LAUSR

Background: There were inconsistent results in the relationship between poor sleep quality and obesity among different population in previous studies. Our study evaluated the association between sleep quality and obesity in a representative adult population of Chinese subjects living in the Macao Special Administrative Region, China. Methods: This cross-sectional study was an analysis of 1426 participants aged 18 to 90 years from a community-based health needs assessment study titled “Healthy Living, Longer Lives”. Recruitment was conducted in seven districts of Macao from 2017 to 2018. Stratified sampling by age and gender strata was adopted. The Chinese version of Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. Higher score of PSQI indicates worse sleep quality. Height, weight, and other covariates were collected by self-administered questionnaire. Obesity was defined as body mass index (BMI) ≥ 25 kg/m 2 according to the WHO standard. Results: Of all participants, 263 (18.4%) were obese and 285 (20.0%) were overweight. The average BMI and global score of PSQI were 22.9±3.0 kg/m 2 and 4.48±2.58 for men, 22.1±3.3 kg/m 2 and 5.05±2.92 for women, respectively. After adjustment of age, sex, income, marital status, education, smoking, and drinking, a significant negative relationship was found between sleep quality and BMI: higher PSQI global score was associated with higher BMI (β = 0.09, 95% CI: 0.03 - 0.15; P < 0.01). Within the 7 domains of PSQI, higher sleep disturbance score (β = 0.63, 95% CI: 0.34 - 0.93) and daytime dysfunction score (β = 0.41, 95% CI: 0.13 - 0.68) predicted higher BMI (both P < 0.01). The poor sleep status (global PSQI score > 5) was associated with 39.2% greater odds of being obese (95% CI: 1.04-1.87; P < 0.05). Conclusions: In a population of young to older adult Macao residents, we found an inverse linear association between sleep quality and BMI. People with sleep disturbance and daytime dysfunction were more likely to be fat. Poor sleep quality was strongly associated with greater obesity.