Research Study Abstract

A preliminary study of a composite sleep health score: associations with psychological distress, body mass index, and physical functioning in a low-income African American community

  • Published on June 14, 2019

Although multiple individual sleep measures (eg, sleep duration, satisfaction) have been linked to a wide range of physical and mental health conditions, scant research has examined how individual sleep dimensions may act independently or additively to influence health. The current study investigates associations of 5 sleep dimensions (duration, satisfaction, efficiency, timing, and regularity), analyzed separately and simultaneously, with psychological distress, body mass index, and physical functioning among a low-income, predominantly African American population.

We constructed a composite sleep health (SH) score from the sum of scores, representing “good’ and “poor” ranges of 5 sleep measures (range 0-5).

Two low-income, predominantly African American neighborhoods in Pittsburgh.

Participants included 738 community-dwelling adults (78% female and 98% black).

Actigraphy-based measures of sleep duration, regularity, timing, and efficiency, and self-reported sleep satisfaction. Outcomes included self-reported psychological distress, physical functioning, and measured body mass index (BMI).

Each 1-unit higher SH score was associated with 0.55-unit lower psychological distress score (range 0-24) and 2.23-unit higher physical functioning score. Participants with at least 2, 3, or 4 sleep dimensions in the “healthy” range, vs fewer, had lower psychological distress scores. Greater sleep satisfaction was associated with higher physical functioning, and longer sleep duration was associated with lower physical functioning. Neither the composite SH score nor any of the individual sleep dimensions were associated with BMI.

Assessing multiple sleep dimensions may provide a more comprehensive understanding of associations of sleep with psychological distress than assessing any single sleep dimension. Although no sleep measures were related to BMI in the current sample, analyses should be replicated in other samples to determine generalizability.


  • Amy S.DeSantisPhD 1
  • Tamara Dubowitz ScD 2
  • Bonnie Ghosh-Dastidar PhD 3
  • Gerald P. Hunter MS 2
  • Matthew Buman PhD 4
  • Daniel J. Buysse MD 5
  • Lauren Hale PhD 6
  • Wendy M. Troxel PhD 2


  • 1

    RAND Corporation, Health Division, Boston, MA 02116

  • 2

    RAND Corporation, Health Division, Pittsburgh, PA 15213

  • 3

    RAND Corporation, Health Division, Washington, DC 22202

  • 4

    Arizona State University, School of Nutrition and Health Promotion, Phoenix, AZ 85004

  • 5

    University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA 15213

  • 6

    Stony Brook University, Program in Public Health, Department of Family, Population and Preventive Medicine, Stony Brook, NY 11794-8338


Sleep Health