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Lau SCL, Hall ML, Terhorst L, Skidmore ER. Bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors: An ecological momentary assessment study. PM R 2024; 16:669-678. [PMID: 37950680 DOI: 10.1002/pmrj.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/13/2023] [Accepted: 11/04/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Sleep plays a critical role in daily functioning and stroke recovery but receives little attention in stroke rehabilitation. Sleep disturbances are linked to affective and cognitive impairments, but temporal associations between sleep and affect and cognitive symptoms are less clear. Understanding these temporal associations may inform new directions in intervention and prevention to support continued stroke recovery. OBJECTIVE To examine the bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors. DESIGN A secondary analysis of a longitudinal observational study involving 7 days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys and a sleep diary per day. Multilevel modeling was used to analyze data. SETTING Community. PARTICIPANTS Community-dwelling stroke survivors (N = 40). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES EMA measures of depressed affect, cheerful affect, and cognitive symptoms. Sleep quality and duration as measured using a sleep diary. RESULTS Between-person sleep quality was negatively associated with next-day depressed affect (B = -.16; p = .028) and positively associated with next-day cheerful affect (B = .63; p < .001). Inversely, between-person depressed affect was negatively associated with next night sleep quality (B = -.77; p = .015), and vice versa for cheerful affect (between-person: B = .45; p < .001; within-person: B = .09; p = .008). Long sleep (>9 hours) was positively associated with next-day cognitive symptoms (B = .13; p = .002), whereas cognitive symptoms were associated with a higher odds of long sleep the following night (odds ratio [OR] = 0.25; p = .047). CONCLUSIONS This study identified the bidirectional associations of sleep with affect and cognitive symptoms in the context of the everyday life of stroke survivors. The findings suggest that interventions addressing sleep quality and duration may impact affect and cognitive symptoms, and vice versa.
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Affiliation(s)
- Stephen C L Lau
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Martica L Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zhao Y, Liu J, Xia JH, Li C, Ma XQ. Dose-response relationship between sleep duration and cardiovascular metabolic multimorbidity among older adults in China: A nationwide survey. J Affect Disord 2024; 354:75-81. [PMID: 38479505 DOI: 10.1016/j.jad.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
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.
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Affiliation(s)
- Yu Zhao
- HanZhong Central Hospital, HanZhong, China
| | - Juan Liu
- HanZhong Central Hospital, HanZhong, China
| | | | - Cui Li
- HanZhong Central Hospital, HanZhong, China
| | - Xiu-Qin Ma
- HanZhong Central Hospital, HanZhong, China.
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Grech E, Cuschieri S. A Good Night's Sleep in Malta in 2023: A Cross-sectional Study Exploring Sleep Quality and its Determinants via Social Media. J Res Health Sci 2024; 24:e00602. [PMID: 39072538 PMCID: PMC10999107 DOI: 10.34172/jrhs.2024.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/10/2024] [Accepted: 03/07/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Sleep quality is affected by a plethora of different factors, although its relationship with chronic diseases is still unclear. This study explored perceived sleep quality and its associated determinants among the adult population of Malta. Study Design: A cross-sectional study. METHODS An anonymous online survey was distributed through social media targeting adults residing in Malta. Data pertaining to socio-demographic, medical history, lifestyle, well-being, sleep, and daytime sleepiness were gathered, and descriptive, univariant, and multiple binary logistic regression modelling analyses were performed. RESULTS A total of 855 adults responded, out of whom 35.09% (95% confidence interval [CI]: 31.90, 38.41) reported sleep difficulties, especially females (81.33%; 95% CI: 76.36, 85.49), while 65.33% (95% CI: 59.61, 70.65) reported suffering from chronic disease(s). Sleep problems were positively associated with multimorbidity (odds ratio [OR]: 2.17; 95% CI: 1.38, 3.40; P=0.001), sleeping<6 hours (OR: 3.79; 95% CI: 1.54, 9.30; P=0.040), and the presence of moderate anxiety symptoms (OR: 1.99; 95% CI: 1.10, 3.59; P=0.020). They were also related to the presence of mild (OR: 2.25; 95% CI: 1.46, 3.45; P=0.001), moderate (OR: 2.40; 95% CI: 1.24, 4.64; P=0.010), and moderately severe (OR: 15.35; 95% CI: 4.54, 31.86; P=0.001) depressive symptoms after adjusting for confounders. CONCLUSION Chronic conditions, including anxiety and depression, along with short sleep duration, appear to contribute to poor sleep quality in Malta. A multifaceted approach is required to deal with the issue holistically and safeguard the health of current and future generations.
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Affiliation(s)
| | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Epidemiology and Biostatistics, Western University, London, Canada
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Wang X, Wang R, Zhang D. Bidirectional associations between sleep quality/duration and multimorbidity in middle-aged and older people Chinese adults: a longitudinal study. BMC Public Health 2024; 24:708. [PMID: 38443848 PMCID: PMC10916205 DOI: 10.1186/s12889-024-17954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
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.
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Affiliation(s)
- Xiaoran Wang
- Institute of Hospital Management/Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Rui Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Dan Zhang
- Institute of Hospital Management/Shenzhen International Graduate School, Tsinghua University, Shenzhen, China.
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Zheng X, Xue B, Xiao S, Li X, Chen Y, Shi L, Liang X, Tian F, Zhang C. Development and validation of a multimorbidity risk prediction nomogram among Chinese middle-aged and older adults: a retrospective cohort study. BMJ Open 2023; 13:e077573. [PMID: 37940154 PMCID: PMC10632863 DOI: 10.1136/bmjopen-2023-077573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES The aim of this study is to establish a self-simple-to-use nomogram to predict the risk of multimorbidity among middle-aged and older adults. DESIGN A retrospective cohort study. PARTICIPANTS We used data from the Chinese Longitudinal Healthy Longevity Survey, including 7735 samples. MAIN OUTCOME MEASURES Samples' demographic characteristics, modifiable lifestyles and depression were collected. Cox proportional hazard models and nomogram model were used to estimate the risk factors of multimorbidity. RESULTS A total of 3576 (46.2%) participants have multimorbidity. The result showed that age, female (HR 0.80, 95% CI 0.72 to 0.89), chronic disease (HR 2.59, 95% CI 2.38 to 2.82), sleep time (HR 0.78, 95% CI 0.72 to 0.85), regular physical activity (HR 0.88, 95% CI 0.81 to 0.95), drinking (HR 1.27 95% CI 1.16 to 1.39), smoking (HR 1.40, 95% CI 1.26 to 1.53), body mass index (HR 1.04, 95% CI 1.03 to 1.05) and depression (HR 1.02, 95% CI 1.01 to 1.03) were associated with multimorbidity. The C-index of nomogram models for derivation and validation sets were 0.70 (95% CI 0.69 to 0.71, p=0.006) and 0.71 (95% CI 0.70 to 0.73, p=0.008), respectively. CONCLUSIONS We have crafted a user-friendly nomogram model for predicting multimorbidity risk among middle-aged and older adults. This model integrates readily available and routinely assessed risk factors, enabling the early identification of high-risk individuals and offering tailored preventive and intervention strategies.
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Affiliation(s)
- Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Benli Xue
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Yimin Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Lei Shi
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xiaoyan Liang
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Feng Tian
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
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Zhou Y, Ni Y, Jones M, Dai X, Lim CCW, Zhu A, Xu X. Sleep Behaviors and Progression of Multimorbidity in Middle-Aged and Older Adults: A Prospective Cohort Study From China. J Gerontol A Biol Sci Med Sci 2023; 78:1871-1880. [PMID: 36943283 DOI: 10.1093/gerona/glad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 03/23/2023] Open
Abstract
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.
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Affiliation(s)
- Yaguan Zhou
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yujie Ni
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Mark Jones
- Institute for Evidence-based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Anna Zhu
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Xiaolin Xu
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
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Nistor P, Chang-Kit B, Nicholson K, Anderson KK, Stranges S. The relationship between sleep health and multimorbidity in community dwelling populations: Systematic review and global perspectives. Sleep Med 2023; 109:270-284. [PMID: 37490803 DOI: 10.1016/j.sleep.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
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.
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Affiliation(s)
- Patricia Nistor
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
| | - Brittany Chang-Kit
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Kathryn Nicholson
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada; Luxembourg Institute of Health, Luxembourg
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Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol 2023; 13:20451253231195274. [PMID: 37663084 PMCID: PMC10469275 DOI: 10.1177/20451253231195274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
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.
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Affiliation(s)
- David M. Carlson
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg. 401, Rm. A236, Mail Code 116AE, Los Angeles, CA 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Zhou Y, Jin Y, Zhu Y, Fang W, Dai X, Lim C, Mishra SR, Song P, Xu X. Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis. Public Health Rev 2023; 44:1605469. [PMID: 37383367 PMCID: PMC10293634 DOI: 10.3389/phrs.2023.1605469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 06/04/2023] [Indexed: 06/30/2023] Open
Abstract
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.
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Affiliation(s)
- Yaguan Zhou
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yichen Jin
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Zhu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Fang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Carmen Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | - Peige Song
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaolin Xu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Ding R, Ding P, Tian L, Kuang X, Huang L, Shi H. Sleep duration trajectories and all-cause mortality among Chinese elderly: A community-based cohort study. BMC Public Health 2023; 23:1095. [PMID: 37344863 DOI: 10.1186/s12889-023-15894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND China is among the largest and fastest aging countries. The elderly population is more vulnerable, with higher proportion of inappropriate sleep duration and risk of mortality, compared with young and middle-aged adults. Single-measured sleep duration has been associated with mortality, but the health effects of long-term sleep duration trajectories remain unknown. This study aimed to explore the prospective associations between sleep duration trajectories and all-cause mortality among Chinese elderly. METHODS Participants (n = 3,895; median age: 82 years; females: 53.3%) who reported sleep duration in all three surveys (2005, 2008, and 2011) from the community-based Chinese Longitudinal Healthy Longevity Survey (CLHLS) were followed up until 2019 (about 8 years). We identified sleep duration trajectories by latent class mixed model and explored their association with all-cause mortality using Cox hazard proportional regression and Laplace regression models. Further, stratified analysis by demographic characteristics and lifestyles and sensitivity analysis by lag effect, health-related factors, and inverse probability weighting were used to verify the robustness of the association. In addition, we explored the threshold effect of baseline sleep duration on the risk of all-cause mortality. RESULTS We documented 1,881 all-cause deaths during 16,689 person-years of follow-up. Five sleep duration trajectories were identified: moderately increased trajectory (28.1%), rapidly increased trajectory (7.2%), persistent sleep trajectory of 7 h (33.7%), moderately decreased trajectory (21.3%), and rapidly decreased trajectory (9.7%). Compared with the persistent sleep trajectory of 7 h, the multivariable-adjusted HRs (95%CI) for moderately increased trajectory, rapidly increased trajectory, moderately decreased trajectory, and rapidly decreased trajectory were 1.21 (1.08, 1.36), 1.21 (1.01, 1.44), 0.95 (0.82, 1.10), and 0.93 (0.78, 1.11), respectively; and the corresponding difference in median survival time (95%CI) were -0.53 (-1.01, -0.05), -0.43 (0.16, -1.02), 0.26 (-0.34, 0.86), and 0.25 (-0.51, 1.02), respectively. Stratified and sensitivity analyses showed consistent results. Threshold analysis indicated a sharply increased risk of mortality in participants whose sleep exceeds 9 h (HR = 1.20, 95%CI: 1.11, 1.30). CONCLUSION Compared with the persistent sleep trajectory of 7 h, moderately and rapidly increased sleep duration trajectories were associated with higher subsequent mortality in Chinese elderly. Those who report sleep exceeding 9 h may be at high risk for all-cause mortality.
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Affiliation(s)
- Rongxiu Ding
- School and Hospital of Stomatology, Wenzhou Medical University, 325000, Wenzhou, Zhejiang, P.R. China
| | - Pan Ding
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, 325000, Wenzhou, China
| | - Liuhong Tian
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, 325000, Wenzhou, China
| | - Xiaodan Kuang
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, 325000, Wenzhou, China
| | - Li Huang
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, 325000, Wenzhou, China
| | - Hongying Shi
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, 325000, Wenzhou, China.
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Guo J, Li A, Chen M, Wei D, Wu J, Wang T, Hu Y, Lin Y, Xu X, Yang L, Wen Y, Li H, Xie X, Wu S. Association of longitudinal patterns of nighttime sleep duration and daytime napping duration with risk of multimorbidity. Sleep Health 2023; 9:363-372. [PMID: 37076420 DOI: 10.1016/j.sleh.2023.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/14/2023] [Accepted: 02/15/2023] [Indexed: 04/21/2023]
Abstract
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.
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Affiliation(s)
- Jianhui Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Aina Li
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350001, China
| | - Mingjun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Donghong Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Jieyu Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Tinggui Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yuduan Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yawen Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xingyan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Le Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yeying Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
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12
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Idalino SCC, Canever JB, Cândido LM, Wagner KJP, de Souza Moreira B, Danielewicz AL, de Avelar NCP. Association between sleep problems and multimorbidity patterns in older adults. BMC Public Health 2023; 23:978. [PMID: 37237275 DOI: 10.1186/s12889-023-15965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
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.
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Affiliation(s)
- Stefany Cristina Claudino Idalino
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
| | - Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
- Post-Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Letícia Martins Cândido
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
| | - Katia Jakovljevic Pudla Wagner
- Federal University of Santa Catarina (UFSC), Campus Curitibanos, Rod. Ulysses Gaboardi, 300, Curitibanos, 89520-000, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais (UFMG), Av. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil.
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Sheehan C, Louie P, Li L, Kulis SS. Exposure to neighborhood poverty from adolescence through emerging adulthood and sleep duration in US adults. Health Place 2023; 81:103004. [PMID: 36940492 PMCID: PMC10164711 DOI: 10.1016/j.healthplace.2023.103004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/22/2023]
Abstract
Does exposure to neighborhood poverty from adolescence to early adulthood have differential influence on sleep duration across racial/ethnic groups? We used data from the National Longitudinal Study of Adolescent to Adult Health that consisted of 6756 Non-Hispanic (NH) White respondents, 2471 NH Black respondents, and 2000 Hispanic respondents and multinomial logistic models to predict respondent reported sleep duration based on exposure to neighborhood poverty during adolescence and adulthood. Results indicated that neighborhood poverty exposure was related to short sleep duration among NH White respondents only. We discuss these results in relation to coping, resilience, and White psychology.
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Affiliation(s)
- Connor Sheehan
- School of Social and Family Dynamics, Arizona State University, USA; T. Denny Sanford School of Social and Family Dynamics, Arizona State University, P.O. Box 873701, Tempe, Arizona, 85287-3701, USA.
| | - Patricia Louie
- Department of Sociology, University of Washington, 211 Savery Hall, Seattle, WA, 98195-3340, USA.
| | - Longfeng Li
- Department of Psychology, The Pennsylvania State University, 140 Moore Building, University Park, PA, 16802, USA.
| | - Stephen S Kulis
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, P.O. Box 873701, Tempe, Arizona, 85287-3701, USA.
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Collings PJ, Backes A, Aguayo GA, Fagherazzi G, Malisoux L. Substituting device-measured sedentary time with alternative 24-hour movement behaviours: compositional associations with adiposity and cardiometabolic risk in the ORISCAV-LUX 2 study. Diabetol Metab Syndr 2023; 15:70. [PMID: 37013622 PMCID: PMC10071757 DOI: 10.1186/s13098-023-01040-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is a considerable burden of sedentary time in European adults. We aimed to quantify the differences in adiposity and cardiometabolic health associated with theoretically exchanging sedentary time for alternative 24 h movement behaviours. METHODS This observational cross-sectional study included Luxembourg residents aged 18-79 years who each provided ≥ 4 valid days of triaxial accelerometry (n = 1046). Covariable adjusted compositional isotemporal substitution models were used to examine if statistically replacing device-measured sedentary time with more time in the sleep period, light physical activity (PA), or moderate-to-vigorous PA (MVPA) was associated with adiposity and cardiometabolic health markers. We further investigated the cardiometabolic properties of replacing sedentary time which was accumulated in prolonged (≥ 30 min) with non-prolonged (< 30 min) bouts. RESULTS Replacing sedentary time with MVPA was favourably associated with adiposity, high-density lipoprotein cholesterol, fasting glucose, insulin, and clustered cardiometabolic risk. Substituting sedentary time with light PA was associated with lower total body fat, fasting insulin, and was the only time-exchange to predict lower triglycerides and a lower apolipoprotein B/A1 ratio. Exchanging sedentary time with more time in the sleep period was associated with lower fasting insulin, and with lower adiposity in short sleepers. There was no significant evidence that replacing prolonged with non-prolonged sedentary time was related to outcomes. CONCLUSIONS Artificial time-use substitutions indicate that replacing sedentary time with MVPA is beneficially associated with the widest range of cardiometabolic risk factors. Light PA confers some additional and unique metabolic benefit. Extending sleep, by substituting sedentary time with more time in the sleep period, may lower obesity risk in short sleepers.
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Affiliation(s)
- Paul J Collings
- Physical Activity, Sport and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, 1 A-B rue Thomas Edison, L-1445, Strassen, Luxembourg
| | - Anne Backes
- Physical Activity, Sport and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, 1 A-B rue Thomas Edison, L-1445, Strassen, Luxembourg
| | - Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, L-1445, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, L-1445, Strassen, Luxembourg
| | - Laurent Malisoux
- Physical Activity, Sport and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, 1 A-B rue Thomas Edison, L-1445, Strassen, Luxembourg.
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Delpino FM, Caputo EL, Arcêncio RA, Cassuriaga J, Huckembeck CM, Nunes BP, Rombaldi AJ, Reichert FF, da Silva MC, Feter N. Association of Sleep Duration and Use of Sleeping Medication with Multimorbidity in Adults: Results from the PAMPA (Brazil) Cohort Study. Sleep Sci 2023; 16:68-74. [PMID: 37151761 PMCID: PMC10157832 DOI: 10.1055/s-0043-1767757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/14/2022] [Indexed: 05/09/2023] Open
Abstract
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.
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Affiliation(s)
- Felipe Mendes Delpino
- Federal University of Pelotas, Postgraduate Program in Nursing, Pelotas, Rio Grande do Sul, Brazil
- University of São Paulo, Postgraduate Program in Nursing in Public Health, São Paulo, São Paulo, Brazil
- Address for correspondence Felipe Mendes Delpino
| | - Eduardo L. Caputo
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | | | - Júlia Cassuriaga
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Caroline Malue Huckembeck
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Bruno Pereira Nunes
- Federal University of Pelotas, Postgraduate Program in Nursing, Pelotas, Rio Grande do Sul, Brazil
| | - Airton José Rombaldi
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Felipe Fossati Reichert
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Marcelo Cozzensa da Silva
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Natan Feter
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
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16
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Méndez-Flores JJ, Marroquín-Cosar RE, Bernabé-Ortiz A. Multimorbidity and Sleep Patterns among Adults in a Peruvian Semi-Urban Area. Sleep Sci 2023; 16:51-58. [PMID: 37151763 PMCID: PMC10157817 DOI: 10.1055/s-0043-1767755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/12/2022] [Indexed: 05/09/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Antonio Bernabé-Ortiz
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Lima, Peru
- Address for correspondence Antonio Bernabé-Ortiz
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Muhammad T, Meher T, Siddiqui LA. Mediation of the association between multi-morbidity and sleep problems by pain and depressive symptoms among older adults: Evidence from the Longitudinal Aging Study in India, wave- 1. PLoS One 2023; 18:e0281500. [PMID: 36758012 PMCID: PMC9910705 DOI: 10.1371/journal.pone.0281500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND There could be several possible mechanisms on how chronic conditions relate to sleep problems in older persons; for instance, pain and sleep have a strong link and depressive symptoms are similarly associated with sleep problems. The present study explored whether pain and depressive symptoms are mediators in the relationship between multi-morbidity and sleep problems among older adults. METHODS Study utilized data from the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults age 60 years and above. Multivariable logistic regression along with mediation analysis using Karlson-Holm-Breen (KHB) method was conducted. RESULTS A proportion of 14.8% of the participants suffered from sleep problems, whereas, 22.5% and 8.7% of older adults had multi-morbidity and had depressive symptoms, respectively. Also, around 10.3% of older adults reported pain and received no medication for the relief of pain, whereas 29.3% of older adults reported pain and received some type of medication for the relief of pain. Older adults with multi-morbidity had higher odds of suffering from sleep problems [adjusted odds ratio (aOR):1.26, confidence interval (CI):1.10-1.45] than those who had no multi-morbidity. Older adults who reported pain but received no medication for the relief of pain [aOR: 1.90, CI: 1.64-2.22] or reported pain and received medication for the relief of pain [aOR: 1.82, CI:1.62-2.04] and those who had depressive symptoms [aOR: 2.21, CI:1.89-2.57%] had higher odds of suffering from sleep problems compared to those who did not report pain and had no depressive symptoms, respectively. Around 11.2% of the association of multi-morbidity with sleep problems was mediated by pain and 4.3% of such association was mediated by depressive symptoms. CONCLUSION Pain and depressive symptoms were found to mediate the association between multi-morbidity and sleep problems; therefore, reducing pain and depressive symptoms may be considered to improve sleep in older multi-morbid patients.
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Affiliation(s)
- T. Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Trupti Meher
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Laeek Ahemad Siddiqui
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, Maharashtra, India
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Somi M, Ostadrahimi A, Gilani N, Haji Kamanaj A, Hassannezhad S, Faramarzi E. Patterns and Predictors of Multimorbidity in the Azar Cohort. ARCHIVES OF IRANIAN MEDICINE 2023; 26:8-15. [PMID: 37543916 PMCID: PMC10685807 DOI: 10.34172/aim.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/27/2022] [Indexed: 08/08/2023]
Abstract
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.
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Affiliation(s)
- Mohammdhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Haji Kamanaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hassannezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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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. PLoS Med 2022; 19:e1004109. [PMID: 36256607 PMCID: PMC9578599 DOI: 10.1371/journal.pmed.1004109] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022] Open
Abstract
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.
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Physical multimorbidity predicts the onset and persistence of anxiety: A prospective analysis of the Irish Longitudinal Study on Ageing. J Affect Disord 2022; 309:71-76. [PMID: 35452758 DOI: 10.1016/j.jad.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aims of the present study were to examine prospective associations of multimorbidity (i.e., ≥2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship. METHODS Data from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. Anxiety referred to score ≥ 8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up. RESULTS Data on 5871 adults aged ≥50 years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, ≥3 chronic conditions were associated with a significant 1.89 (95% CI = 1.16-3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and ≥3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%-37.8% of the associations. CONCLUSION Multimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 262] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Lima MG, Barros MBDA, Malta DC, Medina LDPB, Szwarcwald CL. Association of self-reported sleep problems with morbidities and multimorbidities according to sex: National Health Survey 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021386. [PMID: 35730889 PMCID: PMC9897816 DOI: 10.1590/ss2237-9622202200007.especial] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the association between self-reported sleep problems and the presence of non-communicable diseases (NCDs) and multimorbidity, and whether these associations differ by sex. METHODS This is a cross sectional study performed with data from the Brazilian National Health Survey, 2019. Prevalence ratios between morbidities, the number of NCDs, and the self-report of sleep problems were estimated by Poisson regression with robust variance, according to sex. RESULTS This study analysed data from 85,531 Brazilians age ≥ 18 years. The self-reported sleep problems were associated with all the herein studied morbidities and multimorbidities. The prevalence of sleep problems was higher in those who stated one or two (PR = 2.37; 95%CI 2.22;2.54) and three or more NCDs (PR = 4.73; 95%CI 4.37;5.11). Prevalence ratios of the association with diabetes, lung disease, mental disease, renal disease and multimorbidities were higher among males. CONCLUSION NCDs significantly impacted sleep quality, with a particularly stronger association in both, males and females.
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Affiliation(s)
| | | | | | | | - Célia Landmann Szwarcwald
- Fundação Instituto Oswaldo Cruz, Instituto de Comunicação e
Informação Científica e Tecnológica em Saúde, Rio de Janeiro, RJ, Brazil
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Association between sleep and multimorbidity in Chinese elderly: Results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Sleep Med 2022; 98:1-8. [PMID: 35753186 DOI: 10.1016/j.sleep.2022.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
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.
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Using Structural Equation Modeling to Examine Pathways between Physical Activity and Sleep Quality among Chinese TikTok Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095142. [PMID: 35564536 PMCID: PMC9105446 DOI: 10.3390/ijerph19095142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 02/07/2023]
Abstract
TikTok, the most popular social media, brings various benefits to nowadays living. However, the problematic use of TikTok has also elicited a range of health problems, such as sleep problems. Physical activity (PA) appears to play a protective role in the problematic use of TikTok and its health consequences, but the pathways between PA and sleep health are understudied. Therefore, we aimed to propose a framework to check whether PA can benefit the sleep health of TikTok users by reducing bedtime delays for TikTok. Stress and mental health issues were also considered as they are potential mediators between PA and sleep health and may also influence the problematic use of smartphones. A cross-sectional investigation that involved 660 Chinese TikTok users was conducted in April 2021. The volume of PA, perceived stress (PSS-10), depression (PHQ-9), anxiety (GAD-7), bedtime delay for TikTok use, and sleep quality (PSQI) were investigated through an online questionnaire survey. Structural equation modeling was employed to examine pathways from PA to sleep quality through stress, mental health issues (depression and anxiety), and bedtime delay for TikTok. We found that PA exerted a significant effect on sleep quality through indirect pathways (β = −0.056, p = 0.001). Stress was a critical mediator of all indirect pathways, and the pathway mediated by stress and mental health issues made a major contribution to the total effect (β = −0.048, p = 0.002). The identified pathways mediated by bedtime delay for TikTok were relatively weak but significant. PA showed a distinct effect on bedtime delay for TikTok through stress and mental health issues (β = −0.043, p = 0.001). In conclusion, our framework highlights some pathways to understanding the benefits of PA on TikTok users’ sleep quality. Future research is warranted to explore extra indirect pathways and re-examine the causal relationships between variables.
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Kyprianidou M, Panagiotakos D, Makris KC, Kambanaros M, Christophi CA, Giannakou K. The Lifestyle Profile of Individuals with Cardiovascular and Endocrine Diseases in Cyprus: A Hierarchical, Classification Analysis. Nutrients 2022; 14:nu14081559. [PMID: 35458120 PMCID: PMC9027605 DOI: 10.3390/nu14081559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
The study aims to explore the lifestyle profile of adult individuals with cardiovascular and endocrine diseases in Cyprus. Age and sex-specific analyses were applied. A representative sample of the general adult population was recruited during 2018–2019 using stratified sampling among the five government-controlled municipalities of the Republic of Cyprus. Data on Mediterranean diet adherence, quality of sleep, smoking status, physical activity, Body Mass Index, and the presence of cardiovascular and endocrine diseases were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, Tenth Revision (ICD-10). A total of 1140 men and women over 18 years old (range: 18–94) participated in the study. The prevalence of cardiovascular and endocrine diseases among the adult general population of Cyprus was 24.8% and 17.2%, respectively, with a higher prevalence of cardiovascular diseases in men, and a higher prevalence of endocrine diseases in women. Among individuals with cardiovascular disease, 23.3% were aged between 18–44 years old, while the corresponding percentage among endocrine disease individuals was 48%. The prevalence of smoking, physical activity, a low adherence to the Mediterranean diet, poor quality of sleep and obesity among the study population was 35.5%, 48.0%, 32.9%, 39.0% and 13.6%, respectively. Individuals with cardiovascular and endocrine diseases were characterized by poor quality of sleep, inadequate physical activity, and a higher BMI. This is the first study in Cyprus exploring the profile of individuals with cardiovascular and endocrine diseases in Cyprus. Health promotion and educational programs focusing on the importance of sleep quality, healthier dietary habits, physical activity, and lower BMIs among people with cardiovascular and endocrine diseases should be developed.
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Affiliation(s)
- Maria Kyprianidou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus; (M.K.); (K.C.M.); (C.A.C.)
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece;
| | - Konstantinos C. Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus; (M.K.); (K.C.M.); (C.A.C.)
| | - Maria Kambanaros
- Department of Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
| | - Costas A. Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus; (M.K.); (K.C.M.); (C.A.C.)
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
- Correspondence: ; Tel.: +357-2255-9656
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Zou C, Sun H, Lu C, Chen W, Guo VY. Nighttime sleep duration, restlessness and risk of multimorbidity - A longitudinal study among middle-aged and older adults in China. Arch Gerontol Geriatr 2022; 99:104580. [DOI: 10.1016/j.archger.2021.104580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 01/02/2023]
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Kyprianidou M, Panagiotakos D, Kambanaros M, Makris KC, Christophi CA. Quality of Sleep in the Cypriot Population and Its Association With Multimorbidity: A Cross-Sectional Study. Front Public Health 2021; 9:693332. [PMID: 34778165 PMCID: PMC8585989 DOI: 10.3389/fpubh.2021.693332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Poor sleep is a relatively common condition with possibly serious adverse health consequences. Lack of sleep affects the endocrine, immune, and nervous systems. In Cyprus, there is no information about the quality of sleep in the population. The goal of this study was to assess the quality of sleep in the Cypriot population and evaluate its association with multimorbidity. A representative sample of the adult population of Cyprus was selected in 2018-2019 among the five government-controlled municipalities of the Republic of Cyprus using stratified sampling. Data on sleep quality as well as on the presence of chronic, clinical, and mental health conditions were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision (ICD-10). A total of 1,140 Cypriot men and women over 18-years of age (range: 18-94) participated in the study. The median Pittsburgh sleep quality index score of the participants was 5 (first quartile = 3, third quartile = 7) with the maximum score being 17, which suggests that the Cypriot population has a relatively good quality of sleep overall, although, almost one-third of the study population had a poor quality of sleep. Women, residents of Paphos, and married people had a poorer quality of sleep (p < 0.05). Having a poor quality of sleep was associated with higher odds of multimorbidity (OR = 2.21, 95% CI: 1.55, 3.16), even after adjusting for demographics, socioeconomic, and lifestyle factors. Adopting good sleep habits could be beneficial and would potentially help reduce the risk of multimorbidity. Public health guidelines regarding the importance of sleep and its association with multimorbidity should be considered.
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Affiliation(s)
- Maria Kyprianidou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Maria Kambanaros
- Department of Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Konstantinos C. Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Costas A. Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
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Lee S, Yu S. Effectiveness of Information and Communication Technology (ICT) Interventions in Elderly's Sleep Disturbances: A Systematic Review and Meta-Analysis. SENSORS 2021; 21:s21186003. [PMID: 34577212 PMCID: PMC8468949 DOI: 10.3390/s21186003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022]
Abstract
Sleep is a crucial factor for human health and is closely related to quality of life. Sleep disturbances constitute a health problem that should be solved, especially when it affects the elderly. This study aims to examine the effectiveness of information and communication technologies (ICT) interventions in managing sleep disturbances in the elderly. The study used a systematic review of three databases: Ovid-Medline, Ovid-EMBASE, and the Cochrane library database for papers published till 15 April 2021. Two authors independently selected and screened relevant studies based on predefined inclusion criteria. The meta-analysis of randomized controlled trials (RCTs) was carried out using Review Manager 5.4. Two authors independently screened the titles and abstracts of 4297 studies considering both inclusion and exclusion criteria. The complete texts of 47 articles were then evaluated, 31 articles were excluded, and finally, 16 articles were selected. Our meta-analysis showed that the cognitive-behavioral therapy for insomnia (CBT-I) group had a significantly reduced Insomnia Severity Index (ISI) compared to the control group (−4.81 [−5.56, −4.06], p < 0.00001, I2 = 83%) in RCTs, with a significant reduction in ISI (3.47 [1.58, 5.35], p = 0.0003) found in quasi-experimental studies. A significant improvement was found in total sleep time in the CBT-I group compared to the control group (29.24 [15.41, 43.07], p <0.0001) in RCTs, while the CBT-I group showed significantly reduced wake time after sleep onset compared to the control group (−20.50 [−26.60, −14.41], p < 0.00001). In addition, a significant reduction in depression was found in the CBT-I group compared to the control group (−2.11 [−2.85, −1.37], p < 0.00001, I2 = 0%) in RCTs. The quality of life–mental component score (5.75 [1.64, 9.87], p = 0.006, I2 = 0%) and the quality of life–physical component score (5.19 [0.76, 9.62], p = 0.02, I2 = 0%) showed significant improvement in the CBT-I group compared to the control group. ICT interventions showed positive effects on sleep disturbances of the elderly, specifically confirming the positive effect on depression and quality of life as well as the indicators directly related to sleep such as ISI and quality of sleep. Thus, the application of ICT in the healthcare sector will be greater in the future, with changes in the nursing education and practice guidelines so that nurses can play a pivotal role in promoting health behaviors such as sleep-related quality of life and daily activities of the elderly.
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Affiliation(s)
- Seonheui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Korea;
| | - Soyoung Yu
- College of Nursing, CHA University, Pocheon 11160, Gyeonggido, Korea
- Correspondence: ; Tel.: +82-31-727-8886
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He L, Biddle SJH, Lee JT, Duolikun N, Zhang L, Wang Z, Zhao Y. The prevalence of multimorbidity and its association with physical activity and sleep duration in middle aged and elderly adults: a longitudinal analysis from China. Int J Behav Nutr Phys Act 2021; 18:77. [PMID: 34112206 PMCID: PMC8194125 DOI: 10.1186/s12966-021-01150-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/02/2021] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Li He
- College of Physical Education and Sport, Beijing Normal University, Xinjiekouwai Street 19, Haidian District, Beijing, 100875, China
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - John Tayu Lee
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia.,Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Nadila Duolikun
- Women & Child Health Program, GIC, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Lin Zhang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Zijie Wang
- College of Physical Education and Sport, Beijing Normal University, Xinjiekouwai Street 19, Haidian District, Beijing, 100875, China
| | - Yang Zhao
- Women & Child Health Program, GIC, The George Institute for Global Health at Peking University Health Science Center, Beijing, China. .,WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia.
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Aguayo GA, Pastore J, Backes A, Stranges S, Witte DR, Diederich NJ, Alkerwi A, Huiart L, Ruiz-Castell M, Malisoux L, Fagherazzi G. Objective and subjective sleep measures are associated with HbA1c and insulin sensitivity in the general population: Findings from the ORISCAV-LUX-2 study. DIABETES & METABOLISM 2021; 48:101263. [PMID: 34023494 DOI: 10.1016/j.diabet.2021.101263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022]
Abstract
AIM To analyze the association of objective and subjective sleep measures with HbA1c and insulin sensitivity in the general population. METHODS Using a cross-sectional design, data from 1028 participants in the ORISCAV-LUX-2 study from the general population in Luxembourg were analyzed. Objective sleep measures were assessed using accelerometers whereas subjective measures were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Sleep measures were defined as predictors, while HbA1c and quantitative insulin sensitivity check index (QUICKI) scores were considered outcomes. Linear and spline regression models were fitted by progressively adjusting for demographic and lifestyle variables in the total sample population as well as by stratified analyses using gender, obesity status, depressive symptoms and diabetes status. RESULTS In fully adjusted models, total and deep sleep durations were associated with lower HbA1c (mmol/mol) levels, whereas sleep coefficients of variation (%) and poor sleep efficiency, as measured by PSQI scores (units), were associated with higher HbA1c levels. In stratified models, such associations were observed mainly in men, and in subjects who had depressive symptoms, were overweight and no diabetes. In addition, total sleep, deep sleep, coefficients of variation and poor sleep efficiency as measured by PSQI revealed non-linear associations. Similarly, greater insulin sensitivity was associated with longer total sleep time and with PSQI-6 (use of sleep medication). CONCLUSION Associations were more frequently observed between sleep characteristics and glycaemic control with the use of objective sleep measures. Also, such associations varied within subgroups of the population. Our results highlight the relevance of measuring sleep patterns as key factors in the prevention of diabetes.
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Affiliation(s)
- Gloria A Aguayo
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Jessica Pastore
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Anne Backes
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Saverio Stranges
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg; Department of Epidemiology and Biostatistics and Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Nico J Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Laetitia Huiart
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Maria Ruiz-Castell
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Laurent Malisoux
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Alonzo R, Hussain J, Stranges S, Anderson KK. Interplay between social media use, sleep quality, and mental health in youth: A systematic review. Sleep Med Rev 2020; 56:101414. [PMID: 33385767 DOI: 10.1016/j.smrv.2020.101414] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
Social media applications are increasingly prominent among youth. This systematic review provides a comprehensive assessment of the literature on the relationship between active social media use, sleep quality, and common mental health outcomes (anxiety, depression, and psychological distress) among youth. MEDLINE, PsychINFO, EMBASE and Scopus were searched for observational studies investigating this relationship among youth (aged 16-25). Thirty-six cross-sectional studies and six prospective cohort studies met the inclusion criteria. Among cross-sectional studies, significant associations between excessive social media use with poor mental health outcomes (n = 33), poor sleep quality (n = 24), and significant associations between poor sleep quality and negative mental health (n = 16) were found. In longitudinal studies, frequent social media use was a risk factor for both poor mental health (n = 6) and poor sleep outcomes (n = 5). Some studies showed sleep quality mediating the relationship between social media use and negative mental health outcomes in youth. Overall, included evidence links excessive social media use to poor sleep quality and negative mental health in youth. Given the public health implications of sleep problems, excessive social media use warrants further investigation to clarify the directionality and strength of their associations with poor sleep quality and negative mental health outcomes.
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Affiliation(s)
- Rea Alonzo
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Junayd Hussain
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada.
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Wilk P, Stranges S, Maltby A. Geographic variation in short and long sleep duration and poor sleep quality: a multilevel analysis using the 2015-2018 Canadian community health survey. Sleep Health 2020; 6:676-683. [PMID: 32335041 DOI: 10.1016/j.sleh.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a dearth of evidence on geographic variation in sleep duration and quality, and about the effect of geographic location or "place" on sleep. The objective was to assess the magnitude of geographic variation in sleep duration and sleep quality in Canada, while controlling for individual-level factors. METHODS Data from the 2015-2018 cycles of the Canadian Community Health Survey were used. The sample consisted of 96,484 respondents from 6 provinces. Multilevel logistic regression techniques were used to assess the magnitude of geographic variation in self-reported measures of short and long sleep duration and 3 indicators of sleep quality (difficulty initiating and maintaining sleep, daytime sleepiness, and finding sleep refreshing) across geographic areas, defined by the boundaries of Forward Sortation Areas. RESULTS Overall, 45.31% of respondents reported short sleep, 2.31% reported long sleep, 46.97% had difficulty initiating and maintaining sleep, 29.50% had daytime sleepiness, and 39.11% did not find their sleep refreshing. After controlling for individual-level factors, geographic variation accounted for 4.00% and 13.67% of overall variance in short and long sleep duration, respectively; the corresponding estimates for difficulty initiating and maintaining sleep, daytime sleepiness, and finding sleep refreshing were 3.04%, 3.80%, and 5,08%, respectively. CONCLUSIONS There is a significant level of geographic variation in short and long sleep duration and sleep quality and this variation cannot be accounted for by differential distribution of individual characteristics across geographic areas. Future research is warranted to examine specific contextual factors that can account for this variation.
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Affiliation(s)
- Piotr Wilk
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, Ontario N6A 5C1, Canada; Department of Paediatrics, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada; Child Health Research Institute, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada.
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, Ontario N6A 5C1, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1465 Richmond St, London, Ontario N6G 2M1, Canada; Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B rue Thomas Edison, Strassen L-1445, Luxembourg
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, Ontario N6A 5C1, Canada
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