Prevalence, Incidence and Health Impacts of Sleep Disorders on Coronary Artery Disease Risk Factors: Results of a Community-Based Cohort Study (KERCADRS)
Objective: Sleep disorders are associated with many health problems including anxiety, depression and coronary artery disease (CAD). This study investigated the prevalence, predictors and health impacts of insomnia and hypersomnia in southeastern Iran as well as the five-year incidence rate (IR) of these sleep disorders.
Method: The present study was a cross-sectional, single-stage, cluster sampling study examining nine CAD risk factors (KERCADR study phase two), including sleep disorders, carried out in Kerman on 9997 participants, 15 to 80 years old. Medical examination along with demographic, sleep status, Physical activity level (GPAQ), anxiety and depression status (Beck Inventories) were assessed and fasting blood sample was taken for blood glucose and lipids analysis. STATA v15 software was used for data analysis using survey data analysis package and a univariable survey logistic regression model.
Results: From 9997 participants, 59.4% were female. 45.3% of the participants were suffering from insomnia and hypersomnia, which was 15% more than the phase 1 prevalence (P < 0.001). Participants with insomnia had higher chance of being anxious, but participants with hypersomnia had higher chance of being depressed, be a cigarette smoker, opium user, and sedentary (P < 0.001). In regards to marital status, prevalence of hypersomnia was as follows in ascending order of prevalence: singles > married > widowed > divorced. While the IR of insomnia was higher in females, males had higher IR of hypersomnia. In addition, the IR of both sleep disorders was higher in participants with Low Physical Activity (LPA).
Conclusion: The results showed high current prevalence and increasing trends of sleep disorders in the past five years. If left unaddressed, burden of CVDs in the community will demonstrate a significant increase in the future as a result of sleep disorders and other associated risk factors.
2. Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1).
3. Chaput JP, Dutil C, Featherstone R, Ross R, Giangregorio L, Saunders TJ, et al. Sleep duration and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab. 2020;45(10 (Suppl. 2)):S218-s231
4. Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med. 2015 Aug 15;11(8):931-52.
5. Colten HR, Altevogt BM. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: Committee on Sleep Medicine and Research, Institute of Medicine. .
6. Luyster FS, Strollo PJ, Zee PC, Walsh JK. Sleep: a health imperative. Sleep. 2012 Jun 1;35(6):727-34..
7. Deng N, Kohn TP, Lipshultz LI, Pastuszak AW. The Relationship Between Shift Work and Men's Health. Sex Med Rev. 2018;6(3):446-56.
8. Matricciani L, Bin YS, Lallukka T, Kronholm E, Dumuid D, Paquet C, et al. Past, present, and future: trends in sleep duration and implications for public health. Sleep Health. 2017;3(5):317-23.
9. Najafipour H, Sabahi A, Mirrashidi F, Afshari M, Haghdoost AA. Sleep status and its relationship with other coronary artery diseases risk factors: Findings of a community-based study in South East of Iran. J Sleep Disord Ther. 2015;4(197):2167-0277..
10. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246-56.
11. Jike M, Itani O, Watanabe N, Buysse DJ, Kaneita Y. Long sleep duration and health outcomes: A systematic review, meta-analysis and meta-regression. Sleep Med Rev. 2018;39:25-36.
12. Geoffroy PA, Hoertel N, Etain B, Bellivier F, Delorme R, Limosin F, et al. Insomnia and hypersomnia in major depressive episode: Prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study. J Affect Disord. 2018;226:132-41.
13. Magee CA, Iverson DC, Caputi P. Factors associated with short and long sleep. Prev Med. 2009;49(6):461-7.
14. Kronholm E, Härmä M, Hublin C, Aro AR, Partonen T. Self-reported sleep duration in Finnish general population. J Sleep Res. 2006;15(3):276-90.
15. Ahmadvand A, Sepehrmanesh Z, Ghoreishi FS, Mousavi SG. Prevalence of insomnia among 18 years old people and over in Kashan city, Iran in 2008. KAUMS Journal (FEYZ). 2010 Feb 10;13(4):313-20.
16. Araste M. Evaluation of insomnia in medical students of Kurdistan University. Sci. J. Kurd. Univ. Med. Sci. 2007 Dec 10;12(3):58-63.
17. Najafipour H, Nasri HR, Rostamzadeh F, Amirzadeh R, Shadkam M, Mirzazadeh A. Prevalence and incidence of pre-hypertension and hypertension (awareness/control) in Iran: findings from Kerman coronary artery diseases risk factors study 2 (KERCADRS). J Hum Hypertens. 2020.
18. Najafipour H, Mirzazadeh A, Haghdoost A, Shadkam M, Afshari M, Moazenzadeh M, et al. Coronary Artery Disease Risk Factors in an Urban and Peri-urban Setting, Kerman, Southeastern Iran (KERCADR Study): Methodology and Preliminary Report. Iran J Public Health. 2012;41(9):86-92.
19. Khesht-Masjedi MF, Omar Z, Masoleh SM. Psychometrics properties of the Persian version of Beck Anxiety Inventory in North of Iranian adolescents. IJEPR. 2015 Apr 1;1(2):145..
20. Hojat M, Shapurian R, Mehryar AH. Psychometric properties of a Persian version of the short form of the Beck Depression Inventory for Iranian college students. Psychol Rep. 1986;59(1):331-8.
21. Armstrong T, Bull F. Development of the world health organization global physical activity questionnaire (GPAQ). J Public Health. 2006 Apr;14(2):66-70.
22. Najafipour H, Kahnooji M, Baneshi MR, Yeganeh M, Ahmadi Gohari M, Shadkam Farokhi M, et al. The prevalence and 5-Year incidence rate of low physical activity in an urban population of 10,000 in southeastern Iran: Relationship with other cardiovascular risk factors. J Phys Act Health. 2020;17(4):435-42.
23. Cleland CL, Hunter RF, Kee F, Cupples ME, Sallis JF, Tully MA. Validity of the global physical activity questionnaire (GPAQ) in assessing levels and change in moderate-vigorous physical activity and sedentary behaviour. BMC Public Health. 2014;14:1255.
24. Mohebi F, Mohajer B, Yoosefi M, Sheidaei A, Zokaei H, Damerchilu B, et al. Physical activity profile of the Iranian population: STEPS survey, 2016. BMC Public Health. 2019;19(1):1266.
25. Mahmoodabad SSM, Tonekaboni NR, Farmanbar R, Fallahzadeh H, Kamalikhah T. The effect of motivational interviewing-based intervention using self-determination theory on promotion of physical activity among women in reproductive age: A randomized clinical trial. Electron Physician. 2017;9(5):4461-72.
26. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American psychiatric association; 2013 May.
27. Pourafkary N., Arafi A., Dadashzadeh H., Ghaem Maghami J. A comparative study on the prevalence of sleep disturbances in Psychiatric disorder and general population in Tabriz. Med. J. Tabriz Univ. Med. Sci. 2004 ;38(64):28-33.
28. Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of healthy sleep duration among adults—United States, 2014. MMWR. 2016 Feb 19;65(6):137-41.
29. Suh S, Cho N, Zhang J. Sex differences in insomnia: from epidemiology and etiology to intervention. Curr. Psychiatry Rep. 2018 Sep;20(9):1-2..
30. Franco P, Putois B, Guyon A, Raoux A, Papadopoulou M, Guignard-Perret A, et al. Sleep during development: Sex and gender differences. Sleep Med Rev. 2020;51:101276.
31. Stringhini S, Haba-Rubio J, Marques-Vidal P, Waeber G, Preisig M, Guessous I, et al. Association of socioeconomic status with sleep disturbances in the Swiss population-based CoLaus study. Sleep Med. 2015;16(4):469-76.
32. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-3.
33. Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep. 2015;38(8):1161-83.
34. Hasanpour Baysafar T. Investigation of the effect of growth in service, industrial and agricultural sectors, on unemployment in Iran. J. Intellect. Cap. 2020 Feb 20;5(2):139-59.
35. Whinnery J, Jackson N, Rattanaumpawan P, Grandner MA. Short and long sleep duration associated with race/ethnicity, sociodemographics, and socioeconomic position. Sleep. 2014;37(3):601-11.
36. Zarowski M, Mojs E, Kleka P, Steinborn B. [The impact of smoking cigarettes on insomnia and excessive daytime sleepiness symptoms among teachers]. Przegl Lek. 2007;64(10):645-8.
37. Saleh DK, Nouhi S, Zandi H, Lankarani MM, Assari S, Pishgou B. The quality of sleep in coronary artery disease patients with and without anxiety and depressive symptoms. Indian Heart J. 2008;60(4):309-12.
38. Cox RC, Olatunji BO. Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research. Sleep Med Rev. 2020;51:101282.
39. Ojike N, Sowers JR, Seixas A, Ravenell J, Rodriguez-Figueroa G, Awadallah M, et al. Psychological Distress and Hypertension: Results from the National Health Interview Survey for 2004-2013. Cardiorenal Med. 2016;6(3):198-208.
|Issue||Vol 17 No 3 (2022)|
|Coronary Artery Disease Incidence Mental Health Prevalence Sleep Disorders|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|