The Effect of Sleep on the Association Between Built Environment and Good Health Status

Introduction: Sleep quantity of city residents and environmental assets that support physical activity may jointly improve residents’ general health. Sufficient sleep also may mediate the effect of activity-related environmental factors on the general health. However, evidence regarding such associations is lacking. Thus, we aimed to investigate the moderating and mediating effects of sleep duration of residents on the association between environmental factors and general health status of city residents. Methods Our panel study used 2018/2019, 2021 to 2022 American Fitness Index® data for the 100 most populated US cities. Study outcome was good health status and exposures were environmental factors – percent of parks within a 10-minute walk, Walk Score®, Bike Score®, Complete Streets policy. Sleeping 7 + hours/day was used as a potential mediator or moderator. For analyses, we adopted crude and multivariable-adjusted linear mixed models. Results Our findings showed that most large cities whose residents slept longer had better baseline health and improvement in the general health status of their residents over time. Sufficient daily sleep showed a moderating effect on the association between environmental indicators and general health status. In the cities with higher percent of sufficient daily sleep, the magnitudes of the positive associations were increased, implying synergistic interactions between sufficient daily sleep and better environmental factors on good health status. However, no mediating effect of sufficient daily sleep was observed on the association between environmental indicators and good health status. Conclusion Our findings suggested a synergistic interaction effect between sufficient daily sleep and physical activity-related environmental factors on good health status. However, sleep duration was not found to be a mediator of the association between environmental indicators and good health status.