Testing the Daily Bidirectional Relationships Between Stress and Sleep Using Bivariate Multilevel Autoregressive...

Previous studies have demonstrated that stress and sleep are bidirectional and perseverative cognition (ie, worry and rumination) is a key cognitive mechanism in this relationship. The goal of our study was to examine the relationships between stress and sleep, and test whether physical activity moderates the stress-sleep link.

Participants aged 18 and above were recruited from May 2020 to November 2021 and completed questionnaires and 7 days of twice daily text-based surveys, morning and evening. Morning text-based surveys assessed evening/overnight perseverative cognition and sleep, and evening surveys assessed daily stress ratings. Habitual physical activity was measured by the International Physical Activity Questionnaire. Analyses were conducted using bivariate multilevel autoregressive modeling (ML-VAR), a discrete-time structural equation model (SEM), to test relationships between repeated daily measures of sleep (duration/efficiency), stress, and preservative cognition, which were adjusted for age, sex, and race/ethnicity.

We obtained data from 155 participants (age M =42, SD=15, 82 f) over 1009 days. In the models, 95% credibility intervals for both stress (95% CI=-0.7, -0.1) and perseverative cognition (95% CI=-13.3, -6) showed they predicted shorter sleep duration during the corresponding night. Perseverative cognition had a stronger relationship with sleep duration than stress, but did not mediate its relationship. Participants with higher habitual MVPA had a weaker relationship between stress and sleep duration (95% CI=<0.001, 0.015). Perseverative cognition also predicted lower sleep efficiency that night (95% CI=-0.024, -0.006). There were no significant mediators or moderators in models of sleep efficiency.

Results demonstrated that stress and perseverative cognition had a stronger impact on sleep at night than the opposite direction. In addition, results highlight the importance of physical activity in mitigating the deleterious effects of stress.