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Elderly Health Journal 2024, 10(1): 7-13 |
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Pengpid S, Peltzer K, Anantanasuwong D. Longitudinal Health Consequences of Insomnia Symptoms among Middle-Aged and Older Adults in Thailand. Elderly Health Journal 2024; 10 (1) :7-13
URL: http://ehj.ssu.ac.ir/article-1-313-en.html
URL: http://ehj.ssu.ac.ir/article-1-313-en.html
Longitudinal Health Consequences of Insomnia Symptoms among Middle-Aged and Older Adults in Thailand
1. Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand , kfpeltzer@gmail.com
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Longitudinal Health Consequences of Insomnia Symptoms among Middle-Aged and Older Adults in Thailand
Supa Pengpid 1,2,3, Karl Peltzer 1,4,5*, Dararatt Anantanasuwong 6
Received 7 Apr 2024
Accepted 14 May 2024
A B S T R A C T
Introduction: Insomnia symptoms may impact on various health outcomes. It is unclear how insomnia symptoms impact on health in Thailand. In a longitudinal study of ageing adults in Thailand, the goal of the research was to evaluate the relationships between insomnia symptoms and 20 health indicators.
Methods: Prospective cohort data from the Health, Aging and Retirement in Thailand study, which included participants 45 years of age and older (N = 2863) from three successive waves in 2015, 2017, and 2020 were analyzed. Insomnia symptoms and health indicators were assessed by self-report. Generalized Estimating Equations analysis and logistic regression analysis were used to evaluate the longitudinal relationships between measures of insomnia symptoms and 20 health indicators.
Results: In 2020, 11.7% of people reported having insomnia symptoms, compared to 15.6% in 2015 and 14.6% in 2017. Insomnia symptoms were positively correlated with three poor mental health indicators (depressive symptoms, quality of life and self-rated mental health), eight poor physical health indicators (hypertension, self-rated physical health status, cardiovascular disease, diabetes, osteoporosis, chronic lung disease, kidney disease, and physical injury), and two lifestyle indicators (physical inactivity and meal skipping) in logistic regression models.
Conclusion: The study found that a number of indicators of physical and mental illness as well as lifestyle choices were linked to symptoms of insomnia. Improved detection and management of insomnia symptoms could lower indicators of physical and mental illness in Thailand.
Keywords: Health, Insomnia Symptoms, Lifestyle, Longitudinal Study, Thailand
Copyright © 2024 Elderly Health Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cite.
Introduction
Supa Pengpid 1,2,3, Karl Peltzer 1,4,5*, Dararatt Anantanasuwong 6
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Center for Aging Society Research, National Institute of Development Administration, Bangkapi Bangkok, Thailand
Received 7 Apr 2024
Accepted 14 May 2024
A B S T R A C T
Introduction: Insomnia symptoms may impact on various health outcomes. It is unclear how insomnia symptoms impact on health in Thailand. In a longitudinal study of ageing adults in Thailand, the goal of the research was to evaluate the relationships between insomnia symptoms and 20 health indicators.
Methods: Prospective cohort data from the Health, Aging and Retirement in Thailand study, which included participants 45 years of age and older (N = 2863) from three successive waves in 2015, 2017, and 2020 were analyzed. Insomnia symptoms and health indicators were assessed by self-report. Generalized Estimating Equations analysis and logistic regression analysis were used to evaluate the longitudinal relationships between measures of insomnia symptoms and 20 health indicators.
Results: In 2020, 11.7% of people reported having insomnia symptoms, compared to 15.6% in 2015 and 14.6% in 2017. Insomnia symptoms were positively correlated with three poor mental health indicators (depressive symptoms, quality of life and self-rated mental health), eight poor physical health indicators (hypertension, self-rated physical health status, cardiovascular disease, diabetes, osteoporosis, chronic lung disease, kidney disease, and physical injury), and two lifestyle indicators (physical inactivity and meal skipping) in logistic regression models.
Conclusion: The study found that a number of indicators of physical and mental illness as well as lifestyle choices were linked to symptoms of insomnia. Improved detection and management of insomnia symptoms could lower indicators of physical and mental illness in Thailand.
Keywords: Health, Insomnia Symptoms, Lifestyle, Longitudinal Study, Thailand
Copyright © 2024 Elderly Health Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cite.
Introduction
A significant public health burden, inadequate sleep affects approximately 25% of the world's population (1). Studies indicate that as people age, the prevalence of insomnia rises (2), and the effectiveness of their sleep falls (3), all of which may be related to a rise in multimorbidity, polypharmacy, and psychosocial variables (4). Studies among older adults in Thailand show a high prevalence insomnia symptoms. High prevalence of insomnia symptoms have been found among older adults in Thailand, e.g., in a national survey the prevalence of insomnia (defined as any “often or always having difficulty initiating sleep, difficulty maintaining sleep and early morning awakening”) was 46.3% (5), and in local community surveys among older adults the proportion of poor sleep quality was 62.4% in Songkhla Province (6), and 44.0% in northern Thailand (7), and insomnia was 60% in Khon Kaen (8).
Increased activity of the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis, proinflammatory reactions, alterations in the circadian rhythm, and metabolic effects are linked to sleep disturbances (9). According to a recent review (9), consequences of sleep disruption among adults may include physical and mental ill-health and lifestyle variables. Mental ill-health consequences of sleep disruption may include poor perceived mental health status (10), depression (9, 11, 12), poor quality of life (9, 13), memory related diseases and dementia (14-16). Physical ill-health consequences of sleep disruption can include poor perceived physical health status (10), hypertension (9, 17), cardiovascular disorder (9, 18), diabetes (9, 17, 18), bone diseases (17, 19), functional disability (20, 21) and cancer (9, 22). Lifestyle consequences of sleep disruption can include increased smoking heaviness (23), problem drinking (24-26), physical inactivity (27), and obesity (18, 28).
The majority of studies on sleep disorders and their detrimental effects on health in older adults are carried out in wealthy nations; however, middle-income nations like Thailand lack longitudinal data on these relationships. It is hypothesized that symptoms of insomnia in persons 45 years and older in Thailand are linked to both physical and mental health issues, as well as unhealthy behaviors, based on the cited research. The study's objective was to evaluate the longitudinal associations between insomnia symptoms and 20 health indicators in Thailand from 2015 to 2020 in order to enhance our understanding of the relationship between insomnia symptoms and health outcomes in that country.
Methods
Study design and participants
Thailand's Health, Aging and Retirement (HART) study's longitudinal data (analytic sample 2863) from its three successive waves—2015, 2017, and 2020—were examined. One adult (45 years of age or older) was chosen at random from each home in a nationwide multi-step sampling design; see details (29). In-person interviews were done by the skilled field workers with the participants at their homes.
Measures
Exposure variable
Insomnia symptoms included “almost always (5-7 days) or often (3-4 days) (versus sometimes-1-2 days or very rarely/ never) having trouble falling asleep/insomnia in the past week” (30).
Outcome variables
Poor mental health outcomes
"In general, how would you rate your mental health status?" was the question used to gauge the self-rated mental health status given on a scale of “0 (very poor) to 10 (excellent)”. A self-rated score of 0-7.0 (with 8.0 serving as the median) indicated poor mental health.
The question, "In general, how satisfied are you with your quality of life (or how happy do you feel)?" was used to determine happiness or quality of life given on a scale of “0 (very poor) to 10 (excellent)”. A self-rated 0–7 score indicated a low quality of life or happiness (8 being the median).
Based on the CES-D-10 (30), without the insomnia symptoms item, depressive symptoms (≥ 10 scores) were assessed; in waves 1, 2, and 3, Cronbach's alpha was 0.7, respectively.
Diagnoses from reported healthcare providers were used to evaluate brain disorders, including dementia.
Consequences of physical illness
Self-assessed physical well-being: "Overall, how would you rate your physical well-being?" given on a scale of “0 (very poor) to 10 (excellent)”. Physical health was classified as self-rated (poor) on a scale of 0-6.0, with 7.0 serving as the median.
Chronic physical conditions such as diabetes, hypertension, heart disease, lung disease, osteoporosis, kidney disease, cancer, and physical injuries are diagnosed by healthcare providers.
A modified 4-item activity of daily living (ADL) scale (31) that measures eating, dressing, washing, and bathing was used to determine the ADL disability. There were three response options, with 0 meaning "can do it all by myself" and 3 meaning "need help for every step." ADL disability was identified as one of the four components that requires collaboration. (Cronbach's α = 0.90-0.93).
Lifestyle outcomes
Tobacco smoking included current smoking cigarettes.
Three to four or more and five or more alcoholic beverages units per week, respectively, for women and men, were considered hazardous alcohol use.
Physical exercise/activity was grouped into “none = inactivity, 1–149 min/week = low activity, and ≥ 150 min/week = high activity in the past week.” (32)
Obesity class II (30 + kg/m2) (33) was based on self-reported body weight/height.
Meal skipping was defined as “skipping any breakfast, lunch, or dinner in the last two days.”
Covariates
Marital status, age, sex, education, occupation, religion, and perceived economic status (i.e., "How satisfied are you with your economic situation?" On a scale of 1 to 10) were among the covariates.
Statistical analysis
To compare sample characteristics between study years, chi-square statistics were utilized.
We used Generalized Estimating Equations analysis (GEE) to evaluate the longitudinal relationships between insomnia symptoms and outcomes related to mental and physical illness as well as lifestyle factors across the three study waves (34). There are two models offered to explain how health outcomes evolve. The first model, which regresses insomnia symptoms on each health outcome without adjustment, was replaced by a second model that took lifestyle, mental and physical health, and sociodemographic factors into account for each health outcome. Additionally, correlations between the degree of insomnia symptom experience and incident health indicators (in 2017 and/or 2020, and without the condition at baseline in 2015) were evaluated using logistic regression. The choice of covariates was influenced by earlier studies (9-14, 19-21). Variation Inflation Factors (VIFs) statistics were used to evaluate the degree of collinearity, but none was found. The statistical analyses were conducted using StataSE 15.0 (College Station, TX, USA); p < 0.05 was considered significant, and missing values were eliminated.
Ethical considerations
The “Ethics Committee in Human Research, National Institute of Development Administration – ECNIDA (ECNIDA 2020/00012)” following the Helsinki Declaration, approved the study protocol, and participants gave written informed consent.
Results
Table 1 displays descriptive from the study assessments across three survey waves, while 11.7% of people reported having insomnia symptoms, compared to 15.6% in 2015 and 14.6% in 2017. Lifestyle factors (risky alcohol consumption, tobacco use, and being physically inactive) and poor mental health (like probable depressive symptoms, quality of life, self-reported mental health, and brain disease or dementia) differed significantly. From 2015 to 2017 or 2020, the number of poor physical health conditions—kidney disease, cardiovascular disease, diabetes, chronic lung disease, osteoporosis, hypertension, ADL disability, physical injury, and cancer—increased significantly. Of the 5616 individuals at baseline, 361 passed away, 336 declined, and 2056 could not be located between 2015 and 2020, leaving an analytic sample of 2863. The characteristics that set the loss to follow-up sample apart from the follow-up sample were male, older, widowed, had more education, lived in an urban area, practiced Buddhism, had a lower subjective economic status, and had more limitations with ADLs.
Insomnia symptoms and health outcomes
Insomnia symptoms were positively correlated with three poor mental health indicators (quality of life or happiness, depressive symptoms, and self-rated mental health status), seven poor physical health indicators (hypertension, self-rated physical health status, cardiovascular disorder, diabetes, chronic lung disease, osteoporosis, and physical injury), and two behavioural indicators (meal skipping and physical inactivity) in the final adjusted GEE logistic regression model. (Table 2)
Insomnia symptoms and incident health indicators
According to the adjusted regression analyses, individuals who experienced insomnia symptoms in 1 wave and/or 2-3 waves of the study were more likely to experience incident mental health problems (such as depressive symptoms, self-rated mental health, and quality of life), incident physical health problems (such as, hypertension, osteoporosis, kidney disease, physical injury, and self-rated physical health status) as well as incident meal skipping. (Table 3)
Discussion
The study's objective was to evaluate for the first time the longitudinal associations between insomnia symptoms and 20 health indicators in Thailand from 2015 to 2020. Our research revealed a positive correlation between insomnia symptoms and three mental health issues, eight physical health issues and two lifestyle factors.
In line with earlier studies (9-13), we discovered a positive correlation between insomnia symptoms and mental distress (low quality of life/happiness, depressive symptoms and low self-rated mental health status). Additionally, in line with earlier studies, we discovered in the unadjusted analysis a positive correlation between brain illness/dementia and symptoms of insomnia (14-16). The study discovered strong correlations between depressive and insomnia symptoms, which may be attributed to insomnia's co-occurring condition with depression (35) and/or potential bidirectional relationship with depressive symptoms (36).
In line with previous research (9, 10, 17-19), the study found that insomnia symptoms were positively associated with cardiovascular disorder, low self-rated physical health, diabetes, hypertension, and osteoporosis. “Activation of markers of cellular and transcriptional inflammation might contribute to the link between sleep disturbance and age-related morbidity risk.” (37). Sleep disruption may also “interact directly with central pain processing mechanisms and inflammatory processes, and indirectly with mood and physical functioning to augment clinical bone diseases pain.” (38). Furthermore, this study showed that having insomnia symptoms increased the odds of chronic lung disease. In a previous study (39), the rate of insomnia was higher in persons with COPD, while in another study COPD severity was associated with developing sleep problems (40), which may suggest a bidirectional relationship between COPD and sleep problems. Unlike previous research (9, 20-22) that found an association between sleep problems and functional disability and cancer, we could not find a significant association. In agreement with former research (41), this study found that insomnia symptoms were associated with incident chronic kidney disease (CKD). One possible explanation for this link could be that insomnia symptoms activate the sympathetic nervous system contributing to higher CKD risk and progression (41). Furthermore, consistent with previous research (42, 43), we found that insomnia symptoms increased the odds of physical injury (based on falls, road traffic crash and being hit by an object). This may be explained by sleep problems impairing alertness, judgment and accuracy increasing the vulnerability to sustaining physical injury (42, 43).
Increased activity of the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis, proinflammatory reactions, alterations in the circadian rhythm, and metabolic effects are linked to sleep disturbances (9). According to a recent review (9), consequences of sleep disruption among adults may include physical and mental ill-health and lifestyle variables. Mental ill-health consequences of sleep disruption may include poor perceived mental health status (10), depression (9, 11, 12), poor quality of life (9, 13), memory related diseases and dementia (14-16). Physical ill-health consequences of sleep disruption can include poor perceived physical health status (10), hypertension (9, 17), cardiovascular disorder (9, 18), diabetes (9, 17, 18), bone diseases (17, 19), functional disability (20, 21) and cancer (9, 22). Lifestyle consequences of sleep disruption can include increased smoking heaviness (23), problem drinking (24-26), physical inactivity (27), and obesity (18, 28).
The majority of studies on sleep disorders and their detrimental effects on health in older adults are carried out in wealthy nations; however, middle-income nations like Thailand lack longitudinal data on these relationships. It is hypothesized that symptoms of insomnia in persons 45 years and older in Thailand are linked to both physical and mental health issues, as well as unhealthy behaviors, based on the cited research. The study's objective was to evaluate the longitudinal associations between insomnia symptoms and 20 health indicators in Thailand from 2015 to 2020 in order to enhance our understanding of the relationship between insomnia symptoms and health outcomes in that country.
Methods
Study design and participants
Thailand's Health, Aging and Retirement (HART) study's longitudinal data (analytic sample 2863) from its three successive waves—2015, 2017, and 2020—were examined. One adult (45 years of age or older) was chosen at random from each home in a nationwide multi-step sampling design; see details (29). In-person interviews were done by the skilled field workers with the participants at their homes.
Measures
Exposure variable
Insomnia symptoms included “almost always (5-7 days) or often (3-4 days) (versus sometimes-1-2 days or very rarely/ never) having trouble falling asleep/insomnia in the past week” (30).
Outcome variables
Poor mental health outcomes
"In general, how would you rate your mental health status?" was the question used to gauge the self-rated mental health status given on a scale of “0 (very poor) to 10 (excellent)”. A self-rated score of 0-7.0 (with 8.0 serving as the median) indicated poor mental health.
The question, "In general, how satisfied are you with your quality of life (or how happy do you feel)?" was used to determine happiness or quality of life given on a scale of “0 (very poor) to 10 (excellent)”. A self-rated 0–7 score indicated a low quality of life or happiness (8 being the median).
Based on the CES-D-10 (30), without the insomnia symptoms item, depressive symptoms (≥ 10 scores) were assessed; in waves 1, 2, and 3, Cronbach's alpha was 0.7, respectively.
Diagnoses from reported healthcare providers were used to evaluate brain disorders, including dementia.
Consequences of physical illness
Self-assessed physical well-being: "Overall, how would you rate your physical well-being?" given on a scale of “0 (very poor) to 10 (excellent)”. Physical health was classified as self-rated (poor) on a scale of 0-6.0, with 7.0 serving as the median.
Chronic physical conditions such as diabetes, hypertension, heart disease, lung disease, osteoporosis, kidney disease, cancer, and physical injuries are diagnosed by healthcare providers.
A modified 4-item activity of daily living (ADL) scale (31) that measures eating, dressing, washing, and bathing was used to determine the ADL disability. There were three response options, with 0 meaning "can do it all by myself" and 3 meaning "need help for every step." ADL disability was identified as one of the four components that requires collaboration. (Cronbach's α = 0.90-0.93).
Lifestyle outcomes
Tobacco smoking included current smoking cigarettes.
Three to four or more and five or more alcoholic beverages units per week, respectively, for women and men, were considered hazardous alcohol use.
Physical exercise/activity was grouped into “none = inactivity, 1–149 min/week = low activity, and ≥ 150 min/week = high activity in the past week.” (32)
Obesity class II (30 + kg/m2) (33) was based on self-reported body weight/height.
Meal skipping was defined as “skipping any breakfast, lunch, or dinner in the last two days.”
Covariates
Marital status, age, sex, education, occupation, religion, and perceived economic status (i.e., "How satisfied are you with your economic situation?" On a scale of 1 to 10) were among the covariates.
Statistical analysis
To compare sample characteristics between study years, chi-square statistics were utilized.
We used Generalized Estimating Equations analysis (GEE) to evaluate the longitudinal relationships between insomnia symptoms and outcomes related to mental and physical illness as well as lifestyle factors across the three study waves (34). There are two models offered to explain how health outcomes evolve. The first model, which regresses insomnia symptoms on each health outcome without adjustment, was replaced by a second model that took lifestyle, mental and physical health, and sociodemographic factors into account for each health outcome. Additionally, correlations between the degree of insomnia symptom experience and incident health indicators (in 2017 and/or 2020, and without the condition at baseline in 2015) were evaluated using logistic regression. The choice of covariates was influenced by earlier studies (9-14, 19-21). Variation Inflation Factors (VIFs) statistics were used to evaluate the degree of collinearity, but none was found. The statistical analyses were conducted using StataSE 15.0 (College Station, TX, USA); p < 0.05 was considered significant, and missing values were eliminated.
Ethical considerations
The “Ethics Committee in Human Research, National Institute of Development Administration – ECNIDA (ECNIDA 2020/00012)” following the Helsinki Declaration, approved the study protocol, and participants gave written informed consent.
Results
Table 1 displays descriptive from the study assessments across three survey waves, while 11.7% of people reported having insomnia symptoms, compared to 15.6% in 2015 and 14.6% in 2017. Lifestyle factors (risky alcohol consumption, tobacco use, and being physically inactive) and poor mental health (like probable depressive symptoms, quality of life, self-reported mental health, and brain disease or dementia) differed significantly. From 2015 to 2017 or 2020, the number of poor physical health conditions—kidney disease, cardiovascular disease, diabetes, chronic lung disease, osteoporosis, hypertension, ADL disability, physical injury, and cancer—increased significantly. Of the 5616 individuals at baseline, 361 passed away, 336 declined, and 2056 could not be located between 2015 and 2020, leaving an analytic sample of 2863. The characteristics that set the loss to follow-up sample apart from the follow-up sample were male, older, widowed, had more education, lived in an urban area, practiced Buddhism, had a lower subjective economic status, and had more limitations with ADLs.
Insomnia symptoms and health outcomes
Insomnia symptoms were positively correlated with three poor mental health indicators (quality of life or happiness, depressive symptoms, and self-rated mental health status), seven poor physical health indicators (hypertension, self-rated physical health status, cardiovascular disorder, diabetes, chronic lung disease, osteoporosis, and physical injury), and two behavioural indicators (meal skipping and physical inactivity) in the final adjusted GEE logistic regression model. (Table 2)
Insomnia symptoms and incident health indicators
According to the adjusted regression analyses, individuals who experienced insomnia symptoms in 1 wave and/or 2-3 waves of the study were more likely to experience incident mental health problems (such as depressive symptoms, self-rated mental health, and quality of life), incident physical health problems (such as, hypertension, osteoporosis, kidney disease, physical injury, and self-rated physical health status) as well as incident meal skipping. (Table 3)
Discussion
The study's objective was to evaluate for the first time the longitudinal associations between insomnia symptoms and 20 health indicators in Thailand from 2015 to 2020. Our research revealed a positive correlation between insomnia symptoms and three mental health issues, eight physical health issues and two lifestyle factors.
In line with earlier studies (9-13), we discovered a positive correlation between insomnia symptoms and mental distress (low quality of life/happiness, depressive symptoms and low self-rated mental health status). Additionally, in line with earlier studies, we discovered in the unadjusted analysis a positive correlation between brain illness/dementia and symptoms of insomnia (14-16). The study discovered strong correlations between depressive and insomnia symptoms, which may be attributed to insomnia's co-occurring condition with depression (35) and/or potential bidirectional relationship with depressive symptoms (36).
In line with previous research (9, 10, 17-19), the study found that insomnia symptoms were positively associated with cardiovascular disorder, low self-rated physical health, diabetes, hypertension, and osteoporosis. “Activation of markers of cellular and transcriptional inflammation might contribute to the link between sleep disturbance and age-related morbidity risk.” (37). Sleep disruption may also “interact directly with central pain processing mechanisms and inflammatory processes, and indirectly with mood and physical functioning to augment clinical bone diseases pain.” (38). Furthermore, this study showed that having insomnia symptoms increased the odds of chronic lung disease. In a previous study (39), the rate of insomnia was higher in persons with COPD, while in another study COPD severity was associated with developing sleep problems (40), which may suggest a bidirectional relationship between COPD and sleep problems. Unlike previous research (9, 20-22) that found an association between sleep problems and functional disability and cancer, we could not find a significant association. In agreement with former research (41), this study found that insomnia symptoms were associated with incident chronic kidney disease (CKD). One possible explanation for this link could be that insomnia symptoms activate the sympathetic nervous system contributing to higher CKD risk and progression (41). Furthermore, consistent with previous research (42, 43), we found that insomnia symptoms increased the odds of physical injury (based on falls, road traffic crash and being hit by an object). This may be explained by sleep problems impairing alertness, judgment and accuracy increasing the vulnerability to sustaining physical injury (42, 43).
Table 1. Descriptive statistics of the study variables over time, HART 2015-2020
Table 2. Longitudinal associations between insomnia symptoms and health indicators
aAdjusted for age group, sex, education, marital status, subjective economic status, area of residence, religion, all variables in the table, and study wave; ***p < 0.001; **p < 0.01; *p < 0.05; ADL: Activities of Daily Living; CI: Confidence Interval
Table 3. Longitudinal associations between insomnia symptoms and incident health indicators
aAdjusted for age group, sex, education, marital status, subjective economic status, area of residence, religion, all variables in the table; ***p < 0.001; **p < 0.01; *p < 0.05; ADL: Activities of Daily Living; CI: Confidence Interval; bwithout sleep issues
| Variables | Study year | p-value | |||
| 2015 (n = 2863) | 2017 (n = 2863) | 2020 (n = 2863) | |||
| N (%) | N (%) | N (%) | |||
| Exposure variable | Insomnia symptoms | 446 (15.6) | 418 (14.6) | 336 (11.7) | < 0.001 |
| Sociodemographic factors | Age (70 plus) | 1040 (36.3) | 1149 (40.5) | 1441 (50.3) | < 0.001 |
| Sex (male) | 1270 (44.4) | ||||
| Education (> elementary) | 449 (15.7) | ||||
| Residence (urban) | 1392 (48.6) | ||||
| Marital status (widowed) | 802 (28.4) | 786 (27.7) | 937 (32.8) | 0.002 | |
| Subjective economic status (low) | 762 (26.6) | 1022 (35.7) | 978 (34.2) | < 0.001 | |
| Religion (Buddhist) | 2619 (91.5) | ||||
| Mental ill-health | Self-reported poor mental health | 798 (27.9) | 824 (28.8) | 685 (23.9) | < 0.001 |
| Emotional/psychiatric disease | 12 (0.4) | 9 (0.3) | 22 (0.8) | 0.029 | |
| Poor quality of life/happiness | 769 (26.9) | 1050 (36.7) | 1074 (34.2) | < 0.001 | |
| Probable depression | 334 (11.7) | 279 (9.7) | 160 (5.6) | < 0.001 | |
| Brain disease/dementia | 17 (0.6) | 26 (0.9) | 37 (1.3) | 0.013 | |
| Physical ill-health | Poor self-rated physical health status | 746 (26.1) | 900 (31.4) | 734 (25.6) | < 0.001 |
| Hypertension | 984 (34.4) | 1129 (39.4) | 1303 (45.5) | < 0.001 | |
| Cardiovascular disease | 137 (4.8) | 154 (5.4) | 195 (6.8) | < 0.001 | |
| Diabetes | 414 (14.5) | 419 (14.6) | 543 (19.0) | < 0.001 | |
| Osteoporosis | 108 (3.8) | 103 (3.6) | 175 (6.1) | < 0.001 | |
| Chronic lung disease | 21 (0.7) | 42 (1.5) | 42 (1.5) | 0.003 | |
| Kidney disease | 47 (1.6) | 80 (2.8) | 123 (4.3) | < 0.001 | |
| Physical injury | 342 (11.9) | 463 (16.2) | --- | < 0.001 | |
| ADL disability | 72 (2.5) | 107 (3.7) | 218 (7.6) | < 0.001 | |
| Cancer | 11 (0.4) | 24 (0.8) | 44 (1.5) | < 0.001 | |
| Lifestyle factors | Current tobacco smoking | 339 (11.8) | 380 (13.3) | 316 (11.0) | <0.001 |
| Hazardous alcohol use | 99 (3.5) | 186 (6.5) | 57 (2.0) | < 0.001 | |
| Physical inactivity | 1606 (56.1) | 1256 (43.9) | 1444 (50.4) | < 0.001 | |
| BMI-obesity class II | 189 (6.6) | 225 (7.9) | 220 (7.1) | 0.333 | |
| Meal skipping | 156 (5.4) | 460 (16.1) | 379 (13.2) | < 0.001 | |
Table 2. Longitudinal associations between insomnia symptoms and health indicators
| Outcome variables | Model 1: unadjusted odds ratio (95% CI) | p-value | Model 2: adjusted odds ratio (95% CI)a | p-value |
| Mental ill-health | ||||
| Self-reported poor mental health | 1.68 (1.51 to 1.87) | < 0.001 | 0.99 (0.85 to 1.14) | 0.837 |
| Poor quality of life/happiness | 3.21 (2.88 to 3.58) | < 0.001 | 1.25 (1.09 to 1.42) | 0.002 |
| Depressive symptoms | 4.81 (4.13 to 5.60) | < 0.001 | 3.96 (3.30 to 4.76) | < 0.001 |
| Brain disease/dementia | 2.03 (1.38 to 3.01) | < 0.001 | 0.95 (0.57 to 1.59) | 0.843 |
| Physical ill-health | ||||
| Poor self-rated physical health status | 2.13 (1.92 to 2.36) | < 0.001 | 1.60 (1.41 to 1.83) | < 0.001 |
| Hypertension | 1.51 (1.36 to 1.68) | < 0.001 | 1.25 (1.09 to 1.43) | < 0.001 |
| Cardiovascular disease | 1.74 (1.44 to 2.10) | < 0.001 | 1.42 (1.11 to 1.82) | 0.006 |
| Diabetes | 1.50 (1.31 to 1.71) | < 0.001 | 1.39 (1.18 to 1.63) | < 0.001 |
| Osteoporosis | 2.28 (1.86 to 2.81) | < 0.001 | 1.66 (1.27 to 2.17) | < 0001 |
| Chronic lung disease | 2.01 (1.43 to 2.95) | < 0.001 | 2.16 (1.46 to 3.20) | < 0.001 |
| Kidney disease | 1.55 (1.19 to 2.03) | < 0.001 | 1.18 (0.84 to 1.65) | 0.345 |
| Physical injury | 1.49 (1.28 to 1.74) | < 0.001 | 1.38 (1.10 to 1.64) | < 0.001 |
| ADL disability | 1.23 (0.99 to 1.52) | 0.058 | --- | |
| Cancer | 1.30 (0.79 to 2.14) | 0.305 | --- | |
| Lifestyle factors | ||||
| Current tobacco smoking | 0.83 (0.71 to 0.98) | 0.028 | 0.99 (0.80 to 1.22) | 0.907 |
| Hazardous alcohol use | 0.83 (0.63 to 1.09) | 0.170 | --- | |
| Physical inactivity | 1.17 (1.05 to 1.29) | 0.004 | 1.14 (1.01 to 1.30) | 0.033 |
| Body mass index (BMI)-obesity | 1.07 (0.88 to 1.31) | 0.500 | --- | |
| Meal skipping | 1.56 (1.35 to 1.81) | < 0.001 | 1.68 (1.44 to 1.96) | < 0.001 |
Table 3. Longitudinal associations between insomnia symptoms and incident health indicators
| Outcome variables | Insomnia symptoms | Model 1: unadjusted odds ratio (95% CI) | p-value | Model 2: adjusted odds ratio (95% CI)a | p-value |
| Mental ill-health | |||||
| Incident self-reported poor mental health | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.41 (1.14 to 1.73) 2.10 (1.44 to 2.06) |
< 0.001 < 0.001 |
1 (Reference) 1.39 (1.12 to 1.72) 1.97 (1.33 to 2.92) |
0.003 < 0.001 |
| Incident poor quality of life/happiness | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.17 (0.94 to 1.45) 1.67 (1.15 to 2.44) |
0.169 0.008 |
1 (Reference) 1.15 (0.92 to 1.44) 1.77 (1.18 to 2.64) |
0.227 0.005 |
| Incident depressive symptomsb | 0 waves 1 wave 2-3 waves |
1 (Reference) 2.53 (1.83 to 3.51) 5.26 (3.43 to 8.06) |
< 0.001 < 0.001 |
1 (Reference) 2.45 (1.74 to 3.44) 5.27 (3.36 to 8.27) |
< 0.001 < 0.001 |
| Incident brain disease/dementia | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.32 (0.72 to 2.44) 2.12 (0.92 to 4.90) |
0.373 0.078 |
--- | |
| Physical ill-health | |||||
| Incident poor self-rated physical health status | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.50 (1.22 to 1.84) 2.96 (2.00 to 4.38) |
< 0.001 < 0.001 |
1 (Reference) 1.41 (1.14 to 1.75) 2.66 (1.75 to 4.05) |
0.002 < 0.001 |
| Incident hypertension | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.23 (0.98 to 1.56) 1.82 (1.20 to 2.76) |
0.081 0.005 |
1 (Reference) 1.20 (0.94 to 1.54) 1.65 (1.06 to 2.57) |
0.114 0.025 |
| Incident cardiovascular disease | 0 waves 1 wave 2-3 waves |
1 (Reference) 0.99 (0.70 to 1.41) 0.95 (0.52 to 1.76) |
0.951 0.881 |
--- | |
| Incident diabetes | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.22 (0.90 to 1.66) 1.65 (1.03 to 2.64) |
0.205 0.039 |
1 (Reference) 1.20 (0.87 to 1.65) 1.60 (0.97 to 2.63) |
0.270 0.064 |
| Incident osteoporosis | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.81 (1.33 to 2.48) 3.79 (2.51 to 5.71) |
< 0.001 < 0.001 |
1 (Reference) 1.63 (1.18 to 2.25) 2.99 (1.93 to 4.63) |
0.003 < 0.001 |
| Incident chronic lung disease | 0 waves 1 wave 2-3 waves |
1 (Reference) 2.09 (1.15 to 3.01) 3.46 (1.59 to 7.56) |
0.016 0.002 |
1 (Reference) 2.19 (1.16 to 4.12) 4.12 (1.79 to 9.46) |
0.006 < 0.001 |
| Incident kidney disease | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.86 (1.28 to 2.71) 2.32 (1.33 to 4.03) |
< 0.001 0.003 |
1 (Reference) 1.86 (1.26 to 2.74) 2.06 (1.14 to 3.69) |
0.002 0.016 |
| Incident physical injury | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.39 (1.09 to 1.77) 1.93 (1.33 to 2.81) |
0.008 < 0.001 |
1 (Reference) 1.43 (1.10 to 1.84) 1.81 (1.22 to 2.69) |
0.007 0.003 |
| Incident ADL disability | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.32 (1.01 to 1.73) 1.53 (1.00 to 2.33) |
0.041 0.048 |
1 (Reference) 1.48 (0.86 to 1.62) 1.21 (0.74 to 1.96) |
0.309 0.451 |
| Incident cancer | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.07 (0.55 to 2.06) 0.60 (0.14 to 2.52) |
0.846 0.482 |
--- | |
| Lifestyle factors | |||||
| Incident current tobacco smoking | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.16 (0.83 to 1.63) 0.95 (0.52 to 1.71) |
0.377 0.854 |
--- | |
| Incident hazardous alcohol use | 0 waves 1 wave 2-3 waves |
1 (Reference) 0.85 (0.60 to 1.19) 0.76 (0.42 to 1.40) |
0.344 0.379 |
--- | |
| Incident physical inactivity | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.15 (0.87 to 1.51) 0.80 (0.51 to 1.26) |
0.337 0.339 |
--- | |
| Incident body mass index (BMI)-obesity | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.45 (1.00 to 2.09) 0.42 (0.15 to 1.16) |
0.049 0.095 |
1 (Reference) 1.34 (0.90 to 1.99) 0.44 (0.17 to 1.33) |
0.154 0.158 |
| Incident meal skipping | 0 waves 1 wave 2-3 waves |
1 (Reference) 1.37 (1.12 to 1.68) 2.00 (1.46 to 2.74) |
0.002 < 0.001 |
1 (Reference) 1.34 (1.07 to 1.68) 2.15 (1.51 to 3.06) |
0.010 <0.001 |
In line with a former study (27), this survey showed a positive association between insomnia symptoms and physical inactivity. Exercise has been shown to be beneficial to improve sleep quality (44). Furthermore, we found an association between insomnia symptoms and meal skipping. Poor sleep and meal skipping may be interrelated (45). Unlike some previous studies (18, 23-28), we did not find an association between insomnia symptoms and smoking, hazardous alcohol use and obesity. Alcohol and tobacco use by older adults in Thailand may not be used as a coping mechanism for sleep issues (46).
Conclusion
Our research revealed a positive correlation between insomnia symptoms and three mental health issues, eight physical health issues and two lifestyle factors. Improved detection and management of insomnia symptoms could lower a number of detrimental health consequences in Thailand.
Study limitations
The study's limitations include the use of self-reporting to evaluate variables and the use of a single item to measure insomnia symptoms; nevertheless, strong correlations with multiple item measures have been found (47). One more drawback is the significant loss at follow-up.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
“The Health, Aging, and Retirement in Thailand (HART) study is sponsored by Thailand Science Research and Innovation (TSRI) and National Research Council of Thailand (NRCT).”
Authors’ contribution
“SP, KP and DA contributed to the design and implementation of the research. KP analyzed the results. SP, KP and DA wrote the manuscript. All authors contributed to the article and approved the submitted version.”
References
1. Morin CM, Benca R. Chronic insomnia. Lancet. 2012; 379 (9821): 1129–41.
2. van de Langenberg SCN, Kocevska D, Luik AI. The multidimensionality of sleep in population-based samples: a narrative review. Journal of Sleep Research. 2022; 31(4): 1-11.
3. Evans MA, Buysse DJ, Marsland AL, Wright AGC, Foust J, Carroll LW, et al. Meta-analysis of age and actigraphy-assessed sleep characteristics across the lifespan. Sleep. 2021; 44(9): 1-19.
4. Miner B, Kryger MH. Sleep in the aging population. Sleep Medicine Clinics. 2017; 12(1): 31-8.
5. Sukying C, Bhokakul V, Udomsubpayakul U. An epidemiological study on insomnia in an elderly Thai population. Journal of the Medical Association of Thailand. 2003; 86(4): 316-24.
6. Aunjitsakul W, Pitanupong J, Werachattawan N. Sleep quality among elderly people in Songkhla province, Thailand: A two-stage cluster sampling study. Journal of the Medical Association of Thailand. 2018; 101(1): 137-44.
7. Thichumpa W, Howteerakul N, Suwannapong N, Tantrakul V. Sleep quality and associated factors among the elderly living in rural Chiang Rai, Northern Thailand. Epidemiology and Health. 2018; 40: 1-9.
8. Manjavong M, Limpawattana P, Mairiang P, Anutrakulchai S. Prevalence of insomnia and related impact. International Journal of Psychiatry in Medicine. 2016; 51(6): 544-53.
9. Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nature and Science Sleep. 2017; 9: 151-61.
10. Furihata R, Uchiyama M, Takahashi S, Suzuki M, Konno C, Osaki K, et al. The association between sleep problems and perceived health status: a Japanese nationwide general population survey. Sleep Medicine. 2012; 13(7): 831-7.
11. Mirchandaney R, Asarnow LD, Kaplan KA. Recent advances in sleep and depression. Current Opinion in Psychiatry. 2023; 36(1): 34-40.
12. Hill Almeida LM, Flicker L, Hankey GJ, Golledge J, Yeap BB, Almeida OP. Disrupted sleep and risk of depression in later life: A prospective cohort study with extended follow up and a systematic review and meta-analysis. Journal of Affective Disorders. 2022; 309: 314-23.
13. Lee M, Choh AC, Demerath EW, Knutson KL, Duren DL, Sherwood RJ, et al. Sleep disturbance in relation to health-related quality of life in adults: the Fels longitudinal study. The Journal of Nutrition, Health and Aging. 2009; 13(6): 576-83.
14. Beydoun HA, Beydoun MA, Weiss J, Hossain S, Huang S, Alemu BT, et al. Insomnia as a predictor of diagnosed memory problems: 2006-2016 health and retirement study. Sleep Medicine. 2021; 80: 158-166.
15. Wong R, Lovier MA. Sleep disturbances and dementia risk in older adults: findings from 10 years of national U.S. prospective data. American Journal of Preventive Medicine. 2023; 64(6): 781-7.
16. Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Medicine Reviews. 2018; 40: 4–16.
17. Hernández B, Scarlett S, Moriarty F, Romero-Ortuno R, Kenny RA, Reilly R. Investigation of the role of sleep and physical activity for chronic disease prevalence and incidence in older Irish adults. BMC Public Health. 2022; 22(1):1-11.
18. Piccolo RS, Yang M, Bliwise DL, Yaggi HK, Araujo AB. Racial and socioeconomic disparities in sleep and chronic disease: results of a longitudinal investigation. Ethnicity and Disease. 2013; 23(4): 499-507.
19. Ochs-Balcom HM, Hovey KM, Andrews C, Cauley JA, Hale L, Li W, et al. Short sleep is associated with low bone mineral density and osteoporosis in the women's health initiative. Journal of Bone and Mineral Research. 2020; 35(2): 261-8.
20. Park M, Buchman AS, Lim AS, Leurgans SE, Bennett DA. Sleep complaints and incident disability in a community-based cohort study of older persons. The American Journal of Geriatric Psychiatry. 2014; 22(7): 718-26.
21. Friedman EM. Self-reported sleep problems prospectively increase risk of disability: findings from the survey of midlife development in the United States. Journal of the American Geriatrics Society. 2016; 64(11): 2235-41.
22. Song C, Zhang R, Wang C, Fu R, Song W, Dou K, et al. Sleep quality and risk of cancer: findings from the English longitudinal study of aging. Sleep. 2021; 44(3): 1-8.
23. Gibson M, Munafò MR, Taylor AE, Treur JL. Evidence for genetic correlations and bidirectional, causal effects between smoking and sleep behaviors. Nicotine & Tobacco Research. 2019; 21(6): 731–8.
24. Crum RM, Storr CL, Chan YF, Ford DE. Sleep disturbance and risk for alcohol-related problems. The American Journal of Psychiatry. 2004; 161(7): 1197-203.
25. Dzierzewski JM, Ravyts SG, Martin CE, Polak KM, Nielson SA, Pomm D, et al. Sleep disturbance and problematic alcohol use: Examination of sex and race differences. Frontiers in Sleep. 2022; 1: 1-8.
26. Haario P, Rahkonen O, Laaksonen M, Lahelma E, Lallukka T. Bidirectional associations between insomnia symptoms and unhealthy behaviours. Journal of Sleep Research. 2013; 22(1): 89-95.
27. Holfeld B, Ruthig JC. A longitudinal examination of sleep quality and physical activity in older adults. Journal of Applied Gerontology. 2014; 33(7): 791-807.
28. Norton MC, Eleuteri S, Cerolini S, Ballesio A, Conte SC, Falaschi P, et al. Is poor sleep associated with obesity in older adults? A narrative review of the literature. Eating and Weight Disorders. 2018; 23(1): 23-38.
29. Anantanasuwong D, Theerawanviwat D, Siripanich P. Panel survey and study on health and aging, and retirement in Thailand. In: Gu D, Dupre M, editors. Encyclopedia of gerontology and population aging. Springer, Cham; 2019.
30. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D. American Journal of Preventive Medicine. 1994; 10(2): 77–84.
31. Katz S, Ford AB, Heiple KG, Newill VA. Studies of illness in the aged: Recovery after fracture of the hip. Journal of Gerontology. 1964; 19: 285-93.
32. Kim SH, Park S. A meta-analysis of the correlates of successful aging in older adults. Research on Aging. 2017; 39(5): 657-77.
Conclusion
Our research revealed a positive correlation between insomnia symptoms and three mental health issues, eight physical health issues and two lifestyle factors. Improved detection and management of insomnia symptoms could lower a number of detrimental health consequences in Thailand.
Study limitations
The study's limitations include the use of self-reporting to evaluate variables and the use of a single item to measure insomnia symptoms; nevertheless, strong correlations with multiple item measures have been found (47). One more drawback is the significant loss at follow-up.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
“The Health, Aging, and Retirement in Thailand (HART) study is sponsored by Thailand Science Research and Innovation (TSRI) and National Research Council of Thailand (NRCT).”
Authors’ contribution
“SP, KP and DA contributed to the design and implementation of the research. KP analyzed the results. SP, KP and DA wrote the manuscript. All authors contributed to the article and approved the submitted version.”
References
1. Morin CM, Benca R. Chronic insomnia. Lancet. 2012; 379 (9821): 1129–41.
2. van de Langenberg SCN, Kocevska D, Luik AI. The multidimensionality of sleep in population-based samples: a narrative review. Journal of Sleep Research. 2022; 31(4): 1-11.
3. Evans MA, Buysse DJ, Marsland AL, Wright AGC, Foust J, Carroll LW, et al. Meta-analysis of age and actigraphy-assessed sleep characteristics across the lifespan. Sleep. 2021; 44(9): 1-19.
4. Miner B, Kryger MH. Sleep in the aging population. Sleep Medicine Clinics. 2017; 12(1): 31-8.
5. Sukying C, Bhokakul V, Udomsubpayakul U. An epidemiological study on insomnia in an elderly Thai population. Journal of the Medical Association of Thailand. 2003; 86(4): 316-24.
6. Aunjitsakul W, Pitanupong J, Werachattawan N. Sleep quality among elderly people in Songkhla province, Thailand: A two-stage cluster sampling study. Journal of the Medical Association of Thailand. 2018; 101(1): 137-44.
7. Thichumpa W, Howteerakul N, Suwannapong N, Tantrakul V. Sleep quality and associated factors among the elderly living in rural Chiang Rai, Northern Thailand. Epidemiology and Health. 2018; 40: 1-9.
8. Manjavong M, Limpawattana P, Mairiang P, Anutrakulchai S. Prevalence of insomnia and related impact. International Journal of Psychiatry in Medicine. 2016; 51(6): 544-53.
9. Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nature and Science Sleep. 2017; 9: 151-61.
10. Furihata R, Uchiyama M, Takahashi S, Suzuki M, Konno C, Osaki K, et al. The association between sleep problems and perceived health status: a Japanese nationwide general population survey. Sleep Medicine. 2012; 13(7): 831-7.
11. Mirchandaney R, Asarnow LD, Kaplan KA. Recent advances in sleep and depression. Current Opinion in Psychiatry. 2023; 36(1): 34-40.
12. Hill Almeida LM, Flicker L, Hankey GJ, Golledge J, Yeap BB, Almeida OP. Disrupted sleep and risk of depression in later life: A prospective cohort study with extended follow up and a systematic review and meta-analysis. Journal of Affective Disorders. 2022; 309: 314-23.
13. Lee M, Choh AC, Demerath EW, Knutson KL, Duren DL, Sherwood RJ, et al. Sleep disturbance in relation to health-related quality of life in adults: the Fels longitudinal study. The Journal of Nutrition, Health and Aging. 2009; 13(6): 576-83.
14. Beydoun HA, Beydoun MA, Weiss J, Hossain S, Huang S, Alemu BT, et al. Insomnia as a predictor of diagnosed memory problems: 2006-2016 health and retirement study. Sleep Medicine. 2021; 80: 158-166.
15. Wong R, Lovier MA. Sleep disturbances and dementia risk in older adults: findings from 10 years of national U.S. prospective data. American Journal of Preventive Medicine. 2023; 64(6): 781-7.
16. Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Medicine Reviews. 2018; 40: 4–16.
17. Hernández B, Scarlett S, Moriarty F, Romero-Ortuno R, Kenny RA, Reilly R. Investigation of the role of sleep and physical activity for chronic disease prevalence and incidence in older Irish adults. BMC Public Health. 2022; 22(1):1-11.
18. Piccolo RS, Yang M, Bliwise DL, Yaggi HK, Araujo AB. Racial and socioeconomic disparities in sleep and chronic disease: results of a longitudinal investigation. Ethnicity and Disease. 2013; 23(4): 499-507.
19. Ochs-Balcom HM, Hovey KM, Andrews C, Cauley JA, Hale L, Li W, et al. Short sleep is associated with low bone mineral density and osteoporosis in the women's health initiative. Journal of Bone and Mineral Research. 2020; 35(2): 261-8.
20. Park M, Buchman AS, Lim AS, Leurgans SE, Bennett DA. Sleep complaints and incident disability in a community-based cohort study of older persons. The American Journal of Geriatric Psychiatry. 2014; 22(7): 718-26.
21. Friedman EM. Self-reported sleep problems prospectively increase risk of disability: findings from the survey of midlife development in the United States. Journal of the American Geriatrics Society. 2016; 64(11): 2235-41.
22. Song C, Zhang R, Wang C, Fu R, Song W, Dou K, et al. Sleep quality and risk of cancer: findings from the English longitudinal study of aging. Sleep. 2021; 44(3): 1-8.
23. Gibson M, Munafò MR, Taylor AE, Treur JL. Evidence for genetic correlations and bidirectional, causal effects between smoking and sleep behaviors. Nicotine & Tobacco Research. 2019; 21(6): 731–8.
24. Crum RM, Storr CL, Chan YF, Ford DE. Sleep disturbance and risk for alcohol-related problems. The American Journal of Psychiatry. 2004; 161(7): 1197-203.
25. Dzierzewski JM, Ravyts SG, Martin CE, Polak KM, Nielson SA, Pomm D, et al. Sleep disturbance and problematic alcohol use: Examination of sex and race differences. Frontiers in Sleep. 2022; 1: 1-8.
26. Haario P, Rahkonen O, Laaksonen M, Lahelma E, Lallukka T. Bidirectional associations between insomnia symptoms and unhealthy behaviours. Journal of Sleep Research. 2013; 22(1): 89-95.
27. Holfeld B, Ruthig JC. A longitudinal examination of sleep quality and physical activity in older adults. Journal of Applied Gerontology. 2014; 33(7): 791-807.
28. Norton MC, Eleuteri S, Cerolini S, Ballesio A, Conte SC, Falaschi P, et al. Is poor sleep associated with obesity in older adults? A narrative review of the literature. Eating and Weight Disorders. 2018; 23(1): 23-38.
29. Anantanasuwong D, Theerawanviwat D, Siripanich P. Panel survey and study on health and aging, and retirement in Thailand. In: Gu D, Dupre M, editors. Encyclopedia of gerontology and population aging. Springer, Cham; 2019.
30. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D. American Journal of Preventive Medicine. 1994; 10(2): 77–84.
31. Katz S, Ford AB, Heiple KG, Newill VA. Studies of illness in the aged: Recovery after fracture of the hip. Journal of Gerontology. 1964; 19: 285-93.
32. Kim SH, Park S. A meta-analysis of the correlates of successful aging in older adults. Research on Aging. 2017; 39(5): 657-77.
33. Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutrition. 2009; 12(4): 497-506.
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36. Bao YP, Han Y, Ma J, Wang RJ, Shi L, Wang TY, et al. Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: Meta-analysis and systematic review. Neuroscience and Biobehavioral Reviews. 2017; 75: 257-73.
37. Piber D, Cho JH, Lee O, Lamkin DM, Olmstead R, Irwin MR. Sleep disturbance and activation of cellular and transcriptional mechanisms of inflammation in older adults. Brain Behavior, and Immunity. 2022; 106: 67-75.
38. Smith MT, Quartana PJ, Okonkwo RM, Nasir A. Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model. Current Pain and Headache Reports. 2009; 13(6): 447-54.
39. Budhiraja R, Roth T, Hudgel DW, Budhiraja P, Drake CL. Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. Sleep. 2011; 34(7): 859-67.
40. Luyster FS, Wang J, Sciurba FC, Jessica B. Longitudinal associations between sleep disturbance and disease severity in patients with COPD. Sleep Science and Practice. 2020; 4: 1-9.
41. Bo Y, Yeoh EK, Guo C, Zhang Z, Tam T, Chan TC, et al. sleep and the risk of chronic kidney disease: a cohort study. Journal of Clinical Sleep Medicine. 2019; 15(3): 393-400.
42. Chen YY, Wu KC. Sleep habits and excessive daytime sleepiness correlate with injury risks in the general population in Taiwan. Injury Prevention. 2010; 16(3): 172-7.
43. Zhou T, Dai X, Yuan Y, Xue Q, Li X, Wang M, et al. Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front Immunology. 2023; 14: 1-11.
44. Rubio-Arias JÁ, Marín-Cascales E, Ramos-Campo DJ, Hernandez AV, Pérez-López FR. Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials. Maturitas. 2017; 100: 49-56.
45. Chang ZS, Boolani A, Conroy DA, Dunietz T, Jansen EC. Skipping breakfast and mood: The role of sleep. Nutrition and Health. 2021; 27(4): 373-9.
46. Neale J, Meadows R, Nettleton S, Panebianco D, Strang J, Vitoratou S, et al. Substance use, sleep and intervention design: insights from qualitative data. Journal of Mental Health. 2019; 28(5): 482-9.
47. Snyder E, Cai B, DeMuro C, Morrison MF, Ball W. A new single-item sleep quality scale: results of psychometric evaluation in patients with chronic primary insomnia and depression. Journal of Clinical Sleep Medicine. 2018; 14(11): 1849-57.
35. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues in Clinical Neuroscience. 2008; 10(3): 329-36.
36. Bao YP, Han Y, Ma J, Wang RJ, Shi L, Wang TY, et al. Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: Meta-analysis and systematic review. Neuroscience and Biobehavioral Reviews. 2017; 75: 257-73.
37. Piber D, Cho JH, Lee O, Lamkin DM, Olmstead R, Irwin MR. Sleep disturbance and activation of cellular and transcriptional mechanisms of inflammation in older adults. Brain Behavior, and Immunity. 2022; 106: 67-75.
38. Smith MT, Quartana PJ, Okonkwo RM, Nasir A. Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model. Current Pain and Headache Reports. 2009; 13(6): 447-54.
39. Budhiraja R, Roth T, Hudgel DW, Budhiraja P, Drake CL. Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. Sleep. 2011; 34(7): 859-67.
40. Luyster FS, Wang J, Sciurba FC, Jessica B. Longitudinal associations between sleep disturbance and disease severity in patients with COPD. Sleep Science and Practice. 2020; 4: 1-9.
41. Bo Y, Yeoh EK, Guo C, Zhang Z, Tam T, Chan TC, et al. sleep and the risk of chronic kidney disease: a cohort study. Journal of Clinical Sleep Medicine. 2019; 15(3): 393-400.
42. Chen YY, Wu KC. Sleep habits and excessive daytime sleepiness correlate with injury risks in the general population in Taiwan. Injury Prevention. 2010; 16(3): 172-7.
43. Zhou T, Dai X, Yuan Y, Xue Q, Li X, Wang M, et al. Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front Immunology. 2023; 14: 1-11.
44. Rubio-Arias JÁ, Marín-Cascales E, Ramos-Campo DJ, Hernandez AV, Pérez-López FR. Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials. Maturitas. 2017; 100: 49-56.
45. Chang ZS, Boolani A, Conroy DA, Dunietz T, Jansen EC. Skipping breakfast and mood: The role of sleep. Nutrition and Health. 2021; 27(4): 373-9.
46. Neale J, Meadows R, Nettleton S, Panebianco D, Strang J, Vitoratou S, et al. Substance use, sleep and intervention design: insights from qualitative data. Journal of Mental Health. 2019; 28(5): 482-9.
47. Snyder E, Cai B, DeMuro C, Morrison MF, Ball W. A new single-item sleep quality scale: results of psychometric evaluation in patients with chronic primary insomnia and depression. Journal of Clinical Sleep Medicine. 2018; 14(11): 1849-57.
Type of Study: Research |
Subject:
General
Received: 2024/04/7 | Accepted: 2024/05/14 | Published: 2024/06/21
Received: 2024/04/7 | Accepted: 2024/05/14 | Published: 2024/06/21
References
1. Morin CM, Benca R. Chronic insomnia. Lancet. 2012; 379 (9821): 1129–41.
2. van de Langenberg SCN, Kocevska D, Luik AI. The multidimensionality of sleep in population-based samples: a narrative review. Journal of Sleep Research. 2022; 31(4): 1-11.
3. Evans MA, Buysse DJ, Marsland AL, Wright AGC, Foust J, Carroll LW, et al. Meta-analysis of age and actigraphy-assessed sleep characteristics across the lifespan. Sleep. 2021; 44(9): 1-19.
4. Miner B, Kryger MH. Sleep in the aging population. Sleep Medicine Clinics. 2017; 12(1): 31-8.
5. Sukying C, Bhokakul V, Udomsubpayakul U. An epidemiological study on insomnia in an elderly Thai population. Journal of the Medical Association of Thailand. 2003; 86(4): 316-24.
6. Aunjitsakul W, Pitanupong J, Werachattawan N. Sleep quality among elderly people in Songkhla province, Thailand: A two-stage cluster sampling study. Journal of the Medical Association of Thailand. 2018; 101(1): 137-44.
7. Thichumpa W, Howteerakul N, Suwannapong N, Tantrakul V. Sleep quality and associated factors among the elderly living in rural Chiang Rai, Northern Thailand. Epidemiology and Health. 2018; 40: 1-9.
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