The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

Gender-Specific Associations of Different Anthropometric Indices with Sleep Quality and Daytime Sleepiness



Qassim I. Muaidi1, *, Mohammad Ahsan1
1 Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University; Dammam, Saudi Arabia

Abstract

Background:

Sleep is necessary for all living beings and plays a significant role in preventing health complications. Many health risks are associated with overweight and obesity. Association between sleep habits and anthropometric indices were investigated in this study.

Objective:

The objective of this study was to determine gender-specific associations of different anthropometric indices with sleep quality and daytime sleepiness.

Methods:

This cross-sectional study involved 550 males and females. Anthropometric indices measured with the help of a bioelectric impedance device. The Pittsburgh sleeps quality index was used to evaluate sleep quality over a one-month period, and the Epworth sleepiness scale was used to measure the level of daytime sleepiness. Kruskal-Wallis test was applied for comparative analysis, and Spearman correlation was also used to assess the relationship among all variables.

Results:

A negative correlation identified between the percentage of body fat with sleep quality and daytime sleepiness and other anthropometric indices has a low positive correlation, but not significant for sleep quality and daytime sleepiness. While females have a negative correlation for daytime sleepiness and a significant difference among anthropometric indices for sleep quality and daytime sleepiness was evident. A higher percentage of body fat was found among female participants.

Conclusion:

This study has highlighted the prevalence of obesity with multiple anthropometric indices. Such studies could help evaluate the role of anthropometric indices in predicting the quality of sleep and daytime sleepiness in male and female participants.

Keywords: Obesity prevalence, Health risk, Body fat, Visceral fat, Waist circumference, WHR.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 273
Last Page: 280
Publisher Id: TOPHJ-13-273
DOI: 10.2174/1874944502013010273

Article History:

Received Date: 07/01/2020
Revision Received Date: 22/04/2020
Acceptance Date: 29/04/2020
Electronic publication date: 21/06/2020
Collection year: 2020

© 2020 Ahsan and Muaidi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University; Dammam, Saudi Arabia; E-mail: mahsan@iau.edu.sa





1. BACKGROUND

Sleep is crucial for optimum health. During sleep, our body is able to rest and recharge. Sleep is an excellent indicator of health status in both general and sick populations [1Miro E, Cano-Lozano C, Buela-Casal G. Dream and quality of life. Colo J Psyc 2008; 14: 11-27.]. Quality of sleep is not only a determinant of health but is also an important component of a good quality of life [2Perez SD, Diaz MO, Garrido NR. Prevalence of impaired sleep patterns among nursing students in Huelva. Global Nursing 2007; 6(2)]. American sleeping habits have been significantly affected in recent years, with 15.6% of young adults sleeping less than 7 hours/day in 1960, rising to 43% in 2009 (National Sleep Foundation of America). Furthermore, poor sleep habits lead to social, economic, and health problems. Specific health problems include issues such as vascular problems, cerebrovascular diseases, development of neurodegenerative, and obesity. American adults reported around 27.5% to 29. 1% short sleep duration [3St-Onge MP, Mikic A, Pietrolungo CE. Effects of Diet on Sleep Quality. AdvNutr 2016; 7(5): 938-.
[http://dx.doi.org/10.3945/an.116.012336]
]. Various studies have examined relationships between sleep and obesity risk in adults [4Knutson KL. Does inadequate sleep play a role in vulnerability to obesity? Am J Hum Biol 2012; 24(3): 361-71.
[http://dx.doi.org/10.1002/ajhb.22219] [PMID: 22275135]
].

Noticeable body composition difference has been reported between males and females around the world regardless of ethnicity, region, religion, culture, environment, lifestyle, age, and body size. Females have comparatively higher percentage (25%) of body fat than males (15%), and males tend to have a higher percentage (43%) of muscle mass than females (36%) [5Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: An approach for developing guidelines based on body mass index. Am J Clin Nutr 2000; 72(3): 694-701.
[http://dx.doi.org/10.1093/ajcn/72.3.694] [PMID: 10966886]
]. Males have greater lean mass and a more central fat pattern while females have peripheral fat distribution, identified as fat accumulated in hips and limbs, predominantly into the lower body [6Couillard C, Bergeron N, Prud’homme D, et al. Gender difference in postprandial lipemia : importance of visceral adipose tissue accumulation. Arterioscler Thromb Vasc Biol 1999; 19(10): 2448-55.
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].

Males and females experience sleep differently throughout their life. They face different challenges to sleep. Females are more prone to insomnia, while males are more likely to suffer from a sleep disorder like sleep apnea and snoring [7Galland BC, Gray AR, Penno J, Smith C, Lobb C, Taylor RW. Gender differences in sleep hygiene practices and sleep quality in New Zealand adolescents aged 15 to 17 years. Sleep Health 2017; 3(2): 77-83.
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]. Galland et al. found that 56% of adolescents had poor sleep quality with a higher prevalence among females (63.1% vs. 44.5% among males), and sleep hygiene was significantly worse in females [8Zhang J, Chan NY, Lam SP, et al. Emergence of sex differences in insomnia symptoms in adolescents: a large-scale school-based study. Sleep (Basel) 2016; 39(8): 1563-70.
[http://dx.doi.org/10.5665/sleep.6022] [PMID: 27091537]
]. The insomnia (sleeplessness) enhanced from 3.4% to 12.2% in females and from 4.3% to 9.1% in males [9Ohayon MM, Zulley J. Correlates of global sleep dissatisfaction in the German population. Sleep 2001; 24(7): 780-7.
[PMID: 11683481]
]. Ohayon and Zulley reported that the prevalence of global dissatisfaction of sleep increased with age and was higher in females [10Bjorvatn B, Sagen IM, Øyane N, et al. The association between sleep duration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res 2007; 16(1): 66-76.
[http://dx.doi.org/10.1111/j.1365-2869.2007.00569.x] [PMID: 17309765]
]. A significant age difference was found to be related to sleep disturbance and habitual sleep patterns in 15 years of age or older adolescents. A number of studies have found that sleep duration is inversely related to BMI [11Bawazeer NM, Al-Daghri NM, Valsamakis G, et al. Sleep duration and quality associated with obesity among Arab children. Obesity (Silver Spring) 2009; 17(12): 2251-3.
[http://dx.doi.org/10.1038/oby.2009.169] [PMID: 19498352]
]. The studies on sleep and body composition in Saudi Arabia on adolescents found an inverse association between poor sleep duration (less than seven hours per day) and obesity/overweight [12Al-Hazzaa HM, Musaiger AO, Abahussain NA, Al-Sobayel HI, Qahwaji DM. Prevalence of short sleep duration and its association with obesity among adolescents 15- to 19-year olds: A cross-sectional study from three major cities in Saudi Arabia. Ann Thorac Med 2012; 7(3): 133-9.
[http://dx.doi.org/10.4103/1817-1737.98845] [PMID: 22924070]
, 13Magee CA, Iverson DC, Huang XF, Caputi P. A link between chronic sleep restriction and obesity: methodological considerations. Public Health 2008; 122(12): 1373-81.
[http://dx.doi.org/10.1016/j.puhe.2008.05.010] [PMID: 18722633]
]. Inadequate sleep also reduces the burning of calories throughout the day, leading to weight gain and an unhealthier body. Earlier research assessing the relationship between obesity and sleep duration used BMI or weight gain as outcomes, and limited research measured body fat or abdominal obesity [14Theorell-Haglöw J, Berglund L, Janson C, Lindberg E. Sleep duration and central obesity in women - differences between short sleepers and long sleepers. Sleep Med 2012; 13(8): 1079-85.
[http://dx.doi.org/10.1016/j.sleep.2012.06.013] [PMID: 22841029]
, 15Mahfouz M. Sleep quality among students of the faculty of medicine in jazan university, Saudi Arabia. Middle East J Sci Res 2016; 16: 508-13.]. Mahfouz et al., conducted a cross-sectional study in Saudi Arabia revealed that female university students have poor sleep quality (69.1%) as they slept a mean of 4.77 hours/night [16Hursel R, Gonnissen HK, Rutters F, Martens EA, Westerterp-Plantenga MS. Disadvantageous shift in energy balance is primarily expressed in high-quality sleepers after a decline in quality sleep because of disturbance. Am J Clin Nutr 2013; 98(2): 367-73.
[http://dx.doi.org/10.3945/ajcn.112.054924] [PMID: 23803894]
]. Epidemiological studies had shown a contrary correlation between BMI and sleep duration [17Bahammam AS. Sleep medicine in Saudi Arabia: Current problems and future challenges. Ann Thorac Med 2011; 6(1): 3-10.
[http://dx.doi.org/10.4103/1817-1737.74269] [PMID: 21264164]
]. Sleep medicine in Saudi Arabia emphasizes the need for further sleep investigation to address the prevalence of various sleep disorders amongst the Saudi population according to their lifestyle and body composition [18Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 1985; 41(4): 810-7.
[http://dx.doi.org/10.1093/ajcn/41.4.810] [PMID: 3984933]
].

Research findings regarding gender differences have been inconsistent. Genders not only diverge in height and weight but also multiple anthropometric indices and sleep habits. An increasing body of evidence from various populations demonstrates that there are adverse associations between anthropometric indices and sleep habits. Therefore, this investigation set up to evaluate the association between multiple anthropometric indices and sleep habits for males and females students. We also hypothesized that sleep and multiple anthropometric indices are significantly associated with both genders.

2. METHODS

2.1. Design

We conducted a cross-sectional study of 550 participants. Approval to undertake this study was granted by the deanship of research, Imam Abdulrahman Bin Faisal University, Dammam. All participants voluntarily participated in this study, and the researchers received consent from the participants before the start of the investigation.

2.2. Participants

Data collected from 550 participants, males (n=250), and females (n=300) from the college of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam. The sample size was considered appropriate to identify the relationship between sleep habits and multiple anthropometric indices with 95% confidence and a precision rate of 5%. Convenience sampling technique was used for data collection, i.e., students were invited through advertisement on the university campus to take part in the study. The data between 2017 and 2018 was collected. The exclusion criteria for this study were individuals who have any chronic illness, cardiac problems, mental or physical disabilities, and pregnancy.

2.3. Demographic Data

Researchers handled the collection of anthropometric measurements of every participant. Anthropometric characteristics of male and female students are available in the Table 1 below.

Table 1 showed the mean and standard deviation of anthropometric variables of both genders. Females were older than males 20.8(5.23) and 19.44 (3.33), respectively. Males were taller and heavier than females (166.8(8.6) vs. 157.1 (5.78) cm, 76.1 kg(27.14) vs. 57 kg.11.8), and 27.(8.1) vs. 22.9 BMI units (4.4).

2.4. Measuring Instruments

2.4.1. Weighing Scale

Portable electronic calibrated weight scale (Detecto Scale – model 750, U.S.A.) was used for height and weight measurement. Participants were asked to wear light clothing and take off their shoes for accurate measurement.

Table 1
Descriptive statistics of male and female students.


2.4.2. Bioelectric Impedance (BIA)

A bioelectric impedance device was used to measure multiple anthropometric indices. As described by Lukaski et al. [19Dehghan M, Merchant AT. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J 2008; 7: 26.
[http://dx.doi.org/10.1186/1475-2891-7-26] [PMID: 18778488]
] ,the measurement followed the manufacturer’s instruction of the Bioelectrical Analysis (BIA) (iOi 253, Jawon Medical, South Koria). The multiple anthropometric indices were determined was Body Mass Index (BMI), Visceral Fat Area (VFA), Percentage of Body Fat (PBF) Waist Circumference (WC), and Waist-Hip Ratio (WHR). The multiple anthropometric indices measured at normal body hydration in similar external temperatures [20Sun G, French CR, Martin GR, et al. Comparison of multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of percentage body fat in a large, healthy population. Am J Clin Nutr 2005; 81(1): 74-8.
[http://dx.doi.org/10.1093/ajcn/81.1.74] [PMID: 15640463]
]. The bioelectrical impedance method shows a high correlation (R=0.88) with dual X-ray absorptiometry [21Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28(2): 193-213.
[http://dx.doi.org/10.1016/0165-1781(89)90047-4] [PMID: 2748771]
]. The Hip Circumference (HC) was measured manually with the help of measuring tape. The Waist-Height Ratio calculated as waist measurement divided by height.

2.4.3. The Pittsburgh Sleep Quality Index (PSQI)

The PSQI (Arabic version) self-reported questionnaire, was used to evaluate sleep quality during the past month. The PSQI included seven component scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction). The components range from 0 (no difficulty) to 3 (severe difficulty), and when summed, generate a sum score ranging from 0 to 21, a score > 5 indicates “poor” sleepers and ≤5 indicate “good” sleepers. Good psychometric properties have been established [21Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28(2): 193-213.
[http://dx.doi.org/10.1016/0165-1781(89)90047-4] [PMID: 2748771]
]. The PSQI has been validated previously as Cronbach alpha was 0.83 [22Taylor DJ, Bramoweth AD, Grieser EA, Tatum JI, Roane BM. Epidemiology of insomnia in college students: relationship with mental health, quality of life, and substance use difficulties. Behav Ther 2013; 44(3): 339-48.
[http://dx.doi.org/10.1016/j.beth.2012.12.001] [PMID: 23768662]
, 23Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14(6): 540-5.
[http://dx.doi.org/10.1093/sleep/14.6.540] [PMID: 1798888]
].

2.4.4. Epworth Sleepiness Scale (ESS)

The ESS (Arabic version) was used, which is a self-reported measure designed to estimate the level of the daytime sleepiness in recent times. The measure consists of eight items on a four-point Likert scale on which respondents rate their response about the chance of dozing in each situation, from 0 (would never) to 3 (high chance). Total scores range from 0 to 24, with higher scores indicating more significant sleepiness. Acceptable validity and test-retest reliability for the ESS have been reported [24Magalhães VC, Azevedo G, Mendonça S. Prevalência e fatores associados a sobrepeso e obesidade em adolescentes de 15 a 19 anos das regiões Nordeste e Sudeste do Brasil,1996 a 1997. Cad Saude Publica 2003; 19(Suppl. 1): S129-39.
[http://dx.doi.org/10.1590/S0102-311X2003000700014] [PMID: 12886443]
]. Scores over 10 suggest significant daytime sleepiness, and scores over 15 suggest pathological sleepiness associated with conditions like sleep-related breathing disorders or narcolepsy.

2.5. Procedure

A total of 617 participants consented to taken part in the study. Only 250 males and 300 female students selected due to incomplete information on filled questionnaires. Before the administration of the test, all the important instructions explained to the participants relating to providing their response on the PSQI, ESS, and during multiple anthropometric indices test through BIA. Students completed multiple anthropometric measurement tests in a laboratory setting. Hip Circumference (HC) was measured at the maximum circumference of the hips while the participant stands in an upright position. Participants took 5-6 minutes to complete both questionnaires. To measure multiple anthropometric measurements, participants were requested to stand barefoot on the electrodes of the BIA. Demographic information entered to the device, and the participant was requested to grip hand-hold electrodes and push the button attached. The participants were required to stand in a stationary position while the measurement been taken. Within 2-3 minutes, results were printed by the device.

2.6. Statistical Analysis

The Kolmogorov-Smirnov test was applied to determine the normal distribution of variables. The test found that anthropometric indices and sleep habits variables were not distributed normally. Descriptive statistics as mean and Standard Deviation (SD) were calculated for participants' age, weight, height, and BMI. For the comparative analysis between genders, the Kruskal-Wallis test was applied. A P-value ≤.05 was taken as statistically significant. Spearman correlation test used to estimate the relationship between variables. The Statistical Package for Social Science V-21 (SPSS inc, USA) was used to analyze the data.

3. RESULTS

Table 2 details the mean and standard deviation of all variables by gender. The percentage of body fat is higher in females 30.01(6.49) than males 27.93(9.21). The visceral fat area is lower in female 57.38(31.27) than in male 102.51(7) participants. Males 93.19(21.51) have a wider waist circumference than female 76.65(8.82) participants. The hip circumference of males 108.02(11.43) is wider than the females 97.53(4.74). The waist-hip ratio is higher 0.85(.11) in males than the females 0.78(.06). The waist-height ratio is also greater in males 0.56(.12) than females 0. 49(.06). All the multiple anthropometric variables are significant at 0.05.

Table 2
Descriptive analysis of male and female students for anthropometric indices.


Table 3
The comparison between male and female for different anthropometric indices by Kruskal-Wallis Test.


Table 3 shows the mean rank between males and females for multiple anthropometric indices and sleep habits (PSQI & ESS). The results show that all variables are significant. The significant differences existed at 0.05 levels among males and female participants.

Table 4 shows the correlation (Spearman-correlation (2-tails) among multiple anthropometric indices and sleep habits. There was a negative relationship found between sleep habits and PBF. No significant relationship has been found among any anthropometric indices for sleep quality, and daytime sleepiness also showed an insignificant.

Table 5 reveals that there is a very low positive correlation (Spearman-correlation (2-tails) among multiple anthropometric indices and sleep quality and daytime sleepiness for male and female participants. Whereas, daytime sleepiness for female participants shows low negative correlation among multiple anthropometric indices except for hip circumference. The relationship is insignificant for multiple variables.

Table 4
Correlation of multiple anthropometric indices and sleep habits.


Table 5
Gender-wise correlation of multiple anthropometric indices among sleep quality and daytime sleepiness.


4. DISCUSSION

This research examines the relationship between selected anthropometric indices and sleep habits among male and female subjects. The results of this research demonstrated that there was a significant difference between male and female participants for multiple anthropometric variables, but no significant correlation among any anthropometric indices with sleep habits. Only the percentage of body fat was higher in females than males.

Regarding the gender differences for anthropometric indices, sleep habits, and daytime sleepiness, a prevalence of excess BMI, VFA, WC, HC, WHR, WHtR was observed among males, whereas females had an excess percentage of body fat. Öztürk and Yabanc Ayhan did not find any association between body fat, body fat percentage, BMI, WC, and sleep quality, in a cross-sectional study of Turkish women [25Öztürk ME, Yabancı Ayhan N. Associations between poor sleep quality, obesity, and the anthropometric measurements of women in turkey. Ecol Food Nutr 2018; 57(1): 3-12.
[http://dx.doi.org/10.1080/03670244.2017.1406351] [PMID: 29182367]
]. In another Turkish study, no association between BMI and sleep quality was found [26Ocal O. 2015.Relationship between the Pittsburgh sleep quality scale of dietary consumption in adult individuals who applied to AcıbademMaslakHostantefeed andcitypolyclinic ]. Similarly, it was noticed in China that sleep quality and BMI do not have a significant association in older people [27Yan Z, Chang-Quan H, Zhen-Chan L, Bi-Rong D. Association between sleep quality and body mass index among Chinese nonagenarians/centenarians. Age (Dordr) 2012; 34(3): 527-37.
[http://dx.doi.org/10.1007/s11357-011-9251-3] [PMID: 21590342]
]. In this study, males represented 45% of the sample and had a higher BMI 27.06(8.11) and better sleep habits 8.14(2.24) and daytime alertness 10.92(3.62) than females. Females were more likely than males to report both poor sleep habits 7.75(2.45) and daytime sleepiness 9.84(4.05). These findings are different from the Chinese study where obese adults are more likely to have a short sleep duration than their non-obese counterparts [28Sun W, Huang Y, Wang Z, et al. Sleep duration associated with body mass index among Chinese adults. Sleep Med 2015; 16(5): 612-6.
[http://dx.doi.org/10.1016/j.sleep.2014.12.011] [PMID: 25862120]
]. Most of the females have less daytime sleepiness and poorer sleep habits during the night due to biological and psychological factors such as hormonal makeup, enhanced risk of depression, rearing demands, and overall greater ease of disclosing sleep-related intricacies [29Beck F, Richard JB, Léger D. [Insomnia and total sleep time in France: prevalence and associated socio-demographic factors in a general population survey]. Rev Neurol (Paris) 2013; 169(12): 956-64.
[http://dx.doi.org/10.1016/j.neurol.2013.02.011] [PMID: 24140281]
].

In the present study, females represent 55% of the sample and exhibited more percentage of body fat 30.01(6.49) than males 27.93(9.21). There was a significant difference, but no significant association was observed between the percentage of body fat and sleep habits in either males or females, but females had a negative correlation. These findings are similar to Rontoyanni et al. [30Rontoyanni VG, Baic S, Cooper AR. Association between nocturnal sleep duration, body fatness, and dietary intake in Greek women. Nutrition 2007; 23(11-12): 773-7.
[http://dx.doi.org/10.1016/j.nut.2007.07.005] [PMID: 17884345]
]. They reported a negative correlation between sleep duration and fat percentage in healthy females, supporting the idea that sleep duration significantly correlated with body fat. Daytime sleepiness is the lowest in underweight people, whereas the highest in obese participants. In a study Wang et al. that engaged 5518 children aged 9-12,found that girls had significantly lower weight, BMI, and WHtR, but a higher percentage of body fat than boys. Yen et al. observed a negative and insignificant association between self-reported short sleep duration and the percentage of body fat among Chinese men and women [31Yan LX, Chen XR, Chen B, et al. Gender-specific Association of Sleep Duration with Body Mass Index, Waist Circumference, and Body Fat in Chinese Adults. Biomed Environ Sci 2017; 30(3): 157-69.
[PMID: 28427485]
]. Ozturk and Yabanc Ayhan [25Öztürk ME, Yabancı Ayhan N. Associations between poor sleep quality, obesity, and the anthropometric measurements of women in turkey. Ecol Food Nutr 2018; 57(1): 3-12.
[http://dx.doi.org/10.1080/03670244.2017.1406351] [PMID: 29182367]
] also did not find any relationship between sleep quality and body fat percentage in a cross-sectional study on Turkish women.

In the present study, males exhibited more Visceral Fat Area (VFA) 102.51(70) than females 57.38(31.27). There was a significant difference, but insignificant association was noted between VFA and sleep habits in both genders, but females had a negative correlation for daytime sleepiness. Visceral fat area corresponds to 10-20% of total body fat in men, and 5-8% of total body fat in women, increasing after menopause [32Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000; 21(6): 697-738.
[http://dx.doi.org/10.1210/edrv.21.6.0415] [PMID: 11133069]
]. It has been seen that the number of obesity-related risk factors increases with the visceral fat area [33Hiuge-Shimizu A, Kishida K, Funahashi T, et al. Reduction of visceral fat correlates with the decrease in the number of obesity-related cardiovascular risk factors in Japanese with Abdominal Obesity (VACATION-J Study). J Atheroscler Thromb 2012; 19(11): 1006-18.
[http://dx.doi.org/10.5551/jat.12963] [PMID: 22785136]
]. A six-year longitudinal analysis on sleep and visceral adiposity revealed that the change in sleep duration was not associated with visceral adiposity changes in adults [34Chaput JP, Bouchard C, Tremblay A. Change in sleep duration and visceral fat accumulation over 6 years in adults. Obesity (Silver Spring) 2014; 22(5): E9-E12.
[http://dx.doi.org/10.1002/oby.20701] [PMID: 24420871]
]. A study revealed gender differences for VFA and Obstructive Sleep Apnea (OSA), found there is an independent association with VFA only in men, but not women [35Harada Y, Oga T, Chihara Y, et al. Differences in associations between visceral fat accumulation and obstructive sleep apnea by sex. Ann Am Thorac Soc 2014; 11(3): 383-91.
[http://dx.doi.org/10.1513/AnnalsATS.201306-182OC] [PMID: 24471804]
].

In the present study, males measured larger Waist Circumference (WC) 93.19(21.51) than females 76.65(8.83). There was a significant difference, but no significant association was seen between WC and sleep habits in either male or female. Waist circumference is highly dependent on the quantity of visceral adipose tissue [36Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev 2005; 9(3): 211-24.
[http://dx.doi.org/10.1016/j.smrv.2005.01.006] [PMID: 15893251]
]. The results are in line with some earlier findings in that they did not notice an association between sleep duration and any of obesity indicators among male and female throughout any distribution of BMI and WC [37Yan LX, Chen XR, Chen B, et al. Gender-specific association of sleep duration with body mass index, waist circumference, and body fat in chinese adults. Biomed Environ Sci 2017; 30(3): 157-69.
[PMID: 28427485]
, 25Öztürk ME, Yabancı Ayhan N. Associations between poor sleep quality, obesity, and the anthropometric measurements of women in turkey. Ecol Food Nutr 2018; 57(1): 3-12.
[http://dx.doi.org/10.1080/03670244.2017.1406351] [PMID: 29182367]
]. In contrast, Mathews et al. identified a significant association between high waist circumference and poor sleep quality for university students [38Mathews D. Assessing sleep quality in young adult college students, aged 18-24 in relation to quality of life and anthropometrics 2010.]. Rahe et al. also observed a significant correlation between high waist circumference and poor sleep quality [39Rahe C, Czira ME, Teismann H, Berger K. Associations between poor sleep quality and different measures of obesity. Sleep Med 2015; 16(10): 1225-8.
[http://dx.doi.org/10.1016/j.sleep.2015.05.023] [PMID: 26429750]
]. Davidson et al. have revealed that WC correlates most significantly with sleep duration for both women and men in a cohort of 414 patients [40Davidson TM, Patel MR. Waist circumference and sleep disordered breathing. Laryngoscope 2008; 118(2): 339-47.
[http://dx.doi.org/10.1097/MLG.0b013e3181587d7c] [PMID: 18091340]
].

In this study, males showed wider hip circumference 108.02(11.4) than females 97.53(4.74). There was a significant difference, but no noteworthy association was seen between the hip circumference and sleep habits in either males or females. Mathiyalagen et al. performed a cross-sectional study in a Non-communicable disease clinic of a rural health training center in South India. In their study, they found that there was a significant difference in the hip circumference between the group considered to be at low risk and high risk of developing OSA [41Mathiyalagen P, Govindasamy V, Rajagopal A, Vasudevan K, Gunasekaran K, Yadav D. Magnitude and determinants of patients at risk of developing obstructive sleep apnea in a non-communicable disease clinic. Medicina (Kaunas) 2019; 55(7): E391.
[http://dx.doi.org/10.3390/medicina55070391]
]. A cohort study examines anthropomorphic measures concerning obstructive sleep apnea for men (47%) and women (53%). The stepwise linear regression analysis showed explanatory variable of hip circumference was not significant (P=.064) [42Jones AM, Rogers AE. Anthropomorphic measures and obstructive sleep apnea 2018; 41(Supp;1): A220.]. A cross-sectional study conducted on105 women aged ranged 20-25 years at a public institution found that HC was not different between groups (P <.05). (25). A study was conducted by analyzing the medical records of 952 adults from hospitals. They found that hip circumference was most positively correlated (CC: .403) with apnea-hypopnea index for men and women, (CC:0.420, P ˂ .001) and (CC:.188, P ˂ .001) respectively [43Cho JH, Choi JH, Lee B, et al. Anthropometric characteristics of korean patients with obstructive sleep apnea. J Rhinol 2018; 25(2): 80-5.
[http://dx.doi.org/10.18787/jr.2018.25.2.80]
].

In this study, males showed a greater waist-hip ratio .85(.11) than female .78(.06). There was a significant difference, but no significant association was seen between waist-hip ratio and sleep habits in either males or females. WHR is a feasible and straight forward measure to estimate abdominal fat. A study conducted on Taif University students showed a significant positive correlation of sleep disturbance scale and daytime sleepiness with waist-to-hip ratio, and the daytime sleepiness was more prevalent in females than males [44Kabel AM, Al Thumali AM, Aldowiala KA, Habib RD, Aljuaid SS. Sleep disorders in a sample of students in Taif University, Saudi Arabia: The role of obesity, insulin resistance, anemia and high altitude. Diabetes Metab Syndr 2018; 12(4): 549-54.
[http://dx.doi.org/10.1016/j.dsx.2018.03.024] [PMID: 29622472]
]. A study conducted in Turkey showed no statistically significant differences for WHR with poor sleep quality and good sleep quality in women; they also have a waist-hip ratio within normal limits [25Öztürk ME, Yabancı Ayhan N. Associations between poor sleep quality, obesity, and the anthropometric measurements of women in turkey. Ecol Food Nutr 2018; 57(1): 3-12.
[http://dx.doi.org/10.1080/03670244.2017.1406351] [PMID: 29182367]
]. Andreeva et al. revealed that there was no significant association was observed with WHR for men, but for women, a significant association existed between WHR and chronic insomnia [45Andreeva VA, Torres MJ, Druesne-Pecollo N, et al. Sex-specific associations of different anthropometric indices with acute and chronic insomnia. Eur J Public Health 2017; 27(6): 1026-31.
[http://dx.doi.org/10.1093/eurpub/ckx123] [PMID: 29069319]
]. Turkish adults do not indicate any significant relationship between anthropometric indices and WHR, either males or females too. The lack of relationship between sleep and WHR may be the result of a significant association between any anthropometric indices.

In this study, males indicated a greater waist-height ratio .56(.12) than females .49(.06). There was a significant difference, but no significant association seen between the waist-height ratio (WHtR) for sleep habits in either males or females. Earlier research by Hazzaz illustrated that sleep duration was more affected by the joint, abdominal obesity, and general obesity rather than low WHtR and High BMI or High WHtR and low BMI of adolescents [46Al-Hazzaa HM. Joint associations of body mass index and waist-to-height ratio with sleep duration among Saudi adolescents. Ann Hum Biol 2014; 41(2): 111-7.
[http://dx.doi.org/10.3109/03014460.2013.833291] [PMID: 24098958]
]. In other research, the waist-height ratio measured to be higher in obstructive sleep apnea syndrome patients. Correlation analysis of anthropometric measurement (WHtR) did not reveal any difference in either of the gender [47Nam GE, Han K, Kim DH, Lee JH, Seo WH. Sleep duration is associated with body fat and muscle mass and waist-to-height ratio beyond conventional obesity parameters in Korean adolescent boys. J Sleep Res 2017; 26(4): 444-52.
[http://dx.doi.org/10.1111/jsr.12502] [PMID: 28220585]
]. A cross-sectional study of South Korean adolescents indicated that there was no significant association between sleep duration and WHtR for girls. Whereas a decreased sleep duration was associated significantly with increased WHtR for boys [48Unal Y, Ozturk DA, Tosun K, Kutlu G. Association between obstructive sleep apnea syndrome and waist-to-height ratio. Sleep Breath 2019; 23(2): 523-9.
[http://dx.doi.org/10.1007/s11325-018-1725-4] [PMID: 30238284]
]. These findings are in contrast with earlier researches indicating a negative relationship between WHtR and sleep duration [49Chaput J-P, Leduc G, Boyer C, Bélanger P, LeBlanc AG, Borghese MM. Objectively measured physical activity, sedentary time and sleep duration: independent and combined associations with adiposity in canadian children. Nutr Diabetes 2014; 9(4): e117.
[http://dx.doi.org/10.1038/nutd.2014.14]
].

CONCLUSION

The study concludes on analysis for the anthropometric indices, sleep quality, and daytime sleepiness in regard to gender. All are positively associated with each other, but there is an insignificant difference. Such studies could be helpful in evaluating the role of anthropometric measurement in predicting the quality of sleep and daytime sleepiness between male and female participants.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This study was approved by the Deanship of scientific research and Imam Abdulrahman bin Faisal University, Saudi Arabia with approval no. IRB-2017-03-165.

HUMAN AND ANIMAL RIGHTS

No animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION

The researchers received consent from the participants before the start of the investigation.

AVAILABILITY OF DATA AND MATERIALS

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

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