Sleep Problems and Their Predictors in Community-dwelling Older Adults with Diabetes in India: Evidence from the Longitudinal Ageing Study in India

Overview

Journal Sleep Med X

Date 2024 Mar 19

PMID 38500780

Authors

Vansh Maheshwari

Saurav Basu

Affiliations

Soon will be listed here.

Abstract

Objectives: To ascertain the prevalence and predictors of sleep disorders and poor sleep quality among older adults with Diabetes (DM) in India, and to assess the relationship between sleep quality and DM.

Methods: Data was utilized from the nationally representative Longitudinal Ageing Study in India (Wave-1, 2017-18), with a total sample of 66606 older adults (≥45 years) selected for the study. Sleep problems and sleep quality score were assessed using an adaptation based on the Jenkins Sleep Scale. Multivariate linear and logistic regressions were conducted to determine the effect of sociodemographic and clinical factors on sleep quality. Mediation analysis (Karlson-Holm-Breen) was done to assess the direct and indirect effects of independent variables on the sleep quality scores. Further, Propensity score matching (PSM) was done to assess the impact of diabetes on sleep problems.

Results: The prevalence of DM was 12.34% (n = 8564, 95% CI: 11.54, 13.20) among whom 24.38% (95% CI: 21.38, 27.65) reported sleep problems. On adjusted analysis, sleep problems were significantly associated with increasing education, higher wealth quintile, lack of physical activity, and multimorbidity. Mediation analysis showed adherence to anti-diabetes medication improved sleep quality (aB = -0.28 (95% CI: -0.54, -0.02)), while comorbidities worsened sleep quality (aB = 0.79 (95% CI: 0.67, 0.92)). Analysis from PSM indicated that DM was associated with a 6.2% higher chance of sleep problems.

Conclusions: Poor sleep quality is present in nearly one in four individuals diagnosed with DM in India and linked with certain adverse social determinants. Focused interventions to improve assessment and treatment of sleep problems in resource-limited primary care settings require prioritization.

References

Basu S, Maheshwari V, Malik M, Agarwal P . Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21). J Diabetes Metab Disord. 2023; 22(2):1405-1415. PMC: 10638169. DOI: 10.1007/s40200-023-01263-9. View

Potter G, Skene D, Arendt J, Cade J, Grant P, Hardie L . Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures. Endocr Rev. 2016; 37(6):584-608. PMC: 5142605. DOI: 10.1210/er.2016-1083. View

Kuo C, Lu S, Huang C, Liao W, Lee M . Sleep Quality and Associated Factors in Adults with Type 2 Diabetes: A Retrospective Cohort Study. Int J Environ Res Public Health. 2021; 18(6). PMC: 7999598. DOI: 10.3390/ijerph18063025. View

St-Onge M, Grandner M, Brown D, Conroy M, Jean-Louis G, Coons M . Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation. 2016; 134(18):e367-e386. PMC: 5567876. DOI: 10.1161/CIR.0000000000000444. View

Khan M, Hashim M, King J, Govender R, Mustafa H, Al Kaabi J . Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health. 2020; 10(1):107-111. PMC: 7310804. DOI: 10.2991/jegh.k.191028.001. View

Schwartz J, Roth T . Neurophysiology of sleep and wakefulness: basic science and clinical implications. Curr Neuropharmacol. 2009; 6(4):367-78. PMC: 2701283. DOI: 10.2174/157015908787386050. View

Anjana R, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das A . Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol. 2023; 11(7):474-489. DOI: 10.1016/S2213-8587(23)00119-5. View

. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023; 402(10397):203-234. PMC: 10364581. DOI: 10.1016/S0140-6736(23)01301-6. View

Kinsey A, Ormsbee M . The health impact of nighttime eating: old and new perspectives. Nutrients. 2015; 7(4):2648-62. PMC: 4425165. DOI: 10.3390/nu7042648. View

10.

Heikkala E, Jokelainen J, Mikkola I, Auvinen J, Hagnas M . Recurrent prescription of sleep medication among primary care patients with type 2 diabetes: an observational study of real-world registry data. BMC Prim Care. 2023; 24(1):90. PMC: 10074898. DOI: 10.1186/s12875-023-02045-1. View

11.

Pradeepa R, Mohan V . Epidemiology of type 2 diabetes in India. Indian J Ophthalmol. 2021; 69(11):2932-2938. PMC: 8725109. DOI: 10.4103/ijo.IJO_1627_21. View

12.

Patel N, Grandner M, Xie D, Branas C, Gooneratne N . "Sleep disparity" in the population: poor sleep quality is strongly associated with poverty and ethnicity. BMC Public Health. 2010; 10:475. PMC: 2927542. DOI: 10.1186/1471-2458-10-475. View

13.

Yang Y, Shin J, Li D, An R . Sedentary Behavior and Sleep Problems: a Systematic Review and Meta-Analysis. Int J Behav Med. 2016; 24(4):481-492. DOI: 10.1007/s12529-016-9609-0. View

14.

Kline C . The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement. Am J Lifestyle Med. 2015; 8(6):375-379. PMC: 4341978. DOI: 10.1177/1559827614544437. View

15.

Papatriantafyllou E, Efthymiou D, Zoumbaneas E, Popescu C, Vassilopoulou E . Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients. 2022; 14(8). PMC: 9031614. DOI: 10.3390/nu14081549. View

16.

Khandelwal D, Dutta D, Chittawar S, Kalra S . Sleep Disorders in Type 2 Diabetes. Indian J Endocrinol Metab. 2017; 21(5):758-761. PMC: 5628550. DOI: 10.4103/ijem.IJEM_156_17. View

17.

Lee S, Kim J, Chung J . The association between sleep quality and quality of life: a population-based study. Sleep Med. 2021; 84:121-126. DOI: 10.1016/j.sleep.2021.05.022. View

18.

August K . Marital Status, Marital Transitions, and Sleep Quality in Mid to Late Life. Res Aging. 2021; 44(3-4):301-311. DOI: 10.1177/01640275211027281. View

19.

Cho Y . Early Development of Bidirectional Associations between Sleep Disturbance and Diabetes. Diabetes Metab J. 2020; 44(5):668-670. PMC: 7643604. DOI: 10.4093/dmj.2020.0198. View

20.

Obaseki D, Kolawole B, Gomerep S, Obaseki J, Abidoye I, Ikem R . Prevalence and predictors of obstructive sleep apnea syndrome in a sample of patients with type 2 Diabetes Mellitus in Nigeria. Niger Med J. 2014; 55(1):24-8. PMC: 4071658. DOI: 10.4103/0300-1652.128154. View