Self-reported sleep complaints are associated with adverse health outcomes: cross-sectional analysis of the 2002/03 New Zealand Health Survey

Characteristics of Atypical Sleep Durations Among Older Compared to Younger Adults: Evidence from the New Zealand Health Survey

BACKGROUND

Understanding and supporting sleep is important across the life span. Disparities in sleep status are well documented in mid-life but under-explored among older populations.

METHODS

Data from 40,659 adults pooled from the New Zealand Health Surveys were used; 24.2% were "older adults" (aged ≥65 years), 57% were female, and 20.5% of Māori ethnicity. "Long," "short," or "typical" sleep categories were based on age-related National Sleep Foundation guidelines. Multinomial logistic regression examined predictors of atypical sleep, including sociodemographic characteristics, lifestyle factors, and health status.

RESULTS

Prevalence of short and long sleep among older adults was 296 (3.0%) and 723 (7.4%), respectively. Correspondingly, prevalence among younger adults was 2 521 (8.2%) and 364 (1.2%). Atypical sleep was more significantly associated with indicators of reduced socioeconomic status and ethnicity among younger rather than older adults. Within both age groups, lower physical activity was associated with long sleep status. Higher physical activity and smoking were related to short sleep status among younger adults only. Within both age groups, atypical sleep was associated with SF-12 scores indicating poorer physical and mental health. Having ≥3 health conditions was related to short sleep among the older adults, while for young adults, it was related to both atypical durations.

CONCLUSIONS

Indicators of negative lifestyle and health factors remain consistent predictors of atypical sleep with aging. However, demographic disparities are less apparent among older atypical sleepers. This study highlights individual and contextual factors associated with atypical sleep patterns which may be important for age-appropriate recognition and management of sleep problems.

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

Obstructive sleep apnea (OSA) is a serious, potentially life-threatening condition. Epidemiologic studies show that sleep apnea increases cardiovascular diseases risk factors including hypertension, obesity, and diabetes mellitus. OSA is also responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and bronchial asthma. The aim of this systematic review is to evaluate evidence for the association between OSA and cardiovascular disease morbidities and identify risk factors for the conditions. In a review of 34 studies conducted in 28 countries with a sample of 37,599 people, several comorbidities were identified in patients with severe OSA—these were: heart disease, stroke, kidney disease, asthma, COPD, acute heart failure, chronic heart failure, hyperlipidemia, thyroid disease, cerebral infarct or embolism, myocardial infarction, and psychological comorbidities including stress and depression. Important risk factors contributing to OSA included: age > 35 years; BMI ≥ 25 kg/m²; alcoholism; higher Epworth sleepiness scale (ESS); mean apnea duration; oxygen desaturation index (ODI); and nocturnal oxygen desaturation (NOD). Severe OSA (AHI ≥ 30) was significantly associated with excessive daytime sleepiness and oxygen desaturation index. The risk of OSA and associated disease morbidities can be reduced by controlling overweight/obesity, alcoholism, smoking, hypertension, diabetes mellitus, and hyperlipidemia.

Poor sleep quality and physical performance in older adults

OBJECTIVES

This study aimed to examine the association between sleep quality and physical performance among a group of UK community-dwelling older adults, according to sex.

METHODS

Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Physical performance was assessed using a short physical performance battery (SPPB), a timed up-and-go, and a hand-grip strength test.

RESULTS

Of 591 eligible study members, 401 completed the Pittsburgh Sleep Quality Index. In regression analyses, men who reported poor sleep quality were significantly more likely to have a poor SPPB score, even after adjustment for confounding factors (OR = 2.54, 95% CI 1.10-5.89, P= .03). The direction of the relationship was reversed among women, where those who reported poor sleep were less likely to have a low SPPB score (OR = 0.36, 95% CI 0.15-0.85, P = .02). Poor sleep quality was associated with poorer hand-grip strength among women (regression coefficient = -0.34 z score, 95% CI -0.64, -0.04, P = .03), but this relationship was not observed among men (regression coefficient = 0.28 z score, 95% CI -0.01, 0.57, P = .06).

CONCLUSION

We found evidence of an association between poor sleep quality and poorer physical performance in older adults, though there appear to be important sex differences.

Sleep quantity and quality and cardiometabolic risk factors in Indigenous Australians

Poor sleep is associated with increased risk of cardiovascular disease (CVD). Indigenous Australians have 1.3 times higher risk of CVD compared to non-indigenous Australians. However, there are limited data describing sleep problems and cardiometabolic risk in this population. This study aimed to investigate sleep quantity and quality in indigenous Australians and assess its association with cardiometabolic risk. Two hundred and forty-five indigenous Australians aged > 18 years were recruited via convenience sampling from communities in the Northern Territory and Queensland. Sleep quantity and quality was assessed subjectively with questionnaires including the Epworth Sleepiness Scale. In a sub-population (n = 46), objective sleep assessment was performed over three nights of actigraphy. Cardiometabolic risk measures included glycated haemoglobin, lipids, anthropometric measurements and sitting blood pressure. Sleep duration measured subjectively and objectively averaged 7.5 ± 2.0 hr/night; however, over one-third of participants (self-report 35%; actigraphy 39%) obtained < 7 hr/night. Overall, more than a third of participants experienced poor-quality sleep, with 27% reporting severe daytime sleepiness (ESS score > 10) and a high number of objectively measured awakenings/night (6 ± 4). Short sleep duration (<6 hr/night) measured both subjectively and objectively was an independent predictor of diastolic (β = 5.37, p = .038) and systolic blood pressure (β = 14.30, p = .048). More objectively measured night-time awakenings were associated with increased glycated haemoglobin levels (β = 0.07, p = .020) and greater sleep fragmentation was associated with lower high-density lipoprotein levels (β = -0.01, p = .025). A large proportion of indigenous Australians experienced short sleep durations and had significant sleep disruption. Poor sleep quantity and quality may contribute to heightened cardiometabolic risk in this population.

Serum Vitamin D, Sleep Pattern and Cardiometabolic Diseases: Findings from the National Health and Nutrition Examination Survey

OBJECTIVE

Although poor sleep health and vitamin D deficiency may be associated with diabetes and hypertension, whether this association shows a trend depending on vitamin D concentration is unclear.

SUBJECTS AND METHODS

We analyzed data from 10,742 participants (4997 men) from the 2007-2014 National Health and Nutrition Examination Survey. Abnormal sleep pattern (ie, short sleep duration, sleep complaint, and/or sleep disorder), lifestyle factors, serum vitamin D level, and the status of diabetes and hypertension were assessed. Logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Serum vitamin D significantly interacted with short sleep duration and abnormal sleep pattern (both p = 0.003) on the association with diabetes in men. Short sleep duration (OR: 1.82, 95% CI = 1.29, 2.57) and abnormal sleep pattern (OR: 1.95, 95% CI = 1.38, 2.77) were associated with diabetes in men with serum vitamin D of >75 nmol/L. Serum vitamin D significantly interacted with sleep complaint on the association with hypertension in men and women (both p < 0.05). The magnitude of association between sleep complaint and hypertension in men was stronger when serum vitamin D level was <50 nmol/L (OR: 2.26, 95% CI = 1.57, 3.25) than when the level was >75 nmol/L (OR: 1.28, 95% CI = 0.90, 1.83). Similarly, the magnitude of association between sleep complaint and hypertension in women was stronger when serum vitamin D level was <50 nmol/L (OR: 2.09, 95% CI = 1.53, 2.86) than when the level was >75 nmol/L (OR: 1.64, 95% CI = 0.98, 2.72). No significant interactions were observed between serum vitamin D level and other sleep variables.

CONCLUSION

Abnormal sleep pattern is associated with a high risk of diabetes and hypertension. The relationship between sleep complaint and hypertension may be strong in people with vitamin D deficiency, and this observation should be verified by prospective studies.

"Their Sleep Means More Harmony": Maternal Perspectives and Experiences of Preschoolers' Sleep in Ethnically and Socioeconomically Diverse Families in Aotearoa/New Zealand

Viewing sleep through a socioecological lens, maternal perceptions, and experiences of preschoolers' sleep were explored using semistructured interviews with 15 Māori (indigenous) and 16 non-Māori mothers, with low- and high socioeconomic position. Thematic analysis identified four themes: child happiness and health, maternal well-being, comfort and connection, and family functioning and harmony. Mothers perceived healthy preschooler sleep as supporting children's mental and physical health, parents' sleep/wake functioning, family social cohesion and emotional connectedness, and poor preschooler sleep as negatively influencing child, maternal and family well-being. Although many experiences were shared, some perceptions of sleep and sleep practices differed between mothers. Influences included health paradigms, socioeconomic circumstances, maternal autonomy, employment, parenting approaches, and societal expectations. Healthy preschooler sleep is valued by mothers and may play a protective role in family health and resilience. Preschooler sleep initiatives need to be responsive to maternal perspectives and address societal drivers of sleep experiences.

Sleep duration and psychological well-being among New Zealanders

OBJECTIVE

To identify the prevalence of short and long sleep duration and examine the relationship between sleep duration and psychological well-being among New Zealand adults.

DESIGN

Multiple regression using data from the New Zealand Attitudes Values Study postal questionnaire.

PARTICIPANTS

New Zealand Attitudes Values Study respondents in 2014, 2015, and/or 2016 (Ns =15,820, 13,942, and 21,937).

MEASUREMENTS

Participants were asked, "During the past month, on average, how many hours of actual sleep did you get per night?" They also reported their demographic characteristics, physical and psychological health, and personality traits.

RESULTS

Most New Zealanders reported having optimal sleep duration (7 to <9 hours, 58%), but more than a third reported having short (<7 hours, 37%) and 4.5% reported long sleep duration (≥ 9 hours). Māori and Pacific peoples showed particularly high rates of short sleepers. Compared to optimal sleep, short sleep consistently showed negative relationships with various measures of positive psychological well-being (eg, self-esteem, life satisfaction) independent of a broad range of demographic, health, and personality factors. Long sleep was only associated with an increased likelihood of depression. Personality traits, especially neuroticism, also showed strong associations with psychological well-being.

CONCLUSIONS

The high proportion of short sleepers in New Zealand is a major issue of concern because short sleep showed consistent associations with negative psychological well-being. It is vital to implement sleep awareness campaigns and increase research on the reasons for short sleep among different groups. Given the ethnic disparity in sleep duration, target interventions for Māori and Pacific peoples are particularly crucial.