Hindawi Publishing Corporation Journal of Environmental and Public Health Volume 2012, Article ID 518263, 8 pages doi:10.1155/2012/518263 Research Article The Relationship between Insufﬁcient Sleep and Self-Rated Health in a Nationally Representative Sample Sarah Dee Geiger,1 Charumathi Sabanayagam,1, 2 and Anoop Shankar1 1 Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA 2 Singapore Eye Research Institute and Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 169857 Correspondence should be addressed to Anoop Shankar, ashankar@hsc.wvu.edu Received 16 November 2011; Accepted 22 February 2012 Academic Editor: David Strogatz Copyright © 2012 Sarah Dee Geiger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertension, cardiovascular disease (CVD), and mortality. Self-rated health (SRH) has been shown to be a predictor of CVD and mortality. However, study of the association between insuﬃcient sleep and SRH is limited. We examined participants >18 years of age (n = 377, 160) from a representative, cross-sectional survey (2008 BRFSS). Self-reported insuﬃcient sleep in the previous 30 days was categorized into six groups. The outcome was poor SRH. We calculated odds ratios ((OR) (95% conﬁdence interval (CI)) of increasing categories of insuﬃcient rest/sleep, taking zero days of insuﬃcient sleep as the referent category. We found a positive association between increasing categories of insuﬃcient sleep and poor SRH, independent of relevant covariates. In the multivariable-adjusted model, compared to 0 days insuﬃcient sleep, the OR (95% CI) of poor SRH was 1.03 (0.97–1.10) for 1–6 days, 1.45 (1.34–1.57) for 7– 13 days, 2.12 (1.97–2.27) for 14–20 days, 2.32 (2.09–2.58) for 21–29 days, and and 2.71 (2.53–2.90) for 30 days of insuﬃcient sleep in the prior 30 days (P-trend <0.0001). In a nationally representative sample, increasing categories of insuﬃcient sleep were associated with poor SRH. 1. Introduction Sleep loss, long-term sleep deprivation, and insuﬃcient rest/sleep are pervasive problems in developed countries today. Short sleep duration and insuﬃcient rest/sleep may also be a manifestation of underlying sleep-disordered breathing (SDB). Reduced sleep has been found to be associ- ated with increased risk of diabetes mellitus, hypertension, cardiovascular disease (CVD), and cardiovascular and all- cause mortality [1–5]. Similarly, self-rated health (SRH) has been shown to be a consistent predictor of cardiovascular disease and cardiovascular and overall mortality [6–9]. Self- rated health (SRH) is a commonly used subjective measure of health used in epidemiological studies as well as a secondary outcome in clinical trials to examine changes in subjective health status [6–10]. Epidemiological studies from several countries and social and cultural settings have shown that SRH is a valid and consistent predictor of CVD and cardiovascular and overall mortality [6–9]. Due to its predictive ability of future risk of mortality as well as objec- tive health outcomes, an Institute of Medicine (IOM) report in 2001 recommended the inclusion of SRH measurement in national surveys in the USA as a way of tracking the subjective health status of Americans [11]. However, the mechanisms underlying the reported asso- ciation between SRH and CVD and mortality are not known. It is possible that at least part of the association between insuﬃcient sleep and mortality may be mediated by poor SRH—although, to our knowledge, no study has examined this topic. In this context, we examined association between insuﬃcient rest/sleep and SRH in a large multiethnic survey of US adults after adjusting for main confounders. 2. Methods 2.1. Study Population. The Behavioral Risk Factor Surveil- lance System (BRFSS) is a federally funded, nationally rep- resentative survey of the civilian, noninstitutionalized, adult