Haldar Partha, Prasad Kameshwar, Kant Shashi, Dwivedi Sada Nand, Vibha Deepti, Pandit Awadh Kishor, Srivastava Achal Kumar, Kumar Amit, Ikram M Arfan, Henning Tiemeier
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Rajendra Institute of Medical Sciences, Ranchi, 834009, Jharkhand, India.
Sleep Breath. 2023 Aug;27(4):1541-1555. doi: 10.1007/s11325-022-02725-9. Epub 2022 Oct 25.
To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults.
We analyzed baseline data from adults (≥ 50 years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R, and change was formally tested with the log-likelihood ratio test.
Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R increased from 0.08 to 0.10, p < 0.001).
Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.
确定在印度老年人群中，代谢风险因素是否与睡眠质量差及阻塞性睡眠呼吸暂停样症状（OSA症状）相关，且独立于心理社会问题、人口统计学因素和生活方式因素。
我们分析了来自印度一项基于人群的队列研究LoCARPoN研究中成年人（≥50岁）的基线数据。变量分为以下几类：（a）人口统计学和生活方式因素，如吸烟、饮酒和身体活动；（b）心理社会问题，包括抑郁、焦虑和感知压力症状；（c）代谢风险因素，包括糖化血红蛋白、高密度脂蛋白、低密度脂蛋白、总胆固醇、体重指数和高血压。将这些变量作为睡眠质量差和OSA症状的预测因素进行研究。将变量组逐步添加到逻辑回归模型中。使用麦克法登伪R来量化嵌套模型解释的方差，并通过对数似然比检验对变化进行正式检验。
在7505名成年人中，睡眠质量差的患病率为16.9%（95%置信区间：16.0，17.7），OSA症状的患病率为7.0%（95%置信区间：6.4，7.6）。心理社会问题与睡眠质量差（伪R从0.10增加到0.15，p<0.001）和更多OSA症状（伪R从0.08增加到0.10，p<0.001）均有很强的独立相关性。代谢风险因素与睡眠质量有适度的独立相关性（伪R从0.14增加到0.15，p<0.01），但与OSA症状有很强的相关性（伪R从0.08增加到0.10，p<0.001）。
心理社会和代谢风险因素与睡眠质量和OSA症状独立相关。这一事实意味着OSA症状可能会影响心理健康和身体健康。我们的研究结果具有公共卫生意义，因为印度老年人的数量和比例在增加，而代谢风险因素和心理社会问题的患病率已经很高。这些事实不仅有可能加剧睡眠障碍和OSA症状的负担，还可能加剧相关的心血管和神经后遗症，进一步加重印度医疗保健系统的负担。
