Factors associated with insomnia in older adult outpatients vary by gender: a cross-sectional study

Yu-Ting Peng,Yu-Te Lin,Yu-Chun Wang,Ying-Hsin Hsu,Che-Sheng Chu,Liang-Kung Chen,Chen-San Su,Chih-Kuang Liang,Tsan Yang,Ming-Yueh Chou

doi:10.1186/s12877-021-02643-7

Abstract

BackgroundInsomnia is a common sleep disturbance in older adults and is associated with many poor health outcomes. This study aimed to explore factors associated with insomnia in older adult outpatient clinics, and to further analyze the influence of gender on factors associated with insomnia.MethodsThis cross-sectional study was conducted in the outpatient clinics of a tertiary hospital in Southern Taiwan from July to September 2018. A total of 400 consecutive subjects aged 60 years or older were recruited. Insomnia was defined as a score of ≥6 points on the Athens Insomnia Scale (AIS). Socio-demographics, health behaviors and clinical data were collected by face-to-face interview. Multivariable logistic regression was adopted for statistical analysis of the entire sample and stratified by gender.ResultsParticipants’ mean age was 74.74 ± 8.54 years, and the majority (93%) had more than one chronic disease. The prevalence of insomnia accounted for 30% (120/400) of all subjects, with males 22.9% (46/201) and females 37.2% (74/199). Gender, appetite, exercise, depressive symptoms, and sleep-related conditions such as short sleep duration, sleeping pills usage, medium-high risk of obstructive sleep apnea (OSA) and restless leg syndrome (RLS) were factors associated with insomnia in older adults. Exercise, sleeping pills usage, and RLS were independently associated with insomnia only in men, while appetite and medium-high risk of OSA were associated with insomnia in women only. In addition, after further adjusting for covariates, prevalence of the insomnia-related symptoms such as sleep induction, total sleep duration, sleep quality and sleepiness during the day was significantly higher in females than in males.ConclusionsInsomnia symptoms are highly prevalent among older adults, predominantly females. Significant differences are found between genders in factors associated with insomnia and insomnia-related symptoms. Understanding gender differences may help clinicians to modify associated factors when managing older adults with insomnia.

Highlights

Insomnia is a common sleep disturbance in older adults and is associated with many poor health out‐ comes
When sleep duration was added into Model 2 as an additional covariate, the independent relationship between insomnia and those factors that were significant in Model 1 still existed, including female gender (OR = 2.35, 95% confidence interval (95% CI) = 1.36-4.06), poor appetite within 3 months (OR = 3.87, 95% CI = 1.88-7.97), sleeping pills usage (OR = 1.90, 95% CI = 1.14-3.16), moderate-high risk of obstructive sleep apnea (OSA) (OR = 2.87, 95% CI = 1.56-5.26), depression (OR = 2.79, 95% CI = 1.59-4.87), and restless leg syndrome (RLS) (OR = 5.10, 95% CI = 1.52-17.14)
The present cross-sectional study targeted a total of 400 older adult participants in outpatient clinics to comprehensively investigate the factors associated with insomnia, especially considering the influence of common sleep-related problems such as sleep duration, sleep medication usage, OSA and RLS, and intending to find the influence of gender on the associated factors

Summary

Introduction

Insomnia is a common sleep disturbance in older adults and is associated with many poor health out‐ comes. Female gender [7, 8], older adults who are divorced, separated or widowed [7], and those with lower levels of education and/or income, smoking, alcohol use, and reduced physical activity [7, 9] are factors associated with higher rates of insomnia in older adults Clinical conditions such as physical illness [10], depression [11, 12], and some primary sleep disorders like obstructive sleep apnea (OSA) and restless leg syndrome (RLS) are associated with or are comorbid with insomnia in various populations and clinical settings [2, 13, 14]. Little is known about the influence of gender in factors associated with insomnia in older adults, too [18, 21]

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