Association of Rest‐Activity Rhythm and Sleep Regularity With Cardiometabolic Disease in the CARDIA Study

Mar 18, 2026Journal of the American Heart Association

Links Between Daily Activity and Sleep Patterns and Heart and Metabolic Health in the CARDIA Study

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Abstract

Among 861 participants, weaker rest-activity rhythms were associated with larger body mass index.

Anthropometric markers, such as body mass index and waist circumference, were consistently linked to rest-activity rhythms.
Except for the most active 10-hour start time, all rest-activity indices correlated with body mass index, with β coefficients ranging from -1.74 to 0.86.
Relative amplitude showed a stronger negative association with body mass index in White participants compared to Black participants.
Disrupted circadian indices were linked to glycemic markers, with generally consistent findings across different races.
Associations between rest-activity rhythms and blood pressure were less consistent overall and varied by race.

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BACKGROUND: Disrupted circadian rhythms are associated with cardiometabolic disease. We examined associations between rest-activity rhythms and cardiometabolic disease by race.

METHODS: In 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.

RESULTS: Among 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. There was some effect modification by race (<0.01), with relative amplitude showing stronger associations with body mass index in White (=-2.63 [95% CI, -3.34 to -1.93]) versus Black (=-1.24 [95% CI, -1.97 to -0.50]) participants. Patterns, including effect modification for relative amplitude, were similar for waist circumference. Disrupted circadian indices were associated with glycemic markers, with findings generally consistent by race. Associations between rest-activity rhythms and blood pressure were less consistent overall and by race. P β β

CONCLUSIONS: Less robust rest-activity rhythms and irregular sleep were associated with less favorable anthropometric and glycemic markers but weakly associated with blood pressure, with few racial differences.

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Association of Rest‐Activity Rhythm and Sleep Regularity With Cardiometabolic Disease in the CARDIA Study

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