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Dr. Stranges - Impact of behavioural sleep problems on multimorbidity, health-related quality of life and survival
Insufficient sleep and sleep problems affect more than one third of the adult population in Canada and worldwide, and represent an unmet and neglected public health problem with substantial costs to society yet our understanding of their impact on health and well-being remain a gap. Sleep disruption is more prevalent among older adults than other age groups, affecting over half of seniors. There are also substantial sex differences in sleep problems and their potential health impact. As evidenced by several previous studies led by the principal applicant of the current project, sleep disruption, deprivation and sleep disorders are associated with a range of adverse health outcomes including cardiovascular disease, diabetes, cancer, cognitive decline, mental disorders, musculoskeletal problems, frailty, lower health-related quality of life (HRQL), and mortality. Despite this research, it remains unclear whether the relationships between sleep problems and health outcomes are causal or confounded by other factors.
Indeed, sleep patterns are multifaceted and result from complex interactions among biological, social, behavioral, environmental, and psychological factors, as well as the presence of medical co-morbidities. Hence, it is important to more fully elucidate the factors contributing to the sleep-health association, in particular the role of age and sex differences as well as the influence of socio-economic status (i.e. race/ethnicity, education, income, employment, immigration status, etc.). Moreover, there is limited longitudinal data, in the Canadian context, on the potential health impact of sleep patterns around critical biological and psychosocial transitions across the lifespan, such as menopause among women and retirement from active working life in older adults. While the public health implications of sleep problems and associated health outcomes are clearly significant, sleep has received very little attention from the national public health community to date, and sleep awareness campaigns are noteworthy chiefly by their absence1. Furthermore, in most previous epidemiological studies, assessments of sleep patterns have been made at a single point in time. Changes in sleep duration and sleep quality over time are likely to provide a more comprehensive assessment of sleep patterns and better capture the sustained effects of sleep impairment, as suggested by limited longitudinal data in highly selected populations. Epidemiological studies using objective measures of sleep, such as actigraphy or polysomnography, are certainly valuable. However, these studies are costly and often based on limited and selected samples, which can hinder both statistical power and generalizability of their findings. Consequently, observational longitudinal studies remain key opportunities for addressing changes in sleep duration and sleep quality over time and their potential impact on health outcomes across the lifespan from younger to older adults.
There is a need to provide the best possible observational evidence in large nationally representative Canadian longitudinal studies of adults on the relations between poor sleep patterns (e.g., abnormal sleep duration, poor sleep quality) and sleep disorders and adverse health outcomes relevant to an aging population, as most of the published data come from cross-sectional studies. Our CIHR Sleep Team grant will focus on multimorbidity (i.e., co-occurrence of multiple chronic diseases), health-related quality of life (HRQL), and mortality. Specifically, we will examine bidirectional, prospective associations between sleep patterns and the onset/progression of multimorbidity, while applying the intersectionality framework in order to better elucidate nested layers of influence on both sleep and health, using prospective data from the Canadian Longitudinal Study on Aging.
Intersectionality refers to the ways in which different aspects of a person’s identity, such as race, gender, sexual orientation, socioeconomic status (SES), and others, interact to shape their experiences and access to resources, opportunities, and social power. In the context of health, intersectionality can help to explain how these different factors contribute to health disparities and inequalities, and how they can interact to compound or mitigate health risks and outcomes. For example, a person’s race, gender, and socioeconomic status (SES) may all impact their access to quality healthcare, healthy food options, and safe living environments, which in turn can affect all aspects of their physical and mental health, in particular sleep. By recognizing the multiple and interconnected ways in which different aspects of identity can shape sleep health, intersectionality offers a nuanced and holistic approach to understanding and addressing health disparities, reducing the risk of sleep disorders and promoting sleep health equity.
