Each participant’s usual sleep timing behaviors, mean nocturnal sleep duration, and daily napping behavior were obtained using the baseline standardized questionnaire. Sleep timing behaviors included bedtime and wake-up time, which were ascertained using the following question “During your longest or nocturnal sleep period, what time do you normally go to bed and wake up (in a 24-hour cycle)?” Daily habitual siesta or nap duration was also recorded. Siesta means a short afternoon rest or nap taken after the midday meal, which is a traditional lifestyle in some countries with particularly warm weather. Chronic short sleep was defined as mean nocturnal sleep duration of less than 6 hours,20 and chronic sleep deprivation was defined as mean nocturnal sleep duration of less than 5 hours.21 Bedtime was classified into 5 subgroups: 6 am to 8 pm, 8 pm to 10 pm, 10 pm to midnight, midnight to 2 am, and 2 am to 6 am, based on the human physiology of sleep and circadian rhythm of melatonin that peaks at 2 to 3 am, while keeping awake at night may suppress secretion of melatonin associated with an increased risk of obesity, cardiovascular diseases and cancers.22,23 Wake-up time was categorized into 3 subgroups: before 4 am, 4 am to 6 am, and after 6 am. For nocturnal sleep, we further defined late bedtime as midnight or later and daytime bedtime as between 6 am and 8 pm.

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