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

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.背景 目前针对低收入和中等收入国家中慢性病、慢性病数量与睡眠问题之间关联的研究数据较为匮乏，且尚未有将此类关联与高收入国家开展全球范围对比的相关研究。 方法 本研究分析了两项全国代表性样本的数据集：分别于2011-2012年、2007-2010年开展的欧洲老龄化合作研究（Collaborative Research on Ageing in Europe，涵盖芬兰、波兰、西班牙），以及世界卫生组织（World Health Organization）全球老龄化与成人健康研究（Study on Global Ageing and Adult Health，涵盖中国、加纳、印度、墨西哥、俄罗斯、南非）中，共42116名50岁及以上个体的相关数据。 结果 本研究采用多变量logistic回归（logistic regression）模型，评估了9种慢性病（心绞痛、关节炎、哮喘、慢性肺部疾病、抑郁症、糖尿病、高血压、肥胖症及脑卒中）与受试者近30天内自述的重度/极重度睡眠问题之间的关联。经年龄校正后的睡眠问题患病率范围为2.8%（中国）至17.0%（波兰）。在对混杂因素进行校正后，心绞痛（优势比（Odds Ratio, OR）：1.75~2.78）、关节炎（OR：1.39~2.46）以及抑郁症（OR：1.75~5.12）在多数乃至全部研究国家中均与睡眠问题存在显著相关性。此外，睡眠问题还与以下疾病存在显著关联：芬兰、西班牙与印度的哮喘患者；波兰、西班牙、加纳及南非的慢性肺部疾病患者；印度的糖尿病患者；中国、加纳与印度的脑卒中患者。所有研究国家均观察到慢性病数量与睡眠问题之间存在线性剂量反应关系。与无慢性病的受试者相比，总样本中罹患1、2、3及≥4种慢性病的受试者对应的优势比（Odds Ratio, OR）及95%置信区间（Confidence Interval, CI）分别为1.41（1.09~1.82）、2.55（1.99~3.27）、3.22（2.52~4.11）及7.62（5.88~9.87）。 结论 对慢性病患者共病睡眠问题的情况进行识别并同步开展干预，有望获得更佳的治疗结局。临床医师应警惕多病共存患者发生睡眠问题的高风险。未来仍需开展相关研究，以明确共病睡眠问题的最优干预方案，尤其针对低收入和中等收入国家的人群。