Faculty of Medicine FMS, Sfax University, Tunisia; Department of Respiratory and Sleep Medicine, Hedi Chaker Hospital, Sfax, Tunisia.
Faculty of Medicine FMS, Sfax University, Tunisia; Epidemiology Department, Hedi Chaker Hospital, Sfax, Tunisia.
Sleep Med. 2023 Feb;102:90-104. doi: 10.1016/j.sleep.2022.12.025. Epub 2022 Dec 31.
OBJECTIVES/BACKGROUND: Sleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip.
PATIENTS/METHODS: A population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9.
Three out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality.
Poor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.
目的/背景：创伤经历可能会影响睡眠，从而增加生活质量和日常功能不佳的风险。然而，有关受冲突影响地区睡眠习惯和问题的研究仍然很少。本研究旨在描述睡眠习惯，估计睡眠障碍的患病率，并确定加沙地带的相关因素。
患者/方法：这是一项基于人群的横断面研究，纳入了 1458 名年龄在 18 岁及以上的巴勒斯坦成年人，他们居住在加沙地带，研究于 2022 年 2 月 18 日至 3 月 31 日期间进行。通过免费的 Google Forms 工具进行电子调查来收集数据。使用了一系列与睡眠、情绪和主观生活质量相关的自我报告措施：匹兹堡睡眠质量指数（PSQI）、世界卫生组织-五维度健康指数（WHO-5）、爱泼沃斯嗜睡量表（ESS）和患者健康问卷（PHQ）-9。
参与者中有五分之三（n=882，60.5%）为女性，平均年龄为 34.8±12.77 岁。超过三分之一的参与者（n=556，38.1%）的幸福感较差，根据 WHO-5 评估，有 108 人（7.4%）的 PHQ-9 评分≥20，表明患有严重抑郁。当 PSQI≥6 时，睡眠质量差的患病率为 52.8%，当 PSQI≥8 时，患病率为 30.5%。白天嗜睡（EDS）、睡眠时间短、严重抑郁和幸福感差的患病率分别为 43.6%、26.4%、7.1%和 38.1%。女性和最年轻的参与者在睡眠和情绪障碍以及日间功能障碍方面的患病率最高。使用多元二分类逻辑回归分析，严重抑郁、离婚、有心理疾病史、幸福感差和既往战争伤被确定为睡眠质量差的最强预测因素。
我们样本中的睡眠质量差、EDS、严重抑郁和幸福感差显著增加。女性和最年轻的参与者受影响最大。加沙地带的冲突环境，加上人口密度高和社会经济条件恶化，可能在睡眠障碍中发挥重要作用，主要是因为情绪障碍的高患病率。睡眠和情绪障碍也会对生活质量产生不利影响。
