Sleep behaviours and multimorbidity occurrence in middle-aged and older adults: findings from the Canadian Longitudinal Study on Aging (CLSA)

Dose-response relationship between sleep duration and cardiovascular metabolic multimorbidity among older adults in China: A nationwide survey

AIMS AND OBJECTIVES

The purpose of this study was to explore the relationship between the duration of sleep per day and cardiovascular metabolic multimorbidity (CMM) in older adults and to identify how many hours of sleep per day can lead to a lower risk of CMM in older adults.

BACKGROUND

CMM are a common syndrome in the older adults. There may be an association between sleep duration and CMM in older adults, with both insomnia and sleep deprivation having an impact on the health of older adults. Therefore, it is important to explore the possibility that older adults who sleep for a few hours per day may have a lower prevalence of CMM.

METHODS

The study included 9710 older adults. The sleep duration in this study was assessed by the question "How many hours of sleep do you currently get in a day? ". Older adults were defined as having CMM when they had two or more of the five categories of hypertension, diabetes, heart disease, stroke or cardiovascular disease, dyslipidemia. We used multivariate logistic regression analysis to explore the association among sleep duration and CMM. Restrictive cubic splines were used to examine the shape of the association among sleep duration and the CMM. The STROBE checklist was used for this cross-sectional study.

RESULTS

The mean age was 84.78 ± 11.73 years, with 55.5 % being female. Of the total sample, 21.3 % were CMM. When all covariates were adjusted, there was dose-response relationship between sleep duration and CMM. The dose-response relationship between CMM and sleep duration showed that older adults had a lower risk of cardiovascular and metabolic multimorbidity when they slept 9 h and 10 h per day.

CONCLUSION

With the increasing population of older adults, the number of older adults suffering from CMM continues to rise, and adequate sleep time can effectively prevent the occurrence of CMM. We should pay attention to the sleep problem of the older adults.

RELEVANCE TO CLINICAL PRACTICE

This study provided information for healthcare providers to identify circumstances that increase cardiovascular metabolic multimorbidity and suggest the appropriate sleep duration per day to reduce the risk of disease in older adults.

PATIENT OR PUBLIC CONTRIBUTION

Because of the public database data used in this study, all data were collected by survey agency personnel, so this section is not applicable to this study.

Association between sleep problems and functional disability in community-dwelling older adults

BACKGROUND

Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults.

METHODS

This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest.

RESULTS

Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems.

CONCLUSIONS

Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Sleep Quality as a Critical Pathway Between Adverse Childhood Experiences and Multimorbidity and the Impact of Lifestyle

OBJECTIVES

This study aims to establish the effects of ACEs on multimorbidity through sleep quality and investigate whether lifestyle factors (e.g., eating habits and exercise) may influence this relationship among middle-aged and older adults.

METHODS

Participants were drawn from a cross-sectional sample of community dwelling older adults (N = 276, 55+) and three waves of data from the Midlife in the United States study (MIDUS, N = 843). We examined the direct and indirect effects of ACEs, sleep quality, and health conditions, as well as the conditional effects of physical activity and eating habits.

RESULTS

Across both samples, sleep quality mediated the relationship between ACEs and chronic health conditions. Moderating effects of unhealthy eating and physical activity differed between samples.

DISCUSSION

Sleep quality is an important pathway connecting ACEs and adult multimorbidity, and health behaviors may provide targets for intervention particularly in older adults.

Bidirectional associations between sleep quality/duration and multimorbidity in middle-aged and older people Chinese adults: a longitudinal study

BACKGROUND

Multimorbidity and sleep disorder possess high incidence rates in the middle-aged and older people populations, posing a significant threat to quality of life and physical and mental health. However, investigators have previously only analysed the unidirectional association between sleep status and multimorbidity. We aimed to investigate bidirectional associations between sleep quality or duration and multimorbidity in middle-aged and older Chinese adults from a longitudinal perspective.

METHOD

We enrolled a total of 9823 participants 45 years and older from the China Health and Retirement Longitudinal Study from 2015 to 2018 in our study. Multimorbidity was defined as two or more coexisting chronic diseases in the same individual based on 14 self-reported disease questions. Sleep quality was classified as "good" (restless < 1 day per week) and "poor" (restless ≥ 1 days per week); and sleep duration was divided into short (< 6 h), medium (6-9 h), and long (> 9 h). The bidirectional association between multimorbidity and sleep condition was examined using multivariate logistic regression models with adjustments for covariates.

RESULTS

Individuals with poor sleep quality showed a significantly higher prevalence of multimorbidity in the future. The adjusted OR (95% CI) values of individuals with poor sleep quality with respect to developing two diseases, three diseases, and ≥ 4 diseases were 1.39 (1.19, 1.63), 1.56 (1.23, 2.03), and 2.36 (1.68, 3.33), respectively. In addition, individuals with multimorbidity exhibited a significantly higher risk of poor sleep quality in the future. Short sleep duration led to multimorbidity in the future (OR = 1.49; 95 CI%, 1.37-1.63), while multimorbidity contributed to short sleep duration (< 6 h) in the future (OR = 1.39; 95% CI, 1.27-1.51) after full adjustment.

CONCLUSIONS

There was a bidirectional association between sleep quality or short sleep duration and multimorbidity in middle-aged and older Chinese adults. We recommend that greater attention be given to clinical management among adults with sleep disorders or physical multimorbidities.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging

OBJECTIVES

Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited.

METHODS

We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex.

RESULTS

Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex.

CONCLUSIONS

Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

A novel nomogram for predicting cardiometabolic diseases from modifiable risks in middle-aged adults-implication for health education

Background

Middle-aged adults often overlook critical modifiable risk factors that contribute to the emergence of cardiometabolic diseases (CMDs), including hypertension and diabetes. Many CMDs can be alleviated by addressing these modifiable risks. However, there has been insufficient research focused on rural adults with lower levels of health literacy in this regard. The aim of this study was to explore and develop an intuitive assessment tool for predicting cardiometabolic diseases (CMDs), which can be used for health education with adults of low health literacy.

Methods

This was a community-based, cross-sectional study. A structured questionnaire on health-promoting habits, smoking, sleep, and physiological biomarkers was obtained via community health screening in the coastal region of Yunlin County, Taiwan. Multivariate logistic regression was used to screen for significant variables in the nomogram construction. Analysis with nonlinear restricted cubic spline was performed.

Results

A total of 712 participants (60.9% females) aged 40-64 years, with middle school level or lower education, were included. The average age was 55.6 years (SD=7.3), and 220 individuals (31%) had CMDs. Multivariate logistic regression analysis revealed that age, lower scores of vegetables, fruit, water, and exercise (VFWE), smoking history, sleep deprivation, and being overweight were significantly associated with CMDs. The model incorporating these modifiable risk factors demonstrated good discriminatory ability, as indicated by an area under the receiver operating characteristic curve of 0.75 (0.73-0.76). A predictive nomogram was developed that presented modifiable risk factors in a simple graphical format to facilitate the prediction of CMDs.

Conclusions

This study highlights a high prevalence of CMDs among middle-aged adults, along with the disregard for important risk factors that could be modified. The developed nomogram could be a practical and effective tool for community health education to enhance health literacy and prevent the progression of CMDs.

Evaluation of Candidemia in Solid-Organ Transplant Recipients

OBJECTIVES

Solid-organ transplant recipients have high rates of invasive fungal infections. Candida species are the most commonly isolated fungi. Our aim was to identify risk factors, clinical presentations, and outcomes of candidemia in solid-organ transplant recipients.

MATERIALS AND METHODS

We evaluated adult (≥18 years old) transplant recipients seen from May 2011 to December 2022 at Baskent University Ankara Hospital. From medical records, we retrospectively reviewed age, sex, transplant type, candidemia agent, risk factors, concomitant infections, and mortality of patients with Candida detected in blood culture. We used SPSS statistics software (version 25) to analyze data.

RESULTS

There were 1080 organ transplants performed during the study period (717 kidney, 279 liver, 84 heart). There were 855 who were ≥18 years (655 kidney, 127 liver, 73 heart), of whom candidemia was detected in 26 (16 male; 11 kidney, 11 liver, 4 heart) with a median age of 47.5 years. The most common agents were Candida albicans and Candida glabrata. The most common chronic diseases were hypertension, cirrhosis, and cardiomyopathy. Eighteen patients had a concomitant focus of infection. Ten patients had pneumonia accompanying candidemia. The 30-day mortality rate was as high as 53.8%. The mean duration of candidemia after transplant was 23 months. Catheter-related candidemia was observed in 65% of patients. The 30-day mortality was found to be significantly higher in patients followed in the intensive care unit (P = .014), receiving total parenteral nutrition (P = .001), using broad-spectrum antibiotics (P = .001), and having pneumonia (P = .042) accompanying candidemia.

CONCLUSIONS

For adult solid-organ transplant recipients with candidemia, careful monitoring is essential for successful management of total parenteral nutrition, central catheter, use of broadspectrum antibiotics, and invasive interventions.

Comorbidities are associated with self-reported sleep-disordered breathing and insomnia: a cross-sectional study from China

PURPOSE

We aimed to examine the associations of comorbidities with self-reported sleep-disordered breathing (SDB) and insomnia among Chinese adults.

METHODS

The study used data from a community-based cross-sectional survey performed in China in 2018-2020. Multivariable logistic regression models were used to analyze the associations of 12 comorbidities with SDB and insomnia.

RESULTS

A total of 4329 Han Chinese adults aged ≥ 18 years were enrolled. Of these, 1970 (45.5%) were male, with a median age of 48 years (interquartile range: 34-59). Compared with the participants without any conditions, adjusted ORs for SDB and insomnia for those with ≥ 4 comorbidities were 2.33 (95% CI: 1.58, 3.43, P-trend < 0.001) and 3.89 (95% CI: 2.69, 5.64, P-trend < 0.001), respectively. Seven comorbidities (hypertension, hyperlipidemia, coronary heart disease (CHD), bone and joint disease, neck or lumbar disease, chronic digestive diseases, and chronic urological disease) were positively associated with both SDB and insomnia. Cancer and chronic obstructive pulmonary disease (COPD) were also independently associated with insomnia. Of all comorbidities, cancer was most strongly associated with insomnia (OR = 3.16; 95% CI: 1.78, 5.63; P < 0.001), and CHD was most strongly associated with SDB (OR = 1.77; 95% CI: 1.19, 2.64; P < 0.001).

CONCLUSIONS

The findings showed that adults with an increasing number of comorbidities had higher odds for SDB and insomnia, which were independent of sociodemographic and lifestyle factors.

A nationwide study on sleep complaints and associated factors in older adults: ELSI-Brazil

Sleep problems, such as difficulty falling asleep, staying asleep, early awakening with failure to continue sleep, and altered sleep-wake cycle, are common in the general population. This cross-sectional study with 6,929 older adults (≥ 60 years) aimed to estimate the prevalence of different types of sleep problems, their associated factors, and the population-attributable fraction of associated factors among older adults. The outcome variables consisted of self-reported sleep problems: insomnia (initial, intermediate, late, and any type of insomnia), poor sleep quality, and daytime sleepiness. The independent variables were sociodemographic and behavioral characteristics and health conditions. The prevalence proportions were initial insomnia (49.1%), intermediate insomnia (49.2%), late insomnia (45.9%), any type of insomnia (58.6%), poor sleep quality (15.6%), and daytime sleepiness (38.4%). Female sex, presence of two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health were positively associated with the sleep problems investigated. Consuming alcohol once a month or more was inversely associated with initial insomnia. Population attributable fraction estimates ranged from 3% to 19% considering two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health. High prevalence of self-reported sleep problems was evinced in older adults. These results can be useful to guide public health services in the creation of informational, evaluative, and screening strategies for sleep problems in older Brazilian adults.

Sleep Behaviors and Progression of Multimorbidity in Middle-Aged and Older Adults: A Prospective Cohort Study From China

BACKGROUND

Sleep behavior (eg, sleep duration, sleep quality, and nap) is closely related to many chronic conditions. However, less is known about its association with multiple chronic conditions (multimorbidity), particularly evidence from cohort studies.

METHODS

Data were collected from a cohort of 8 937 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (2011-2018). Sleep duration, sleep quality, and nap duration were collected in 2011 and 2013. Progression of multimorbidity was defined as the first report of 2 or more chronic conditions for participants without multimorbidity or the new report of 1 or more conditions for those with multimorbidity. Cox regression models were performed to calculate the hazard ratios and 95% confidence intervals (CIs) of the associations between sleep behaviors and the progression of multimorbidity.

RESULTS

Short sleep duration and poor sleep quality were associated with the progression of multimorbidity independently and jointly, especially in those less than 65 years and females. The U-shaped dose-response relationships were observed between nighttime and total sleep duration and the progression of multimorbidity. Persistent short and unsteadily changed sleep behaviors increased the risk of multimorbidity progression. Individuals sleeping ≤5 h/night with 5-7 restless days/week had 1.53 times higher risk of multimorbidity progression (95% CI: 1.37-1.71), compared to those sleeping 7-8 h/night with <1 restless day/week.

CONCLUSIONS

Short sleep duration and poor sleep quality were independently and jointly associated with a higher risk of multimorbidity progression in a mid-to-older population. Optimal sleep duration and sleep quality should be emphasized in multimorbidity prevention and control.

The relationship between sleep health and multimorbidity in community dwelling populations: Systematic review and global perspectives

Previous research has identified a relationship between sleep problems and multimorbidity, defined as the co-occurrence of two or more chronic health conditions in the same individual. This systematic review sought to summarize the literature on the association between sleep duration and quality and multimorbidity in adult community-dwelling populations. A comprehensive search of the PubMed, Embase and CINAHL databases identified studies published between January 1990 and January 2023. Studies were included if they focused on community-dwelling populations, used an observational design, measured sleep quality or duration, used multimorbidity as the main study outcome, and explored the relationship between sleep and multimorbidity. Two reviewers independently conducted study screening, data extraction, and bias assessments. Twenty-four cross-sectional and five prospective cohort studies met the inclusion criteria, with studies from 16 countries and two with cross-country comparisons, and a total participant number of 481,862. Overall, poorer sleep quality and sleep duration outside current recommendations were consistently associated with multimorbidity, though with varying strength. This association was present regardless of specific multimorbidity definitions from different studies. Definitions of sleep duration and quality were inconsistent across studies, possibly contributing to mixed evidence on the observed association. Most studies were cross-sectional, limiting the assessment of the temporal direction of association. Our results corroborate relationships between poor sleep and risk of multimorbidity in adult community-dwelling populations around the world. Examining this relationship may help increase public health awareness of sleep as a modifiable risk factor for the prevention of chronic disease and healthy aging.

Managing medical and psychiatric multimorbidity in older patients

Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.

The Multimorbidity and Lifestyle Correlates in Chinese Population Residing in Macau: Findings from a Community-Based Needs Assessment Study

Multimorbidity has become one of the most pressing public health concerns worldwide. The objectives of this study were to understand the prevalence of multimorbidity and its relationship with lifestyle factors among Chinese adults in Macau, and to investigate the combined contribution of common lifestyle factors in predicting multimorbidity. Data were collected through face-to-face interviews using a self-reported questionnaire on common chronic diseases, lifestyle factors and sociodemographics. BMI, physical activity, drinking status, smoking status and sleep quality were assessed, and a composite lifestyle score (0 to 9 points) was calculated, and the higher the score, the healthier the lifestyle. A total of 1443 participants were included in the analysis, of whom 55.2% were female, 51.8% were middle aged or elderly and 30.5% completed tertiary education or higher. The prevalence of multimorbidity was 10.3%. The combination of hypertension and hyperlipidaemia was the most common (22.2%) multimorbidity among the participants with multimorbidity. After the adjustment of the covariates, it was found that the participants who were overweight (OR: 1.95, 95% CI: 1.18-3.20, p = 0.009) or obese (OR: 3.76, 95% CI: 2.38-5.96, p < 0.001), former drinkers (OR: 2.43, 95% CI: 1.26-4.69, p = 0.008), and those who reported poor sleep quality (OR: 2.25, 95% CI: 1.49-3.40, p < 0.001) had a high risk of developing multimorbidity. A one-unit increase in the lifestyle score was associated with a 0.33-times reduction in the risk of developing multimorbidity (OR: 0.67; 95% CI: 0.59-0.77, p < 0.001). A combination of lifestyle factors can influence a variety of multimorbidity among the Chinese adults in Macau. Thus, comprehensively assessing the combined contribution of several lifestyle factors in predicting multimorbidity is important.

Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis

Objectives: To summarize the evidence on the association between sleep problems and multimorbidity. Methods: Six electronic databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, and Wan fang) were searched to identify observational studies on the association between sleep problems and multimorbidity. A random-effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals for multimorbidity. Results: A total of 17 observational studies of 133,575 participants were included. Sleep problems included abnormal sleep duration, insomnia, snoring, poor sleep quality, obstructive sleep apnea (OSA) and restless legs syndrome (RLS). The pooled ORs (95% CIs) for multimorbidity were 1.49 (1.24-1.80) of short sleep duration, 1.21 (1.11-1.44) of long sleep duration and 2.53 (1.85-3.46) for insomnia. The association of other sleep problems with multimorbidity was narratively summarized due to limited number of comparable studies. Conclusion: Abnormal sleep duration and insomnia are associated with higher odds of multimorbidity, while the evidence on association of snoring, poor sleep quality, obstructive sleep apnea and restless legs syndrome with multimorbidity remains inconclusive. Interventions targeting sleep problems should be delivered for better management of multimorbidity.

Association of longitudinal patterns of nighttime sleep duration and daytime napping duration with risk of multimorbidity

OBJECTIVES

To determine whether longitudinal trajectories of nighttime sleep duration and daytime napping duration are related to subsequent multimorbidity risk. To explore whether daytime napping can compensate for negative effects of short nighttime sleep.

METHODS

The current study included 5262 participants from China Health and Retirement Longitudinal Study. Self-reported nighttime sleep duration and daytime napping duration were collected from 2011 to 2015. The 4-year sleep duration trajectories were conducted by group-based trajectory modeling. The 14 medical conditions were defined by self-reported physician diagnoses. Multimorbidity was diagnosed as participants with 2 or more of the 14 chronic diseases after 2015. Associations between sleep trajectories and multimorbidity were assessed by Cox regression models.

RESULTS

During 6.69 years of follow-up, we observed multimorbidity in 785 participants. Three nighttime sleep duration trajectories and three daytime napping duration trajectories were identified. Participants with persistent short nighttime sleep duration trajectory had the higher risk of multimorbidity (hazard ratio = 1.37, 95% confidence interval: 1.06-1.77), compared with those with persistent recommended nighttime sleep duration trajectory. Participants with persistent short nighttime sleep duration and persistent seldom daytime napping duration had the highest risk of multimorbidity (hazard ratio = 1.69, 95% confidence interval: 1.16-2.46).

CONCLUSIONS

In this study, persistent short nighttime sleep duration trajectory was associated with subsequent multimorbidity risk. Daytime napping could compensate for the risk of insufficient night sleep.

Association between sleep problems and multimorbidity patterns in older adults

BACKGROUND

Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults.

METHODS

This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns.

RESULTS

Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively.

CONCLUSIONS

These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.

Health Effects of Sleep Quality in Premutation Carrier Mothers of Individuals With Fragile X Syndrome

Sleep plays an integral role in supporting well-being, and sleep difficulties are common in mothers of individuals with developmental disabilities, including fragile X syndrome (FXS). This study assessed whether the effects of sleep quality on physical health and depression are exacerbated by genetic risk factors (CGG repeats) in FMR1 premutation carrier mothers of individuals with FXS. Poor sleep quality predicted a greater number of physical health conditions for mothers with CGG repeats in the mid-premutation range (90-110 repeats), but not for those in the lower (< 90 repeats) or higher (> 110 repeats) ends of the range. A significant association between poor sleep quality and maternal depressive symptoms was also observed, but there was no evidence that this effect varied by level of genetic vulnerability. This research extends our understanding of individual differences in the effects of sleep quality among mothers of individuals with FXS.

Association of Sleep Duration and Use of Sleeping Medication with Multimorbidity in Adults: Results from the PAMPA (Brazil) Cohort Study

Objective  To analyze the association of sleep duration and use of sleeping medication with multimorbidity. Materials and Methods  We conducted a cross-sectional study using data from the Prospective Study about Mental and Physical Health (PAMPA) cohort. Multimorbidity was defined as the presence of two or more conditions from a list of twelve health problems. Descriptive analyses were performed considering proportion and its 95% confidence interval (95%CI). We performed logistic regression (to obtain odds ratios, ORs) to estimate the associations, including models adjusted for confounding factors. Results  In total, 2,936 participants were included, 79,1% of them women, 54.2% aged between 18 and 39 years, and 88.9% with white skin color. Compared with regular sleep (seven to eight hours a day), five hours or less of sleep increased the odds of multimorbidity by 145% (95%CI: 1.90-3.14), and 9 hours or more of sleep increased the odds by 49% (95%CI: 1.14-1.95) for the crude model; the results remained significant even in the adjusted models. Discussion  Consumption of sleeping medication was associated with multimorbidity. Short and prolonged sleep duration increased the odds of multimorbidity, regardless of the sociodemographic and behavior characteristics. The regular use of sleeping medication was also associated with multimorbidity. The results of the present study are important but require caution due to reverse causality, and longitudinal studies are needed to confirm the findings.

Multimorbidity and Sleep Patterns among Adults in a Peruvian Semi-Urban Area

Objective  To assess if the duration and quality of sleep vary due to the presence of multimorbidity. Materials and Methods  We performed a secondary analysis using data from a population-based study involving adult subjects aged between 30 and 69 years residing in a semi-urban area of Tumbes, Peru. The duration (normal, short or prolonged) and quality (good or poor) of sleep were our outcome variables, whereas the exposure was multimorbidity (two or more chronic conditions). Crude and adjusted Poisson regression models were built to assess the association of interest, and prevalence ratios (PRs) and 95% confidence intervals (95%CIs) were reported. Results  We analyzed data from 1,607 subjects with a mean age of 48.2 (standard deviation [SD]: ± 10.6) years, 809 (50.3%) of whom were women. Multimorbidity was present in 634 (39.5%; 95%CI: 37.1-41.9%) subjects, and 193 (12.1%; 95%CI: 10.5-13.7%) were short sleepers, 131 (8.2%; 95%CI: 6.9-9.6%) were long sleepers, and 312 (19.5%; 95%CI: 17.5-21.5%) had poor sleep quality. In the multivariable model, multimorbidity was associated with prolonged sleep duration (PR = 1.45; 95%CI: 1.03-2.04) and poor sleep quality (PR = 2.04; 95%CI: 1.65-2.52). Conclusions  Multimorbidity was associated with prolonged, but not short, sleep duration, as well as with poor sleep quality. Our results suggest the need of assessing sleep patterns among adults with multimorbidity.

Patterns and Predictors of Multimorbidity in the Azar Cohort

BACKGROUND

The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort.

METHODS

We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires.

RESULTS

The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM.

CONCLUSION

The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.

Sleep Problems and Psychological Well-Being: Baseline Findings from the Canadian Longitudinal Study on Aging

International studies have demonstrated associations between sleep problems and poor psychological well-being; however, Canadian data are limited. This study investigated this association using cross-sectional baseline data from the Canadian Longitudinal Study on Aging, a national survey of 30,097 community-dwelling adults, 45–85 years of age. Short sleep duration, sleep dissatisfaction, insomnia symptoms, and daytime impairment were consistently associated with a higher prevalence of dissatisfaction with life, psychological distress, and poor self-reported mental health. Long sleep duration was associated with a higher prevalence of psychological distress and poor self-reported mental health, but not with dissatisfaction with life. Associations between sleep problems and psychological distress were 11–18 per cent stronger in males. With each 10-year increase in age, the association between daytime impairment and life dissatisfaction increased by 11 per cent, and insomnia symptoms and poor mental health decreased by 11 per cent. Sleep problems in middle-aged and older adults warrant increased attention as a public health problem in Canada.

Association of sleep duration at age 50, 60, and 70 years with risk of multimorbidity in the UK: 25-year follow-up of the Whitehall II cohort study

BACKGROUND

Sleep duration has been shown to be associated with individual chronic diseases but its association with multimorbidity, common in older adults, remains poorly understood. We examined whether sleep duration is associated with incidence of a first chronic disease, subsequent multimorbidity and mortality using data spanning 25 years.

METHODS AND FINDINGS

Data were drawn from the prospective Whitehall II cohort study, established in 1985 on 10,308 persons employed in the London offices of the British civil service. Self-reported sleep duration was measured 6 times between 1985 and 2016, and data on sleep duration was extracted at age 50 (mean age (standard deviation) = 50.6 (2.6)), 60 (60.3 (2.2)), and 70 (69.2 (1.9)). Incidence of multimorbidity was defined as having 2 or more of 13 chronic diseases, follow-up up to March 2019. Cox regression, separate analyses at each age, was used to examine associations of sleep duration at age 50, 60, and 70 with incident multimorbidity. Multistate models were used to examine the association of sleep duration at age 50 with onset of a first chronic disease, progression to incident multimorbidity, and death. Analyses were adjusted for sociodemographic, behavioral, and health-related factors. A total of 7,864 (32.5% women) participants free of multimorbidity had data on sleep duration at age 50; 544 (6.9%) reported sleeping ≤5 hours, 2,562 (32.6%) 6 hours, 3,589 (45.6%) 7 hours, 1,092 (13.9%) 8 hours, and 77 (1.0%) ≥9 hours. Compared to 7-hour sleep, sleep duration ≤5 hours was associated with higher multimorbidity risk (hazard ratio: 1.30, 95% confidence interval = 1.12 to 1.50; p < 0.001). This was also the case for short sleep duration at age 60 (1.32, 1.13 to 1.55; p < 0.001) and 70 (1.40, 1.16 to 1.68; p < 0.001). Sleep duration ≥9 hours at age 60 (1.54, 1.15 to 2.06; p = 0.003) and 70 (1.51, 1.10 to 2.08; p = 0.01) but not 50 (1.39, 0.98 to 1.96; p = 0.07) was associated with incident multimorbidity. Among 7,217 participants free of chronic disease at age 50 (mean follow-up = 25.2 years), 4,446 developed a first chronic disease, 2,297 progressed to multimorbidity, and 787 subsequently died. Compared to 7-hour sleep, sleeping ≤5 hours at age 50 was associated with an increased risk of a first chronic disease (1.20, 1.06 to 1.35; p = 0.003) and, among those who developed a first disease, with subsequent multimorbidity (1.21, 1.03 to 1.42; p = 0.02). Sleep duration ≥9 hours was not associated with these transitions. No association was found between sleep duration and mortality among those with existing chronic diseases. The study limitations include the small number of cases in the long sleep category, not allowing conclusions to be drawn for this category, the self-reported nature of sleep data, the potential for reverse causality that could arise from undiagnosed conditions at sleep measures, and the small proportion of non-white participants, limiting generalization of findings.

CONCLUSIONS

In this study, we observed short sleep duration to be associated with risk of chronic disease and subsequent multimorbidity but not with progression to death. There was no robust evidence of an increased risk of chronic disease among those with long sleep duration at age 50. Our findings suggest an association between short sleep duration and multimorbidity.

Investigation of the role of sleep and physical activity for chronic disease prevalence and incidence in older Irish adults

Background

Chronic diseases are the leading cause of death worldwide. Many of these diseases have modifiable risk factors, including physical activity and sleep, and may be preventable. This study investigated independent associations of physical activity and sleep with eight common chronic illnesses.

Methods

Data were from waves 1, 3 and 5 of The Irish Longitudinal Study on Ageing (n = 5,680). Inverse probability weighted general estimating equations were used to examine longitudinal lifetime prevalence and cumulative incidence of self-reported conditions.

Results

Sleep problems were significantly associated with increased odds of incident and prevalent arthritis and angina. Additionally sleep problems were associated with higher odds of lifetime prevalence of hypertension and diabetes. Physical activity was negatively associated incident osteoporosis and respiratory diseases and negatively associated with lifetime prevalence of hypertension, high cholesterol and diabetes.

Conclusions

Worse sleep quality and lower physical activity were associated with higher odds of chronic diseases. Interventions to improve sleep and physical activity may improve health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14108-6.

Associations between sleep patterns, smoking, and alcohol use among older adults in Canada: Insights from the Canadian Longitudinal Study on Aging (CLSA)

Poor sleep is associated with chronic health conditions among older adults. As substance use rates increase in this population, age-related physiological and cognitive declines may exacerbate its detrimental consequences, including sleep problems. We analyzed cross-sectional associations between sleep patterns, smoking, and alcohol use using baseline data from 30,097 community-dwelling Canadian adults aged 45-85 years from the Canadian Longitudinal Study on Aging. Insomnia symptoms (difficulties falling/staying asleep), sleep duration (short:<6h; long:>8h), and sleep satisfaction(dissatisfied/neutral/satisfied) were measured. Smoking and alcohol-use frequency (past 12 months), average daily amount (past 30 days), and binge drinking (past 12 months) were self-reported, and associations were examined using modified Poisson regression. Approximately 23% of participants had insomnia symptoms, and 26% reported sleep dissatisfaction. 91% of participants were current non-smokers, whereas 7% reported smoking daily. Over 50% drank ≤ 2 drinks daily, and 3% reported binge drinking. There was a higher adjusted prevalence of insomnia among daily smokers (PR = 1.10, 95% CI = 1.00-1.21) and binge drinkers (PR = 1.21, 95% CI = 1.02-1.43). Odds of short sleep duration were lower among regular drinkers (COR = 0.71, 95% CI = 0.56-0.90) and higher among daily smokers (COR = 1.19, 95% CI = 1.01-1.40). Heavy and frequent smoking and alcohol use are associated with both insomnia symptoms and sleep dissatisfaction, but not consistently with sleep duration. Further longitudinal investigation of this relationship in aging populations is needed in clinical and public health settings to infer the extent of causality and design effective public health interventions in this vulnerable population.

Using Bayesian networks with Max-Min Hill-Climbing algorithm to detect factors related to multimorbidity

Objectives

Multimorbidity (MMD) is a medical condition that is linked with high prevalence and closely related to many adverse health outcomes and expensive medical costs. The present study aimed to construct Bayesian networks (BNs) with Max-Min Hill-Climbing algorithm (MMHC) algorithm to explore the network relationship between MMD and its related factors. We also aimed to compare the performance of BNs with traditional multivariate logistic regression model.

Methods

The data was downloaded from the Online Open Database of CHARLS 2018, a population-based longitudinal survey. In this study, we included 10 variables from data on demographic background, health status and functioning, and lifestyle. Missing value imputation was first performed using Random Forest. Afterward, the variables were included into logistic regression model construction and BNs model construction. The structural learning of BNs was achieved using MMHC algorithm and the parameter learning was conducted using maximum likelihood estimation.

Results

Among 19,752 individuals (9,313 men and 10,439 women) aged 64.73 ± 10.32 years, there are 9,129 ones without MMD (46.2%) and 10,623 ones with MMD (53.8%). Logistic regression model suggests that physical activity, sex, age, sleep duration, nap, smoking, and alcohol consumption are associated with MMD (P < 0.05). BNs, by establishing a complicated network relationship, reveals that age, sleep duration, and physical activity have a direct connection with MMD. It also shows that education levels are indirectly connected to MMD through sleep duration and residence is indirectly linked to MMD through sleep duration.

Conclusion

BNs could graphically reveal the complex network relationship between MMD and its related factors, outperforming traditional logistic regression model. Besides, BNs allows for risk reasoning for MMD through Bayesian reasoning, which is more consistent with clinical practice and thus holds some application prospects.

Does Shiftwork Impact Cognitive Performance? Findings from the Canadian Longitudinal Study on Aging (CLSA)

Few large nationwide studies have investigated the relationship between shiftwork and cognitive performance, and little is known about whether and how psychological distress may impact this relationship. This study aimed to examine: (1) the cross-sectional relationship between shiftwork (yes/no) and some aspects of cognitive performance (declarative memory and executive functioning) and (2) the potential moderating effect of psychological distress among 20,610 community-dwelling adults from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Differences by sex and retirement status were also explored. Shiftwork was significantly associated with poorer performance for executive functioning (interference condition: ß = 0.47, 95% CI: 0.31 to 0.63; MAT: ß = -0.85, 95% CI: -1.21 to -0.50) but not for declarative memory. Completely and not/partly retired males showed poorer cognitive performance on executive functioning. However, no evidence of a moderating effect by psychological distress was found. Our findings confirm the association between shiftwork and cognitive performance and highlight important health correlates of shiftwork.

Examining the prevalence and correlates of multimorbidity among community-dwelling older adults: cross-sectional evidence from the Canadian Longitudinal Study on Aging (CLSA) first-follow-up data

INTRODUCTION

multimorbidity has become an increasingly important issue for many populations around the world, including Canada. The objectives of this study were to estimate the prevalence of multimorbidity at first follow-up and to identify factors associated with multimorbidity using data from the Canadian Longitudinal Study on Aging (CLSA).

METHODS

this study included 27,701 community-dwelling participants in the first follow-up of the CLSA. Multimorbidity was operationalised using two definitions (Public Health and Primary Care), as well as the cut-points of two or more chronic conditions (MM2+) and three or more chronic conditions (MM3+). The prevalence of multimorbidity was calculated at first follow-up and multivariable regression models were used to identify correlates of multimorbidity occurrence.

RESULTS

the prevalence of multimorbidity at first follow-up was 32.3% among males and 39.3% among females when using the MM2+ Public Health definition, whereas the prevalence was 67.2% among males and 75.8% among females when using the MM2+ Primary Care definition. Older age, lower alcohol consumption, lower physical activity levels, dissatisfaction with sleep quality, dissatisfaction with life and experiencing social limitations due to health conditions were significantly associated with increased odds of multimorbidity for both males and females, regardless of the definition of multimorbidity used.

CONCLUSION

various sociodemographic, behavioural and psychosocial factors are associated with multimorbidity. Future research should continue to examine how the prevalence of multimorbidity changes with time and how these changes may be related to specific risk factors. This future research should be supplemented with studies examining the longitudinal impacts of multimorbidity over time.

Association between sleep and multimorbidity in Chinese elderly: Results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

OBJECTIVE

Abnormal sleep duration and poor sleep quality were associated with multiple diseases. However, the association between sleep behavior (including sleep duration and quality) and multimorbidity among the elderly remains unclear. Thus, our study aimed to explore this association in the Chinese elderly.

METHODS

We conducted a cross-sectional study using data from the Chinese Longitudinal Healthy Longevity Survey (2014 wave). Nineteen chronic diseases were used to measure multimorbidity. Self-reported nighttime sleep duration and sleep quality were used as exposures. Multivariate logistic regression analysis and stratification were used to explore the association between sleep behavior and multimorbidity in different groups. Restrictive cubic splines were used to examine the exposure-response relationship.

RESULTS

Compared with those with nighttime sleep duration between 7 and 9 h, participants with shorter (<7 h) and longer (>9 h) sleep duration had a higher prevalence of multimorbidity (odds ratio [OR], 95% confidence interval [CI] were 1.38, 1.18-1.61 and 1.30, 1.09-1.56 respectively). Besides, poor sleep quality (OR = 2.25, 95% CI:1.82-2.72) and moderate sleep quality (OR = 1.35, 95% CI:1.16-1.58) were positively associated with multimorbidity.

CONCLUSIONS

Although the role of sleep behavior in multimorbidity has not been fully understood, this study highlighted the importance of normal nighttime sleep duration and good sleep quality in preventing multimorbidity.

Calidad de sueño, variables personales, laborales y estilo de vida de enfermeros de hospital

Resumen Objetivo: identificar posibles asociaciones entre la calidad de sueño, las variables personales y laborales y los estilo de vida de los enfermeros de hospital. Método: estudio transversal, exploratorio, correlacional, cuantitativo, realizado de octubre a diciembre de 2019. Los datos fueron recolectados mediante un cuestionario que abordó las características personales, estilo de vida y condiciones de trabajo de los encuestados. Para evaluar la calidad de sueño, se utilizó el Pittsburgh Sleep Quality Index (PCSI), versión en portugués de Brasil. Resultados: participaron 42 profesionales, 31 (73,8%) mujeres, con edad entre 26 y 66 años (media 40,2); el 61,9% trabajaba horas extras; el 26,2% tenía dos vínculos laborales y el 40,5% faltó al trabajo. La calidad de sueño fue considerada buena por el 9,5% de los participantes, mala por el 64,3% y con trastornos del sueño por el 26,2%. El 26,2% de la población que hacía turnos rotativos, calificó la calidad como mala. Los peores resultados se encontraron en la franja etaria de 30 a 39 años y hubo significación estadística en la variable “vive en pareja”. Conclusión: la calidad de sueño de los enfermeros se vio afectada; es necesario monitorear a estos trabajadores, en particular a los que trabajan por turnos, a fin de implementar medidas preventivas que reduzcan los daños a su salud.

Sleep quality, personal and work variables and life habits of hospital nurses

OBJECTIVE

to identify the possible associations between sleep quality, personal and work variables and the life habits of hospital nurses.

METHOD

a cross-sectional, exploratory, correlational and quantitative study, carried out from October to December 2019. The data were collected with the application of a questionnaire that addressed the respondents' personal characteristics, life habits and working conditions. The Pittsburgh Sleep Quality Index (PSQI), Brazilian Portuguese version, was used to assess sleep quality.

RESULTS

the participants were 42 professionals: 31 (73.8%) women, aged between 26 and 66 years old (mean of 40.2); 61.9% worked overtime; 26.2% had two employment contracts and 40.5% had absences from work. Sleep quality was considered good by 9.5% of the participants, poor by 64.3% and categorized as with sleep disorders by 26.2%. In the population that worked rotating shifts, this quality was identified as poor by 26.2%. The worst results were found in the age group from 30 to 39 years old and there was a statistical significance in the "living with a partner" variable.

CONCLUSION

there was impairment in the nurses' sleep quality and there is a need to monitor these workers, particularly those who work in shifts, in order to provide preventive measures to mitigate the harms to their health.

Sleep quality, personal and work variables and life habits of hospital nurses

Abstract Objective: to identify the possible associations between sleep quality, personal and work variables and the life habits of hospital nurses. Method: a cross-sectional, exploratory, correlational and quantitative study, carried out from October to December 2019. The data were collected with the application of a questionnaire that addressed the respondents’ personal characteristics, life habits and working conditions. The Pittsburgh Sleep Quality Index (PSQI), Brazilian Portuguese version, was used to assess sleep quality. Results: the participants were 42 professionals: 31 (73.8%) women, aged between 26 and 66 years old (mean of 40.2); 61.9% worked overtime; 26.2% had two employment contracts and 40.5% had absences from work. Sleep quality was considered good by 9.5% of the participants, poor by 64.3% and categorized as with sleep disorders by 26.2%. In the population that worked rotating shifts, this quality was identified as poor by 26.2%. The worst results were found in the age group from 30 to 39 years old and there was a statistical significance in the “living with a partner” variable. Conclusion: there was impairment in the nurses’ sleep quality and there is a need to monitor these workers, particularly those who work in shifts, in order to provide preventive measures to mitigate the harms to their health.

Clustering of obesity-related characteristics: A latent class analysis from the Canadian Longitudinal Study on Aging

Measures of obesity, including body mass index (BMI) and waist circumference (WC), do not fully capture the complexity of obesity-related health risks. This study identified distinct classes of obesity-related characteristics and evaluated their associations with BMI, WC, and percent body fat (%BF) using cross-sectional data from 30,096 participants aged 45-85 in the Canadian Longitudinal Study on Aging (2011-2015). Sixteen obesity-related variables, including behavioural, metabolic, physical health, and mental health/social factors, were included in a latent class analysis to identify distinct classes of participants. Adjusted odds ratios (OR) were estimated from logistic regression for associations between each class and obesity defined by BMI, WC and %BF. Six latent classes were identified: "low-risk" (39.8%), "cardiovascular risk" (19.4%), "metabolic risk" (16.9%), "sleep and mental health risk" (12.1%), "multiple and complex risk" (6.7%), and "cardiometabolic risk" (5.1%). Compared to "low-risk", all classes had increased odds of BMI-, WC- and %BF-defined obesity. For example, the "complex and multiple risk" class was associated with obesity by BMI (OR: 10.70, 95% confidence interval (CI): 9.51, 12.04), WC (OR: 9.21, 95% CI: 8,15, 10,41) and %BF (OR: 7.54, 95% CI: 6.21, 9.16). Distinct classes of obesity-related characteristics were identified and were strongly associated with obesity defined by multiple measures.

How Do Non-Catastrophic Natural Disasters Impact Middle-Aged-to-Older Persons? Using Baseline Canadian Longitudinal Study on Aging Data to Explore Psychological Outcomes Associated with the 2013 Calgary Flood

The objective of this study was to identify group-level health outcomes associated with the 2013 Calgary flood on Calgary participants (45-85 years of age) in the Canadian Longitudinal Study on Aging (CLSA). We compared baseline CLSA data collected on Calgary participants during the 6 months prior to and following the flood. Logistic regression models were created to explore whether select psychological outcomes were associated with the flood for participants categorized by evacuation status. Participants living in evacuated communities pre-flood had significantly lower levels of a diagnosed anxiety disorder than non-evacuated communities, which disappeared post-flood. Participants with higher household income were less likely to have post-traumatic stress disorder symptoms, worse self-rated mental health, and lower life satisfaction post-flood. Living alone reduced and female gender increased levels of perceived functional social support post-flood. Although natural disasters can shape research findings, the scope of the data being collected and the representativeness of impacted groups may challenge the ability to detect subtle impacts.

The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China

Background

Preventing chronic disease is important in health policy in countries with significantly ageing populations. This study aims to examine the prevalence of chronic disease multimorbidity and its association with physical activity and sleep duration; and to understand whether physical activity modifies associations between sleep duration and multimorbidity.

Methods

We utilized longitudinal data of a nationally-representative sample from the China Health and Retirement Longitudinal Study (in year 2011 and 2015; N = 5321; 54.7% female; age ≥ 45 years old). Fourteen chronic diseases were used to measure multimorbidity (ten self-reported, and four by blood test). Participants were grouped into high, moderate, and low level based on self-reported frequencies and durations of physical activity with different intensities for at least 10 min at a time in a usual week. Poor and good sleepers were categorized according to average hours of actual sleep at each night during the past month. Panel data method of random-effects logistic regression model was applied to estimate the association of physical activity and sleep with multimorbidity, adjusting for social-demographic and behavioural confounders.

Results

From 2011 to 2015, the prevalence of multimorbidity increased from 52.2 to 62.8%. In 2015, the proportion of participants engaging in high, moderate, and low level of physical activity was 30.3, 24.4 and 45.3%, respectively, and 63.6% of adults had good sleep. For both genders, compared with good sleep, poor sleep was associated with higher odds of multimorbidity (OR = 1.527, 95% CI: 1.277, 1.825). Compared to the high-level group, participants with a low level of physical activity were significantly more likely to have multimorbidity (OR = 1.457, 95% CI: 1.277, 1.825), but associations were stronger among women. The relative excess risk due to interaction between poor sleep and moderate or low physical activity was positive but non-significant on multimorbidity.

Conclusions

The burden of multimorbidity was high in China. Low physical activity and poor sleep was independently and significantly associated with a higher likelihood of multimorbidity in women and both genders, separately. Physical activity could modify the association between sleep and multimorbidity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01150-7.

Development and Validation of a Clinical Prediction Model for Sleep Disorders in the ICU: A Retrospective Cohort Study

Background

Sleep disorders, the serious challenges faced by the intensive care unit (ICU) patients are important issues that need urgent attention. Despite some efforts to reduce sleep disorders with common risk-factor controlling, unidentified risk factors remain.

Objectives

This study aimed to develop and validate a risk prediction model for sleep disorders in ICU adults.

Methods

Data were retrieved from the MIMIC-III database. Matching analysis was used to match the patients with and without sleep disorders. A nomogram was developed based on the logistic regression, which was used to identify risk factors for sleep disorders. The calibration and discrimination of the nomogram were evaluated with the 1000 bootstrap resampling and receiver operating characteristic curve (ROC). Besides, the decision curve analysis (DCA) was applied to evaluate the clinical utility of the prediction model.

Results

2,082 patients were included in the analysis, 80% of whom (n = 1,666) and the remaining 20% (n = 416) were divided into the training and validation sets. After the multivariate analysis, hemoglobin, diastolic blood pressure, respiratory rate, cardiovascular disease, and delirium were the independent risk predictors for sleep disorders. The nomogram showed high sensitivity and specificity of 75.6% and 72.9% in the ROC. The threshold probability of the net benefit was between 55% and 90% in the DCA.

Conclusion

The model showed high performance in predicting sleep disorders in ICU adults, the good clinical utility of which may be a useful tool for providing clinical decision support to improve sleep quality in the ICU.

Sleeping when the world locks down: Correlates of sleep health during the COVID-19 pandemic across 59 countries

Objectives

COVID-19 escalated into a global pandemic affecting countries around the world. As communities shut down to reduce disease spread, all aspects of life have been altered, including sleep. This study investigated changes in sleep patterns and correlates of sleep health in a global sample and examined relationships between sleep health and psychological distress.

Design

Cross-sectional.

Settings

Online survey distributed between April 19 and May 3, 2020.

Participants

Total 6882 participants (18-94 years) across 59 countries.

Measurements

Sleep health (RU-SATED), demographics, pandemic-related factors, mood.

Results

More than half the sample shifted their sleep toward later bed- and wake-times, and more than a third reported increased sleep disturbances during the pandemic. Older age, being partnered, and living in a higher income country were associated with better sleep health, while a stricter level of quarantine and pandemic-related factors (being laid off from job, financial strain, or difficulties transitioning to working from home) were associated with poorer sleep health. Domestic conflict was the strongest correlate of poorer sleep health. Poorer sleep health was strongly associated with greater depression and anxiety symptoms. Participants from Latin America reported the lowest sleep health scores.

Conclusions

COVID-19-associated factors have impacted sleep health on a global level. While our data are correlational, sleep health is strongly linked with mental health and could play a protective role against developing mental distress during pandemic-related isolation. Sleep health should be incorporated into public health messages aimed at helping people cope with the effects of a pandemic to maintain optimal mental and physical health.

Sleep duration and all-cause mortality in the elderly in China: a population-based cohort study

Background

Although a U-shaped association between sleep duration and all-cause mortality has been found in general population, its association in the elderly adults, especially in the oldest-old, is rarely explored.

Methods

In present cohort study, we prospectively explore the association between sleep duration and all-cause mortality among 15,092 participants enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2019. Sleep duration and death information was collected by using structured questionnaires. Cox regression model with sleep duration as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). The dose-response association between them was explored via a restricted cubic spline function.

Results

During an average follow-up of 4.51 (standard deviation, SD: 3.62) years, 10,768 participants died during the follow-up period. The mean (SD) age of the participants was 89.26 (11.56) years old. Compared to individuals with moderate sleep duration (7–8 hours), individuals with long sleep duration (> 8 hours) had a significantly higher risk of all-cause mortality (HR: 1.13, 95%CI: 1.09–1.18), but not among individuals with short sleep duration (≤ 6 hours) (HR: 1.02, 95%CI: 0.96–1.09). Similar results were observed in subgroup analyses based on age and gender. In the dose-response analysis, a J-shaped association was observed.

Conclusions

Sleep duration was associated with all-cause mortality in a J-shaped pattern in the elderly population in China.