Chronic Conditions and Sleep Problems among Adults Aged 50 years or over in Nine Countries: A Multi-Country Study

Abstract

BackgroundData on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted.MethodsData on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011–2012 and 2007–2010 respectively were analyzed.ResultsThe association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75–2.78), arthritis (OR 1.39–2.46), and depression (OR 1.75–5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and≥4 chronic conditions was 1.41 (1.09–1.82), 2.55 (1.99–3.27), 3.22 (2.52–4.11), and 7.62 (5.88–9.87) respectively in the overall sample.ConclusionsIdentifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.

Associations of common chronic non-communicable diseases and medical conditions with sleep-related problems in a population-based health examination study

“…Further, short sleep duration was significant risk factor for hypertension [23]. Self-reported hypertension was associated with sleep problems also in Finland [16]. In the present study, CVD risk factors were significantly associated with one or more sleep problems.…”

“…On the other hand, patients with lung diseases often had poor sleep quality due to abnormalities in breathing during sleep [37]. In a large multi-country survey, the likelihood of sleep problem was significantly higher among older asthmatics (≥50years) than other chronic diseases in Finland [16]. In the present study, the odds for poor sleep quality were increased more than 1.5-fold among those with respiratory disease.…”

“…Further, sleep-related problems decrease the quality of life and productivity and diminish the coping capacity for chronically ill patients, which in turn accelerate the disease's progression [14], [15]. According to a most recent study, patients who have asthma, chronic lung disease, diabetes, and strokes reported significantly higher sleep problems [16]. Several other studies suggest that common pathophysiological mechanisms co-occur in sleep-related problems and chronic diseases [12], [17].…”

Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries

“…Given that depression, mobility difficulties, pain/discomfort and sleep problems may be linked with chronic conditions as part of the symptomatology per se or the consequences of the symptoms [42], we investigated the mediating effect of these factors with the use of Karlson-Holm-Breen command in Stata [43]. This method can be applied to logistic regression models and decomposes the total effect into direct and indirect effects.…”

The role of muscle mass and body fat on disability among older adults: A cross-national analysis

“…The combined criteria referred to selfreported diagnosis and/or diagnosis based on past-12 month symptoms with the exception of hypertension which was based on blood pressure measurement, and stroke which was based on lifetime symptoms. The symptom-based algorithms were based on WHO's SAGE study, clinical guidelines, and reference publications, and the details are provided in a previous publication using the same dataset (Koyanagi et al, 2014). Combined criteria were used as although self-report of diseases has been shown to demonstrate good agreement with medical records in developed countries (Kriegsman et al, 1996), in settings with limited access to health care systems, under-reporting of diagnosis may be widespread.…”