Bidirectional correlation between gastroesophageal reflux disease and sleep problems: a systematic review and meta-analysis

Objectives

Gastroesophageal reflux disease (GERD) and sleep problems are highly prevalent among the general population. Both them are associated with a variety of psychiatric disorders such as depression and anxiety, which is highlighting an underexplored connection between them. This meta-analysis aims to explore the association between sleep problems and GERD.

Methods

We conducted a comprehensive search on PubMed, Cochrane Library, Embase, and Web of Science, using Medical Subject Headings (MeSH) and keywords, covering articles from the inception of the databases until August 2023. Stata statistical software, version 14.0, was utilized for all statistical analyses. A fixed-effects model was applied when p > 0.1 and I2 ≤ 50%, while a random-effects model was employed for high heterogeneity (p < 0.1 and I2 > 50%). Funnel plots and Egger's test were used to assess publication bias.

Results

Involving 22 studies, our meta-analysis revealed that insomnia, sleep disturbance, or short sleep duration significantly increased the risk of GERD (OR = 2.02, 95% CI [1.64-2.49], p < 0.001; I2 = 66.4%; OR = 1.98, 95% CI [1.58-2.50], p < 0.001, I2 = 50.1%; OR = 2.66, 95% CI [2.02-3.15], p < 0.001; I2 = 62.5%, respectively). GERD was associated with an elevated risk of poor sleep quality (OR = 1.47, 95% CI [1.47-1.79], p < 0.001, I2 = 72.4%), sleep disturbance (OR = 1.47, 95% CI [1.24-1.74], p < 0.001, I2 = 71.6%), or short sleep duration (OR = 1.17, 95% CI [1.12-1.21], p < 0.001, I2 = 0).

Conclusion

This meta-analysis establishes a bidirectional relationship between four distinct types of sleep problems and GERD. The findings offer insights for the development of innovative approaches in the treatment of both GERD and sleep problems.

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.

Poor quality of sleep and musculoskeletal pains among highly trained and elite athletes in Senegal

BACKGROUND

Previous studies reported that poor sleep quality (PSQ) was associated with musculoskeletal pains (MSP) and poor physical performance in athletes.

OBJECTIVE

The current study aimed at determining PSQ and its associations with MSP in some sub-Saharan athletes.

METHODS

A cross sectional study was conducted among 205 highly trained and 115 elite athletes (aged: 25 ± 2 years, Body mass index: 22.8 ± 0.9 kg/m2) in Dakar, Senegal, during a competitive season in a variety of sport disciplines including athletics, basketball, football, rugby, wrestling, tennis. Quality of sleep and MSP were assessed using the French version Pittsburgh Sleep Quality Index (PSQI) and French version of Nordic questionnaire respectively. Pain on body joints during a week was defined as seven-day MSP (MSP-7d) and PSQ for a PSQI > 5.

RESULTS

27.8% (95%CI: 23.2-32.9) of the overall sample suffered PSQ, with 33.7% (95%CI: 24.7-44.0) in basketball and 24.7% (95%CI: 16.9-34.6) in football. According to athletic status and gender, PSQ was more prevalent among highly trained (66.3; 95%CI: 55.9-75.3) and men (69.7%; 95%CI: 59.5-78.7). Among athletes with PSQ 43.8% (95%CI: 33.9-54.2) suffered MSP-7d, with 36.6%; highly trained (95%CI: 23.7-42.9) and 28.1% female. Considering body region, hips/thigh (14.6%; 95% CI: 8.74-23.4) and upper back (13.5%; 95%CI: 7.88 -21, 1) were more affected. Basketball players were more affected from MSP (MSP-7d = 38.5%; 95%CI: 24. 9-54.1) on high on wrists/hands (MSP-7d = 44.4%; 95%CI: 18.9 -73.3; P = 0.04). Based on athletic status, MSP-7d were higher on highly trained necks (100%; 95%CI: 56.1-100; p = 0.04). PSQ was associated with basketball (OR: 3.062, 95%CI: 1.130-8.300, p = 0.02) compared to Athletic. PSQ and MSP-7d were associated on Wrist/hands (OR: 3.352, 95%CI: 1.235-9.099, p = 0.01), and at the upper back (OR: 5.820, 95%CI: 2.096-16.161, p = 0.0007).

CONCLUSION

These results indicate that PSQ is considerable among Senegalese athletes and is associated with MSP during a week. Hence, we recommend to look for strategies optimizing good quality of sleep in order to reduce pains, to improve health.

Association of obstructive sleep apnea and sleep quality with cognitive function: a study of middle-aged and elderly persons in India

INTRODUCTION

Symptoms of obstructive sleep apnea (OSA) and poor sleep quality affect around one in ten people in India. We aimed to determine if OSA symptoms and poor sleep quality are independently associated with cognition in middle-aged and elderly urban Indian populations.

METHODS

We studied the cross-sectional association between OSA symptoms (by Berlin Questionnaire), poor sleep quality (by Pittsburgh Sleep Quality Index), and cognitive function in adults ≥ 50 years. Using a standard neuropsychological battery for cognitive function, a G-factor was derived as the first rotated principal component assessing domains of information processing, memory, and executive function. The associations of exposures with cognitive measures were modeled using linear regression, adjusted for metabolic risk factors, lifestyle factors, and psychosocial problems, followed by stratified analysis by decadal age group.

RESULTS

A total of 7505 adults were enrolled. Excluding those with MMSE < 26 (n 710), of 6795 individuals (49.2% women), mean (SD) age 64.2 (9.0) years, 38.3% had high risk of OSA symptoms, and 15.9% had poor sleep quality. OSA symptoms were negatively associated with cognitive domains of information processing (adjusted beta coefficient of z-score - 0.02, p-value 0.006), memory (- 0.03, 0.014), and G-factor (- 0.11, 0.014) in full-model. Stratified analysis by age group showed significant adverse effects of OSA symptoms on cognition for middle-aged people (50-60 years) (- 0.26, 0.001), but not in later age groups. Poor sleep quality was also associated with lower cognitive scores for G-factor (- 0.48, < 0.001), memory (- 0.08, 0.005), and executive domains (- 0.12, < 0.001), but not with information domain.

CONCLUSION

The findings suggest that both symptoms of OSA and poor sleep quality have a direct adverse impact on cognition in an Indian setting. A modest effect of age on the relationship of OSA and cognition was also observed.

Ketogenic diet may improve sleep quality and daytime somnolence in patients affected by multiple sclerosis. Results of an exploratory study

OBJECTIVE/BACKGROUND

Patients with multiple sclerosis (MS) frequently report sleep complaints. The ketogenic diet (KD) is safe and tolerable in MS patients. Our aim was: 1) to investigate the effects of KD on sleep complaints in patients affected by relapsing-remitting MS and 2) to verify if sleep changes can positively impact on psychological status and quality of life (QoL) in these patients.

PATIENTS/METHODS

From January 2020 to November 2022, we consecutively enrolled 21 non-disabled or minimally disabled MS patients. We collected information regarding: 1) anthropometric measures; 2) psychological status by the Depression Anxiety Stress Scale-21; 3) QoL by the Multiple Sclerosis Quality of Life-54 (MSQOL-54); 4) subjective sleep complaints, i.e. sleep quality, by the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness (EDS), by the Epworth Sleepiness Scale (ESS).

RESULTS

After 6 months of KD therapy, anthropometric measures considerably changed, psychological status significantly improved, and almost all the MSQOL-54 subscales ameliorated. Regarding sleep, we observed that the global PSQI (T0: 7.7 ± 3.1 versus T1: 4.4 ± 3.1, p = 0.002) and the ESS (T0: 7.5 ± 3.9 versus T1: 4.9 ± 3.2, p = 0.001) scores significantly decreased after KD therapy. At T1, only the global PSQI score was an independent predictor of anxiety, stress, and mental health.

CONCLUSIONS

For the first time, we demonstrated that KD may improve sleep complaints in MS patients. In addition, KD seems to have a positive impact on psychological status and QoL of MS patients, mainly through improving sleep quality. Further controlled studies with larger sample sizes are needed to confirm these preliminary results.

Poor sleep quality and suicidal ideation among pregnant women during COVID-19 in Ethiopia: systematic review and meta-analysis

Introduction

COVID-19 has profoundly impacted the mental health and well-being of pregnant women worldwide. In Ethiopia, the poor sleep quality and suicidal ideation among pregnant women has increased due to the COVID-19 pandemic. This study aimed to provide comprehensive evidence on the prevalence and associated factors of poor sleep quality and suicidal ideation among pregnant women during COVID-19 in Ethiopia.

Materials and Methods

This study is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation. Data were searched from PubMed, Google Scholar, and African Journals Online from the occurrence of the COVID-19 pandemic to February 2023. Two researchers extracted the data and performed the methodological quality assessment independently. Random-effect model was used to estimate the pooled effect size and I2was used to check heterogeneity. Stata 14.0 (StataCorp, Collage Station, Texas, USA) was used for statistical analysis.

Results

From six studies the pooled prevalence of poor sleep quality was 55% (95% CI [0.42-0.69], I2 = 98.1%, p < 0.001). Age ≥ 30 years pooled AOR = 1.95, 95% CI (0.85, 3.06), 3rd trimester pooled AOR = 3.20, 95% CI (1.82, 4.58), substance use pooled AOR = 2.51, 95% CI (0.99, 4.04), depression pooled AOR = 2.97, 95% CI (0.92, 5.02) and stress pooled AOR 2.14, 95% CI (0.24, 4.03) were associated factors of poor sleep quality. Three studies reported about suicidal ideation and pooled prevalence was 11% (95% CI: 0.09, 0.13, I2 = 48.2%, p = 0.145). Depression pooled AOR = 3.19, 95% CI (1.68, 4.71) was the only associated factor of suicidal ideation.

Conclusion

Due to COVID-19 pregnant women in Ethiopia were affected by poor sleep quality and suicidal ideation. Thus, suitable and well designed programs proposing awareness of COVID-19, mental health counseling and involvement should be designed to improve the general mental health of pregnant women.

Trial registration

PROSPERO registration number CRD42023389896.

Metabolic risk factors and psychosocial problems independently explain poor sleep quality and obstructive sleep apnea symptoms among adults in urban India

STUDY OBJECTIVES

To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults.

METHODOLOGY

We analyzed baseline data from adults (≥ 50 years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R2, and change was formally tested with the log-likelihood ratio test.

RESULTS

Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R2 increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R2 increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001).

CONCLUSION

Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.

Sleep of migraine patients is ameliorated by ketogenic diet, independently of pain control

OBJECTIVE/BACKGROUND

Migraine patients are frequently affected by sleep complaints. The ketogenic diet (KD) is an option for the treatment of migraine. Our aim was: 1) to assess the effects of KD on sleep complaints in patients affected by migraine and 2) to verify if sleep changes were related to the effects of the diet on headache symptoms.

PATIENTS/METHODS

From January 2020 to July 2022 we consecutively enrolled 70 migraine patients who were treated with KD as a preventive therapy. We collected information regarding: 1) anthropometric measures; 2) migraine intensity, frequency and disability; 3) subjective sleep complaints, i.e. insomnia, sleep quality, by the Pittsburgh Sleep Quality Index (PSQI), and excessive Daytime Sleepiness (EDS), by the Epworth Sleepiness Scale (ESS).

RESULTS

After 3 months of KD therapy, anthropometric measures considerably changed, i.e. body mass index and free fat mass, and migraine significantly improved, i.e. lower intensity, frequency and disability. Regarding sleep, we observed that insomnia affected a decreased rate of patients (T0: 60% versus T1: 40%, p < 0.001). Similarly, patients with poor sleep were significantly less after KD therapy (T0: 74.3% versus T1: 34.3%, p < 0.001). Finally, EDS prevalence declined at the follow-up (T0: 40% versus T1: 12.9%, p < 0.001). Sleep features modifications were not correlated with migraine improvements and with anthropometric changes.

CONCLUSIONS

For the first time we demonstrated that KD may improve sleep complaints in migraine patients. Interestingly, the positive effect of KD on sleep is independent of migraine improvements and anthropometric modifications.

Association of Poor Quality of Sleep with Vision-Threatening Diabetic Retinopathy: A Matched Case-Control Study

INTRODUCTION

Vision-threatening diabetic retinopathy, a long-term microvascular complication of diabetes in the eye, is a major cause of blindness worldwide. Sleep is regulated by a special area of the brain, and poor quality of sleep has been implicated in long-term diabetic complications, including diabetic retinopathy. The study was aimed at exploring whether poor sleep quality is associated with the likelihood of developing vision-threatening diabetic retinopathy.

METHODS

A matched case-control study was conducted from 6 May 2022 to 6 September 2022. The study was based on patients with diabetes (both type 1 and type 2), attending a retina clinic of the referral center. Patients with confirmed vision-threatening diabetic retinopathy were defined as cases and matched with control study subjects. Rating of sleep quality was done by Pittsburgh Sleep Quality Index assessment tool. Conditional logistic regression model was applied to assess the effect of overall poor sleep quality on vision-threatening diabetic retinopathy.

RESULTS

The study recruited a total of 126 (63 duration-matched pairs) patients with diabetes. The overall quality of sleep was poor among 71.90% of patients in the case groups, significantly higher compared with those of the control groups (28.10%) (p < 0.00). The mean quality of sleep for cases [mean (M) = 7.10, standard deviation (SD) = 4.30] was higher than the control group (M = 3.60, SD = 2.70). The magnitude of the difference [M difference = 3.50, 95% confidence interval (CI): 2.25-4.75] was significant. Poor sleep quality predicted the chance of developing vision-threatening diabetic retinopathy in a diabetic cohort.

CONCLUSIONS

This study revealed a significant association between the overall poor quality of sleep and vision-threatening diabetic retinopathy. Co-management of sleep disruption and vision-threatening diabetic retinopathy, and better sleep advisory are warranted.

Sleep quality in men with androgenetic alopecia

PURPOSE

Sleep disturbances affect human health and contribute to several comorbidities. In men, androgenetic alopecia (AGA) is a common, non-scarring form of hair loss that affects a patient's self-esteem. There are limited data regarding the association between poor sleep quality and male AGA. We aimed to compare the prevalence of sleep abnormalities between male patients with AGA and controls to identify an association between the two conditions.

METHODS

A case-control study on patients with AGA and age-matched controls was conducted. Participants completed a standardized questionnaire that contained self-evaluated sleep measures, including Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and STOP-BANG questionnaire. Patients with AGA were classified into mild, moderate, and severe subgroups according to the Hamilton-Norwood classification for stratified analyses. Data between groups and among subgroups were compared.

RESULTS

Of 446 male participants, 223 (50%) were in the AGA group, and the remainder (50%) were in the control group. Multivariable logistic regression analysis revealed that hypertension (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.16-3.11, p = 0.011) and STOP-BANG score ≥ 5 (OR = 2.05, 95%CI = 1.15-3.66, p = 0.015) were associated with AGA. For subgroup analyses, ordinal logistic regression model showed a significant association between severe AGA and three sleep profiles, namely total sleep time ≤ 6 h (OR = 2.16, 95%CI = 1.02-4.57, p = 0.044), PSQI > 5 (OR = 3.72, 95%CI = 1.42-9.72, p = 0.008), and STOP-BANG score ≥ 5 (OR = 3.01, 95%CI = 1.11-8.13, p = 0.030).

CONCLUSION

Our findings revealed an association between sleep disturbances and AGA, which may help guide appropriate management in these patients.

Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis

Lack of sleep can affect the health and performance of firefighters. This systematic review and meta-analysis estimated the global prevalence of sleep disorders and poor sleep quality among firefighters and reported associated factors. Four academic databases (Scopus, PubMed, Web of Science, and Embase) were systematically searched from January 1, 2000 to January 24, 2022. These databases were selected as they are known to index studies in this field. The search algorithm included two groups of keywords and all possible combinations of these words. The first group included keywords related to sleep and the second group keywords related to the firefighting profession. The relevant Joanna Briggs Institute checklist was used to evaluate study quality. Data from eligible studies were included in a meta-analysis. In total, 47 articles informed this review. The pooled prevalence of sleep disorders and poor sleep quality in firefighters were determined as 30.49% (95% CI [25.90, 35.06]) and 51.43% (95% CI [42.76, 60.10]), respectively. The results of a subgroup analysis showed that individuals in low- and middle-income countries (LMICs) had a higher prevalence of sleep disorders than those in high-income countries (HICs) but HICs had a higher prevalence of poor sleep quality than LMICs. Various factors, including shift work, mental health, injuries and pain, and body mass index were associated with sleep health. The findings of this review highlight the need for sleep health promotion programs in firefighters.

Prevalence and associated factors of poor sleep quality among Chinese retirees: A multicenter cross-sectional study

BACKGROUND

Sleep problems are common among older adults worldwide. The present study aims to determine the prevalence of poor sleep quality and its independent factors among retired people in health check-ups population in China.

METHOD

In this multicenter, cross-sectional survey in 2017, a group of retired people was invited to participate in an online survey of health status, and their data, including socio-demographic information, lifestyle, and medical characteristics, were recorded. Binary logistic regression was used to analyze the independent factors responsible for poor sleep quality.

RESULTS

Data from 17,408 responders who met the inclusion criteria were analyzed; among them, 53.04 % (95 % CI = 52 %-54 %) reported poor sleep quality. Binary logistic regression showed that poor sleep quality was associated with a number of factors, including being female (OR = 1.42, 95 % CI = 1.32-1.53), being single (OR = 1.35, 95 % CI = 1.18-1.54), non-smoker (OR = 1.12, 95 % CI = 1.03-1.22), physical inactivity (OR = 1.14, 95 % CI = 1.05-1.23), poor self-rated health status (OR = 1.69, 95 % CI = 1.43-2.00), long-term medication use (OR = 1.05, 95 % CI = 1.07-1.23), chronic pain (OR = 1.33, 95 % CI = 1.22-1.45), comorbidity (OR = 1.16, 95 % CI = 1.07-1.25), and depressive symptoms (mild depression: OR = 2.14, 95 % CI = 1.96-2.34; moderate depression: OR = 4.00, 95 % CI = 3.49-4.58, moderately severe depression: OR = 4.15, 95 % CI = 3.47-4.97, severe depression: OR = 4.27, 95 % CI = 2.93-6.22); while age (OR = 0.99, 95 % CI = 0.99-1.00) was negatively related to poor sleep quality.

CONCLUSION

The prevalence of poor sleep quality in the studied population is relatively high (53.04 %). Sleep problems are common among Chinese retirees, especially older females, and have a great impact on their quality of life. People living with depression, chronic diseases, and chronic pain were at a higher risk of developing sleep disorders. Therefore, it is critical to formulate effective management strategies for Chinese retirees with poor sleep quality in the context of healthy aging.

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.

Prevalence and associated factors of poor sleep quality among postpartum women in North West Ethiopia: a community-based study

INTRODUCTION

Although sleep disturbance is a community problem, there is limited study in Ethiopia. Therefore, this study aimed to identify the prevalence and factors affecting postpartum poor sleep quality in women.

METHOD

A community-based cross-sectional study was conducted from July 1st to August 30th, 2021 in Gondar city. The cluster sampling method was used to address 858 study participants. The Pittsburgh Sleep Quality Index (PSQI) 19-item self-report measure of sleep quality over the past month was used to measure maternal sleep quality during the postpartum period and a global PSQI score of 5 or more was used to indicate poor sleep quality. Binary logistic regression was used to identify variable association and 95% confidence level and adjusted Odds Ratio were used to declare association.

RESULT

Poor sleep quality prevalence during postpartum period was 24.0% (95%CI: 21.3-26.9). factors significantly associated with poor sleep quality were family size [AOR = 1.76; 95% CI: (1.14-2.73)], unplanned pregnancy [AOR = 2.11; 95%CI: (1.17-3.80)], had a family history of mental illness [AOR = 3.70; 95%CI: (2.15-6.37)], had known medical disorders [AOR = 2.59; 95%CI: (1.51-4.43)], having intimate partner violence [AOR = 2.58; 95%CI: (1.78-3.75)], and women who can read and write and who complete secondary school [AOR = 2.60; 95% CI: (1.20-5.66)] and [AOR = 2.02; 95%CI: (1.16-3.53)] respectively. On the other hand, being housewife, merchant, and government-employed [AOR = 0.32; 95%CI: (0.14-0.73)], [AOR = 0.13; 95%CI: (0.05-0.34)], and [AOR = 0.38; 95%CI: (0.14-0.98)] respectively were identified to be factors significantly associated with poor sleep quality.

CONCLUSION

Poor sleep quality prevalence is high in the community of Gondar city. Thus, setting strategies to increase women's educational level, providing health education programs to create awareness on the consequence of intimate partner violence which could reduce the violence; increasing screening for medical disorders before or during maternity period, preventing unplanned pregnancy with effective family planning method, and employing women in a certain organization will have a great role in reducing poor sleep quality.

Postoperative poor sleep quality and its associated factors among adult patients: A multicenter cross-sectional study

Background

Sleep quality refers to a sense of being refreshed and rested after waking up from sleep. Postoperative patients were vulnerable to poor sleep quality due to having different contributing factors. The prevalence of poor sleep quality among postsurgical patients was left undisclosed in our study setting. Knowing the prevalence and contributing factors for poor sleep quality helps us to develop a strategic plan for prevention and management.

Method and materials

A multicenter cross-sectional study design was conducted on 424 postsurgical patients who were selected by a systematic random sampling method. Data was collected using the Pittsburgh Sleep Quality Index by a face-to-face interview. Data analysis was done using SPSS version 25. For categorical data, a chi-square test was done. Bivariable and multivariable analyses were performed to determine whether each of the independent variables is associated with the outcome variable.

Result

Based on this study result, the prevalence of poor sleep quality was 64.9%. Among the factors included in this study, variables which had an association with poor postoperative sleep quality were age range 25–54 years (AOR = 15.13), male gender (AOR = 4.81), educational level of secondary school (AOR = 6.29), patient income less than 2500 birr (AOR = 3.77), anxiety (AOR = 2.53), depression(AOR = 22.8), light exposure(AOR = 19.60), poor social support (AOR = 1.98), being emergency surgery (AOR = 2.46) and having a history of moderate to severe pain (AOR = 38.18, (95% CI).

Conclusion

Poor sleep quality among adult post-surgical patients was significantly high in Amhara regional comprehensive referral hospitals. Therefore; Clinicians need to prioritize postoperative sleep quality assessment and needs to minimize factors inducing postoperative sleep disturbances.

•

The prevalence of postoperative poor sleep quality was 64.9%.

•

Pain is associated with poor sleep qualities.

•

Postoperative sleep quality was poorly managed.

Zolpidem improves patients' sleep quality after surgical treatment for infective endocarditis: a prospective observational study

PURPOSE

The objective of this study was to investigate the efficacy of zolpidem for improving post-operative sleep quality among patients with infective endocarditis (IE) and to identify the potential risk factors for impaired sleep quality at 6 months after surgery.

METHODS

Patients with IE who underwent surgical treatment were divided into two groups according to zolpidem usage. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate patients' sleep quality and daytime sleepiness at baseline, which was the second day after transferal, and at 6 months after surgery. Logistic regression was used to identify potential risk factors.

RESULTS

There were 32 patients in the zolpidem group and 42 in the control group. The PSQI and ESS scores at 6 months after surgery were significantly lower than those at baseline in both groups (P = 0.04). Additionally, 9 patients (28%) in the zolpidem group and 22 patients (52%) in the control group suffered poor sleep quality. Multivariate analysis identified age (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.12-1.42), baseline PSQI score (OR = 2.66, 95%CI: 1.55-4.65), and no zolpidem usage (OR = 45.48, 95%CI: 3.01-691.23) as independent factors for poor sleep quality.

CONCLUSIONS

Poor sleep quality after IE surgery was prevalent among patients even 6 months after IE surgery. Age, baseline PSQI score and no zolpidem usage were independently associated with poor sleep quality. Therefore, zolpidem has the potential to be an effective part of a treatment arsenal for poor sleep quality after surgical treatment for IE.

Long-term exposure to ambient PM1 strengthened the association of depression/anxiety symptoms with poor sleep quality: The Henan Rural Cohort study

Evidence from numerous epidemiological studies for the relationship between mental disorder and sleep quality was inconclusive and few studies assessed the modification effect of exposure to ambient air PM₁ (particulate matter with an aerodynamic diameter ≤ 1.0 µm) on this association. In this study, 27,572 participants aged 18-79 years from The Henan Rural Cohort study were included in the final analyses. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) scales were used to estimate the frequency of depression and anxiety symptoms of all participants, respectively. The Pittsburgh Sleep Quality Index (PSQI) scale was used to assess night sleep quality and PSQI global score (GSC) ≥ 6 was classified as poor sleep quality. The three-year average exposure concentration of PM₁ before the baseline survey was determined as long-term exposure concentration of ambient PM₁. Logistic regression model was conducted to estimate the independent or joint effect of depression/anxiety symptoms and ambient PM₁ exposure on poor sleep quality. In the adjusted models, the odds ratios (ORs) and 95% confidence intervals (95% CIs) of poor sleep quality associated with depression and anxiety symptoms were 3.75 (3.37, 4.17) and 3.42 (3.06, 3.81), respectively, and that associated with long-term exposure to PM₁ was 1.06 (1.03, 1.09). An interaction effect was observed between anxiety symptoms score and PM₁ concentration on poor sleep quality. With the increment of PM₁ concentration, the association was strengthened between depression/anxiety symptoms and poor sleep quality. Besides, compared with the reference group, the ORs (95% CIs) of poor sleep quality in those with comorbidity of depression and anxiety symptoms were 4.98 (3.95, 6.29), 5.23 (3.98, 6.87), 5.76 (4.42, 7.49), and 5.58 (3.83, 8.14), respectively, from the first to the fourth quartile level of the PM₁ concentration. These findings suggested that long-term exposure to PM₁ strengthened the association of depression/anxiety symptoms with poor sleep quality in rural China.

Association between household fuel use and sleep quality in the oldest-old: Evidence from a propensity-score matched case-control study in Hainan, China

STUDY OBJECTIVES

Emerging evidence has documented that poor sleep quality associated with adverse effects with physical, psychological and neurological disorders, which impeded healthy aging. There is limited knowledge regarding the association of household air pollution (HAP) from solid fuel use with sleep quality, particularly among the population at advanced ages. The aim of this study is to investigate this association in oldest-old (≥80 years) populations.

METHODS

China Hainan Centenarian Cohort Study was conducted in the 18 cities and counties of Hainan Province from 2015 to 2017. A total of 1725 individuals aged 80 years and older were included in the study. We used the Pittsburgh sleep quality index (PSQI) to measure individuals' sleep quality with a score of PSQI >8 indicating poor sleep quality. Solid fuel users were defined as those who primarily use coal, biomass charcoal, wood or straw for cooking in their daily life. The propensity score matching (PSM) was adopted and logistic regressions were performed based on the matched sample to estimate the association between the two factors. We adjusted for a wide range of covariates, including demographic, socioeconomic, health-related, and environmental factors.

RESULTS

After matching, a total of 1616 participants (mean [SD] age, 94.5 [9.5] years; 72.5% women) were included in the final analysis. About 50.9% of the participants used solid fuel for cooking. The average global PSQI score was 8.26 (SD = 3.3), 49.0% of them were detected as poor sleep quality with a global PSQI score >8. We found significantly higher risk of having poor sleep quality among those who were currently solid fuel users than among clean fuel users, with an odds ratio (OR) of 1.43 (95% CI: 1.14-1.80), adjusting for a wide range of confounders. The associations were more pronounced in those who did not use any ventilation (compared to those who used either mechanical or natural cooking ventilation; 1.79 [1.30-2.47] vs. 1.27 [1.01-1.53], P for interaction = 0.016) and in those who were frequent cooking at home (compared to those who never cooked; 1.65 [1.21-2.26] vs. 1.18 [0.93-1.40], P for interaction = 0.025).

CONCLUSIONS

Exposure to HAP from solid fuel combustion increases the risk of poor sleep quality at oldest-old ages. Our findings point to the need of reducing HAP from polluted fuel combustion and implementing cooking ventilation as a public health priority for healthy aging initiatives.

The association of sleep quality and sleep duration with nutritional status in older adults: Findings from the WCHAT study

OBJECTIVE

To identify the associations between sleep quality, sleep duration and nutritional status in older adults.

METHODS

Data from a total of 6792 community-dwellings adults aged 50 and over from the baseline of the West China Health and Aging Trend (WCHAT) study were analyzed. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). PSQI scores >5 were categorized as poor sleep quality. Duration of sleep was classified as <6 h, 6-7 h, 7-8 h, 8-9 h and ≥9 h. The Mini Nutritional Assessment Short Form (MNA-SF) was used to assess nutritional status and a score <12 was identified as indicating a risk of malnutrition. Logistic regression models were used to explore the associations.

RESULTS

Of 6792 participants (mean age 62.4 ± 8.3 years, 62.5 % women), 1831 (27.0 %) were at risk of malnutrition. The prevalence of poor sleep quality was 47.1 %. In the logistic regression model adjusted for potential confounders, poor sleep quality was significantly associated with a risk of malnutrition (OR = 1.62, 95 %CI = 1.44, 1.82). Sleep durations of less than 6 h and of more than 9 h were shown to increase the odds of malnutrition risk (OR = 1.42, 95 %CI = 1.16, 1.73 and OR = 1.24, 95 %CI = 1.05, 1.47, respectively).

CONCLUSIONS

Sleep disorders were significantly associated with malnutrition risk among older adults. Our results highlight the importance of good sleep quality and enough sleep in order to maintain good nutritional status in older adults.

Evaluation of sleep quality and restless legs syndrome in adult patients with sickle cell anemia

PURPOSE

To determine the prevalence of poor sleep quality and RLS in adult patients with sickle cell anemia (SCA). The second aim was to identify the risk factors for RLS and impairment of sleep quality in SCA patients.

MATERIALS AND METHODS

Patients at least 18 years old, with hemoglobin electrophoresis confirmation of sickle cell disease, were included. Restless legs syndrome was diagnosed according to the International Restless Legs Syndrome Study Group criteria. The sleep quality of the patients was determined using the Pittsburgh Sleep Quality Index (PSQI) scale. The Epworth Sleepiness Scale (ESS) was used to assess excessive daytime sleepiness.

RESULTS

Of 72 patients enrolled in the study, the median total PSQI score was 5 (R 1-17). The total PSQI score was significantly associated with increased age and number of acute severe or extremely severe painful crises during the previous year (p < 0.001, r = 0.45; p = 0.013, r = 0.291 respectively). Of 72 patients, 13 (18%) had RLS and 11 (15%) had excessive daytime sleepiness. The presence of RLS was significantly associated with increased age (p = 0.004). The presence of RLS was not associated with fetal hemoglobin, hemoglobin, hematocrit, or ferritin levels (p > 0.05 for all).

CONCLUSION

The prevalence of RLS among this sample of adult patients with sickle cell anemia was much higher than that previously reported for the general Turkish population. The presence of RLS was an important cause of sleep disturbance in these adult patients with SCA.

Prevalence and associated factors of poor sleep quality among Chinese returning workers during the COVID-19 pandemic

OBJECTIVES

The 2019 novel coronavirus (COVID-19) pandemic is a severe global crisis which has resulted in many public health problems. This study aimed to investigate the prevalence of poor sleep quality and its related factors among employees who returned to work during the COVID-19 pandemic.

METHODS

Our online cross-sectional study included 2,410 participants aged ≥17 years in Deqing and Taizhou, Zhejiang Province, China from 5th to 14th March 2020. The questionnaire covered information on demographic characteristics, health status, workplace, lifestyle, attitude towards COVID-19, assessment of anxiety, depression and sleep quality. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) was administered to measure the poor sleep quality. Poor sleep quality was defined as a global PSQI score>5. Factors associated with sleep quality were analyzed by logistic regression models.

RESULTS

In sum near half (49.2%) of 2,410 returning workers were females and the average year of subjects was 36.3 ± 9.1 years. The overall prevalence of poor sleep quality was 14.9% (95%CI: 13.5%-16.3%). The average score of PSQI was 3.0 ± 2.5 and average sleep duration was 7.6 ± 1.2 h. Independent related factors of poor sleep quality included age older than 24 years, higher education level, negative attitude towards COVID-19 control measures, anxiety and depression.

CONCLUSIONS

Poor sleep quality was common and there was a shorter sleep duration among returning workers during the COVID-19 pandemic. Possible risk factors identified from this study may be of great importance in developing proper intervention for the targeted population to improve the sleep health during the COVID-19 public health emergency.

Factors associated with poor sleep quality in the Korean general population: Providing information from the Korean version of the Pittsburgh Sleep Quality Index

BACKGROUND

Recently, studies have been conducted to address the research gap in the understanding of poor-quality sleep and its relationship to health outcomes, through the evaluation of sleep quality. The aim of this study was to provide information regarding poor sleep quality based on a nationwide general population sample in Korea.

METHODS

We conducted a cross-sectional study using data from a nationwide sample of 165,193 individuals (males: 44%) aged 19 years or older from the 2018 Korea Community Health Survey. The age range of the participants was 19-107 years (mean: 55.3 ± 17.5). The Korean version of the Pittsburgh Sleep Quality Index (PSQI) was used for assessing sleep quality. Poor sleep quality was defined as a total PSQI score of >5.

RESULTS

The overall prevalence of poor sleepers was 41.0% (males: 35.6%; females: 46.2%). Poor sociodemographic status (illiteracy, low income, and unemployment), poor health behaviors (smoking, high-risk drinking, diabetes, hypertension, non-participation in walking, and obesity), and poor mental health (perceived poor health status, stress, depressive symptoms, and subjective cognitive decline) were all associated with poor sleep quality in both males and females.

LIMITATIONS

As this study relies on self-reported and cross-sectional data, causal inferences cannot be made.

CONCLUSIONS

Poor sleep quality is highly prevalent in females. In addition, poor socio-demographic status, poor health behaviors, and poor mental health were associated with poor sleep quality. The mechanisms underlying sex differences in sleep quality remain to be elucidated, and further studies are required to address this.

Prevalence and associated factors of poor sleep quality among Chinese older adults living in a rural area: a population-based study

Objective

To investigate the prevalence and associated factors of poor sleep quality among community-dwelling elderly population in a rural area of Northern China.

Methods

We conducted a cross-sectional survey in August–December 2014 and recruited 2195 participants who were aged 65 years or older and living in Yanlou Town of Yanggu County in western Shandong Province, China. Data on demographics, health-related behaviors, and clinical conditions were collected through structured interviews. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality and patterns. Poor sleep quality was defined as a PSQI score > 7. We employed multiple logistic models to relate poor sleep quality to various factors.

Results

The overall prevalence rates of poor sleep quality were 33.8% in the total sample, 39.2% in women and 26.3% in men (P < 0.01). The most common abnormal sleep domains were prolonged sleep latency (39.7%), decreased sleep duration (31.0%), and reduced habitual sleep efficiency (28.8%). Multiple logistic regression analyses revealed that poor sleep quality was significantly associated with female sex (OR = 1.76, 95% CI 1.46–2.12) and clinical comorbidities such as hypertension (OR = 1.28, 95% CI 1.06–1.54), coronary heart disease (OR = 1.60, 95% CI 1.27–2.00), and chronic obstructive pulmonary disease (OR = 1.82, 95% CI 1.34–2.49).

Conclusions

The sleep disorders were highly prevalent among the elderly in rural China. Modifiable risk factors such as cardiometabolic risk factors and disorders were associated with poor sleep quality, which might be potential targets for interventions to improve sleep quality in elderly population.

Predialysis fluid overload linked with quality of sleep in patients undergoing hemodialysis

OBJECTIVE

Hemodialysis (HD) patients are exposed to dysregulated fluid balance which can lead to overhydration. Poor sleep quality and excessive daytime sleepiness are particularly common in these patients, however the relationship between fluid status and sleep quality and daytime sleepiness has not yet been studied. Therefore, the aim of this study is to evaluate the correlations between fluid status and sleep quality and daytime sleepiness in HD patients.

METHOD

This cross-sectional study included 115 HD patients and 30 healthy control subjects from the HD center of Shanghai Ninth People's Hospital. Fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by multifrequency bio-impedance (BCM). Overhydration was defined as OH/ECW≥7%. HD patients were divided into an overhydration group and non overhydration group according to OH/ECW. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale (ESS).

RESULTS

The prevalence rate of fluid overload in HD patients was 65.2%. Poor sleep quality (PSQI≥5) and excessive daytime sleepiness (ESS≥11) were significantly higher in HD patients compared with the healthy controls [6 (3, 10) vs.2.11 ± 1.59, p = 0.000; 3 (0, 6) vs.1.68 ± 1.07, p = 0.045]. Furthermore, the PSQI scores were higher in HD patients with overhydration (7.8 ± 4.5 vs. 4.8 ± 3.2, p = 0.000). The component scores 1, 2, 3 and 5 of the PSQI showed significant differences between the overhydration and non overhydration groups. The ESS scores did not show differences between the two groups (3.9 ± 4.1 vs. 3.3 ± 3.5, p = 0.508). OH was correlated with Systolic BP and Diastolic BP, and additionally was an independent predictor of poor sleep quality.

CONCLUSION

Fluid overload is significantly linked with poor quality of sleep in HD patients, however there is no association with excessive daytime sleepiness. Our study provides new insight into possible treatment strategies. Future studies should examine the effects of optimizing fluid status on quality of sleep.

Poor sleep quality and influencing factors among rural adults in Deqing, China

BACKGROUND

Poor sleep quality is prevalent and is associated with cognitive decline, impaired health, and reduced quality of life. There is a lack of studies about sleep quality and its potential risk factors among rural adults aged 45 years or above under rapid urbanization in China.

METHODS

In a cross-sectional survey conducted in Deqing County, China in 2015, we included 1584 adults 45+ years of age. Sleep quality was measured by using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Poor sleep quality was defined by a CPSQI global score > 5. Other data collected included sociodemographic and lifestyle factors as well as physical health. Logistic regression model was applied to assess factors influencing sleep quality by calculating crude odds ratio (cOR), adjusted OR (aOR), and their 95% confident intervals (CI).

RESULTS

Of 1584 subjects, more than half were female with an average age of 58.9 ± 8.1 years. Their night sleep duration was 7.7 ± 1.2 h, sleep latency was 31.9 ± 32.0 min, and 17% of them could not fall asleep within half hour, averagely. The mean score of CPSQI was 4.4 ± 2.7. The prevalence of poor sleep quality was 27.7% (95% CI = 25.4-29.7%) overall, and there existed a significant sex difference-30.6% (95% CI = 27.7-33.7%) for women and 24.0% (95% CI = 20.9-27.2%) for men. Five domains of the CPSQI except for sleep efficiency and use of sleeping medication also showed a sex difference (p < 0.05). Logistic regression analysis indicated that unmarried status (aOR = 1.51, 95% CI = 1.03-2.22), lower monthly individual income (aOR = 2.09, 95% CI = 1.49-2.94), and chronic diseases (aOR = 1.95, 95% CI = 1.51-2.51) were significantly related to poor sleep quality.

CONCLUSIONS

Sleep problems were prevalent among the rural Chinese adults aged 45+ years. People who were unmarried or had low personal income or any chronic diseases were more likely to have poor sleep quality.

Poor sleep during early pregnancy increases subsequent risk of gestational diabetes mellitus

OBJECTIVES

To examine the relationship between poor sleep quality during pregnancy and the risk of gestational diabetes mellitus (GDM).

METHODS

A total of 4066 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed. Sleep quality and duration during early pregnancy were self-reported by enrolled women at their first antenatal care visit before 16 weeks of gestation. Gestational diabetes mellitus (GDM) was assessed with a 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Information about self-reported sleep quality and duration in mid-pregnancy were also collected at this time. Odds ratios (OR) and 95% CIs were calculated by multivariable logistic regression models, and adjusted for potential confounders to estimate the effect of poor sleep quality and the interaction between sleep quality and duration on the development of GDM. Stratified analyses were performed according to age, parity, family history of diabetes and napping.

RESULTS

A total of 335 (8.2%) participants were diagnosed with GDM. Poor sleep quality was reported in 259 (6.4%) women during early pregnancy and 248 (6.1%) in mid-pregnancy. The risk of GDM was increased in women with poor sleep quality during early pregnancy (OR 1.77, 95% CI 1.20-2.61). No association was found between poor sleep quality during mid-pregnancy and the risk of GDM. The risk of GDM was highest in women with poor sleep and longer nighttime sleep duration during early pregnancy (OR 2.27, 95% CI 1.20-4.29) when compared with those who reported good sleep and 7.0-8.5 h of sleep duration per night. Stratified analysis found that the association between poor sleep quality in early pregnancy and the risk of GDM was stronger among women aged ≥30 years (OR 2.35, 95% CI 1.35-4.09) and those with a family history of diabetes (OR 4.02, 95% CI 1.54-10.48).

CONCLUSIONS

Poor sleep quality during early pregnancy was associated with an increased risk of GDM. Screening for and treating sleep problems in early pregnancy could potentially reduce the risk of GDM.

Predictors of poor sleep quality in patients with systemic lupus erythematosus

Sleep problems are common in patients with systemic lupus erythematosus (SLE). This study aimed to examine the following: (1) predictors of sleep quality and (2) fluctuations in sleep quality in patients with SLE. Patients with SLE were recruited from three rheumatology centers in Japan. We collected demographic and clinical data and data on sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), the Medical Outcome Study Short Form-12, and the Lupus Patient Reported Outcome Tool (LupusPRO). Fluctuations in sleep quality were examined by administering the PSQI a second time after a 2-week interval. We used multiple linear regression analysis to predict sleep quality. Of 205 patients who completed the survey, 62.9% showed poor sleep quality. The largest fluctuation in sleep quality was for "waking in the middle of the night or early morning." "LupusPRO pain/vitality" was a major predictor of poor sleep. The other significant predictors were mostly LupusPRO subscales and clinical variables and SF-12 subscales were mostly non-predictive. The majority of the participants had poor sleep quality. A lupus-specific QoL scale is important for understanding poor sleep quality in SLE patients. Symptom management appeared to play a key role in improving sleep quality.

Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women

OBJECTIVE

Poor sleep quality has been linked to inflammatory processes and worse disease outcomes in the context of many chronic illnesses, but less is known in conditions such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This study examines the relationships between sleep quality, pro-inflammatory cytokines, and CFS/ME symptoms.

METHODS

Sixty women diagnosed with CFS/ME were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Symptom Inventory (FSI) and Center for Disease Control and Prevention (CDC)-based CFS/ME symptom questionnaires. Circulating plasma pro-inflammatory cytokine levels were measured by ELISA. Multiple regression analyses examined associations between sleep, cytokines and symptoms, controlling for age, education, and body mass index.

RESULTS

Poor sleep quality (PSQI global score) was associated with greater pro-inflammatory cytokine levels: interleukin-1β (IL-1β) (β=0.258, p=0.043), IL-6 (β=0.281, p=0.033), and tumor necrosis factor-alpha (TNF-α) (β=0.263, p=0.044). Worse sleep quality related to greater fatigue severity (β=0.395, p=0.003) and fatigue-related interference with daily activities (β=0.464, p<0.001), and more severe and frequent CDC-defined core CFS/ME symptoms (β=0.499, p<0.001, and β=0.556, p<0.001, respectively).

CONCLUSIONS

Results underscore the importance of managing sleep-related difficulties in this patient population. Further research is needed to identify the etiology of sleep disruptions in CFS/ME and mechanistic factors linking sleep quality to symptom severity and inflammatory processes.

Prevalence of self-reported sleep duration and sleep habits in type 2 diabetes patients in South Trinidad

The present study aims to determine the prevalence of self-reported sleep duration and sleep habits and their associated factors in patients with type 2 diabetes in Trinidad. This was a cross-sectional multicenter study. There were 291 patients with type 2 diabetes studied. Sleep habits were assessed using the Epworth Sleepiness Scale (ESS) and the National Health and Nutrition Examination Survey sleep disorder questionnaire. Demographic, anthropometric and biochemical data were also collected. The sample had a mean age of 58.8 years; 66.7% were female. The mean BMI was 28.9 kg/m(2). The prevalence of Excessive Daytime Sleepiness (EDS) was 11.3%. The prevalence of patients with short sleep (⩽6h) was 28.5%. The prevalence of patients with poor sleep was 63.9%. Poor sleep was associated with age, intensive anti-diabetic treatment and longer duration of diabetes. Short sleep was associated with intensive anti-diabetic treatment and BMI, while EDS was associated with increased BMI. In a sample of patients with type 2 diabetes, a high prevalence of self-reported sleep duration and unhealthy sleep habits was found. There needs to be an increased awareness of sleep conditions in adults with type 2 diabetes by doctors caring for these patients.