SLEEP QUALITY, ANXIETY-DEPRESSION, AND QUALITY OF LIFE IN EXTREME OBESITY
The Complex Associations Among Sleep Quality, Anxiety-Depression, and Quality of Life in Patients with Extreme Obesity
Marzieh Hosseini Araghi, BSc, MPH1,2; Alison Jagielski, BSc, MSc1,2; Iraida Neira, BSc, MSc3; Adrian Brown, BSc, MSc1,4; Suzanne Higgs, MA, PhD3; G. Neil Thomas, PhD1,5,6; Shahrad Taheri, MB BS, PhD, FRCP1,7,8
1Birmingham and Black Country NIHR CLAHRC, University of Birmingham, United Kingdom; 2School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom; 3School of Psychology, University of Birmingham, United Kingdom; 4Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, United Kingdom; 5Public Health, Epidemiology and Biostatistics, University of Birmingham, United Kingdom; 6Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; 7Department of Medicine Weill-Cornell Medical College, New York, NY and Doha, Qatar; 8Department of Medicine, King's College London, London, UK
Sleep duration and quality have been associated with obesity. Sleep disturbance has been reported to be associated with stress and depression among non-obese populations, but these relationships have not been previously examined in the obese population. The objective of the current study was to examine the complex associations among sleep disturbance, quality of life, anxiety, and depression in a patient sample with severe obesity.
Two hundred seventy consecutively recruited patients with a mean body mass index (BMI) of 47.0 kg/m2 were studied. The correlation coefficient, multiple linear regressions, and structural equation modeling (SEM) analysis were used to evaluate the association between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and Hospital Anxiety and Depression Scale (HADS).
The mean (standard deviation; SD) PSQI score was 8.59 (5.11), and mean ESS score was 8.84 (5.79). After controlling for potential confounders, poor sleep quality and excessive daytime sleepiness were found to be significantly associated of all the components of IWQOL-Lite; physical function (β = -0.32, β = -0.27; P < 0.01), self-esteem (β = -0.23, β = -0.30; P < 0.05), sexual-life (β = -0.30, β = -0.35; P < 0.05), public distress (β = -0.39, β = -0.39; P < 0.01), and work (β = -0.26, β = -0.48; P < 0.01). We also found that the PSQI global score had a positive significant association with anxiety (β = 0.29; P = 0.01) and depression (β = 0.31; P = 0.01) components of HADS.
Poor sleep quality was strongly associated with mood disturbance and poor quality of life among extremely obese patients. Future interventions are needed to address sleep disturbance to prevent further development of psychological co-morbidity and potentially worsening of obesity among these individuals.
Araghi MH; Jagielski A; Neira I; Brown A; Higgs S; Thomas GN; Taheri S. The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. SLEEP 2013;36(12):1859-1865.