160 Underlying Factors Contributing to Sleep Health Among Middle-aged and Older Adults

Rebecca Lorenz, Varun Chandola, Samantha Auerbach, Heather Orom, Chin-Shang Li and Yu-Ping Chang (2021) . Sleep.



Although poor sleep is not inherent with aging, an estimated 50-70 million adults in the US have insufficient sleep. Sleep duration is increasingly recognized as incomplete and insufficient. Instead, sleep health (SH), a multidimensional concept describing sleep/wake patterns that promote well-being has been shown to better reflect how sleep impacts the individual. Therefore, focusing on the underlying factors contributing to sleep health may provide the opportunity to develop interventions to improve sleep health in middle-age and older adults.


Data from the 2014 wave of the Health and Retirement Study (HRS) were used. Sample size was restricted to those who completed an additional questionnaire containing sleep variables. A derivation of the SH composite was constructed using eight selected sleep variables from the HRS data based on the five dimensions of sleep: Satisfaction, Alertness, Timing, Efficiency, and Duration. Total score ranged from 0-100, with higher scores indicating better SH. Weighting variables were based on complex sampling procedures and provided by HRS. Machine learning-based framework was used to identify determinants for predicting SH using twenty-six variables representing individual health and socio-demographics. Penalized linear regression with elastic net penalty was used to study the impact of individual predictors on SH.


Our sample included 5,163 adults with a mean age of 67.8 years (SD=9.9; range 50-98 years). The majority were female (59%), white (78%), and married (61%). SH score ranged from 27-61 (mean=50; SD=6.7). Loneliness (coefficient=-1.92), depressive symptoms (coefficient=-1.28), and physical activity (coefficient=1.31) were identified as the strongest predictors of SH. Self-reported health status (coefficient=-1.11), daily pain (coefficient=-0.65), being middle-aged (coefficient=-0.26), and discrimination (coefficient=-0.23) were also significant predictors in this model.


Our study identified key predictors of SH among middle-aged and older adults using a novel approach of Machine Learning. Improving SH is a concrete target for health promotion through clinical interventions tailored towards increasing physical activity and reducing loneliness and depressive symptoms among middle-aged adults.

Support (if any)

This study was supported by National Heart, Lung, and Blood Institute (NHLBI) UB Clinical Scholar Program in Implementation Science to Achieve Triple Aims-NIH K12 Faculty Scholar Program in Implementation Science


    author = {Lorenz, Rebecca and Chandola, Varun and Auerbach, Samantha and Orom, Heather and Li, Chin-Shang and Chang, Yu-Ping},
    title = "{160 Underlying Factors Contributing to Sleep Health Among Middle-aged and Older Adults}",
    journal = {Sleep},
    volume = {44},
    number = {Supplement_2},
    pages = {A65-A65},
    year = {2021},
    month = {05},
    issn = {0161-8105},
    doi = {10.1093/sleep/zsab072.159},
    url = {https://doi.org/10.1093/sleep/zsab072.159},
    eprint = {https://academic.oup.com/sleep/article-pdf/44/Supplement\_2/A65/37655478/zsab072.159.pdf},