Prevalence of poor sleep quality in the Ethiopian population: a systematic review and meta-analysis

Poor sleep quality and associated factors among healthcare professionals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Poor sleep quality is linked to physiological dysfunction, which increases the risk of obesity, cardiovascular disease, cognitive impairment, and other medical conditions. Despite the known health risks of sleep disturbances, literature is still scant regarding sleep quality and its associated factors among healthcare professionals in Ethiopia. Therefore, this study aimed to determine the prevalence of poor sleep quality and its associated factors among healthcare professionals at the University of Gondar Comprehensive Specialized Hospital.

Methods

An institution-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A total of 418 healthcare professionals participated in the study. The study participants were chosen using the stratified random sampling method. Data were collected using a structured, self-administered questionnaire. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of participants. Bi-variable and multivariable logistic regression models were used. p ≤ 0.05 was used to declare statistically significant variables.

Results

The mean age of the study participants was 30.7 years (SD ± 6.3). The overall prevalence of poor sleep quality was 58.9% [95% CI (54.2, 63.6%)]. Being female [adjusted odds ratio (AOR) = 1.9, 95% CI (1.2, 2.9)], being a shift worker [AOR = 5.7, 95% CI (2.3, 14.3), not performing regular exercise [AOR = 2.08 (1.2-3.6)], being a khat chewer [AOR = 3.1, 95% CI (1.2, 7.6)], and having depressive symptoms [AOR = 2.6, 95% CI (1.3, 6.8)] were significantly associated with higher odds of having poor sleep quality.

Conclusion

The prevalence of poor sleep quality among healthcare professionals was found to be high. As a result, we recommend that healthcare providers at the University of Gondar Comprehensive Specialized Hospital focus on early regular screening for sleep disturbances and pay special attention to shift work schedules and behaviors such as khat chewing, exercise, and depressive symptoms.

Sleep quality and associated factors among university students in Africa: a systematic review and meta-analysis study

Background

Poor sleep quality significantly impacts academic performance in university students. However, inconsistent and inconclusive results were found in a study on sleep among university students in several African nations. Therefore, this study aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in Africa.

Methods

The databases PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar were searched to identify articles. A total of 35 primary articles from 11 African countries were assessed and included in this systematic review and meta-analysis. Data were extracted by using a Microsoft Excel spreadsheet and exported to STATA version 14 for analysis. The I2 test was used to assess the statistical heterogeneity. A random effect meta-analysis model was employed with 95% confidence intervals. Funnel plots analysis and Egger regression tests were used to check the presence of publication bias. A subgroup analysis and a sensitivity analysis were done.

Results

A total of 16,275 study participants from 35 studies were included in this meta-analysis and systematic review. The overall pooled prevalence of poor sleep quality among university students in Africa was 63.31% (95% CI: 56.91-65.71) I2 = 97.2. The subgroup analysis shows that the combined prevalence of poor sleep quality in East, North, West, and South Africa were 61.31 (95% CI: 56.91-65.71), 62.23 (95% CI: 54.07-70.39), 54.43 (95% CI: 47.39-61.48), and 69.59 (95% CI: 50.39-88.80) respectively. Being stressed (AOR= 2.39; 95% CI: 1.63 to 3.51), second academic year (AOR= 3.10; 95% CI: 2.30 to 4.19), use of the electronic device at bedtime (AOR= 3.97 95% CI: 2.38 to 6.61)) and having a comorbid chronic illness (AOR = 2.71; 95% CI: 1.08, 6.82) were factors significantly associated with poor sleep quality.

Conclusion

This study shows that there is a high prevalence of poor sleep quality among university students in Africa. Being stressed, in the second year, using electronic devices at bedtime, and having chronic illness were factors associated with poor sleep quality. Therefore, addressing contributing factors and implementing routine screenings are essential to reduce the burden of poor sleep quality.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023493140.

The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies

BACKGROUND

The high prevalence of poor sleep quality (PSQ) in the general population leads to negative health outcomes. Since estimates of PSQ prevalence in the Chinese general population vary widely, this meta-analysis aimed to refine these estimates and to identify moderating factors.

METHODS

A comprehensive literature search was undertaken in both international (PubMed, PsycINFO, Web of Science, and EMBASE) and Chinese (Wanfang, and the China National Knowledge Infrastructure databases) databases from inception to 23 November 2023. Studies were required to have used standard scales such as the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). The pooled prevalence of PSQ and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify sources of heterogeneity.

RESULTS

In 32 studies with a combined 376,824 participants, the pooled prevalence of PSQ was 19.0% (95% CI 15.8-22.8%; range 6.6-43.6%). Across 22 studies that reported PSQI data, the pooled mean score was 4.32 (95%CI 3.82-4.81; SD = 0.502). The pooled mean sleep duration across 8 studies was 7.62 (95% CI 7.23-8.00; SD = 0.194) hours. Subgroup analyses showed that lower education (Q = 4.12, P = 0.042), living in less developed regions (Q = 60.28, P < 0.001), and lower PSQI cutoff values (Q = 9.80, P = 0.007) were significantly associated with PSQ. Meta-regression analyses showed that study quality was inversely associated with estimated PSQ prevalence (β = - 0.442, P = 0.004).

LIMITATIONS

Although measures such as subgroup and meta-regression analyses were performed, substantial heterogeneity remained. Information related to sleep quality, such as comorbid physical diseases or psychiatric disorders, substance use, occupational types, and employment status, were not reported in most studies.

CONCLUSION

One in five people in the general population of China may have PSQ and people with lower education or living in western regions may be more susceptible.

Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.

Sweet dreams are not made of this: no association between diet and sleep quality

STUDY OBJECTIVES

Numerous studies have emphasized the significance of nutrition on the quality of sleep, but few have evaluated the effect of various coexisting dietary markers on middle-aged adults. We assessed the association between sleep quality and a large array of dietary markers among middle-aged, community-dwelling participants.

METHODS

Data from the first, second, and third follow-ups of CoLaus|PsyCoLaus, a population-based study in Lausanne, Switzerland, was used. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Dietary intake was assessed by a validated food frequency questionnaire.

RESULTS

Data from 3857 (53% women, 57.2 ± 10.4 years), 2370 (52% women, 60.7 ± 9.5 years), and 1617 (52% women, 63.5 ± 9.0 years) participants from the first, second, and third follow-ups was used. Bivariate correlations showed fish, vegetables, fruit, and cheese intake to be associated with a better sleep quality (lower Pittsburgh Sleep Quality Index), while rusks, sugar, and meat intake were associated with a poorer sleep quality (higher Pittsburgh Sleep Quality Index). After multivariable adjustment, participants reporting poor sleep quality (Pittsburgh Sleep Quality Index > 5) had a lower Mediterranean diet score and a lower likelihood of complying with the meat and fish recommendations, but the results were inconsistent between surveys. No association was found between sleep quality and macro- or micronutrients in the three surveys.

CONCLUSIONS

No consistent associations were found between a large panel of nutritional markers and sleep quality. Components of the Mediterranean diet such as dairy, fruits, and vegetables might favor good sleep quality, while increased consumption of sugary foods or meat might favor poor sleep quality.

CITATION

Oliveira JL, Marques-Vidal P. Sweet dreams are not made of this: no association between diet and sleep quality. J Clin Sleep Med. 2023;19(12):2005-2014.

Factors associated with poor sleep quality among construction workers in Arba Minch town, Ethiopia: A cross-sectional study

Background and Aims

Sleep is critical for human physical and cognitive health. Even though poor sleep quality had a major negative impact on workers' health and safety, there is a scarcity of study that attempts to demonstrate its magnitude and causative factors in labor-intensive environments.

Methods

A cross-sectional study design was employed. A total of 423 individuals were selected using a simple random sampling technique, starting from April 1, 2020 to May 1, 2020. Interviews were administered using the validated and pretested Pittsburgh Sleep Quality Index (PSQI) tool. EpiData version 4.4.3.1 was used for data entry and SPSS version 25 for analysis. To associate factors with poor sleep quality binary logistic regression model was fitted at 95% confidence interval (CI). A p < 0.25 and p < 0.05 were used to declare association in bivariable and multivariable analysis, respectively.

Results

A total of 415 building construction workers take part in this study, with a response rate of 98.1%. A PSQI global score showed 66.3% (95% CI: [0.63, 0.71]) of construction workers suffering from poor sleep quality. Working hours, work experience, previous injury status, managerial support on occupational safety and health, cigarette smoking, and job satisfaction were the factors that were associated with poor sleep quality significantly.

Conclusions

Two-thirds of construction workers suffer from poor sleep quality. Risk factors include shorter working years, longer working hours, prior injury, lack of managerial support, cigarette smoking, and low job satisfaction. Efficient health education and promotion through taking the identified associated factors into account could help reduce poor sleep quality.

Prevalence and associated factors of poor sleep quality among industrial workers in Addis Ababa, Ethiopia: findings from a cross-sectional study

OBJECTIVE

This study aimed to investigate the prevalence and associated factors of poor sleep quality among Bole Lemi Industrial Park workers in Addis Ababa, the capital of Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted from July to August 2022. The data were collected using a validated and standardised Pittsburgh Sleep Quality Index Questionnaire. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14. A multivariable binary logistic regression analysis was conducted to identify factors associated with poor sleep quality. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.

SETTING

The study was conducted in Bole Lemi Industrial Park in Addis Ababa.

PARTICIPANTS

A total of 370 workers participated in this study.

OUTCOME MEASURES

The primary outcome of the study was the prevalence of poor sleep quality.

RESULTS

The total response rate was 87.7%. The majority (260, 70.3%) of the participants were female. The mean (±SD) age of the participants was 30.5 (±10.6) years. The prevalence of poor sleep quality during the last months was found to be 75.4% (n=279) (95% CI: 70.7% to 79.7%). Undiversified dietary intake (AOR: 1.63; 95% CI (1.09 to 2.78)), caffeine consumption more than 250 mg per day (AOR: 2.57; 95% CI (1.12 to 6.05)) and night shift work (AOR: 2.36; 95% CI (1.27 to 4.41)) were risk factors for poor sleep quality among sampled workers.

CONCLUSION

This study detected that poor sleep quality is highly prevalent among garment and textile industry workers, indicating that it is a significant public health issue that requires immediate attention. Therefore, modifications of the work environment involving night shift work and the improvement of workers' personal lifestyles involving dietary diversification and caffeine consumption are needed to minimise the burden of poor sleep quality among workers.

Comparison of three measures for insomnia in ischemic stroke patients: Pittsburgh sleep quality index, insomnia severity index, and Athens insomnia scale

Objective

This study investigated the consistency and determined the optimal threshold values of three scales in the diagnosis of insomnia of ischemic stroke (IS) patients.

Methods

Participants in this study consisted of 569 acute IS patients. All 569 patients completed the assessment of the three insomnia scales. Insomnia of IS patients were assessed by Pittsburgh sleep quality index (PSQI), Insomnia Severity Index (ISI), and Athens insomnia scale (AIS). Also, basic patient information, neurological function, and activities of daily living were assessed. General information was compared between the insomnia group and the no-insomnia group. Cronbach's α coefficients, Cohen's Kappa consistency, Receiver operating characteristic (ROC) curve and DeLong's test analysis were used to analyze the reliability and diagnostic validity of PSQI, ISI, and AIS.

Results

The PSQI and ISI showed high reliability with Cronbach's α of 0.875 and 0.858, respectively, while the AIS had an α coefficient of 0.734, demonstrating acceptable reliability. The PSQI, ISI, and AIS showed outstanding diagnostic ability with an AUC of 0.960 (95% CI: 0.946, 0.974), 0.911 (95% CI: 0.882, 0.941), and 0.876 (95% CI:0.837, 0.916). The best diagnostic cutoffs for PSQI, ISI, and AIS are ≥9, ≥15, and ≥8.

Conclusion

Each of the three questionnaires has advantages and disadvantages when assessing insomnia. In the evaluation of insomnia in IS patients, the best questionnaire selection should be made according to the purpose of clinical evaluation and considering the sensitivity and specificity.

Assessment of sleep quality and its factors among clinicians working in critical care units and operation theaters at North West Ethiopia, 2022: a multicenter cross-sectional study

The quality of sleep has an effect on the health of clinicians and the quality of patient care. Maintaining cognitive function/mood, facilitation of glucose metabolism, and strengthening of the immune system are among the roles that adequate sleep may contribute. Poor sleep quality is multifactorial, and studies had shown inconsistencies in the factors that contribute to the development of this poor sleep quality. The prevalence of poor sleep quality among clinicians working in the critical care unit and operation theater in the study setting was not investigated yet.

OBJECTIVE

The objective of this study was conducted for the purpose of assessing the quality of sleep and associated factors among clinicians working in the critical care unit and operation theater.

METHODS

A cross-sectional study was conducted from 15 May to 15 June 2022. Data were collected using a self-administered questionnaire from 421 clinicians selected by simple random sampling techniques. Sleep quality was measured by the Pittsburg sleep quality index. The data were entered into Epi-data and exported to SPSS. Frequency and percentage were used for the descriptive analysis. Binary and multivariate logistic regression analysis were used to identify factors associated with poor quality of sleep. The strength of the association was measured with an OR within the 95% CI and P-value of <0.05.

RESULT

About half 220 (52.3%) of the study participants age between 25 and 30 year old and the majority 321 (76.2%) of them were males. The prevalence of poor sleeps quality was 81.5% (95% CI: 77.9-85.5). Working night shift (AOR: 3.37, 95% CI: 1.754-6.484), having depressive symptoms (AOR: 3.25, 95% CI: 1.485-7.147) and having no regular exercises (AOR: 0.299, 95% CI: 0.166-0.537) were predisposing factors for poor sleep quality.

CONCLUSION AND RECOMMENDATION

The prevalence of poor sleep quality among clinicians working in the ICU and operation room was high. Clinicians who had no regular exercise, who worked in night shift, and who had depressive symptoms were associated with poor quality of sleep. Clinicians should have an awareness on the symptoms of depression, implement sleep hygiene education programs and promoting regular exercise. The authors recommend healthcare policy makers for improving working schedules.

Association of sleep duration and sleeping pill use with mortality and life expectancy: A cohort study of 484,916 adults

OBJECTIVES

To compare mortality risk and life expectancy among individuals with different sleep durations and sleeping pill use.

METHODS

A cohort of 484,916 community-dwelling adults in Taiwan was recruited into a health screening program from 1994 to 2011. Subjects were categorized by daily sleep duration into 4 groups: extremely short (<4 hours), short (4-6 hours), medium (6-8 hours), and long (>8 hours). Cox proportional hazards models were used to investigate the associations of mortality risk with sleep duration and sleeping pill use. Models were adjusted for sociodemographic characteristics, lifestyle, and comorbidities. Life expectancy tables were calculated among sleeping pill users and nonusers with different sleep durations.

RESULTS

With 6- 8 hours of daily sleep, sleeping pill nonusers had the lowest mortality risk. Sleeping pill users, even with this optimal amount of sleep, had a 55% (p < .001, 95% CI, 1.38-1.73) higher mortality risk than nonusers. The life expectancy of 30-year-old male sleeping pill users with extremely short or long sleep durations was 12-13 years shorter than sleeping pill nonusers who had 6-8 hours of sleep. On average, life expectancy in individuals using sleeping pills (vs. nonusers) was shorter by 5.3 (95% CI, 4.10-6.32) years in men and 5.7 (95% CI, 5.28-7.98) years in women.

CONCLUSIONS

This study suggests that the use of sleeping pills is associated with an increased risk of mortality and shortened life expectancy, especially in extreme sleepers. Regular users should be aware of potential harms from sleeping pills.

Sleep duration during the COVID-19 pandemic in Bangladesh: A GIS-based large sample survey study

Although several studies have been conducted in Bangladesh regarding sleep problems during the COVID-19 pandemic, none have utilized a large nationwide sample or presented their findings based on nationwide geographical distribution. Therefore, the aim of the present study was to explore the total sleep duration, night-time sleep, and daily naptime and their associated factors as well as geographic information system (GIS) distribution. A cross-sectional survey was carried out among 9730 people in April 2020, including questions relating to socio-demographic variables, behavioral and health factors, lockdown, depression, suicidal ideation, night sleep duration, and naptime duration. Descriptive and inferential statistics, both linear and multivariate regression, and spatial distribution were performed using Microsoft Excel, SPSS, Stata, and ArcGIS software. The results indicated that 64.7% reported sleeping 7-9 h a night, while 29.6% slept less than 7 h nightly, and 5.7% slept more than 9 h nightly. 43.7% reported 30-60 min of daily nap duration, whereas 20.9% napped for more than 1 h daily. Significant predictors of total daily sleep duration were being aged 18-25 years, being unemployed, being married, self-isolating 4 days or more, economic hardship, and depression. For nap duration, being aged 18-25 years, retired, a smoker, and a social media user were at relatively higher risk. The GIS distribution showed that regional division areas with high COVID-19 exposure had higher rates of non-normal sleep duration. Sleep duration showed a regional heterogeneity across the regional divisions of the country that exhibited significant associations with a multitude of socioeconomic and health factors.

Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis

Lack of sleep can affect the health and performance of firefighters. This systematic review and meta-analysis estimated the global prevalence of sleep disorders and poor sleep quality among firefighters and reported associated factors. Four academic databases (Scopus, PubMed, Web of Science, and Embase) were systematically searched from January 1, 2000 to January 24, 2022. These databases were selected as they are known to index studies in this field. The search algorithm included two groups of keywords and all possible combinations of these words. The first group included keywords related to sleep and the second group keywords related to the firefighting profession. The relevant Joanna Briggs Institute checklist was used to evaluate study quality. Data from eligible studies were included in a meta-analysis. In total, 47 articles informed this review. The pooled prevalence of sleep disorders and poor sleep quality in firefighters were determined as 30.49% (95% CI [25.90, 35.06]) and 51.43% (95% CI [42.76, 60.10]), respectively. The results of a subgroup analysis showed that individuals in low- and middle-income countries (LMICs) had a higher prevalence of sleep disorders than those in high-income countries (HICs) but HICs had a higher prevalence of poor sleep quality than LMICs. Various factors, including shift work, mental health, injuries and pain, and body mass index were associated with sleep health. The findings of this review highlight the need for sleep health promotion programs in firefighters.

Risk factors for the prevalence of poor sleep quality in lecturers during COVID-19 pandemic in Ethiopia: an institution-based cross-sectional study

OBJECTIVE

This study was conducted to assess the prevalence and risk factors of poor sleep quality (SQ) among the academic staff at the University of Gondar, Northwestern Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted from March to April 2021. A validated, self-administered, standardised Pittsburgh Sleep Quality Index (PSQI) was used to quantify the amount of self-reported poor SQ. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. Binary logistic regressions were computed to determine the association between variables. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.

SETTING

The study was conducted at the University of Gondar, Northwestern Ethiopia.

PARTICIPANTS

A total of 607 lecturers participated in this study.

OUTCOME MEASURES

The primary outcome is the prevalence of poor SQ, which was measured using the PSQI.

RESULTS

Overall response rate was 95.60% (N=607). The age of the participants ranges from 21 to 70 with a mean of 32.39 (SD±6.80) years. The magnitude of poor SQ during the COVID-19 pandemic in the last month was 60.30% (95% CI (56.28% to 64.21%)). Working greater than 10 hours per day (AOR=2.19, 95% CI (1.16 to 4.27)), electronic device use before bedtime (AOR=1.53, 95% CI (1.04 to 2.27)), high-risk perception of COVID-19 infections (AOR=1.60, 95% CI (1.04 to 2.46)) and perceived job stress (AOR=2.15 (95% CI (1.50 to 3.08)) were risk factors for poor SQ.

CONCLUSION

The study revealed that the prevalence of poor SQ was high during the COVID-19 pandemic. The finding highlights the importance of optimising the working hours per day, minimising electronic device use before bedtime, promoting risk perception toward COVID-19 infection and developing workplace coping strategies for stress, which play a substantial role in minimising poor SQ.

Sleep Deficiency: Epidemiology and Effects

Adequate sleep is an important pillar of physical and mental health. Sleep deficiency, resulting from short sleep or suboptimal sleep quality, is highly prevalent in modern society. Occupation, social demands, psychiatric disorders, physical disorders, and sleep disorders are some of the contributing factors to sleep deficiency. Some populations are at increased risk of sleep deficiency based on ethnicity, age, marital status, sex, and hospitalization. Sleep deficiency influences cognition, alertness, mood, behavior, diabetes, cardiovascular health, renal function, immune system, and respiratory physiology. This review summarizes the epidemiology and effects of sleep deficiency.

The Interplay Between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa

Neurological disorders related to neuroinfections are highly prevalent in Sub-Saharan Africa (SSA), constituting a major cause of disability and economic burden for patients and society. These include epilepsy, dementia, motor neuron diseases, headache disorders, sleep disorders, and peripheral neuropathy. The highest prevalence of human immunodeficiency virus (HIV) is in SSA. Consequently, there is a high prevalence of neurological disorders associated with HIV infection such as HIV-associated neurocognitive disorders, motor disorders, chronic headaches, and peripheral neuropathy in the region. The pathogenesis of these neurological disorders involves the direct role of the virus, some antiretroviral treatments, and the dysregulated immune system. Furthermore, the high prevalence of epilepsy in SSA (mainly due to perinatal causes) is exacerbated by infections such as toxoplasmosis, neurocysticercosis, onchocerciasis, malaria, bacterial meningitis, tuberculosis, and the immune reactions they elicit. Sleep disorders are another common problem in the region and have been associated with infectious diseases such as human African trypanosomiasis and HIV and involve the activation of the immune system. While most headache disorders are due to benign primary headaches, some secondary headaches are caused by infections (meningitis, encephalitis, brain abscess). HIV and neurosyphilis, both common in SSA, can trigger long-standing immune activation in the central nervous system (CNS) potentially resulting in dementia. Despite the progress achieved in preventing diseases from the poliovirus and retroviruses, these microbes may cause motor neuron diseases in SSA. The immune mechanisms involved in these neurological disorders include increased cytokine levels, immune cells infiltration into the CNS, and autoantibodies. This review focuses on the major neurological disorders relevant to Africa and neuroinfections highly prevalent in SSA, describes the interplay between neuroinfections, immune system, neuroinflammation, and neurological disorders, and how understanding this can be exploited for the development of novel diagnostics and therapeutics for improved patient care.

Poor Sleep Quality and Factors Among Reproductive-Age Women in Southwest Ethiopia

BACKGROUND

Adequate sleep is vital for physical and mental wellbeing. Sleep-related problems including poor quality of sleep have been increasing throughout the world among reproductive-aged women. Poor sleep quality has been related with number of diseases and health problems However, evidences are scarce regarding poor sleep quality and its associated factors among women of the reproductive age group in Ethiopia.

OBJECTIVE

To assess sleep quality and associated factors among women of reproductive age group in Mizan Aman town, Southwest Ethiopia.

METHOD

Community-based cross-sectional study was conducted among 606 reproductive-aged women from 06 November to 20 December 2020, in Mizan Aman town. Data were collected using structured interview administered questionnaires. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Multivariable logistic regression was applied using an adjusted odds ratio with a corresponding 95% confidence interval to evaluate the statistical significance of associated factors.

RESULT

The overall prevalence of poor sleep quality was 71.3%. The late age group of 42-49 (AOR, 95% CI; 1.21 (1.08-5.76), palpable/visible thyroid gland (AOR, 95% CI; 2. 12 (1.08-3.82), current substance use (AOR, 95% CI; 1.76 (1.11-6.10) and having premenstrual syndrome (AOR, 95% CI; 1.86 (1.38-3.12) were significantly associated with poor sleep quality among reproductive age group women.

CONCLUSION

Significant majority of reproductive age group women faced poor sleep quality. Therefore, screening of sleep patterns among this particular age group is warranted. Moreover, education about sleep hygiene needs to be given considering the identified factors to improve sleep quality.

Sleep Quality and Associated Factors Among Adult Cancer Patients Under Treatment at Oncology Units in Amhara Region, Ethiopia

INTRODUCTION

Poor sleep quality, a common, under-diagnosed, and under-treated problem in cancer patients, has negative physical and psychological consequences, but its prevalence and associated factors are not well studied in Ethiopia. Thus, the present study aimed to assess the prevalence of sleep quality and its associated factors among adult cancer patients receiving treatment at oncology units in Amhara region, Ethiopia.

METHODS AND MATERIALS

An institution-based cross-sectional study was conducted among adult patients with cancer under treatment at the oncology units in the Amhara region from April 12 to May 12/2021. A systematic random sampling technique was used to select 423 samples. Data were collected using a structured Interviewer-administered questionnaire. Sleep quality and depression were assessed by the Pittsburgh Sleep Quality Index and depression subscale of Hospital Anxiety and Depression Scale, respectively. Bivariable and multivariable logistic regression analyses were computed, considering p < 0.25 to select candidate variables for multivariable analysis and p < 0.05 to be statistically significant in the final model.

RESULTS

A total of 410 cancer patients participated in this study. The mean of the participant's age was 44.2 (range: 20-77) years. More than half (52.7%) of participants received chemotherapy and the remaining were treated with a combination of treatments. Two-hundred ninety-three (71.5%) of participants had poor sleep quality and 28.5% had good sleep quality. The factors found to be significantly associated with poor sleep quality were advanced age [AOR = 1.037, 95% CI: (1.012-1.062)]; having depressive symptoms [AOR = 2.862, 95% CI: (1.133, 7.228)]; having distant metastasis cancer [AOR = 3.758, 95% CI: (1.585, 8.909)]; and increased severity of pain [AOR = 1.331, 95% CI: (1.106, 1.601)].

CONCLUSION

The study found a high prevalence of poor sleep quality among cancer patients. Early screening and management of sleep problems are crucial in patients with cancer.

Association between loneliness, sleep behavior and quality: a propensity-score-matched case-control study

OBJECTIVE

To explore the influence of loneliness on sleep behavior and sleep quality based on propensity score-matched samples in Southwest China.

METHODS

Individual-level data were obtained from a Southwest China cohort study. Participants who felt lonely were matched with those who did not with propensity scores on the basis of age, gender, socioeconomic factors, physical exercise and social connection level. Sleep behavior (onset and offset timing), sleep quality (sleep latency, nocturnal awakenings and subjective sleep quality), and daytime function (daytime sleepiness and fatigue) were assessed with the Pittsburgh Sleep Index Scale (PSQI) and compared between the two groups. The data were collected between May 2019 and December 2019, and data analyses were completed in April 2021.

RESULTS

A total of 11,696 participants were included, and 824 out of 839 participants who felt loneliness were statistically matched with 824 participants who did not. Analyses of the matched samples showed that sleep onset and offset timing were similar between those who felt lonely and those who did not (p = 0.110 and p = 0.751, respectively). Sleep latency was longer in those who felt lonely (26.84 [0.9] vs. 35.52 [1.2] min, p < 0.001) than in those who did not. Furthermore, participants who felt lonely tended to have poor subjective sleep, a higher frequency of nocturnal awakenings, daytime sleepiness and fatigue (all p < 0.001).

CONCLUSIONS

Loneliness was associated with extended sleep latency, increased nocturnal awakenings, and reduced subjective sleep quality and daytime function but was not associated with sleep behavior, including sleep onset and offset timings.

Structural validity of the Insomnia Severity Index: A systematic review and meta-analysis

The factor structure of the Insomnia Severity Index (ISI) is discussed, with examples being drawn from about 13 disparate reported models. A systematic appraisal of procedural details of studies investigating the dimensionality of the ISI was performed. The databases CINAHL, Cochrane Library, Embase, Medline, and PsycINFO were searched thoroughly, and all articles in English, published, and/or available online as of 14th March 2019, were included. Meta-analyses of Cronbach's alpha and structural validity measures were performed. Several inadequacies or omissions were found in analyses using the three groups of measures. Fifteen out of 20 studies did not employ either EFA or CFA, 10 studies did not report CFA, while five did not report EFA. The most common omissions related to multivariate normality, final model selection based on consideration of fit indices, parsimony, and failure to consider the theoretical construct in the final model selection. Meta-analysis showed that CFA outcome is more robust compared to EFA, two-factor solution is the vigorous presentation of dimensionality compared to a three-factor solution, and ISI has a high pooled Cronbach's alpha. Further validation of the disparate models of the ISI is needed with more comprehensive reporting guidelines, such as the one suggested in the present review.

Obstructive sleep apnea screening in young people: Psychometric validation of a shortened version of the STOP-BANG questionnaire using categorical data methods

BACKGROUND:

The STOP-BANG is an easily administrable questionnaire for the screening of obstructive sleep apnea in adults, which may be adapted for use by young people. Here, we assessed the psychometric properties of the STOP-BN, a shortened version of the STOP-BANG questionnaire, using categorical data methods.

METHODS:

Four hundred and three young people (age 20.71 ± 1.93 years) were selected by random sampling to participate in this cross-sectional study. Participants completed the STOP-BN, a tool for recording social and demographic characteristics, and the Epworth Sleepiness Scale (ESS), a measure of daytime sleepiness. The obtained data were analyzed using categorical data methods.

RESULTS:

A two-factor model was identified for the STOP-BN, using the Kaiser's criteria (eigenvalue >1) and the screen test. However, the parallel analysis based on minimum rank, and the cumulative variance criteria (>40%) identified an one-factor model. Factor loadings ranged from 0.364 to 0.745. The identified two-factor model showed acceptable fit as the reported goodness of fit index and weighted root mean square residual were in the ideal range, and the comparative fit index was close to the ideal range. Greatest lower bound to reliability for two factors of the STOP-BN was 0.67 and 0.67, indicating an acceptable internal consistency. A weak to a nonsignificant correlation between the ESS and the STOP-BN score was demonstrated, favoring STOP-BN's divergent validity.

CONCLUSION:

Categorical methods support the psychometric validity of the STOP-BN in the study population.

Psychometric Properties of the Athens Insomnia Scale in Occupational Computer Users

Background: Various studies have shown that insomnia is associated with computer use. The Athens Insomnia Scale (AIS) is an 8-item tool that has been widely used for screening insomnia. No studies have investigated the psychometric validity of AIS in occupational computer users. Objective: the current research aimed to test the psychometric properties of the AIS among occupational computer users. Materials and Methods: a sample of four hundred and twenty-four occupational computer users (age: 20-65 years and body mass index: 21.6 ± 3.5 kg/m2) completed an AIS and a socio-demographic questionnaire in this cross-sectional study. Results: a confirmatory factor analysis demonstrated that the three-factor model had an adequate fit (the goodness of fit index (0.95), incremental fit index (0.90) and χ2/df (2.61)). Evidence was found for configural, scalar and metric invariance of the 3-factor model across gender groups. A moderate level of internal consistency was implied by a Cronbach's alpha of 0.66. Conclusion: the findings of the present research support the validity of AIS for screening insomnia, as demonstrated by the scale's psychometric properties; its internal consistency, internal homogeneity, item discrimination, and factorial validity.

Psychometric Analysis Of The Sleep Hygiene Index And Correlation With Stress And Anxiety Among Saudi University Students

AIMS

This study aimed to assess the psychometric properties of the Sleep Hygiene Index (SHI) instrument in screening poor sleep hygiene practices among Saudi university students. As a secondary goal, the association of sleep hygiene practices with stress and anxiety scores were assessed.

METHODS

Two-hundred and four healthy college and university students aged 18 to 25 years participated in this cross-sectional questionnaire-based survey. Participants were asked to complete the English version of the SHI instrument, the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder (GAD-7) scale, and to provide demographic details.

RESULTS

The average scores for the SHI, the GAD-7, and the PSS-10 were 6.6, 5.3, and 16.2, respectively. The internal consistency of the SHI was adequate (McDonald's Omega 0.76). The corrected item-total correlations for all the items were fair (range, 0.31-0.50). A statistically significant positive correlation/association of the SHI scores with the PSS score, GAD-7, and self-reported poor sleep were obtained in this sample of Saudi university students. Factor analysis favored a 4-factor model of the SHI in the study sample.

CONCLUSION

The SHI scale demonstrated an adequate level of internal consistency as a self-reported instrument in the assessment of sleep hygiene among Saudi university students. In addition, poor sleep hygiene was correlated with stress and anxiety scores.