Sleepless in Beirut: sleep duration and associated subjective sleep insufficiency, daytime fatigue, and sleep debt in an urban environment

Abstract

Insufficient sleep is not well studied in developing countries. We assessed sleep duration among adults in Lebanon and examined its potential predictors and relationship with subjective sleep insufficiency, daytime fatigue, and weekday sleep debt. This cross-sectional study included 501 adults (mean age 45.2 (SD15.2) years, 64% females) from the community in Beirut and Mount Lebanon. Socio-demographic, lifestyle and health characteristics, subjective sleep insufficiency, daytime fatigue, and weekday sleep debt (weekend vs. weekdays sleep duration) were compared between individuals who reported sleeping < 6:00, 6-7:59(reference), or ≥ 8:00h/night. Symptoms and predictors of sleep duration were assessed using logistic regression. Thirty-nine percent of participants reported sleeping < 6h/night while 15% reported sleeping ≥ 8:00h/night. Age (OR = 1.16/year, 95% CI [1.02-1.33]) and female sex (OR = 1.71, 95% CI [1.14-2.58]) were significant predictors of short sleep (< 6:00h/night) in multivariable adjusted analyses. Compared to referent (6:00-7:59h/night) and long sleepers (≥ 8:00h/night), short sleepers were significantly more likely to report subjective sleep insufficiency (OR = 3.00, 95% CI [2:00-4.48], and OR = 4.52, 95% CI [2.41-8.51]; respectively) and daytime fatigue (OR = 1.53, 95% CI [1.04-2.24], and OR = 1.83, 95% CI [1.06-2.04]; respectively). Compared to long weekdays sleepers, short and referent weekdays sleepers were more likely to sleep longer on weekend (OR = 2.47, 95% CI [1.18-5.15], and OR = 4.16, 95% CI [2.03-8.5]; respectively). Short sleep is highly prevalent in this urban cohort from a low- to medium-income country especially among women and older adults, and is associated with subjective sleep insufficiency, daytime fatigue, and weekday sleep debt. The socio-cultural determinants of sleep duration need to be studied across different populations to better evaluate the causes and implications of short sleep.