Factors associated with sleep problems and sleeping pill use in Brazilians

Araújo, Mayonara Fabíola Silva; Souza, Talita Araújo de; Medeiros, Arthur de Almeida; Souza, Jane Carla de; Barbosa, Isabelle Ribeiro

doi:10.11606/s1518-8787.2022056004088

Brasil

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056004088 linkcopy

Factors associated with sleep problems and sleeping pill use in Brazilians

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To estimate the prevalence of sleep problems and sleeping pill use and associated factors in the Brazilian population.

METHODS This study was conducted with data from the 2019 Brazilian National Health Survey. Our sample consisted of 94,114 participants and the outcomes analyzed were sleep problems and sleeping pill use. Sociodemographic, lifestyle, and health characteristics were explored in a descriptive and multivariate analysis with Poisson regression, robust variance, and 5% significance.

RESULTS We found a 35.1% (95%CI: 34.5–35.7) and 8.5% (95%CI: 8.2–8.9) prevalence of sleep problems and sleeping pill use, respectively. Sleep problems were associated with women (PR = 1.41; 95%CI: 1.36–1.46), individuals who self-assess their health as regular/poor/very poor (PR = 1.56; 95%CI: 1.51–1.62), those with chronic diseases (PR = 1.70; 95%CI: 1.64–1.78), those who use alcohol excessively (PR = 1.14; 95%CI: 1.09–1.20), and smokers (PR = 1.16; 95%CI: 1.10–1.22). Sleeping pill use was associated with women (PR = 1.57; 95%CI: 1.43–1.73), divorcees (PR = 1.46; 95%CI: 1.30–1.65), urban denizens (PR = 1.32; 95%CI: 1.21–1.45) those who self-assess their health as regular/poor/very poor (PR = 1.79; 95%CI: 1.64–1.95), those with chronic diseases (PR = 4.07; 95%CI: 3.48–4.77), and smokers (PR = 1.49; IC95%: 1.33–1.67).

CONCLUSION This study found that the prevalence of sleep problems and sleeping pill use in Brazilians indicates the need for attention and sleep care for this population, especially in women and those with lifestyle and health conditions associated with the analyzed outcomes.

Sleep Initiation and Maintenance Disorders, epidemiology; Sleep Aids, Pharmaceutical, therapeutic use; Risk Factors; Health Surveys

Variables	n	Descriptive		Bivariate analysis			Multivariate analysis
Variables	n	Prevalence	95%CI	_crude PR	95%CI	p	_adjusted PR	95%CI	p
Gender
Male	44,752	27.50	26.65–28.36	1			1
Female	49,362	41.84	41.03–42.64	1.52	1.47–1.57	< 0.005	1.41	1.36–1.46	< 0.005
Race/skin color
White	34,320	36.15	35.19–37.12	1			1
Black	58,390	34.34	33.56–35.11	0.94	0.91–0.98	0.020	0.96	0.92–0.99	0.019
Asian	692	29.42	23.05–36.70	0.81	0.63–1.03	0.100	0.79	0.62–1.01	0.071
Indigenous	702	39.95	32.80–47.56	1.10	0.91–1.33	0.310	1.04	0.88–1.23	0.592
Marital status
Single	42,325	32.04	31.12–32.95	1			1
Married	36,354	35.46	34.56–36.36	1.10	1.06–1.14	< 0.005	0.99	0.95–1.02	0.66
Divorced	7,713	42.81	40.79–44.84	1.33	1.26–1.40	< 0.005	1.05	1.00–1.11	0.027
Widower	7,722	46.19	44.31–48.07	1.44	1.37–1.51	< 0.005	0.96	0.91–1.01	0.165
Educational attainment
Higher education	18,287	36.08	34.71–37.46	1			1
Secondary education	31,128	31.38	30.38–32.39	0.86	0.83–0.91	< 0.005	0.89	0.85–0.93	< 0.005
Primary education	36,829	36.94	35.97–37.92	1.02	0.98–1.06	0.270	0.88	0.84–0.92	< 0.005
Illiterate/no formal education	7,870	43.52	41.44–45.60	1.20	1.13–1.28	< 0.005	0.94	0.88–1.01	0.120
Household size
1 resident	14,760	41.00	39.72–42.28	1
2–3 residents	49,219	36.06	35.31–36.81	0.87	0.84–0.91	< 0.005
> 4 residents	30,135	32.97	31.96–33.99	0.80	0.77–0.83	< 0.005
Area of residence
Rural	21,405	30.03	28.95–31.12	1			1
Urban	72,709	35.92	35.21–36.63	1.19	1.15–1.24	< 0.005	1.16	1.11–1.20	< 0.005
FHS Coverage
Yes	59,358	35.25	34.52–35.97	1
No	23,424	35.62	34.32–36.93	1.01	0.97–1.04	0.589
Does not know	11,332	33.03	31.39–34.71	0.93	0.88–0.98	0.015
Health self-assessment
Very good/good	60,055	27.65	26.92–28.38	1			1
Regular/poor/very poor	34,059	51.38	50.34–52.40	1.85	1.80–1.91	< 0.005	1.56	1.51–1.62	< 0.005
Has NCD
No	37,093	23.15	22.33–23.98	1			1
Yes	44,125	47.51	46.64–48.37	2.05	1.97–2.13	< 0.005	1.70	1.64–1.78	< 0.005
Alcohol use
Teetotalism	55,430	35.98	35.24–36.72	1			1
Moderate use	20,384	33.92	32.69–35.15	0.94	0.90–0.98	0.003	1.02	0.98–1.07	0.196
Excessive use	15,032	33.70	32.17–35.26	0.93	0.89–0.97	0.004	1.14	1.09–1.20	< 0.005
Smoking habit
Never smoked	55,236	32.17	31.44–32.90	1			1
Former smoker	24,224	40.31	39.08–41.54	1.25	1.20–1.29	< 0.005	1.11	1.07–1.15	< 0.005
Smoker	11,386	38.80	37.15–40.47	1.20	1.25–1.26	< 0.005	1.16	1.10–1.22	< 0.005
Weekly vegetable consumption
≥ 5	46,754	35.48	34.64–36.33	1			1
< 5	44,092	34.64	33.74–35.53	0.96	0.93–0.99	0.029	1.06	1.02–1.09	< 0.005
Age
15–29 years old	18,648	27.44	26.18–28.72	1
30–59 years old	52,322	36.22	35.45–36.99	1.32	1.25–1.38	< 0.005
≥ 60 years old	23,144	42.05	40.93–43.17	1.53	1.45–1.61	< 0.005
Per capita income
Up to 1 minimum wage	10,964	35.18	34.38–35.98	0.96	0.90–1.00	0.186
1 to 3 minimum wages	31,109	34.60	33.60–35.61	0.95	0.92–1.01	0.062
Above 3 minimum wages	52,017	36.35	34.70–38.03	1
BMI
Malnutrition	2,197	34.47	30.62–38.52	1.05	0.93–1.18	0.366
Eutrophic	36,356	32.68	31.74–33.62	1
Overweight	32,972	35.46	34.51–36.42	1.08	1.04–1.12	< 0.005
Obesity	18,106	39.04	37.82–40.26	1.19	1.14–1.24	< 0.005
Weekly physical activity (minutes)	94,114	48.69 ± 1.20	46.33–51.04	1.09	1.03–1.15	0.003

Variables	n	Descriptive		Bivariate analysis			Multivariate Analysis
Variables	n	Prevalence	95%CI	_crude PR	95%CI	p	_adjusted PR	95%CI	p
Gender
Male	44,752	5.21	4.84–5.59	1			1
Female	49,362	11.51	11.02–12.03	2.21	2.03–2.40	< 0.005	1.57	1.43–1.73	< 0.005
Race/skin color
White	34,320	10.37	9.79–10.98	1			1
Black	58,390	7.18	6.82–7.56	0.69	0.64–0.74	< 0.005	0.72	0.67–0.78	< 0.005
Asian	692	6.10	3.37–10.79	0.58	0.31–1.08	0.088	0.55	0.31–0.98	0.044
Indigenous	702	8.68	5.55–13.33	0.83	0.54–1.29	0.423	0.78	0.53–1.15	0.222
Marital status
Single	42,325	5.61	5.21–6.04	1			1
Married	36,354	9.06	8.56–9.22	1.61	1.47–1.77	< 0.005	1.03	0.93–1.13	0.536
Divorced	7,713	15.77	14.31–17.35	2.81	2.48–3.17	< 0.005	1.46	1.30–1.65	< 0.005
Widower	7,722	18.32	16.87–19.87	3.26	2.92–3.64	< 0.005	1.19	1.06–1.34	< 0.005
Educational attainment
Higher education	18,287	8.37	7.59–9.22	1			1
Secondary education	31,128	6.04	5.57–6.55	0.72	0.63–0.81	< 0.005	0.80	0.71–0.91	0.001
Primary education	36,829	10.36	9.81–10.93	1.23	1.11–1.37	< 0.005	0.91	0.81–1.02	0.112
Illiterate/no formal education	7,870	13.44	12.02–15.01	1.60	1.39–1.85	< 0.005	0.95	0.81–1.12	0.594
Household size
1 resident	14,760	12.68	11.88–13.54	1
2–3 residents	49,219	9.68	9.23–10.14	0.76	0.70–0.82	< 0.005
> 4 residents	30,135	6.51	6.02–7.04	0.51	0.46–0.57	< 0.005
Area of residence
Rural	21,405	6.37	5.84–6.93	1			1
Urban	72,709	8.90	8.54–9.28	1.39	1.27–1.52	< 0.005	1.32	1.21–1.45	< 0.005
FHS coverage
Yes	59,358	8.68	8.29–9.08	1
No	23,424	8.46	7.77–9.20	0.97	0.89–1.06	0.572
Does not know	11,332	8.03	7.11–9.07	0.92	0.80–1.06	0.269
Health self-assessment
Very good/good	60,055	5.26	4.93–5.62	1			1
Regular/poor/very poor	34,059	15.72	15.02–16.45	2.98	2.75–3.23	< 0.005	1.79	1.64–1.95	< 0.005
Has NCD
No	37,093	2.41	2.10–2.77	1			1
Yes	44,125	15.20	14.59–15.82	6.29	5.42–7.31	< 0.005	4.07	3.48–4.77	< 0.005
Alcohol use
Teetotalism	55,430	10.39	9.95–10.85	1			1
Moderate use	20,384	6.65	6.03–7.33	0.63	0.57–0.71	< 0.005	0.75	0.67–0.84	< 0.005
Excessive use	15,032	4.79	4.20–5.45	0.46	0.40–0.52	< 0.005	0.68	0.59–0.78	< 0.005
Smoking habit
Never smoked	55,236	7.41	7.04–7.79	1			1
Former smoker	24,224	10.35	9.69–11.06	1.39	1.28–1.52	< 0.005	1.15	1.05–1.25	0.002
Smoker	11,386	10.48	9.48–11.56	1.41	1.26–1.58	< 0.005	1.49	1.33–1.67	< 0.005
Weekly vegetable consumption
≥ 5 times	46,754	9.31	8.84–9.81	1
< 5 times	44,092	7.64	7.21–8.09	0.81	0.75–0.88	< 0.005
Age
15–29 years old	18,648	3.03	2.58–3.55	1			1
30–59 years old	52,322	8.70	8.26–9.17	2.87	2.43–3.39	< 0.005	1.50	1.26–1.79	< 0.005
≥ 60 years old	23,144	15.27	14.47–16.10	5.04	4.27–5.96	< 0.005	1.50	1.24–1.81	< 0.005
Per capita income
Up to 1 minimum wage	10,964	7.94	7.52–8.38	0.76	0.68–0.84	< 0.005
1 to 3 minimum wages	31,109	8.86	8.29–9.46	0.85	0.76–0.95	0.006
Above 3 minimum wages	52,017	10.38	9.41–11.44	1
BMI
Malnutrition	2,197	7.61	5.91–9.75	1.03	0.78–1.35	0.823
Eutrophic	36,356	7.38	6.91–7.87	1
Overweight	32,972	9.05	8.50–9.64	1.22	1.12–1.34	0.006
Obesity	18,106	10.54	9.82–11.31	1.42	1.29–1.58	0.006
Weekly physical activity (minutes)	94,114	53.86 ± 2.47	49.00–58.72	1.18	1.08–1.30	< 0.005

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[TFN1] _crude PR: crude prevalence ratio; _adjusted PR: adjusted prevalence ratio; 95%CI: 95% confidence interval; FHS: family health strategy; NCD: chronic non-communicable diseases; BMI: body mass index.