Sleep problems and chronic conditions in single parents in Ghana: Serial mediating roles of health-related quality of life and functional limitations.

OBJECTIVES

Data on the association between sleep problems and chronic conditions among single parents in low- and middle-income countries (LMICs) are limited, and no study has, to date, reported the serial mediation effects of functional limitations and poor health-related quality of life (HRQoL) in this association. This study examines the extent to which functional limitations and poor HRQoL serially explain the link between sleep problems and chronic conditions among single parents in Ghana.

METHODS

Data on 627 single mothers and fathers were obtained through a multi-stage stratified sampling technique. Sleep duration, nocturnal sleep problems, and daytime sleep problems were used to assess sleep problems. The EQ-5D-3L questionnaire was used to measure HRQoL. Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations.

RESULTS

The mean age (SD) was 45.0 (14.66) years; 67.3% females. After full adjustment, sleep problems were significantly associated with increases in chronic conditions (β = .238, 95%CI = .100-.377), poor HRQoL (β = .604, 95%CI = .450-.757), and functional limitations (β = .234, 95%CI = .159-.307). Chronic conditions were positively influenced by poor HRQoL (β = .352, 95%CI = .284-.421) and functional limitations (β = .272, 95%CI = .112-.433). Sleep problems were indirectly related to chronic conditions via poor HRQoL (β = .213, BootSE = .039, 95%CI = .143-.295), functional limitations (β = .063, BootSE = .029, 95%CI = .013-.130) and functional limitations → HRQoL (β = .099, BootSE = .025, 95%CI = .054-.152), mediating 34.70%, 10.31% and 16.15% of the total effect, respectively.

CONCLUSIONS

Sleep problems and poor HRQoL were positively associated with chronic conditions. Functional limitations and poor HRQoL partially and serially explained this association. Efforts to address chronic conditions among single parents should consider interventions for sleep problems and physiological health outcomes, particularly in LMICs.