Abstract

INTRODUCTION

The sleep is considered to be a complex biological process which alternates with periods of wakefulness. The sleep-wake states are mediated by neural and hormonal modulations, such physiological processes alter the body temperature, the cardiac work and the hormone production¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34., leading to a neurological condition essential to the growth (during childhood and adolescence), learning/memory and functioning of the organism^2,33. Carter PJ, Taylor BJ, Williams SM, Taylor RW. Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study. BMJ 2011; 342: d2712.. The sleep consists of two distinct states: the rapid eye movement (REM) and the non-rapid eye movement (NREM)²2. McCarley RW. Neurobiology of REM and NREM sleep. Sleep Med 2007; 8(4): 302-30., which are manifested in cycles organized throughout an average night's sleep. However, disorders affecting these two states may result in the worsening of the quality of life and the installation, in long term, of several metabolic and cardiovascular diseases¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34..

Nowadays, alterations in sleep patterns are very common among children³3. Carter PJ, Taylor BJ, Williams SM, Taylor RW. Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study. BMJ 2011; 342: d2712., adults⁴4. Liu Y, Croft JB, Wheaton AG, Perry GS, Chapman DP, Strine TW, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health 2013; 13: 84.^,55. Singareddy R, Vgontzas AN, Fernandes-Mendoza J, Liao D, Calhoun S, Shaffer ML, et al. Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med 2012; 13(4): 346-53. and elderly people⁶6. Lo CM, Lee PH. Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults. Health Qual Life Outcomes 2012; 10: 72., with international studies indicating a high prevalence of sleep disorders in adults (37.2 to 69.4%)⁴4. Liu Y, Croft JB, Wheaton AG, Perry GS, Chapman DP, Strine TW, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health 2013; 13: 84.^,77. Ryu SY, Kim KS, Han MA. Factors associated with sleep duration in Korean adults: results of a 2008 community health survey in Gwangju metropolitan city, Korea. J Korean Med Sci 2011; 26(9): 1124-31.. Studies carried out in São Paulo show that 32% of São Paulo's citizens presented symptoms of insomnia⁸8. Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol 2013; 74(4): 537-46., as well as that, between 1987 and 2007, the percentage of paulistanos who had "trouble sleeping", "maintaining the sleep throughout the night" and "waking up" increased significantly⁹9. Santos-Silva R, Bittencourt LR, Pires ML, de Mello MT, Taddei JA, Benedito-Silva AA, et al. Increasing trends of sleep complaints in the city of Sao Paulo, Brazil. Sleep Med 2010; 11(6): 520-4..

Besides that, recent studies have identified an association between sleep disorders, metabolic and cardiovascular diseases (hypertension, dyslipidemia and diabetes mellitus)¹⁰10. Pandey A, Williams N, Donat M, Ceide M, Brimah P, Ogedegbe G, et al. Linking sleep to hypertension: greater risk for blacks. Int J Hypertens 2013; 2013: 436502.

11. Kobayashi D, Takahashi O, Deshpande GA, Shimbo T, Fukui T. Relation between metabolic syndrome and sleep duration in Japan: a large scale cross-sectional study. Intern Med 2011; 50(2): 103-7.^-1212. Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO. Insomnia with objective short sleep duration is associated with type 2 diabetes. Diabetes Care 2009; 32(11): 1980-5., risk behaviors (smoking)¹³13. Kim SK, Kim JH, Park SY, Won HR, Lee HJ, Yang HS, et al. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med 2012; 8(4): 367-74.^,1414. Peters EN, Fucito LM, Novosad C, Toll BA, O'Malley SS. Effect of night smoking, sleep disturbance, and their co-occurrence on smoking outcomes. Psychol Addict Behav 2011; 25(2): 312-9. and the presence of overweight and/or obesity¹⁵15. Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care 2011; 14(4): 402-12.. Sleep disorders, as well as the shorter duration of sleep, are associated to weight gain¹⁶16. Marshall NS, Glozier N, Grunstein RR. Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev 2008; 12(4): 289-98.^,1717. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring) 2008; 16(3): 643-53., and the decrease in the quality of sleep seems to be associated to higher food intake and alcohol consumption¹⁸18. Galli G, Piaggi P, Mattingly MS, de Jonge L, Courville AB, Pinchera A, et al. Inverse relationship of food and alcohol intake to sleep measures in obesity. Nutr Diabetes 2013; 3: e58.. On the other hand, the improvement on the sleep quality seems to be mediated by factors such as regular physical activity¹⁹19. Zuo H, Shi Z, Yuan B, Dai Y, Hu G, Wu G, et al. Interaction between physical activity and sleep duration in relation to insulin resistance among non-diabetic Chinese adults. BMC Public Health 2012; 12: 247.^,2020. Pereira EG, Gordia AP, Quadros TMB. Padrão de sono em universitários brasileiros e sua relação com a prática de atividades físicas: uma revisão de literatura. Rev Bras Ciênc Saúde 2011; 9(30): 55-60..

Although there is a high prevalence of sleep disorders among the world's population, and that this outcome is associated to a higher occurrence of complications and health expenses⁴4. Liu Y, Croft JB, Wheaton AG, Perry GS, Chapman DP, Strine TW, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health 2013; 13: 84.^,2121. Sichieri R, do Nascimento S, Coutinho W. The burden of hospitalization due to overweight and obesity in Brazil. Cad Saúde Pública 2007; 23(7): 1721-7.^,2222. Brasil. Ministério da Saúde. VIGITEL Brasil 2011. Vigilância e fator de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2012., there is little national information on the investigation of sleep disorders and associated variables in the Brazilian population. This absence of information is relevant in cities in the inner country areas, in which the sleep behavior seems to differ significantly from the one in big metropolitan centers.

Thus, the objective of this study was to analyze the occurrence of sleep-related disorders among adults in Presidente Prudente, São Paulo, as well as to identify their associations to behavioral, sociodemographic and nutrition status variables.

METHODS

DESIGN AND PARTICIPANTS

A descriptive/analytical cross-sectional study. During the second half of 2012, 743 adults (older than 18 years of age) of both gender , living in the city of Presidente Prudente were interviewed. The municipality is located in the West region of the state of São Paulo, it has about 208,000 inhabitants and a human development index of 0.846. The interview consisted of questionnaires in order to report the quality of sleep²³23. Zomer J, Peled R, Rubin AH, Lavie P. Mini-sleep Questionnaire (MSQ) for screening large populations for EDS complaints. In: Koella WP, Rüther E, Schulz H (eds). Sleep '84 1985: Proceedings of the Seventh European Congress on Sleep Research. Stuttgart: Gustav Fischer; 1985. p. 467-70. and the practice of physical activities during leisure time²⁴24. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36(5): 936-42.. Behavioral and sociodemographic variables were also registered.

The sample size calculation was performed considering an estimated occurrence of sleep related disorders among adults of 35%¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34. (due to the absence of representative national values, this reference was extracted from a great epidemiological survey with the American population). The minimum sample size in order to conduct the study was of 708 adults, estimated through an equation for the estimation of populational parameters, which considered a total population of approximately 208,000 inhabitants, alpha of 5% (Z = 1.96), error of 3% and design effect of 30% (for using their households as final sample unit).

The sample consisted of individuals from the five geographic regions in the city (Center, East, West, North and South), listing and selecting randomly all the districts in each region. Within each district, 20 streets/avenues were randomly selected, and 6 households randomly selected in each one of them were assessed. All residents of these households were considered eligible and, then, invited into taking part in the study, respecting the inclusion criteria: (a) to be aged 18 years old or older; (b) to be living in the city for at least two years. All the subjects accepted taking part in the study and signed the Informed Consent approved by the Research Ethics Committee of the Faculdade de Ciências e Tecnologia of the Universidade Estadual Paulista, Campus of Presidente Prudente, São Paulo.

DEPENDENT VARIABLE: SLEEP RELATED DISORDERS

In order to analyze the sleep related disorders, we used the Mini-sleep Questionnaire²³23. Zomer J, Peled R, Rubin AH, Lavie P. Mini-sleep Questionnaire (MSQ) for screening large populations for EDS complaints. In: Koella WP, Rüther E, Schulz H (eds). Sleep '84 1985: Proceedings of the Seventh European Congress on Sleep Research. Stuttgart: Gustav Fischer; 1985. p. 467-70. (translated into Portuguese and validated in our midst)²⁵25. Falavigna A, de Souza Bezerra ML, Teles AR, Kleber FD, Velho MC, da Silva RC, et al. Consistency and reliability of the Brazilian Portuguese version of the Mini-Sleep Questionnaire in undergraduate students. Sleep Breath 2011; 15(3): 351-5., consisting of 10 questions with 7 possibilities of answers (never = 1; almost never = 2; rarely = 3; sometimes = 4; often = 5; very often = 6; and always = 7), which analyze different aspects related to sleep: sleepiness, insomnia, snoring, difficulty to sleep and waking up during the night. The sumo f these 10 questions results in a numerical score classified into 4 categories for each sleep disorder degree: good sleep (score between 10 and 24 points), slight disorder (score between 25 and 27 points), moderate disorder (score between 28 and 30 points) and severe disorder (score above 30 points). For this study, we observed the presence of "sleep disorders" when there are values ≥ 25 points.

INDEPENDENT VARIABLES: BEHAVIORAL

The current practice of physical activities during leisure time (leisure PA) was assessed using the questionnaire of Baecke et al.²⁴24. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 1982; 36(5): 936-42., which was previously validated for the Brazilian population by Florindo et al.²⁶26. Florindo AA, Latorre M do R, Jaime PC, Tanaka T. Zerbini CA. Methodology to evaluation the habitual physical activity in men aged 50 years or more. Rev Saúde Pública 2004; 38(2): 307-14.. The questionnaire was answered during the face to face interview in the interviewees' own households. The leisure PA was evaluated by the second section of the instrument, regarding the athletic activities held during leisure time. The practice of other activities other than athletic ones (weightlifting, gymnastics, fighting modalities and walks) were also computed. Three constructs of this physical activities practices during leisure time were analyzed: the intensity (low, moderate and vigorous), weekly time of practice, in hours per week (h/week) (< 1h/week; 1 - 2h/week; 2 - 3h/week; 3 - 4h/week; > 4h/week) and the prior engagement time (< 1 month; 1 - 3 months; 4 - 6 months; 7 - 9 months; > 9 months). This way, we considered as physically active the participants who reported a minimum of 180 minutes per week (3 - 4 h/week) of physical activities of moderate or vigorous intensity, within the last four months (4 - 6 months). Three categories were created: (i) absence of leisure physical activity (leisure AP): individuals who did not report any physical activity practice; (ii) < 180 min: individuals who reported less than 180 minutes per week or lower intensity than the one established or shorter prior engagement time; (iii) > 180 min: individuals who reached the proposed cutoff point²⁷27. Fernandes RA, Zanesco A. Early physical activity promotes lower prevalence of chronic diseases in adults. Hypertens Res 2010; 33(9): 926-31.^,2828. Fernandes RA, Christofaro DGD, Casonatto J, Codogno JS, Rodrigues EQ, Cardoso M, et al. Prevalência de dislipidemia em indivíduos fisicamente ativos durante a infância, adolescência e idade adulta. Arq Bras Cardiol 2011; 97(4): 317-23..

The consumption of alcohol and smoking were also identified: smoking (the interviewee self-reports being a smoker [yes or no]) and the consumption of alcohol (no[no day at all] / yes [at least once a week]).

INDEPENDENT VARIABLES: SOCIODEMOGRAPHIC

During the interview, the participants reported: gender (male/ female); chronological age (categorized into four groups: 18 - 29.9; 30 - 44.9; 45 - 59.9; and ≥ 60 years of age); ethnics (caucasian, black, yellow and others). School education was registered in 1 to 4 years of elementary school; 5 to 8 years of complete elementary school; complete high/technical school; and complete college education.

INDEPENDENT VARIABLES: NUTRITIONAL STATE

The body mass and height were related by the participants themselves, and later on, the Body Mass Index (BMI) was calculated through the division of the body mass by the squared height (kg/m²). Thus, the participants were classified in average weight (values between 18.6 and 24.99 kg/m²), overweight (values between 25 and 29.99 kg/m²) and obesity (values ≥ 30 kg/m²).

STATISTICAL ANALYSIS

The category variables were expressed as prevalence, and their respective confidence intervals were calculated. The χ²2. McCarley RW. Neurobiology of REM and NREM sleep. Sleep Med 2007; 8(4): 302-30. test was used in the analysis of the associations between the presence of sleep disorders and the independent variables. Later on, the binary logistic regression was employed, using the variables which presented significance of up to 20% in the χ² 2. McCarley RW. Neurobiology of REM and NREM sleep. Sleep Med 2007; 8(4): 302-30.test, in order to develop three multivariate models, in which the hierarchical entrance of independent variables of sociodemographic (gender, age and school education) and behavioral (physical activity, alcohol consumption and smoking) origin and the nutritional state was adopted. This process resulted in adjusted values of odds ratio (OR) and confidence intervals of 95% (95%CI). The test of Hosmer and Lemeshow was used in order to analyze the degree of adjustment of the multivariate models created. Significance values (p-value) were statistically considered when lower than 5%, and all the analysis were performed in the statistical BioEstat (version 5.0) software.

RESULTS

The average age of the interviewees was 49.9 ± 17.3 years of age (95%CI 48.6 - 51.1 years of age). In the analyzed sample, the occurrence of sleep related disorders was 46.7% (95%CI 43.1 - 50.2) (slightly altered sleep: 8,9%; moderately altered sleep: 9%; severely altered sleep: 28.8%). As for age, 30.6% of the interviewees were 60 years old or older. There was an elevated occurrence of overweight/obesity in the analyzed sample (58.3%), as well as an increased percentage of people with, at least, complete high/technical school degree (61.8%).

Sleep disorders were more often reported by women (OR = 1.75; 95%CI 1.30 - 2.37), older people (60 years old or older; OR = 2.26; 95%CI 1.40 - 3.64) and overweight people (OR = 3.00; 95%CI 2.04 - 4.41). On the other hand, people with higher school education less often present the analyzed outcome (Table 1).

Using the independent variables with significance of up to 20% in the χ² 2. McCarley RW. Neurobiology of REM and NREM sleep. Sleep Med 2007; 8(4): 302-30.test, three multivariate models were developed adopting a hierarchical entry of socioeconomical and behavioral variables and nutritional state. The last model created did not get saturated (test of Hosmer and Lemeshow with p = 0.987) and identified that women (OR = 1.74; 95%CI 1.26 - 2.40), people with lower school education and overweight (OR = 1.99; 95%CI 1.39 - 2.85) and obesity (OR = 2.90; 95%CI 1.94 - 4.35) presented higher occurrence of the analyzed outcome.

DISCUSSION

The occurrence of sleep related disorders was 46.7% (95%CI 43.1 - 50.2). This percentage is higher than the one observed in previous studies on the theme in adult populations of other countries and, also, in the city of São Paulo¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34.^,88. Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol 2013; 74(4): 537-46.^,2929. Siu YF, Chan S, Wong KM, Wong WS. The comorbidity of chronic pain and sleep disturbances in a community adolescent sample: prevalence and association with sociodemographic and psychosocial factors. Pain Med 2012; 13(10): 1292-303.. Throughout the last few years, it has been possible to observe a significant decrease in sleep time of the adult population¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34. and, along with this decrease, it has also been observed the decrease of the sleep quality⁹9. Santos-Silva R, Bittencourt LR, Pires ML, de Mello MT, Taddei JA, Benedito-Silva AA, et al. Increasing trends of sleep complaints in the city of Sao Paulo, Brazil. Sleep Med 2010; 11(6): 520-4.. On the other hand, most studies on the theme are conducted with populations living in great urban areas, and little is known about this variable in smaller towns (places significantly different from great urban centers as for quality of life and behaviors, which may impact in the quality of sleep). Our study shows that, although yet little explored in the Brazilian population of countryside cities, this kind of outcome deserves more attention, once it is also highly present in this portion of the population and it is related to the development of different health problems¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34..

Obesity is related to the development of sleep disorders¹1. Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK. Sleep: A health imperative. Sleep 2012; 35(6): 727-34.. In this sense, this high occurrence of sleep disorders may be associated to the excess of weight (overweight and obesity) rates observed in these interviewees (58% of them). The excess of weight affects the quality of sleep in different ways, as is the case of the obstructive sleep apnea, in which the excess of adiposity in the neck area interferes in the circulation of the air and, consequently, in breathing³⁰30. Schmid SM, Hallschmid M, Jauch-Chara K, Born J, Schultes B. A single night of sleep deprivation increases ghrelin levels and feelings of hunger in normal-weight healthy men. J Sleep Res 2008; 17(3): 331-4.. Furthermore, sleep disorders are related to weight gain, since an sole night of sleep deprivation significantly affects the levels of ghrelin and cortisol, favoring, thus, the reduction of energy expenditure³⁰30. Schmid SM, Hallschmid M, Jauch-Chara K, Born J, Schultes B. A single night of sleep deprivation increases ghrelin levels and feelings of hunger in normal-weight healthy men. J Sleep Res 2008; 17(3): 331-4.. Besides, there is a relation between obstructive sleep apnea and the resistance to leptin by the organism³¹31. Shimura R, Tatsumi K, Nakamura A, Kasahara Y, Tanabe N, Takiguchi Y, et al. Fat accumulation, leptin, and hypercapnia in obstructive sleep apnea-hypopnea syndrome. Chest 2005; 127(2): 543-9.. On the other hand, although there are some consistent biological theories connecting both variables, it is necessary to stress that it is still not possible to indicate with absolute certainty the causality relations between the sleep disorder and the higher body adiposity.

Also, the relation between weight excess and the insufficient physical activity practice seems to also affect the quality of sleep. In a longitudinal study performed by Zuo et al.¹⁹19. Zuo H, Shi Z, Yuan B, Dai Y, Hu G, Wu G, et al. Interaction between physical activity and sleep duration in relation to insulin resistance among non-diabetic Chinese adults. BMC Public Health 2012; 12: 247. in China, it was verified, in a sample of 1,224 adults, that the practice of physical activities was pointed out as a prevention factor against sleep disorders. On the other hand, the insufficient practice of physical activities did not remain associated to the outcome after the addition of the excess of weight (overweight and obesity), showing that this possible protective effect of physical activities, apparently, is due to the lower BMI of the subject, i.e., more active people have better quality of sleep because they have lower adiposity levels³²32. Fernandes RA, Christofaro DG, Casonato J, Costa Rosa CS, Costa FF, Freitas Júnior IF, et al. Leisure time behaviors: prevalence, correlates and associations with overweight in Brazilian adults. A cross-sectional analysis. Rev Med Chil 2010; 138(1): 29-35..

Women presented higher occurrence of sleep disorders. Biologically, women's sleep is more fragmented when compared to men's³³33. Vigeta SM, Hachul H, Tufic S, de Oliveira EM. Sleep in postmenopausal women. Qual Health Res 2012; 22(4): 466-75.. Besides, the stressful social context in which women are in (social expectations as to their work, family caring, aesthetics, etc.) may lead them into taking up unhealthy behaviors of negative impact on their sleep³⁴34. Oliveira BHD, Yassuda MS, Cupertino APFB, Neri AL. Relações entre padrão do sono, saúde percebida e variáveis socioeconômicas em uma amostra de idosos residentes na comunidade - Estudo PENSA. Ciênc Saúde Colet 2010; 15(3): 851-60..

In this study, people with higher school education presented lower occurrence of sleep disorders. This association shows that factors related to school education (economic condition and occupation) may interfere in the processes related to sleep disorders. The school education has been used as an economic status indicator²⁷27. Fernandes RA, Zanesco A. Early physical activity promotes lower prevalence of chronic diseases in adults. Hypertens Res 2010; 33(9): 926-31.^,2828. Fernandes RA, Christofaro DGD, Casonatto J, Codogno JS, Rodrigues EQ, Cardoso M, et al. Prevalência de dislipidemia em indivíduos fisicamente ativos durante a infância, adolescência e idade adulta. Arq Bras Cardiol 2011; 97(4): 317-23.^,3232. Fernandes RA, Christofaro DG, Casonato J, Costa Rosa CS, Costa FF, Freitas Júnior IF, et al. Leisure time behaviors: prevalence, correlates and associations with overweight in Brazilian adults. A cross-sectional analysis. Rev Med Chil 2010; 138(1): 29-35., and lower school education refers back to more stressful occupations as well as to lower access to health services with the intention of prevention³⁵35. Codogno JS, Fernandes RA, Sarti FM, Freitas Júnior IF, Monteiro HL. The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study. BMC Public Health 2011; 11: 275.. Also, higher school education may also mean higher capability of association of what are beneficial health behaviors and, thus, preventing problems which may cause sleep disorders.

This study did not identify smoking as a risk factor to sleep disorders, as oppose to the others¹³13. Kim SK, Kim JH, Park SY, Won HR, Lee HJ, Yang HS, et al. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med 2012; 8(4): 367-74.^,1414. Peters EN, Fucito LM, Novosad C, Toll BA, O'Malley SS. Effect of night smoking, sleep disturbance, and their co-occurrence on smoking outcomes. Psychol Addict Behav 2011; 25(2): 312-9.. In the study of Kim et al.¹³13. Kim SK, Kim JH, Park SY, Won HR, Lee HJ, Yang HS, et al. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med 2012; 8(4): 367-74., it was observed that smoking may trigger sleep disorders and even be a risk factor to the obstructive sleep apnea syndrome. This way, the differences observes between these studies may be explained, at least in parts, by the difference between the questionnaires used and the absence of more accurate analysis on the problems with obstructive sleep apnea; also, due to the fact that former smokers were inserted in the group of "non-smokers".

As a study limitation, we stress the absence of more detailed measures on the consumption of alcohol (amount consumed) and smoking (number of cigarettes consumed per day and prior exposure to smoking), as well as the absence of information regarding the kind of workload. Such information may be very useful to future studies interested in analyzing more thoroughly the relation of the outcome at hand regarding behavioral variables.

Finally, the results presents evidence a problem in public health, which deserves attention from the professionals of the area, because actions on raising awareness on the matter and education related to a good quality of sleep are little common, whether in basic care or in prevention in school grounds.

CONCLUSION

In short, it is possible to conclude that there is a high prevalence of sleep disorders among adult individuals in the city of Presidente Prudente, São Paulo, as well as the fact that this outcome is associated to female gender, to the presence of overweight/obesity and to lower school education.

References

Publication Dates

History