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The participants answered how often during the past 3 months they had experienced difficulties falling asleep at night, repeated awakenings during the night, early awakenings without being able to go back to sleep, loud snoring, stopping to breath while asleep (sleep disordered breathing), sweating while asleep, daytime sleepiness, waking up with a headache, and having an uncomfortable feeling in the legs. The HUNT-3 questionnaire included nine questions about sleep. The process of selecting the participants is illustrated in Figure 1. The participants also responded to a physical activity questionnaire. A total of 4,631 participants accepted the invitation and completed the fitness test, which measured VO 2peak. Among them, 12,609 participants were residents in the three townships that were selected for the fitness study, and these participants were invited to the fitness study.
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Anthropometry, including measurements of height, weight, and waist and hip, was recorded, and blood pressure and serum lipids, including total and high-density lipoprotein (HDL) cholesterol, were measured.Īmong the participants in HUNT-3, 30,513 were free from known cardiovascular or pulmonary diseases, cancer, and sarcoidosis and did not use antihypertensive medication at baseline, and were potentially eligible for a separate fitness study. Thus, the self-reported information includes health status use of tobacco, alcohol, and coffee responses to some dietary items use of medication and information on sleep, physical activity, education, and work history. In the study, information was collected by self-administered questionnaires, clinical measurements, and blood samples. Approximately 51,000 participated (54% of those invited).
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The adult population of Nord-Trøndelag County in Norway was invited to participate in the third wave of the countywide health survey “Helseundersøkelsen i Nord-Trøndelag” (HUNT-3) between October 2006 and June 2008. In our large population-based study we could also take into account the effects of established cardiovascular risk factors, determinants of VO 2peak and psychologic distress. Our aim was to investigate the association of different symptoms of insomnia with VO 2peak, in a healthy group of men and women. Both measures are inversely associated with cardiovascular disease morbidity and mortality, 12, 13 but it has recently been shown that peak oxygen uptake (VO 2peak), the gold standard measure of cardiorespiratory fitness, is a stronger determinant of cardiovascular disease risk and longevity than measures of physical activity. 10, 11 Whereas physical activity corresponds to any bodily movement produced by skeletal muscles that results in energy expenditure, cardiorespiratory fitness refers to the maximum ability of the circulatory system to supply and extract oxygen during heavy dynamical work with large muscle groups. However, so far only two relatively small studies have assessed the association between sleep and cardiorespiratory fitness using exercise tests. Insomnia could also be inversely associated with cardiorespiratory fitness because its major determinant is physical activity. However, several studies have reported that people with insomnia symptoms tend to have a lower level of physical activity, 6 – 9 which could represent a possible explanation for the increased risk of coronary heart disease in these individuals. 1, 2 Insomnia is common in patients with cardiovascular disease and a growing body of evidence suggests that insomnia is associated with an increased risk of coronary heart disease, 3 – 5 but the underlying mechanisms for this association are largely unknown. Insomnia is a self-reported condition that includes difficulty falling asleep or remaining asleep.