An Epidemiological Study of Sleep-Related Disorders and Their Association With Cardiovascular Risk Factors in an Adult Population (30-69 Years) of South Delhi
TL;DR
Questionnaire-based sleep screening is inexpensive and scalable and could be integrated into existing non-communicable disease screening encounters and could be integrated into existing non-communicable disease screening encounters.
Abstract
Background Sleep-related disorders (SRDs) are a major yet underdiagnosed public health burden in India, and community-level evidence linking them with cardiometabolic risk factors remains scarce. This study aimed to estimate the point prevalence of selected SRDs assessed by four validated screening questionnaires, and to examine their association with cardiovascular risk factors in an urban adult population of South Delhi. Methodology A community-based, cross-sectional study was conducted among 700 apparently healthy adults aged 30-69 years recruited by four-stage random sampling from five wards of the Central Zone of the South Delhi Municipal Corporation (SDMC). SRDs were assessed using the Global Sleep Assessment Questionnaire (GSAQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and STOP-Bang questionnaire. Hypertension was defined as blood pressure ≥140/90 mmHg and diabetes as fasting blood glucose ≥126 mg/dL. Associations and independent predictors were identified using the chi-square test and binary logistic regression in SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA). Results Sleep-related breathing disorder (SRBD) prevalence was 37.0% and primary insomnia 36.0% by GSAQ. Daytime sleepiness (ESS ≥8) was present in 13.3%, obstructive sleep apnea (OSA; STOP-Bang ≥3) in 20.9%, and poor sleep quality (PSQI >5) in 23.9%. OSA was significantly more prevalent in males (41.5%) than females (13.9%) (p < 0.001). Newly detected hypertension was 19.3% and diabetes 12.3%. In multivariable binary logistic regression across seven sleep outcomes, restless legs syndrome was independently associated with female sex (adjusted odds ratio (AOR) = 4.05) and physical inactivity (AOR = 2.61); daytime sleepiness with diabetes (AOR = 1.84) and abnormal waist-hip ratio (AOR = 1.62); and insomnia with mental disorder (AOR = 2.28) and poor sleep latency (AOR = 1.77) with female sex. Because male sex, body mass index, and blood pressure are themselves STOP-Bang scoring components, the estimates obtained for STOP-Bang screen positivity are structural associations with the instrument rather than independent predictors of OSA, and are reported as such. Conclusions Screening positivity for SRDs was high in this community. STOP-Bang screen positivity was concentrated among men and older participants, whereas GSAQ-defined SRBD was more frequent in women and not explained by anthropometric factors, suggesting the two constructs capture different phenomena. Questionnaire-based sleep screening is inexpensive and scalable and could be integrated into existing non-communicable disease screening encounters. As this was a cross-sectional screening survey, no inference is drawn regarding the effect of any intervention on these outcomes.