Sleep Quality and Associated Factors among Diabetes, Hypertension, and Heart Failure Patients at Debre Markos Referral Hospital, Northwest Ethiopia

Quality of Sleep and Its Determinants Among People with Diabetes Mellitus in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BACKGROUND

Poor sleep quality is a serious concern among diabetes mellitus patients, adversely affecting glycemic management and the prognosis of diabetic patients. Therefore, the main aim of this study was to estimate the overall pooled prevalence of poor sleep quality and its associated factors among diabetic patients in Sub-Saharan Africa.

METHODS

Several search databases were employed to retrieve the eligible studies. A standardized data extraction format was used to extract the data, and the analysis was conducted using STATA version 14. To determine heterogeneity, the I2 test was conducted, and both the funnel plot and Egger's regression test were used to assess the publication bias. A random effects model meta-analysis was performed to estimate the overall prevalence and associated factors of poor sleep quality.

RESULTS

In the current meta-analysis, a total of 11 studies with 3,766 study participants were included. The overall pooled prevalence of poor sleep quality among diabetic patients was 53.22% (95% CI: 36.26, 70.19). Poor sleep quality was significantly associated with longer duration of diabetes (OR = 2.94, 95% CI: 1.85, 4.67), poor glycemic control (OR = 2.24, 95% CI: 1.51, 3.32), depression (OR = 4.09, 95% CI: 2.07, 8.05) and comorbidity (OR = 1.94, 95% CI: 1.31, 2.88).

CONCLUSION

In this study, more than half of diabetic patients in Sub-Saharan Africa had poor sleep quality. Therefore, healthcare providers should give more attention to sleep disorders when screening diabetic patients to improve their poor sleep quality.

Relationship between sleep quality and depression in people with type 2 diabetes

Background

sleep quality disorder is both a risk factor for diabetics and a symptom of depression. This study aimed to determine the relationship between sleep quality and depression in people with type 2 diabetes in Delijan city in 2022.

Methods

The present study was a descriptive-analytical study conducted on 245 people with Type 2 Diabetes Mellitus(T2DM). The data were collected from health centers and homes, diabetes clinics in the city of Delijan. The sampling method in this study was Convenienc. Inclusion criteria include people over 30 years old, people with a history of diabetes for more than six months and and people with no known mental disorders. Data collection tools included the Pittsburgh Sleep Quality Index (PSQI), the Beck questionnaire, clinical information about diabetes(FBS, %HbA1c level and duration of diabetes), and a checklist of demographic information. SPSS 23 software was used for data analysis. Data were analyzed using independent t-tests, Chi-square, ANOVA and logistic regression. A significance level of P < 0.05 was considered significant.

Results

The mean (SD) age of the participants was 57.58 (10.58) years. Regarding gender, 162 subjects (66.1%) were female. A statistically significant relationship was observed between the quality of sleep in people with type 2 diabetes with gender, education, Family history T2DM, age, and between depression with gender and FBG. a statistically significant relationship was observed between sleep quality and depression. Also, according to the logistic regression, sleep quality (dependent variable) showed a significant relationship with depression, age, sex, and education.

Conclusion

According to the results, there is a significant relationship between sleep quality and depression In people with T2DM, so it can be used in periodic care of diabetic people to screen for depression, which could improve their sleep quality to some extent.

Sleep quality among patients with chronic illness in Ethiopia: systematic review and meta-analysis

Background

Poor sleep quality impedes the progression of chronic illnesses, while chronic illnesses themselves are caused by poor sleep quality. Despite this fact, there is no research that has been conducted in Ethiopia that provides a thorough estimate of the self-reported sleep quality among patients with chronic illnesses. In order to present a complete picture of poor sleep quality among diabetes, hypertension, heart failure, cancer, HIV/AIDS and epilepsy patients, this systematic review and meta-analysis was carried out.

Methods

Systematic review and meta-analysis was conducted to estimate the quality of sleep among patients with chronic illness in Ethiopia. The Preferred Reporting Items for Systematic Review and Meta Analysis standard was followed in the reporting of this systematic review and meta-analysis. An extensive exploration of digital repositories, including PubMed, EMBASE, Cochrane, Africa Journal of Online, Google Scholar, and an advanced Google search, was conducted to obtain published studies until December 1st, 2023 detailing poor sleep quality of patients with chronic illness. STATA version 17 commands were used to create the pooled estimate. The I2 test and Egger's test, respectively, were used to identify the presence of heterogeneity and publication bias. To manage heterogeneity, a subgroup analysis and random effect model were used.

Results

A total 21 articles with a total of 7393 participants were included in the final systematic review and meta-analysis. The pooled estimate of poor sleep quality among patients with chronic illness was 52% (95% of CI: 48%, 59%; I2 = 97.26%). In subgroup analysis, the highest pooled estimate of poor sleep quality was observed in cancer patients 63% (95% CI: (95% CI: 45% - 80%). Regarding to data collection period, the highest pooled estimate of poor sleep quality was seen during spring 68% (95% CI: 42% - 94%).

Conclusions

Patients with chronic illnesses in Ethiopia had a high pooled estimate of poor sleep quality. Patients with cancer had the highest pooled estimate of poor-quality sleep compared with other patients. Patients with chronic illnesses had trouble sleeping in the spring, according to this systematic review and meta-analysis. Therefore, attention and intervention should be given to enhance the quality of sleep for patients with chronic illnesses.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Effect of a Single Light-intensity Walking Session on Sleep Quality of Patients with Bladder Cancer: A Randomized Cross-Over Study

OBJECTIVES

Exercise has been recommended to enhance sleep. However, there is a paucity of studies investigating the relationships between exercise and sleep problems in patients with bladder cancer. The authors explored the effects of a single bout of light-intensity walking on the sleep quality of patients with bladder cancer who have sleep disorders.

DATA SOURCES

A total of 14 patients with bladder cancer with sleep disorders were recruited for this trial. The participants were randomly assigned to the walking or control condition in a cross-over design to explore the effects of a single light-intensity walking session on objectively measured sleep quality. A two-way repeated measures analysis of variance and a nonparametric permutation test were used to examine intervention effects. Twelve participants (85.7%) completed the trial. A significant group × time interaction for sleep latency (P = .023) was identified. The pairwise comparison showed significant results (P = .012) for the difference between the post-test sleep latency and the pre-test. No significant group × time interactions were observed for the remaining seven sleep parameters. Additionally, only the main effects of time on length of awakening and time in bed were significant (P < .001).

CONCLUSION

A single bout of light-intensity walking has a positive effect on shortening the sleep latency of patients with bladder cancer who have sleep disorders.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses can encourage patients with bladder cancer to exercise, even light-intensity walking, which may improve sleep quality.

The effect of using a sports application on the quality of sleep in patients with heart failure: a randomized clinical trial study

BACKGROUND

Patients with heart failure often suffer from sleep disorders. Due to the side effects of medications used to treat this disorder, non-pharmacological methods may be used to improve these patients' sleep quality. This study aimed to determine the effect of a sports application on sleep quality in patients with heart failure.

METHODS

In this single-blinded randomized clinical trial, 60 patients aged 30-70 referred to Shafa Hospital in Kerman were randomly assigned to control (n = 30) and intervention (n = 30) groups based on convenience sampling. The intervention group used the sports application for eight consecutive weeks. Data was collected using a demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI). An independent t-test and a Mann-Whitney U test were used for comparisons between groups and paired t-tests and Wilcoxon tests were used for comparisons within groups.

RESULTS

The data analysis revealed a significant difference in sleep quality scores between the two groups after the intervention, meaning that the intervention group had better sleep quality than the control group (P < 0.05).

CONCLUSIONS

As a result of the study, it was found that the sport application improved the quality of sleep in patients with heart failure. Our recommendation is for healthcare providers to use this sports application to present educational content related to physical activity and improve the sleep quality of patients.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT. 2019123045475N1." Registered 16 December 2019.

Social disparities in sleep health of African populations: A systematic review and meta-analysis of observational studies

OBJECTIVES

To document the relationship between socioeconomic status (SES) and sleep health in African populations.

METHODS

Observational cross-sectional or cohort studies examining the association between SES indicators and sleep outcomes in participants from African countries were included. The search was performed in the MEDLINE, Embase, and Web of Science Core Collection electronic databases in June 2021. Selection, confounding, attrition/exclusion, detection, and selective reporting bias were assessed using the OHAT Risk of Bias Tool. Random effects meta-analysis was used for summarizing the effect estimates.

RESULTS

Forty-three reports were selected, having sampled 153,372 Africans from 26 countries. Education was the most frequent SES indicator and composite measures of sleep quality or disturbances was the most common sleep outcome. Low educational attainment was significantly associated with lower odds of short sleep (odds ratio [OR]=0.65, 95% confidence intervals [0.50, 0.84], p = .001) and higher odds of insomnia (OR=1.53, [1.18, 1.99], p = .001) or poor sleep quality (OR=1.60, [1.17, 2.18], p = .003). Low levels of income/assets were related to higher odds of insomnia (OR=1.38, [1.02, 1.86], p = .04) and low occupational/employment status was linked to lower odds of short sleep duration (OR=0.49, [0.30, 0.79], p = .004).

CONCLUSIONS

Socioeconomic disadvantage was a significant predictor of insomnia and poor sleep quality, while it was associated with longer sleep duration. Significant heterogeneity in terms of exposure and outcomes, scarcity of longitudinal designs, lack of objective outcome measurement, and low representation of rural samples and participants from low-income countries limit the quality of evidence.

Sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia

Introduction

Sleep plays an essential role in every individual’s life since it contributes greatly to their well-being and health. Poor sleep quality is one of the most common consequences of hypertension (HTN), which is a leading public health problem. In Ethiopia, it is the main health concern among hypertension patients. Thus, in the study area, there is limited information regarding the investigation of sleep quality among hypertension patients. Therefore, this study aimed to assess sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted among adult HTN patients from March 15/2021 to May 15/2021 in Northwest Amhara Regional State Referral Hospitals. A systematic random sampling method was used to select the study participants. A face-to-face interviewer-administered questionnaire with chart review was used. The Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality was used in this study. A binary logistic regression was used to see the association between dependent and independent variables. Variables having a p-value < 0.05 with a 95% CI were considered statistically significant in the multivariable logistic regression analysis.

Results

In this study, 563 hypertensive patients were included, with a response rate of 96.9%. The overall prevalence of poor sleep quality was 37.7% (95% CI: 33.4%–41.6%). Female gender (AOR = 2.55, 95% CI: 1.55–4.18), age ≥ 65 years (AOR = 4.07, 95% CI: 2.07–7.97), overweight (BMI) ≥ 25 kg/m2 (AOR = 1.68, 95% CI: 1.06–2.65), WHO stage II hypertension (AOR = 1.78, 95% CI:1.01–3.12), poor physical activity (AOR = 2.39, 95% CI:1.41–4.05), participants who had depression (AOR = 2.03,95% CI:1.24–3.34) and participants who had anxiety (AOR = 1.89, 95% CI: 1.16–3.03) were factors associated with poor sleep quality.

Conclusions

In this study, more than one-third of the study participants had poor sleep quality. Female gender, age ≥ 65 years, overweight (BMI) ≥ 25 kg/m2, stage II hypertension, physical inactivity, depression, and anxiety were all associated with poor sleep quality. Managing depression and anxiety disorders, encouraging physical activity, and providing health education about weight loss are all necessary for HTN patients.

Prevalence of Sleep Disturbance in Patients With Cancer: A Systematic Review and Meta-Analysis

Sleep disturbance is one of the most common and troubling symptoms that harm the quality of life throughout all phases of treatment and stages of the illness among patients with cancer. The aim of this meta-analysis is to examine the present status of sleep disturbance prevalence in patients with cancer. The following databases were searched: PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, from inception to April 2021. Prevalence rates were pooled with meta-analysis using a random-effects model. A total of 160 studies (N = 46,279) published between 1998 and 2021 met the inclusion criteria. The overall prevalence of sleep disturbance was 60.7% (26,448/46,279 participants, 95% CI 58.1–63.3%) with significant heterogeneity between studies (p < .000, τ² = .0000, I² = 96.4%). This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce sleep disturbance and improve the quality of life of cancer patients.

The relationship between sleep quality and physical activity among patients with heart failure: a cross-sectional study

BACKGROUND

Sleep disorders are one of the most common and annoying problems among patients with heart failure, which decrease their quality of life. Participation in physical activity is one of the most effective methods to reduce sleep disorders; however, few patients participate. This study was conducted to examine the relationship between physical activities and sleep quality among heart failure patients.

METHODS

A convenience sample of 100 patients with heart failure referred to rehabilitation centers in southeastern Iran was used in this descriptive cross-sectional study. The Pittsburgh Sleep Quality Index and the Rapid Assessment of Physical Activity (RAPA) were used to collect data. The Spearman correlation coefficient and regression were used to analyze the data. The significance level was < 0.05.

RESULTS

The results revealed that the mean score of sleep quality was 8.74 ± 2.83, with the majority of them (84.47%) having poor sleep quality. The mean score of physical activity was 2.59 ± 1.33, and the majority of them (95.15%) had sub-optimal physical activity. There was a significant and inverse relationship between the total scores of sleep quality and physical activity, and patients' sleep quality improved while physical activity increased. Physical activity, sex, history of heart surgery, and the stage of illness were found to account for 31% of the variances in patients' sleep quality.

CONCLUSION

The results of this study showed better sleep quality among patients who were more physically active. Given that the majority of patients with heart failure suffer from sleep disorders, patients' knowledge of physical activity should be increased to improve their quality of sleep and quality of life.

Sleep Quality and Its Determinants Among Type 2 Diabetes Patients with Comorbid Metabolic Syndrome

PURPOSE

The prevalence of poor sleep quality in patients with diabetes was higher than the general population. This study aimed to explore risk factors for not only poor sleep quality, but also long sleep latency, short sleep duration and low sleep efficiency, in type 2 diabetes patients (T2DM) with comorbid metabolic syndrome (MS).

PATIENTS AND METHODS

A total of 281 patients aged 18-75 years were enrolled from Ningbo First Hospital during October 2021 to March 2022. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). Sleep latency, sleep duration and sleep efficiency were obtained by a response to the questionnaire. Descriptive, independent two-sample t-test, Chi-square test and multiple logistic regression were conducted using SPSS Version 28.

RESULTS

The prevalence of poor sleep quality in T2DM with comorbid MS patients was 59.10%. The factors significantly associated with poor sleep quality were depression symptoms (OR = 3.10, 95% CI: 1.38 to 6.96, P = 0.006), poor quality of life (OR = 2.49, 95% CI: 1.24 to 4.99, P = 0.010), and age (OR = 1.07, 95% CI: 1.04 to 1.10, P < 0.001). The factor significantly associated with long sleep latency was depression symptoms (OR = 2.19, 95% CI: 1.15 to 4.16, P = 0.017). The factors significantly related to short sleep duration were depression symptoms (OR = 2.56, 95% CI: 1.31 to 5.00, P = 0.006) and age (OR = 1.05, 95% CI: 1.02 to 1.08, P = 0.002). The factor significantly related to short sleep efficiency was age (OR = 1.03, 95% CI: 1.01 to 1.06, P = 0.019).

CONCLUSION

This study found that depression symptoms, together with poor quality of life, and increasing age were associated with poor sleep quality. Symptoms of depression were related to long sleep latency and short sleep duration. The increasing age was associated with short sleep duration and low sleep efficiency.

Poor sleep quality is associated with new-onset hypertension in a diverse young and middle-aged population

BACKGROUND

Sleep disorders have been proposed as the potential risk factors for hypertension, thus we aimed to investigate the association of sleep quality with new-onset hypertension.

METHODS

We evaluated sleep quality using Pittsburgh Sleep Quality Index (PSQI) and it's seven components in normotensive population aged 18 years old and over in Emin Xinjiang, China in 2016 and followed up till 2019 using annual health checkup data. Poor sleep quality was defined as a PSQI score>5, and good sleep quality was defined as a PSQI score⩽5.

RESULTS

Among 9344 analytic sample 57.29% were female. A total of 2958 (31.66%) subjects developed hypertension during 22,960 person-years of follow-up. Poor sleep quality (HR 1.131, 95% CI 1.045, 1.224) showed had higher risk of development hypertension in total population in adjusted Cox models. Fairly bad subjective sleep quality (HR 1.148, 95% CI 1.015, 1.298), habitual sleep efficiency of <65%-75% group (HR 1.174, 95% CI 1.026, 1.344), and mild (HR 1.194, 95% CI 1.098, 1.299) and moderate (HR 1.264, 95% CI 1.080, 1.479) sleep disturbance increased the risk of developing hypertension compared to their counterparts. In age stratification, poor sleep quality (HR 1.100, 95% CI 1.007, 1.202) had higher risk of developing hypertension in the young and middle-aged population after adjusted all covariates.

CONCLUSIONS

Poor sleep quality is associated with higher risk of new-onset hypertension in young and middle-aged population.