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Kyrtsopoulos M, Tsiptsios D, Karapepera V, Karatzetzou S, Tsiakiri A, Manolis A, Leontidou E, Sousanidou A, Tsamakis K, Kaltsatou A, Trypsiani I, Nena E, Serdari A, Steiropoulos P, Tripsianis G. A Questionnaire-Based Cross-Sectional Study of Insomnia among Middle-Aged Adults from Greece's Northeastern Fringe, Thrace. Maedica (Bucur) 2023; 18:404-412. [PMID: 38023757 PMCID: PMC10674121 DOI: 10.26574/maedica.2023.18.3.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background, aim: Insomnia constitutes a common and very debilitating disorder in modern societies. A better understanding of the etiologies and risk factors, modifiable or not, of insomnia is essential for a swifter diagnosis and a more appropriate treatment, mitigating its toll on individuals and society. To this purpose, the present study assessed the prevalence of insomnia in a randomly-selected adult population and its relation with a diverse range of socio-demographic characteristics and medical conditions. Methods:A sample of 771 participants aged 24 to 89 years (mean age 58±13 years; 42.7% women) was randomly selected from the general population of Thrace, a prefecture in Northeastern Greece with special cultural considerations, using a two-stage stratified sampling scheme. The Greek version of the Athens Insomnia Scale (AIS) was utilized to evaluate the presence of insomnia. Moreover, the Berlin Questionnaire for Obstructive Sleep Apnea and the Epworth Sleepiness Scale for Excessive Daytime Sleepiness were also utilized. Results:A total of 141 study participants (18.3%) were found to suffer from insomnia. Impaired sleep maintenance was reported as the most frequent symptom (62%). The following independent statistically significant risk factors emerged (p-value <0.05): BMI ≥35 (aOR=2.91), divorced or widowed individuals (aOR=2.23), female gender (aOR=1.76), age >70 years (aOR=1.61), snoring (aOR=1.61), midday sleep (aOR=1.58) and presence of chronic disease (aOR=1.55). Conclusion:The prevalence of isomnia in Thrace aligns with similar studies conducted in Greece and internationally. A multitude of socio-demographic characteristics and diseases, especially chronic, predispose to insomnia.
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Affiliation(s)
- Mihail Kyrtsopoulos
- Neurology Department, Democritus University of Thrace, Alexandroupolis Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, Alexandroupolis Greece
| | - Vaya Karapepera
- Neurology Department, Democritus University of Thrace, Alexandroupolis Greece
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, Alexandroupolis Greece
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, Alexandroupolis Greece
| | - Apostolos Manolis
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eleni Leontidou
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - Antonia Kaltsatou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Greece
| | - Ioanna Trypsiani
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Gregory Tripsianis
- Laboratory of Medical Statistics, Democritus University of Thrace, Alexandroupolis, Greece
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Fountoulakis PN, Terzoudi A, Tsiptsios D, Triantafyllis AS, Matziridis A, Leontidou E, Manolis A, Tsamakis K, Ouranidis A, Steiropoulos P, Vorvolakos T, Serdari A, Tripsianis G. Exploring the association between sleep insufficiency and self-reported cardiovascular disease among northeastern Greeks. Sleep Sci 2022; 15:388-398. [DOI: 10.5935/1984-0063.20220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
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Tsiptsios D, Leontidou E, Fountoulakis PN, Ouranidis A, Matziridis A, Manolis A, Triantafyllis AS, Tsamakis K, Serdari A, Terzoudi A, Dragioti E, Steiropoulos P, Tripsianis G. Association between sleep insufficiency and dyslipidemia: a cross-sectional study among Greek adults in the primary care setting. Sleep Sci 2022; 15:49-58. [PMID: 35273747 PMCID: PMC8889970 DOI: 10.5935/1984-0063.20200124] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/08/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the potential association between sleep insufficiency and dyslipidemia (DL) in the primary care setting using self-reported questionnaires. Material and Methods 957 adults aged between 19 and 86 years old from the rural area of Thrace, Greece were enrolled in this cross-sectional study. Multistage stratifed cluster sampling was used and the subjects were classifed into three groups according to sleep duration [short (<6h), normal (6-8h), and long (>8h) sleep duration]. DL was defined by a positive response to the question "Have you ever been told by a doctor or health professional that your blood cholesterol or triglyceride levels were high?", or if they were currently taking antilipidemic agents. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results DL prevalence was significantly associated with short sleep duration (aOR=2.18, p<0.001) and insomnia (aOR=1.43, p=0.050), while its relation with poor sleep quality (aOR=1.31, p=0.094) and risk for obstructive sleep apnea (aOR=1.32, p=0.097) were of marginal statistical significance. Concerning insomnia subtypes, DL was significantly associated with difficulties maintaining sleep (aOR=2.99, p<0.001) and early morning awakenings (aOR=1.38, p=0.050), but not difficulties initiating sleep (aOR=1.18, p=0.328). Conclusion This study reveals an association between sleep pathology and DL. Thus, early pharmacological and cognitive or behavioral interventions that improve sleep are deemed necessary in order to decrease DL burden.
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Affiliation(s)
- Dimitrios Tsiptsios
- South Tyneside & Sunderland NHS Foundation Trust, Department of Clinical Neurophysiology - Sunderland - Tyne & Wear - United Kingdom
| | - Eleni Leontidou
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | | | - Andreas Ouranidis
- Aristotle University of Thessaloniki, Department of Pharmaceutics - Thessaloniki - Central Macedonia - Greece
| | - Anestis Matziridis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | - Apostolos Manolis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | | | - Konstantinos Tsamakis
- King’s College, Institute of Psychiatry, Psychology and Neuroscience - London - London - United Kingdom
| | - Aspasia Serdari
- Democritus University of Thrace, Department of Child and Adolescent Psychiatry - Alexandroupolis - Thrace - Greece
| | - Aikaterini Terzoudi
- Democritus University of Thrace, Neurology Department - Alexandroupolis - Thrace - Greece
| | - Elena Dragioti
- Linköping University, Department of Health, Medicine and Caring Sciences - Linköping - Linköping - Sweden
| | - Paschalis Steiropoulos
- Democritus University of Thrace, Department of Pneumonology - Alexandroupolis - Thrace - Greece
| | - Gregory Tripsianis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
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Fountoulakis PN, Terzoudi A, Tsiptsios D, Triantafyllis AS, Matziridis A, Leontidou E, Manolis A, Tsamakis K, Ouranidis A, Steiropoulos P, Vorvolakos T, Tripsianis G. Sleep insufficiency and incidence of cardiovascular disease among adults in Greece. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Sleep disorders are an increasing and modifiable risk factor for cardiovascular disease (CVD).
Purpose
The aim of our study was to investigate potential associations between sleep insufficiency and incident CVD.
Methods
In this cross-sectional study, 957 participants, (mean age 49.62 ± 14.79) from the region of Thrace, Greece were enrolled and classified into three groups [short (<6 h), normal (6-8 h) and long (>8 h) sleep duration]. CVD was assessed by a positive response to the following questions: "Have you been told by a doctor that you have had a heart attack or angina (chest pain or exertion that is relieved by medication)?" or "Have you been told by a doctor that you have had a stroke?". Participants’ sleep quality was estimated with the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire.
Results
The overall prevalence of CVD was 9.5%. The population with CVD exhibited reduced sleep duration and efficiency reduced by 33 min and 10%, respectively. After adjusting for all possible cofounders, short sleep duration was 3.07-times more frequent in patients with CVD and sleep duration of less than 5:33 hours could be a potential risk factor for CVD, especially among females. Additionally, CVD was significantly associated with excessive increased daytime sleepiness, insomnia, poor sleep quality and increased risk of obstructive sleep apnea.
Conclusion(s): Our study depicts a strong correlation of sleep insufficiency with CVD and promotes early pharmacological or cognitive behavioral interventions in order to protect cardiovascular health.
Abstract Figure. Results
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Affiliation(s)
- PN Fountoulakis
- Asklepeion General Hospital, Department of Cardiology, Athens, Greece
| | - A Terzoudi
- Medical School, Democritus University of Thrace, Department of Neurology, Alexandroupolis, Greece
| | - D Tsiptsios
- South Tyneside & Sunderland NHS Foundation Trust, Neurophysiology Department, Sunderland, United Kingdom of Great Britain & Northern Ireland
| | - AS Triantafyllis
- Asklepeion General Hospital, Department of Cardiology, Athens, Greece
| | - A Matziridis
- Medical School, Democritus University of Thrace, Laboratory of Medical Statistics, Alexandroupolis, Greece
| | - E Leontidou
- Medical School, Democritus University of Thrace, Laboratory of Medical Statistics, Alexandroupolis, Greece
| | - A Manolis
- Medical School, Democritus University of Thrace, Laboratory of Medical Statistics, Alexandroupolis, Greece
| | - K Tsamakis
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience,, London, United Kingdom of Great Britain & Northern Ireland
| | - A Ouranidis
- Aristotle University of Thessaloniki, School of Chemical Engineering, Thessaloniki, Greece
| | - P Steiropoulos
- Medical School, Democritus University of Thrace, Department of Psychiatry, Alexandroupolis, Greece
| | - T Vorvolakos
- Medical School, Democritus University of Thrace, Department of Pneumonology, Alexandroupolis, Greece
| | - G Tripsianis
- Medical School, Democritus University of Thrace, Laboratory of Medical Statistics, Alexandroupolis, Greece
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Matziridis A, Tsiptsios D, Manolis A, Ouranidis A, Triantafyllis AS, Tsamakis K, Serdari A, Leontidou E, Terzoudi A, Dragioti E, Steiropoulos P, Tripsianis G. Sleep insufficiency and incident diabetes mellitus among indigenous and minority populations in Greece. Sleep Sci 2021; 14:101-110. [PMID: 35082978 PMCID: PMC8764944 DOI: 10.5935/1984-0063.20200081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/08/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the potential association between sleep pathology and diabetes mellitus (DM) using self-reported questionnaires. Material and Methods 957 adults aged between 19 and 86 years old were enrolled in this cross-sectional study. Multistage stratified cluster sampling was used and subjects were classified into three groups [short (<6h), normal (6-8h) and long (>8h) sleep duration]. Individuals were classified as diabetics if they responded positively to the questions: “Have you ever been told that you are diabetic or have high blood sugar by a health professional?” or “Are you on antidiabetic medication?”. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results DM prevalence was higher among expatriated and Muslim Greeks (23.1% and 18.7%, respectively) compared to indigenous Greek Christians (4.4%). DM prevalence was significantly associated with short sleep duration (aOR=2.82, p<0.001), excessive daytime sleepiness (aOR=2.09, p=0.019) and poor sleep quality (aOR=2.56, p<0.001), while its relation with insomnia (aOR=1.63, p=0.065) and risk for obstructive sleep apnea (aOR=1.53, p=0.080) were of marginal statistical significance. Conclusion This study indicates an association between sleep quantity, quality and DM and supports early pharmacological and cognitive behavioral interventions on sleep disturbances in order to reduce the burden of DM with increased focus on minority population needs.
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Affiliation(s)
- Anestis Matziridis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | - Dimitrios Tsiptsios
- South Tyneside & Sunderland NHS Foundation Trust, Department of Clinical Neurophysiology - Sunderland - Tyne & Wear - United Kingdom
| | - Apostolos Manolis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | - Andreas Ouranidis
- Aristotle University of Thessaloniki, Department of Chemical Engineering - Thessaloniki - Central Macedonia - Greece
| | | | - Konstantinos Tsamakis
- King's College, Institute of Psychiatry, Psychology and Neuroscience - London - United Kingdom
| | - Aspasia Serdari
- Democritus University of Thrace, Department of Child and Adolescent Psychiatry - Alexandroupolis - Thrace - Greece
| | - Eleni Leontidou
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | - Aikaterini Terzoudi
- Democritus University of Thrace, Neurology Department - Alexandroupolis - Thrace - Greece
| | - Elena Dragioti
- Linköping University, Department of Health, Medicine and Caring Sciences - Linköping - Linköping - Sweden
| | - Paschalis Steiropoulos
- Democritus University of Thrace, Department of Pneumonology - Alexandroupolis - Thrace - Greece
| | - Gregory Tripsianis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
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Vorvolakos T, Leontidou E, Tsiptsios D, Mueller C, Serdari A, Terzoudi A, Nena E, Tsamakis K, Constantinidis TC, Tripsianis G. The association between sleep pathology and depression: A cross-sectional study among adults in Greece. Psychiatry Res 2020; 294:113502. [PMID: 33068911 DOI: 10.1016/j.psychres.2020.113502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/03/2020] [Indexed: 12/28/2022]
Abstract
A cross-sectional population based study was conducted in order to evaluate the potential association of sleep characteristics with depression using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants aged between 19 and 86 years old were enrolled in our study. Depression symptoms were assessed using the Beck Depression Inventory. Participants self-reported their daily sleep habits and filled in the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of depression was 28.4%. Depression symptoms were more prominent among minority groups. Subjects with depression reported shorter sleep duration and had reduced sleep efficiency. In patients with depression mean sleep duration was reduced by 23 min and mean sleep efficiency by 4%. Patients with depression were at higher risk of insomnia, poor sleep quality and obstructive sleep apnea, but not of excessive daytime sleepiness. Concerning insomnia subtypes, depression was associated with difficulties maintaining sleep and early morning awakening, but not problems initiating sleep. Sleep disturbances are highly prevalent in depression and our findings support early pharmacological or cognitive behavioral interventions in order to address this key depression-associated symptom. Only addressing problems initiating sleep might not be sufficient in depression.
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Affiliation(s)
- Theofanis Vorvolakos
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eleni Leontidou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurophysiology Department, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, United Kingdom.
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aikaterini Terzoudi
- Department of Neurology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Tsamakis
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Theodoros C Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tripsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Zissimopoulou O, Leontidou E, Tsiptsios D, Manolis A, Ioannides D, Trypsiani I, Steiropoulos P, Constantinidis TC, Tripsianis G, Nena E. Association of Family Income with Health Indices and Healthcare Utilization in a Large Sample of Residents in Northern Greece. Maedica (Bucur) 2020; 15:490-502. [PMID: 33603907 PMCID: PMC7879352 DOI: 10.26574/maedica.2020.15.4.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:To describe the impact of subjects' family income, which was used as a proxy for socioeconomic status, with health characteristics and healthcare utilization of a large representative sample of population in Northern Greece, taking into account several socio-demographic characteristics and health behaviors of the participants. Material and method:Eight hundred and twelve participants (43.7% males) with a mean age of 49.±14.8 years (range 19-83 years), from the area of Thrace, Greece, were enrolled in this cross-sectional populational study. A two-stage stratified sampling scheme was used and subjects were classified, according to the net mean monthly household income, into three financial levels: low .1000 Euro; medium 1001-2000 Euro; and high >2000 Euro. Self-reported questionnaires for socio-demographic, lifestyle and health related characteristics were collected. Sleep characteristics, utilizing Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire, and mental health, using Zung Self-rating Anxiety Scale and Beck Depression Inventory have been also assessed. Results:The majority of participants belonged to the lower income level (476 subjects, 58.6%). Lower income level was associated with a higher prevalence of high alcohol consumption (p=0.030), low adherence to Mediterranean diet (p=0.016), low physical activity (p<0.001) and either short or long nocturnal sleep duration (p<0.001). After adjusting for all socio-demographic and lifestyle characteristics, subjects with low income had a higher risk for anxiety (aOR=1.97, p=0.017), depression (aOR=4.88, p<0.001), dyslipidemia (aOR=2.50, p=0.007), diabetes (aOR=3.58, p<0.001), obesity (aOR=1.97, p=0.038), cardiovascular disease (aOR=3.04, p=0.015) and sleep disorders, as well as for primary (aOR=3.56, p=0.017) and secondary (aOR=2.49, p=0.010) healthcare utilization compared to subjects with high income. Conclusion:Low income is an important factor, which adversely affects the health of individuals via different pathways such as adaptation of harmful everyday habits. Large-scale prospective cohort studies are necessary to verify these associations in a methodologically more robust way.
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Affiliation(s)
- Orestia Zissimopoulou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eleni Leontidou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurophysiology Department, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Apostolos Manolis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Ioanna Trypsiani
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Theodoros C Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tripsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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