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Respiratory symptoms are more common among short sleepers independent of obesity
  1. Erla Björnsdóttir1,2,
  2. Christer Janson3,
  3. Eva Lindberg3,
  4. Erna Sif Arnardottir1,4,
  5. Bryndís Benediktsdóttir1,4,
  6. Judith Garcia-Aymerich5,6,7,
  7. Anne Elie Carsin5,6,7,
  8. Francisco Gómez Real8,
  9. Kjell Torén9,
  10. Joachim Heinrich10,11,
  11. Dennis Nowak10,
  12. José Luis Sánchez-Ramos12,
  13. Pascal Demoly13,
  14. Sandra Dorado Arenas14,
  15. Ramon Coloma Navarro15,
  16. Vivi Schlünssen16,17,
  17. Chantal Raherison18,
  18. Debbie L Jarvis19,20 and
  19. Thorarinn Gislason1,4
  1. 1 Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  2. 2 Faculty of Medicine, University of Iceland, Reykjavík, Iceland
  3. 3 Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  4. 4 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  5. 5 ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  6. 6 Universitat Pompeu Fabra (UPF), Barcelona, Spain
  7. 7 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  8. 8 Department of Clinical Science, University of Bergen, Bergen, Norway
  9. 9 Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  10. 10 Ludwig Maximilians University Munich, Ludwig Maximilians University Munich, University Hospital Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
  11. 11 Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
  12. 12 Department of Nursing, University of Huelva, Huelva, Spain
  13. 13 Department of Pneumology, University Hospital of Montpellier, Montpellier, France
  14. 14 Pulmonology Department, Galdakao-Usansolo Hospital, Biscay, Spain
  15. 15 Unidad del Sueño, Servicio de Neumología, Hospital General Universitario, Albacete, Spain
  16. 16 Department of Public Health, Aarhus University, Aarhus, Denmark
  17. 17 National Research Centre for the Working Environment, Copenhagen, Denmark
  18. 18 U1219, Bordeaux Population Health Research Center, Bordeaux, France
  19. 19 Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
  20. 20 MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
  1. Correspondence to Dr Thorarinn Gislason; thorarig{at}


Introduction Sleep length has been associated with obesity and various adverse health outcomes. The possible association of sleep length and respiratory symptoms has not been previously described. The aim of this study was to investigate the association between sleep length and respiratory symptoms and whether such an association existed independent of obesity.

Methods This is a multicentre, cross-sectional, population-based study performed in 23 centres in 10 different countries. Participants (n=5079, 52.3% males) were adults in the third follow-up of the European Community Respiratory Health Survey III. The mean±SD age was 54.2±7.1 (age range 39–67 years). Information was collected on general and respiratory health and sleep characteristics.

Results The mean reported nighttime sleep duration was 6.9±1.0 hours. Short sleepers (<6 hours per night) were n=387 (7.6%) and long sleepers (≥9 hours per night) were n=271 (4.3%). Short sleepers were significantly more likely to report all respiratory symptoms (wheezing, waking up with chest tightness, shortness of breath, coughing, phlegm and bronchitis) except asthma after adjusting for age, gender, body mass index (BMI), centre, marital status, exercise and smoking. Excluding BMI from the model covariates did not affect the results. Short sleep was related to 11 out of 16 respiratory and nasal symptoms among subjects with BMI ≥30 and 9 out of 16 symptoms among subjects with BMI <30. Much fewer symptoms were related to long sleep, both for subjects with BMI <30 and ≥30.

Conclusions Our results show that short sleep duration is associated with many common respiratory symptoms, and this relationship is independent of obesity.

  • Sleep length
  • respiratory symptoms
  • ALEC
  • epidemiology

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  • Contributors EB drafted the paper, participated in designing the study and performed the statistical analysis. CJ and EL designed the study, participated in manuscript preparation and reviewed the paper on several stages. CJ also contributed to the statistical analysis. BB participated in data collection and reviewing the paper. ESA contributed to the statistical analysis and reviewed the paper, JG-A, AEC, FGR, KT, JH, DN, JLS, PD, SDA, RCN, VS, CR and DLJ. TG is the correspondence author, and he designed the study, participated in manuscript preparation and reviewed the paper on several stages.

  • Funding The ALEC Study is funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No 633212.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethical approval for the study from local research ethics committees and written consent from participants were obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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