Device-Derived Social Jet Lag in CPAP-Treated Obstructive Sleep Apnea: Prevalence, Behavioral Signatures, and Age Gradients
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Background
Social jet lag (SJL), the discrepancy timing between work nights and free nights, reflects schedule-related circadian misalignment. Time-stamped CPAP adherence records may provide objective, longitudinal estimates of sleep timing and could augment conventional CPAP reports by adding information on sleep regularity and weekday–weekend misalignment.
Objectives
To quantify CPAP-derived SJL in two independent clinical cohorts, characterize its behavioral correlates and age-related patterns, and assess cross-site reproducibility.
Methods
We analyzed CPAP-derived sleep timing in patients from Rutgers-RWJ Health (RWJ, N = 1,437) and Hackensack Meridian Health (HMH, N = 1,510) with at least 31 valid nights and at least one valid work night and free night. Mid-sleep on work nights (MSW) and free nights (MSF) was estimated using circular statistics. SJL was defined as the absolute circular difference between MSF and MSW and categorized as none (<1 h), moderate (1–2 h), or severe (≥2 h). Sleep duration, free-night rebound, age-stratified prevalence, and cross-site differences were evaluated using nonparametric and categorical tests.
Results
SJL was right-skewed at both sites, with median values below 0.5 h at RWJ and HMH. SJL >1 h was present in 21.2% and 16.4% of patients, respectively; severe SJL occurred in 4.0% and 2.8%. Moderate and severe SJL were associated with shorter work-night sleep and greater free-night rebound, consistent with weekday restriction and weekend compensation. SJL prevalence and variability were highest in younger and middle-aged adults, particularly those aged 26–50 years, and declined markedly after age 65. Core timing phenotypes, including MSW, MSF, and free-night rebound, were highly reproducible across sites despite modest differences in absolute sleep duration and overall SJL prevalence.
Conclusions
In CPAP-treated cohorts, SJL is common but usually modest, is associated with weekday sleep restriction and free-night rebound, and declines substantially with age. These findings support the use of routinely collected CPAP data as a scalable, low-burden source of device-anchored circadian screening phenotypes. CPAP-derived SJL may augment standard adherence reports by helping identify patients who warrant further behavioral, circadian, or activity-based assessment.
