Multiple factors contribute to sleep troubles in middle-aged Asian women

More than a third of women in Singapore have difficulty sleeping, according to a study. Factors such as education level, irritability, vaginal dryness, disability, urinary incontinence, and breast cancer history contribute to poor sleep quality, the magnitude of which varying by ethnicity.

In a cohort of 1,094 women with a mean age of 56.4 years, 38.2 percent had a Pittsburgh Sleep Quality Index (PSQI) score of >5, indicating poor sleep quality. Compared with Chinese women (n=897), Indian women (n=59) had a higher sleep disturbance score (mean, 1.33 vs 1.17), while Malay women (n=106) had a higher daytime dysfunction score (mean, 0.54 vs 0.33) and a higher overall PSQI global score (mean, 6.00 vs 5.02). [Sleep Med X 2022;5:100060]

“No significant ethnic differences were observed in subjective sleep quality, sleep latency, sleep duration, and habitual sleep efficiency,” the investigators reported.

“Our findings agree with other studies that ethnic minorities tend to report poorer quality of sleep… This finding may be related to previous findings in Singapore of increased habitual snoring and breathing-related disorders among Indian and Malay vs Chinese women,” they noted. [Sleep Med X 2022;4:100043; Sleep 2008:31:979-990; Menopause 2003;10:19-28]

The investigators also pointed out that the differences in sleep quality among the various ethnicities might be explained by the higher prevalence of obesity and hypertension among Malays and Indians. [Arch Osteoporos 2019;14:80; Eur Respir J 1998;12:198-203]

Risk factors

In the cohort, poor sleep quality was more prevalent among women with moderate to severe menopausal symptoms (eg, hot flushes, heart discomfort, joint or muscle discomfort, irritability, physical mental exhaustion, sexual problems, and vaginal dryness) than among those with mild to no symptoms. Women with urinary incontinence, asthma, moderate to severe disability (compared to none to mild symptoms), a history of breast cancer, and with at least three health conditions were also more likely to struggle with sleep.

In a multivariable logistic regression model, six variables emerged as risk factors for poor sleep quality:  having a low education level (no formal education or until the primary level vs university degree; adjusted odds ratio [aOR], 1.76, 95 percent confidence interval [CI], 1.01–3.05), irritability (aOR, 2.67, 95 percent CI, 1.56–4.60), vaginal dryness (aOR, 1.62, 95 percent CI, 1.03–2.54), moderate to severe disability (aOR, 2.99, 95 percent CI, 1.20–7.44), urinary incontinence (aOR, 1.53, 95 percent CI, 1.08–2.17), and breast cancer history (aOR, 2.77, 95 percent CI, 1.36–5.64).

Conditions such as urinary incontinence, irritability, vaginal dryness, moderate to severe disability, and a history of breast cancer are specific to midlife women and may explain why the prevalence of poor sleep quality observed in the current cohort was higher than that reported among the general population of Singapore, according to the investigators. [Sleep Med X 2022;4:100043]

Taken together, the findings of the present study underscore the need for improved sleep management in women with the above-mentioned conditions, as well as for ethnically targeted interventions, they added.

The investigators called for longitudinal studies to confirm their findings.