Sleep Hygiene, Sleep Quality, and Psychological Stress Among Adults With Cardiovascular Risk

Poor sleep quality and psychological stress are interrelated and disproportionately affect adults with multiple cardiovascular disease (CVD) risk factors. Maintaining an optimal home environment and engaging in healthy bedtime behaviors are important components of sleep hygiene practices that influence sleep health. This study sought to examine: (1) the association between sleep hygiene and psychological stress, and (2) the moderating effect of sleep quality in the relationship between sleep hygiene and psychological stress, among adults with multiple CVD risk factors. A cross-sectional study was conducted with 300 adults diagnosed with hypertension and diabetes. Individuals were recruited from a large academic health center and were asked to complete an online survey. Sleep hygiene was assessed by nine individual factors focusing on negative household environment (safety, physical comfort, temperature, noise, and light) and poor bedtime behaviors (watching TV, playing video games, using small screens, and eating), and by a composite score. Multivariable linear regression was employed to examine the associations. Of the sample, 78% reported poor sleep quality and 44% reported high psychological stress. The composite sleep hygiene score was significantly associated with higher psychological stress after controlling for sleep quality, and the relationship was not modified by sleep quality. Unsafe household, uncomfortable physical environment, uncomfortable temperature, and eating at bedtime were independently related to increased stress levels. The study highlights strong links between sleep hygiene and psychological stress. Current evidence suggests that promoting home environment and bedtime behaviors may alleviate psychological burdens in adults with multiple CVD risk factors.