Abstract
Background: Poor sleep quality is associated with various health outcomes, such as cardiovascular disease, cancer and death. Although the epidemiology of poor sleep has been well described internationally, few studies investigated its prevalence in Saudi Arabia.
Methods: We conducted a multicenter, cross-sectional study to investigate the prevalence of poor sleep in three primary healthcare clinics in Riyadh, Saudi Arabia. Sociodemographic and clinical characteristics were collected along with self-reported sleep characteristics, including subjective sleep quality, sleep duration and latency, were also recorded. We used the Pittsburgh sleep quality index (PSQI) to assess sleep quality, with lower scores indicating better sleep quality. We considered an overall PSQI score > 5 to indicate poor sleep quality. We also evaluated health-related quality of life (QoL) via the health-related quality-of-life questionnaire short-form SF-12 Health Survey (SF-12).
Results: Between [October], 2020, and [January], 2021, we enrolled 400 participants who met all eligibility criteria. The median (interquartile range [IQR]) age of participants was 36 (26-46) years, and 206 (52%) were male. We found that 49.5% (95% confidence interval [CI]= 44-55%) of 331 participants with valid data were considered as poor sleepers (PSQI>5). The median (IQR) PSQI score was 5 (3-8). Male sex (mean difference [MD]: -0.98, 95% CI = -1.70 to - 0.26, P=0.008), employed participants (MD: -0.78, 95% CI = -1.51 to - 0.05, P= 0.04) and physically active patients (MD:-1.0, 95% CI = -1.72 to - 0.28, P=0.007) were associated with significantly lower mean PSQI scores. QoL was inversely associated with PSQI scores (b: -0.78 units, 95% CI, -0.95 to -0.61, P<0.001).
Conclusions: The prevalence of poor sleep quality is high among Saudi patients served by the primary care setting. There is a direct association between sleep quality and QoL. Our results may have implications for health promotion interventions and policy programs to prevent sleep disorders and improve sleep quality in Saudi Arabia.
Keywords: Sleep quality, Health related quality of life, Saudi Arabia
References
- Van Someren EJ, Cirelli C, Dijk DJ, Van CE, Schwartz S, Chee MW. Disrupted Sleep: From Molecules to Cognition. J Neurosci 2015; 35:13889-95.
- Reimer MA, Flemons WW. Quality of life in sleep disorders. Sleep Med Rev 2003; 7:335-49.
- Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep 2015; 38:843-4.
- Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med 2005; 6:23-7.
- Tao F, Cao Z, Jiang Y, Fan N, Xu F, Yang H et al. Associations of sleep duration and quality with incident cardiovascular disease, cancer, and mortality: a prospective cohort study of 407,500 UK biobank participants. Sleep Med 2021; 81:401-9.
- Yin J, Jin X, Shan Z, Li S, Huang H, Li P et al. Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc 2017; 6.
- Grandner MA. Epidemiology of insufficient sleep and poor sleep quality. Sleep and health. Elsevier; 2019. 11-20.
- Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin 2008; 24:307-17.
- Madrid-Valero JJ, Martínez-Selva JM, Ribeiro do CB, Sánchez-Romera JF, Ordoñana JR. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gac Sanit 2017; 31:18-22.
- Ohayon MM. Nocturnal awakenings and difficulty resuming sleep: their burden in the European general population. J Psychosom Res 2010; 69:565-71.
- Simonelli G, Marshall NS, Grillakis A, Miller CB, Hoyos CM, Glozier N. Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration. Sleep Health 2018; 4:239-50.
- Adams RJ, Appleton SL, Taylor AW, Gill TK, Lang C, McEvoy RD et al. Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health 2017; 3:35-42.
- Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019; 13:S31-S34.
- Shahid A, Wilkinson K, Marcu S, Shapiro CM. Pittsburgh Sleep Quality Index (PSQI). STOP, That and One Hundred Other Sleep Scales. Springer; 2011. 279-283.
- Suleiman KH, Yates BC, Berger AM, Pozehl B, Meza J. Translating the Pittsburgh Sleep Quality Index into Arabic. West J Nurs Res 2010; 32:250-68.
- Al-Shehri AH, Taha AZ, Bahnassy AA, Salah M. Health-related quality of life in type 2 diabetic patients. Ann Saudi Med 2008; 28:352-60.
- Zou C, Sun H, Lu C, Chen W, Guo VY. Nighttime sleep duration, restlessness and risk of multimorbidity - A longitudinal study among middle-aged and older adults in China. Arch Gerontol Geriatr 2021; 99:104580.
- Anujuo K, Agyemang C, Snijder MB, Jean-Louis G, van den Born BJ, Peters RJG et al. Contribution of short sleep duration to ethnic differences in cardiovascular disease: results from a cohort study in the Netherlands. BMJ Open 2017; 7:e017645.
- Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med 2003; 163:205-9.
- Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med 2017; 32:246-56.
- Dong L, Xie Y, Zou X. Association between sleep duration and depression in US adults: A cross-sectional study. J Affect Disord 2022; 296:183-8.
- Sella E, Miola L, Toffalini E, Borella E. The relationship between sleep quality and quality of life in aging: a systematic review and meta-analysis. Health Psychol Rev 2021;1-23.
- Menefee LA, Frank ED, Doghramji K, Picarello K, Park JJ, Jalali S et al. Self-reported sleep quality and quality of life for individuals with chronic pain conditions. Clin J Pain 2000; 16:290-7.
- Sut HK, Asci O, Topac N. Sleep Quality and Health-Related Quality of Life in Pregnancy. J Perinat Neonatal Nurs 2016; 34:302-9.
- Kumar B, Tilea A, Gillespie BW, Zhang X, Kiser M, Eisele G et al. Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study. Clin Nephrol 2010; 73:104-14.
- Al-Khani AM, Sarhandi MI, Zaghloul MS, Ewid M, Saquib N. A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia. BMC Res Notes 2019; 12:665.
- Darraj A, Mahfouz MS, Alsabaani A, Sani M, Alameer A. Assessment of sleep quality and its predictors among patients with diabetes in Jazan, Saudi Arabia. Diabetes Metab Syndr Obes 2018; 11:523-31.
- Bahammam AS. Sleep medicine in Saudi Arabia: Current problems and future challenges. Ann Thorac Med 2011; 6:3-10.
- Saleem AH, Al Rashed FA, Alkharboush GA, Almazyed OM, Olaish AH, Almeneessier AS et al. Primary care physicians' knowledge of sleep medicine and barriers to transfer of patients with sleep disorders. A cross-sectional study. Saudi Med J 2017; 38:553-9.
- Cheung JMY, Jarrin DC, Ballot O, Bharwani AA, Morin CM. A systematic review of cognitive behavioral therapy for insomnia implemented in primary care and community settings. Sleep Med Rev 2019; 44:23-36.
Corresponding Author
Ahlam Saad Al-Mutairi
Family Medicine Resident, PO Box. 13223-6600, Riyadh 13223, Kingdome of Saudi Arabia