Association between depressive symptoms and poor sleep quality among Han and Manchu ethnicities in a large, rural, Chinese population

Healthier Dietary Patterns Are Associated with Better Sleep Quality among Shanghai Suburban Adults: A Cross-Sectional Study

BACKGROUND

More is to be explored between dietary patterns and sleep quality in the Chinese adult population.

METHODS

A cross-sectional study including 7987 Shanghai suburban adults aged 20-74 years was conducted. Dietary information was obtained using a validated food frequency questionnaire. Adherence to a priori dietary patterns, such as the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet (MD), was assessed. Sleep quality was assessed from self-reported responses to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Logistic regression models adjusting for confounders were employed to examine the associations.

RESULTS

The overall prevalence of poor sleep (PSQI score ≥ 5) was 28.46%. Factor analysis demonstrated four a posteriori dietary patterns. Participants with a higher CHEI (ORQ4 vs. Q1: 0.81, 95% CI: 0.70-0.95), DASH (ORQ4 vs. Q1: 0.70, 95% CI: 0.60-0.82) or MD (ORQ4 vs. Q1: 0.75, 95% CI: 0.64-0.87) had a lower poor sleep prevalence, while participants with a higher "Beverages" score had a higher poor sleep prevalence (ORQ4 vs. Q1: 1.18, 95% CI: 1.02-1.27).

CONCLUSIONS

In Shanghai suburban adults, healthier dietary patterns and lower consumption of beverages were associated with better sleep quality.

The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies

BACKGROUND

The high prevalence of poor sleep quality (PSQ) in the general population leads to negative health outcomes. Since estimates of PSQ prevalence in the Chinese general population vary widely, this meta-analysis aimed to refine these estimates and to identify moderating factors.

METHODS

A comprehensive literature search was undertaken in both international (PubMed, PsycINFO, Web of Science, and EMBASE) and Chinese (Wanfang, and the China National Knowledge Infrastructure databases) databases from inception to 23 November 2023. Studies were required to have used standard scales such as the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). The pooled prevalence of PSQ and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify sources of heterogeneity.

RESULTS

In 32 studies with a combined 376,824 participants, the pooled prevalence of PSQ was 19.0% (95% CI 15.8-22.8%; range 6.6-43.6%). Across 22 studies that reported PSQI data, the pooled mean score was 4.32 (95%CI 3.82-4.81; SD = 0.502). The pooled mean sleep duration across 8 studies was 7.62 (95% CI 7.23-8.00; SD = 0.194) hours. Subgroup analyses showed that lower education (Q = 4.12, P = 0.042), living in less developed regions (Q = 60.28, P < 0.001), and lower PSQI cutoff values (Q = 9.80, P = 0.007) were significantly associated with PSQ. Meta-regression analyses showed that study quality was inversely associated with estimated PSQ prevalence (β = - 0.442, P = 0.004).

LIMITATIONS

Although measures such as subgroup and meta-regression analyses were performed, substantial heterogeneity remained. Information related to sleep quality, such as comorbid physical diseases or psychiatric disorders, substance use, occupational types, and employment status, were not reported in most studies.

CONCLUSION

One in five people in the general population of China may have PSQ and people with lower education or living in western regions may be more susceptible.

Night eating habits, sleep quality, and depression, are they associated with vitamin D status?

INTRODUCTION

In addition to the well-established roles of vitamin D on bone health, it also appears to be an effective factor on mental health and circadian behaviors, that include eating and sleeping habits.

OBJECTIVE

This study aimed to assess the association between vitamin D status with night eating habits, sleep quality and depression in female college students.

MATERIALS AND METHODS

This cross-sectional study studied healthy female students from Shiraz University of Medical Sciences, Iran. Demographic and anthropometric information as well as data on sleep quality and depression were recorded and serum levels of 25-hydroxyvitamin D were measured. A 3-day food record questionnaire was completed to assess night eating habits. Data analyses were undertaken using Chi-square, Mann-Whitney U test and logistic regression. A P-value of <0.05 was considered significant.

RESULTS

The study participants comprised of 272 female students with median (Inter Quartile Range) age of 22 (21-24) years. The majority of the participants (82.3 %) were classified as night eaters, who had higher rates of poor sleep quality compared to non-night eaters (P < 0.05). With 1 ng/ml increase in serum levels of 25-hydroxyvitamin D, the odds of being a night eater fell by 3 % (OR = 0.97; 95%CI = 0.95, 0.99), and the odds of having depression or poor sleep quality decreased by 5 % (OR = 0.95; 95%CI = 0.93, 0.97) and 6 % (OR = 0.94; 95%CI = 0.91, 0.97), respectively.

CONCLUSION

There was an inverse association between serum 25-hydroxyvitamin D level with night eating habits, depression and poor sleep quality. This association needs be confirmed using cohort and interventional studies.

Associations of daytime napping and nighttime sleep quality with depressive symptoms in older Chinese: the Guangzhou biobank cohort study

BACKGROUND

Poor sleep quality has been linked to depression in older adults, but results of the association between daytime napping and depression remains limited and conflicting. Moreover, whether the association of daytime napping with depression varies by nighttime sleep quality is unclear. Hence, we examined the associations of daytime napping and nighttime sleep quality with depressive symptoms in older Chinese.

METHODS

A total of 16,786 participants aged ≥50 from the Guangzhou Biobank Cohort Study second-round examination (2008-2012) were included in this cross-sectional study. Geriatric Depression Scale (GDS-15), Pittsburgh Sleep Quality Index (PSQI), napping and demographic data were collected by face-to-face interview using a computerized questionnaire. Logistic regression was used to calculate odds ratio (OR) of depressive symptoms for napping and sleep quality.

RESULTS

The prevalence of depressive symptoms (GDS score > 5) and poor global sleep quality (PSQI score ≥ 6) was 5.3 and 31.9%, respectively. Compared to non-nappers, nappers showed significantly higher odds of depressive symptoms, with OR (95% confidence interval (CI)) being 1.28 (1.11-1.49). The odds of depressive symptoms for daytime napping varied by nighttime sleep quality (P for interaction = 0.04). In good-quality sleepers, compared to non-nappers, nappers had significantly higher odds of depressive symptoms, with OR (95% CI) being 1.57 (1.23-2.01), whereas no association was found in poor-quality sleepers (OR = 1.13, 0.94-1.36).

CONCLUSION

Napping was associated with higher odds of depressive symptoms in older people, and the association was stronger in good-quality sleepers.

Evaluation of Sleep Quality and Related Factors in Community-Dwelling Adults: Ardakan Cohort Study on Aging (ACSA)

BACKGROUND

Sleep is a necessary physiological process that affects health. The current study aimed to evaluate sleep quality (SQ) and the related factors in Iranian community-dwelling adults. Study Design: A cross-sectional study. Method: Population-based cross-sectional data from the first wave of the Ardakan cohort study on aging (ACSA) were analyzed. The analytical sample consisted of 5197 community-dwelling adults aged≥50. All data were collected by trained staff. Pittsburgh Sleep Quality Index (PSQI) scores were used to measure SQ. Univariable and multivariable logistic regression were used to identify predictors of SQ.

RESULTS

The mean age of the participants was 62.22±7.7 years, and 51.8% were female. About threequarters of them (76.36%) were found to have poor SQ (PSQI score≥5). Multivariable logistic regression analysis revealed a relationship between SQ and gender, education, work, and financial level. Furthermore, SQ was found to be associated with self-reported health and physical activity. Regarding comorbidity, SQ had a significant relationship with cardiovascular diseases, musculoskeletal diseases, depression, and anxiety (P<0.05).

CONCLUSION

The prevalence of poor SQ was high in these community-dwelling adults in Iran. These findings highlight the importance of intervention programs for sleep hygiene education and screening for middle-aged and older adults.

Adverse childhood experiences and depressive symptoms among adolescents during the COVID-19 pandemic: mediating roles of poor sleep quality and psychological inflexibility

Previous studies have found that adverse childhood experiences can lead to depressive symptoms. But the underlying mechanisms have not been determined. Guided by the 3-P model of insomnia and acceptance and commitment therapy, this study examined the mediating role of poor sleep quality and psychological inflexibility in the relationship between adverse childhood experiences and depressive symptoms during the COVID-19 pandemic. A total of 996 senior high school students in China (Mage = 16.57 years; SD = 1.03) completed the self-report measures of adverse childhood experiences, depressive symptoms, poor sleep quality, and psychological inflexibility. Multiple mediation analysis revealed that adverse childhood experiences were related to depressive symptoms through poor sleep quality and psychological inflexibility, serially. These findings point to potential targets in the prevention of and intervention in adolescent depressive symptoms.

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

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.

Determinants of sleep quality in 5835 individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey

PURPOSE

The present study aimed to quantify the level of sleep problems in 5835 breast, prostate, and colorectal cancer survivors, and explore a number of potential determinants of poor sleep quality in the present sample. BMI, diet, and physical activity were of particular interest as potential determinants.

METHODS

Participants who completed the 'Health and Lifestyle after Cancer' survey were adults who had been diagnosed with breast, prostate, or colorectal cancer (mean time since cancer diagnosis was 35.5 months, SD=13.56). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. BMI was calculated from self-reported height and weight. Participants were categorised as meeting/not meeting the World Cancer Research Fund (WCRF) recommendations for fibre, fruit and vegetables, added sugar, red meat, processed meat, fat, alcohol, and physical activity. Analyses accounted for demographic and clinical factors.

RESULTS

Fifty-seven percent of those with sleep data were classified as poor sleepers (response rate 79%). Being female, having a higher number of cancer treatments, more comorbid conditions, and being more anxious/depressed increased the odds of being a poor sleeper. After adjustment for these factors, there were no associations between diet/alcohol/physical activity and sleep. However, BMI was associated with sleep. Individuals in the overweight and obese categories had 22% and 79% higher odds of being poor sleepers than individuals in the underweight/healthy weight category, respectively.

CONCLUSIONS

The findings suggest that there may be a need to develop sleep quality interventions for cancer survivors with obesity. Even after adjustment for multiple clinical and demographic factors, BMI (particularly obesity) was associated with poor sleep. Thus, researchers and health professionals should find ways to support individuals with overweight and obesity to improve their sleep quality.

IMPLICATIONS FOR CANCER SURVIVORS

The present findings highlight that poor sleep is a common issue in cancer survivors. Interventions seeking to improve outcomes for cancer survivors over the longer term should consider sleep quality.

University Students' Sleep and Mental Health Correlates in South Korea

Sleep closely relates to emotional instability. Recent studies report an increase in young adults’ poor sleep and associated mental health problems, including attention deficit hyperactivity disorder (ADHD), anxiety, depression, and so on. However, the information on related modifiable factors of these variables is still lacking. This cross-sectional study examined the association of sleep patterns and sleep quality with ADHD and depression in university students. A total of 290 participants aged 18−27 (Mean = 22.0, SD = 2.1) completed a structured questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI), the Adult ADHD, and the Center for Epidemiologic Studies Depression scales (CES-D). Of the participants, more than half (52.7%) slept 6 to 8 h per night, and 37% slept less than 6 h. Only 10% reported they went to bed before midnight; 40% went to sleep after 2 am. The mean PSQI score was 5.9 (SD = 2.9) for total participants and significantly correlated with ADHD scores and with depression scores. After adjusting for covariates, PSQI significantly aligned with increased risk for ADHD (β = 0.29, p = 0.036) and depression (β = 0.67; p < 0.001). Late bedtime was a significant factor for depression only. Sleep quality rather than sleep pattern significantly related to ADHD scores, whereas both sleep quality and bedtime aligned with depression scores. Additional studies are needed to develop strategic interventions for university students with ADHD and depression as well as underlying mechanisms.

Poor sleep quality and associated factors among HIV-positive pregnant women in Northwest, Ethiopia: a facility-based, cross-sectional study

BACKGROUND

Poor sleep quality during pregnancy might have an impact on adverse birth outcomes like premature rupture of membrane, preterm birth, lifelong neurocognitive impairment, low birth weight, and increased the risk of neonatal morbidity and mortality. In Ethiopia, the magnitude of poor sleep quality among this group of people is extremely limited. So, this study aims to determine the magnitude of poor sleep quality and its associated factors among HIV-positive pregnant women attending public hospitals in Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was done using a simple random sampling technique to recruit 411 HIV-positive pregnant women from January to March; 2021. Sleep quality over the last 1 month was measured using the Pittsburgh Sleep Quality Index (PSQI). General anxiety disorder (GAD-7), Sleep Hygiene Index (SHI), and List of Threatening of Experiences (LTE) instruments were used to identify factors associated with poor sleep quality. Bivariate and multivariable logistic regression with odds ratio and 95% CI were employed to identify determinant factors of poor sleep quality. Statistical significance association was declared at P-value < 0.05.

RESULTS

A total of 411 out of 423 HIV-positive pregnant women were interviewed, with a response rate of 97.1%. The overall magnitude of poor sleep quality among HIV-positive pregnant was found to be 39.4% with a 95% of confidence interval (CI) (34.3, 44.3). Stressful life events, [AOR = 3.10, 95% CI (1.60, 6.01)], having comorbid general anxiety symptoms [AOR = 2.46, 95% CI (1.58, 3.81)], unplanned pregnancy [AOR = 2.18, 95% CI (1.20, 3.96)], and poor sleep hygiene practice [AOR = 2.23, 95% CI (1.21, 4.10)] were significantly associated with poor quality of sleep.

CONCLUSION

The overall magnitude of poor sleep quality among HIV-positive pregnant women was high. Stressful life events, poor sleep hygiene, unplanned pregnancy, and comorbid general anxiety symptoms were the determinant factors of poor sleep quality that should be taken high consideration for early detection and appropriate intervention for poor sleep quality in HIV-positive pregnant women.