Association Of Rest-Activity Rhythm And Sleep Regularity With Cardiometabolic Disease In The CAR

18 Mar 20264 min read0 viewsJournal Feed

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Journal of the American Heart Association, Volume 15, Issue 7 , April 7, 2026. BackgroundDisrupted circadian rhythms are associated with cardiometabolic disease.

We examined associations between rest‐activity rhythms and cardiometabolic disease by race.MethodsIn cross‐sectional analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) sleep ancillary study (2020–2023), 861 participants wore wrist actigraphy for 7 days. Sleep Regularity Index and rest‐activity rhythm measures were calculated: interdaily stability, intradaily variability, relative amplitude, and most active 10‐hour and least active 5‐hour period start times.

Cardiometabolic disease markers included body mass index, waist circumference, blood pressure, hypertension, fasting glucose, estimated insulin resistance, and diabetes. Linear regression models with interaction terms evaluated effect modification by race.ResultsAmong 354 Black and 507 White participants, the most consistent associations were between anthropometric markers and rest‐activity rhythms.

Except for most active 10‐hour start, remaining indices and Sleep Regularity Index were associated with body mass index with β coefficients ranging from −1.74 to 0.86, consistent with our hypothesis that weaker rest‐activity rhythms relate to larger body mass index.

Clinical Editorial

Study framework and scope

Cross-sectional examination within the CARDIA sleep ancillary study (2020–2023) involving 861 adults who wore wrist actigraphy for seven days.
Objective: explore associations between rest-activity rhythm metrics, Sleep Regularity Index, and cardiometabolic disease markers, with attention to potential racial modification of associations.

Population and measures

Participants comprised 354 Black and 507 White individuals.
Rest-activity rhythm metrics calculated from actigraphy included interdaily stability, intradaily variability, relative amplitude, and start times for the most active 10-hour window and the least active 5-hour window.
Sleep Regularity Index was derived from activity patterns.
Cardiometabolic markers assessed encompassed body mass index (BMI), waist circumference, blood pressure, hypertension status, fasting glucose, estimated insulin resistance, and diabetes status.

Analytical approach

Linear regression models tested relationships between rhythm metrics and cardiometabolic markers.
Interaction terms evaluated whether race modified observed associations.

Principal findings

Weaker rest-activity rhythms and lower sleep regularity tended to align with higher BMI in general.

The strongest and most consistent associations involved anthropometric markers.
With the exception of the most active 10-hour start time, other rhythm indices and Sleep Regularity Index showed associations with BMI in directions indicating higher BMI with weaker rhythms.
Race-modified effects were evident for relative amplitude: White participants exhibited a stronger inverse association with BMI than Black participants (White β ≈ −2.63, 95% CI −3.34 to −1.93; Black β ≈ −1.24, 95% CI −1.97 to −0.50).
Similar race-dependent patterns emerged for waist circumference.
Glycemic markers generally aligned with disrupted circadian indices, with patterns resembling those observed for anthropometric measures and showing consistency across races.
Associations between rest-activity rhythms and blood pressure were less consistent, both overall and by race.

Context and limitations

The study is cross-sectional, limiting causal inference.
Findings emphasize associations rather than definitive risk estimates for cardiometabolic disease development.