# Associations between weekend catch-up sleep and health-related quality of life using a generalized additive model and sex and chronotype sub-analysis

## TL;DR

This study finds that weekend catch-up sleep can improve quality of life, but the benefits depend on the amount of sleep and individual factors like sex and chronotype.

## Contribution

The study introduces a nonlinear S-shaped association between catch-up sleep and quality of life using continuous data and subgroup analyses by sex and chronotype.

## Key findings

- A nonlinear S-shaped association was found between weekend catch-up sleep and health-related quality of life.
- Females showed significant improvements in quality of life with 0.47–2.10 hours of catch-up sleep.
- Intermediate and evening chronotype females had significant nonlinear associations with catch-up sleep.

## Abstract

Weekend catch-up sleep (WCUS) has been identified as a potential compensatory alternative for weekday sleep deprivation. While previous studies have highlighted the positive association between the appropriate duration of WCUS and health-related quality of life (HRQoL), precise estimation has not been much conducted. Moreover, considering that sex and chronotype may specifically influence the association, a more flexible and detailed approach is required.

We mainly focused on 15 038 healthy adults without severe medical conditions from the 7th (2016–2018) Korea National Health and Nutrition Examination Survey and used a generalized additive model to investigate nonlinear associations between WCUS and HRQoL. In addition, we conducted subgroup analyses by sex and chronotype to understand the associations from various perspectives.

In the results with the total subjects, we found a significant nonlinear association of a supine S-shape. In this association, the range of WCUS that could significantly improve HRQoL was 0.49–2.13 hours (h), and the corresponding odds ratio (OR) was 1.11–1.26. In addition, we conducted subgroup analyses using sex and chronotype. In the sex subgroup analyses, no significant results were observed in males, whereas females showed a significantly nonlinear supine S-shaped association, and the significant range of WCUS was 0.47–2.10 h (OR = 1.14–1.34). After chronotype was additionally considered, only the intermediate-type and evening-type females showed significant nonlinear associations.

Tailored sleep interventions based on individual characteristics and specific WCUS durations may serve as an effective strategy to improve HRQoL.

Statement of Significance Previous studies on weekend catch-up sleep (WCUS) and health-related quality of life (HRQoL) have analyzed WCUS as a categorical variable, which restricted the precise estimation of its associations. Therefore, this study treated WCUS as a continuous variable and identified a nonlinear S-shaped association. The optimal WCUS duration for HRQoL improvement was 0.49–2.13 hours (h) in the total subjects. Furthermore, subgroup analyses considering sex and chronotype revealed that WCUS significantly improved HRQoL in females within 0.47 to 2.10 h. Among females, intermediate and evening chronotype individuals showed significant nonlinear associations. These findings emphasize the importance of tailored sleep recommendations based on individual characteristics and more attention on biological and behavioral mechanisms underlying WCUS effects and their long-term health effects.

Graphical Abstract