Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia

Abstract

Objective: To estimate the prevalence of sleep problems and the effect of potential correlates in low-income settings from Africa and Asia, where the evidence is lacking.

Design: Cross-sectional.

Setting: Community-wide samples from 8 countries across Africa and Asia participating in the INDEPTH WHO-SAGE multicenter collaboration during 2006-2007. The participating sites included rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam, and Indonesia, and an urban area in Kenya.

Participants: There were 24,434 women and 19,501 men age 50 yr and older.

Interventions: N/A.

Measurements and results: Two measures of sleep quality, over the past 30 days, were assessed alongside a number of sociodemographic variables, measures of quality of life, and comorbidities. Overall, 16.6% of participants reported severe/extreme nocturnal sleep problems, with a striking variation across the 8 populations, ranging from 3.9% (Purworejo, Indonesia and Nairobi, Kenya) to more than 40.0% (Matlab, Bangladesh). There was a consistent pattern of higher prevalence of sleep problems in women and older age groups. In bivariate analyses, lower education, not living in partnership, and poorer self-rated quality of life were consistently associated with higher prevalence of sleep problems (P < 0.001). In multivariate logistic regression analyses, limited physical functionality or greater disability and feelings of depression and anxiety were consistently strong, independent correlates of sleep problems, in both women and men, across the 8 sites (P < 0.001).

Conclusions: A large number of older adults in low-income settings are currently experiencing sleep problems, which emphasizes the global dimension of this emerging public health issue. This study corroborates the multifaceted nature of sleep problems, which are strongly linked to poorer general well-being and quality of life, and psychiatric comorbidities.

Keywords: Sleep; aging; comorbidities; correlates; epidemiology; global health; quality of life.

Figure 1

Weighted prevalence of self-reported nocturnal sleep problems by sex in 8 Health and Demographic Surveillance System sites in Africa and Asia, 2006-2007. Percentage of female and male participants, for each country, who reported severe/extreme problems with falling asleep (Q1016).

Figure 2

Weighted prevalence of self-reported difficulty related to daytime function by sex in 8 Health and Demographic Surveillance System sites in Africa and Asia, 2006-2007. Percentage of female and male participants, for each country, who reported severe/extreme problems with not feeling rested and refreshed during the day (Q1017).