IR or MetS ( p  ≥ 0.227). Conclusions Long sleep was not associated with increased sleep fragmentation. Short, fragmented sleep was associated with insulin resistance. Exposure to at least one bout of short, fragmented sleep increased the likelihood of hypertension. Further studies are required to identify the factors associated with short, fragmented sleep in this setting.

Objectively-measured sleep patterns and cardiometabolic health in a rural South African setting: a cross sectional analysis