The PURE study is a multinational community-based prospective urban-rural epidemiology study designed to quantify the global burden of cardiovascular diseases and risk factors in 26 countries involving 60 study centers, with 4 high-income countries (Canada, Sweden, Saudi Arabia, and United Arab Emirates), 17 middle-income countries (Ecuador, Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, Palestine, Poland, South Africa, Sudan, Philippines, Russia, Kazakhstan, Kyrgyzstan, and Turkey) and 5 low-income countries (Bangladesh, India, Pakistan, Tanzania, and Zimbabwe), classified according to the World Bank classification for 2006 when the study was initiated. Details of the study design and participant recruitment have been described previously.17 In brief, baseline data were collected at the community, household, and individual levels using standardized questionnaires, collecting information on sociodemographic factors, sleep, and other lifestyle behavior factors (eg, smoking, diet, and physical activity), past medical history, and family history of medical conditions.

Physical activity was assessed by total physical activities from occupational, transportation, housework, and leisure time according to the International Physical Activity Questionnaire,18 and categorized into low (<600 metabolic equivalent of task [MET]–min/wk; eg, having 3 days of walking for 30 min/d in 1 week), moderate (600-3000 MET-min/wk; eg, having 5 days of bicycling at a regular pace for 30 min/d in 1 week) and high (>3000 MET-min/week; eg, having 7 days of fast bicycling for 1 h/d in 1 week) activity. The total energy intake of each participant was estimated based on country-specific validated food frequency questionnaires.19 Among all 181 882 participants with anthropometric measurements, 45 230 were excluded from further data analyses owing to missing (because of either being enrolled prior to inclusion of sleep questions or no response) or implausible nocturnal sleep duration (or napping hours) or missing data of sex or age using the same inclusion and exclusion criteria of our previous report.15 Finally, a total of 136 652 men and women aged 35 to 70 years who completed baseline information on sleep and anthropometric measurements and recruited mainly during 2005 to 2009 were included. The flowchart of participant recruitment is shown in the eFigure in the Supplement.

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