Sleep Duration and Quality of Life in Young Rural Chinese Residents

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  • This article was downloaded by: [Flinders University of South Australia]On: 07 October 2014, At: 22:20Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

    Behavioral Sleep MedicinePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/hbsm20

    Sleep Duration and Quality of Life inYoung Rural Chinese ResidentsHelen F. K. Chiu a , Yu-Tao Xiang a b , Jing Dai c , Sandra S. M. Chan a

    , Xin Yu d , Gabor S. Ungvari e f & Eric D. Caine ga Department of Psychiatry , Chinese University of Hong Kong , HongKong SAR, Chinab Beijing Anding Hospital, Capital Medical University , Beijing , Chinac Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital,Shenzhen Mental Health Center , Shenzhen , Chinad Institute of Mental Health, Peking University , Beijing , Chinae School of Psychiatry and Clinical Neurosciences, University ofWestern Australia , Perth , Australiaf The University of Notre Dame Australia/Marian Centre , Perth ,Australiag Center for the Study and Prevention of Suicide, Department ofPsychiatry , University of Rochester Medical Center , Rochester , NYPublished online: 05 Mar 2013.

    To cite this article: Helen F. K. Chiu , Yu-Tao Xiang , Jing Dai , Sandra S. M. Chan , Xin Yu , Gabor S.Ungvari & Eric D. Caine (2013) Sleep Duration and Quality of Life in Young Rural Chinese Residents,Behavioral Sleep Medicine, 11:5, 360-368, DOI: 10.1080/15402002.2013.764524

    To link to this article: http://dx.doi.org/10.1080/15402002.2013.764524

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    http://www.tandfonline.com/page/terms-and-conditionshttp://www.tandfonline.com/page/terms-and-conditions

  • Behavioral Sleep Medicine, 11:360368, 2013

    Copyright Taylor & Francis Group, LLC

    ISSN: 1540-2002 print/1540-2010 online

    DOI: 10.1080/15402002.2013.764524

    Sleep Duration and Quality of Life in YoungRural Chinese Residents

    Helen F. K. ChiuDepartment of Psychiatry

    Chinese University of Hong Kong, Hong Kong SAR, China

    Yu-Tao XiangDepartment of Psychiatry

    Chinese University of Hong Kong, Hong Kong SAR, China

    Beijing Anding Hospital

    Capital Medical University, Beijing, China

    Jing DaiShenzhen Institute of Mental Health

    Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China

    Sandra S. M. ChanDepartment of Psychiatry

    Chinese University of Hong Kong, Hong Kong SAR, China

    Xin YuInstitute of Mental Health

    Peking University, Beijing, China

    Gabor S. UngvariSchool of Psychiatry and Clinical Neurosciences

    University of Western Australia, Perth, Australia

    The University of Notre Dame Australia/Marian Centre, Perth, Australia

    Eric D. CaineCenter for the Study and Prevention of Suicide

    Department of Psychiatry

    University of Rochester Medical Center, Rochester, NY

    Correspondence should be addressed to Yu-Tao Xiang, Department of Psychiatry, Chinese University of Hong

    Kong, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, N.T., Hong Kong, China. E-mail: xyutly@gmail.com

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  • CHIU ET AL. 361

    The aim of this study was to determine the mean total sleep time (TST) and the relation between

    sleep duration (short sleep: < 7 hr per day; medium sleep: 78 hr per day; and long sleep:

    > 8 hr per day) and quality of life (QOL) in young Chinese rural residents. A sample of 1,632

    participants was recruited in Mianyang, Sichuan province and interviewed. Expected and actual

    TSTs were asked using standardized questions. QOL was measured with the Chinese version of the

    World Health Organization Quality of Life Schedule-Brief. In the full sample, the mean expected

    TST was 8:8 1:3 hr, and the mean actual TST was 8:3 1:4 hr. Multivariate analyses revealed

    that compared to medium sleepers, short sleepers had lower QOL in the physical, psychological,

    and environmental domains, whereas long sleepers had higher QOL in the environmental domain.

    Being short or long sleepers was not associated with more major medical conditions. Given the

    significant associations between short sleep and poor QOL, more attention should be paid to young

    Chinese rural residents with short sleep.

    Compared with those who sleep 7 to 8 hr daily, both short and long sleepers have an increased

    total mortality risk (Heslop, Smith, Metcalfe, Macleod, & Hart, 2002; Youngstedt & Kripke,

    2004), sleep complaints (Grandner & Kripke, 2004; Kripke et al., 2001), and depression

    (Grandner & Drummond, 2007). In recent years, the association between sleep duration and

    quality of life (QOL) has been gaining attention.

    Several studies have explored the association between sleep duration and QOL in Western

    settings. For example, Faubel et al. (2009) examined 3,834 people aged 60 and over and found

    that both short and long sleep were associated with poor QOL. In contrast, Jean-Louis, Kripke,

    and Ancoli-Israel (2000) interviewed 273 people aged 40 to 64 and found no association

    between sleep duration and QOL.

    Preliminary evidence indicates that cross-cultural and ethnic differences exist in both QOL

    (Warner et al., 1998) and sleep problems (Gureje, Makanjuola, & Kola, 2007; Ohayon &

    Partinen, 2002). Therefore, the findings reported from Western settings may not be applicable

    to those with different ethnic and cultural backgrounds.

    In China, the suicide rates in rural Chinese women and men aged 15 to 34 years are

    quite high (38 and 23 per 100,000, respectively; Phillips, Li, & Zhang, 2002). Given that

    adolescent suicidal behaviors are closely associated with sleep problems, which, in turn, could

    cause a number of health problems (Grandner & Drummond, 2007; Tamakoshi & Ohno,

    2004; Youngstedt & Kripke, 2004), it is important to understand the sleep patterns in this

    population.

    To date, no study has examined sleep duration and its relation to QOL in young Chinese

    rural residents. This study set out to explore (a) the expected and actual mean total sleep time

    (TST) and (b) the relations between short, medium, and long sleep and QOL in young Chinese

    rural residents aged 16 (the minimum statutory age of independent consent in China) through

    34 years.

    METHOD

    Participants and Sampling

    The study was part of a large-scale epidemiologic survey on suicidal behavior and sleep

    disturbance in young Chinese rural residents in the rural area of Mianyang, Sichuan province,

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  • 362 SLEEP DURATION IN RURAL CHINESE RESIDENTS

    China (Dai et al., 2011). The study examined a stratified, multistage, and systematic sample

    of residents aged 16 to 34. Besides participants ages and places of residence, the only

    other inclusion criterion was the ability to communicate with the researchers to complete

    the interview. Mianyang was chosen as the study site as it is a typical rural area in China in

    terms of financial and living conditions, and also the enormous number of outgoing migrant

    workers.

    Chinas administrative division is a three-tier system that consists of a hierarchy of provinces,

    counties or cities, and towns. A town is composed of a group of villages (rural) and a small

    township area (urban). The details of the recruitment process have been described elsewhere

    (Dai et al., 2011). The key procedures were as follows: (a) Of the 277 towns in Mianyang

    district, Sichuan province, 24 towns and 266 surrounding villages were randomly selected, of

    which 11 villages were again randomly selected as study sites. One village was randomly chosen

    for pilot testing and as a training site for the interviewers. From the other 10 villages, 3,008

    participants aged 16 to 34 were identified using the comprehensive list of residents included

    in the Chinese household registration system (hukou; the hukou system was implemented

    in China in the 1950s to improve migration control and economic planning, and it is still

    functioning). (b) The field work was carried out in two waves in late 2005 and early 2006

    to maximize the recruitment of participants, particularly migrant workers who returned home

    only around the time of the Chinese New Year. Figure 1 depicts the sampling process of

    the study.

    We recruited 24 interviewers from experienced Centers for Disease Control and Prevention

    field staff, who had completed 7 days of intensive training and interrater reliability exercises.

    The selection of interviewers was based on training performance, the results of the interrater

    reliability testing, and a paper examination. The interviews were conducted in locations that

    were convenient for the participants.

    Assessment Tools

    Socio-demographic data were collected using a questionnaire designed for the study that in-

    quired about TST; major medical conditions affecting the cardiovascular, respiratory, digestive,

    hematological, endocrine, urinary, connective tissue, and nervous systems; and psychiatric

    disorders. Perceptions of financial situations were rated as poor, moderate, or good based on

    participants self-appraisals. To measure expected and actual TST in the past month, participants

    were asked the following questions: How many hours of sleep per night do you think you

    need?, and How many hours do you sleep each night on average? There is no gold standard

    definition of short and long sleepers. In this study, we used the criteria proposed by Heslop

    et al. (2002), which have also been used in other investigations (Grandner & Kripke, 2004;

    Xiang et al., 2009): short sleep: < 7 hr per day; medium sleep: 7 to 8 hr per day; and long

    sleep: > 8 hr per day.

    QOL is defined as individuals perceptions of their position in life in the context of the

    culture and value systems in which they live and in relation to their goals, expectations,

    standards and concerns (World Health Organization [WHO], 1998, p. 551). QOL is a broad

    concept that consists of four main domains: physical health, psychological condition, social

    relationships, and relation to the environment. In this study, all four domains of QOL were

    assessed with the Chinese version of the WHO Quality of Life ScheduleBrief (WHO, 1995).

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  • CHIU ET AL. 363

    FIGURE 1 Recruitment of participants. aHukou is the Chinese household registration system.

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  • 364 SLEEP DURATION IN RURAL CHINESE RESIDENTS

    The study protocol was approved by the Survey and Behavioral Ethics Committee of the

    Chinese University of Hong Kong and the Human Research and Ethics Committees of local

    participating institutions. Written consent was obtained from all participants.

    Statistical Analysis

    First, comparisons of the basic socio-demographic and clinical characteristics of the different

    sleepers were performed using one-way analyses of variance or chi-square tests, as appropriate.

    Second, analyses of covariance were used to compare the physical, psychological, social, and

    environmental domains of QOL between different sleepers, after adjusting for the potential

    confounding variables including age, gender, marital status, education, employment, perceived

    financial situation, and psychiatric disorders and major medical conditions. Third, the inde-

    pendent associations between sleep duration and presence of major medical conditions were

    explored using multiple logistic regression (the Enter method), with the presence of major

    medical conditions as the dependent variable and sleep duration as the independent variable

    after controlling for age, gender, marital status, education, financial situation, employment, psy-

    chiatric disorders, and QOL by entering them as covariates. The level of statistical significance

    was set at .01 (two-tailed) to reduce the risk of Type 1 error due to multiple tests.

    RESULTS

    Figure 1 depicts the studys sampling results. Of the 3,008 names generated from the hukou list,

    1,284 were either living away permanently or were migrant workers who did not return home

    for prolonged periods and, thus, were not contactable. A total of 1,689 people were contacted,

    and 1,632 were finally included in this study; thus, the response rate was 97%. The actual

    TST hours were 5:8 0:8, 7:8 0:4, and 9:6 0:9 in the short, medium, and long sleepers,

    respectively. Table 1 shows the basic socio-demographic and clinical characteristics of the

    participants. Univariate analyses revealed significant differences between the three groups with

    respect to age, perception of financial situation, and the presence of major medical conditions.

    After controlling for potential confounding variables, there were significant differences

    between the three groups in terms of physical, psychological, and environmental domains

    of QOL. Specifically, compared to medium sleepers, short sleepers had lower QOL in the

    physical, psychological, and environmental domains, whereas long sleepers had higher QOL

    in the environmental domain (see Table 2).

    Multiple logistic regression analysis revealed that after controlling for potential confounding

    variables, compared to medium sleepers, being short .p D :01/ or long sleepers .p D :80/

    was not significantly associated with more major medical conditions.

    DISCUSSION

    In this study, we found that in contrast to medium sleepers, short sleepers had lower physical,

    psychological, and environmental QOL, whereas long sleepers had highe...

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