# Prevalence of poor sleep quality and its associated factors in patients with concurrent type 2 diabetes mellitus and hypertension

## TL;DR

This study found that nearly 60% of patients with both type 2 diabetes and hypertension in Hunan, China, experience poor sleep quality, with age, stroke history, and anxiety being key factors.

## Contribution

The study identifies specific factors associated with poor sleep quality in patients with concurrent T2DM and hypertension using a cross-sectional design in a Chinese population.

## Key findings

- 59.4% of patients with concurrent T2DM and hypertension had poor sleep quality.
- Advanced age, history of stroke, and anxiety were significantly associated with poor sleep quality.
- Regular physical activity was linked to lower odds of poor sleep quality.

## Abstract

The coexistence of type 2 diabetes mellitus (T2DM) and hypertension can impair sleep quality, potentially leading to a wide range of adverse health outcomes. Therefore, this study aimed to evaluate sleep quality and its associated factors in patients with concurrent T2DM and hypertension in Hunan, China.

This cross-sectional study recruited patients with concurrent T2DM and hypertension who visited the Department of Endocrinology at the First People’s Hospital of Ruanjiang City, Hunan Province, China, between July 2022 and February 2023. Trained investigators conducted face-to-face interviews to collect data on sociodemographic, lifestyle, and disease-related factors, and assessed anxiety and sleep quality using the Generalized Anxiety Disorder-7 scale and the Pittsburgh Sleep Quality Index, respectively. Multivariable logistic regression analysis was performed to identify factors independently associated with sleep quality. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive ability of the model, and the Hosmer–Lemeshow test was used to assess model calibration. Subgroup analyses were conducted by sex, educational level, and number of T2DM complications to test model robustness.

A total of 475 patients with concurrent T2DM and hypertension were included. The prevalence of poor sleep quality was 59.4% (95% confidence interval (CI) [54.9%–63.9%]). Multivariable logistic regression analysis showed that advanced age (adjusted odds ratio (aOR) = 2.12, 95% CI [1.29–3.48]), history of stroke (aOR = 2.16, 95% CI [1.15–4.06]), and anxiety (aOR = 4.24, 95% CI [2.58–6.98]) were associated with higher odds of poor sleep quality. Regular physical activity was associated with lower odds (aOR = 0.53, 95% CI [0.34–0.84]). The area under the receiver operating characteristic (ROC) curve was 0.776 (95% CI [0.735–0.818]), and the Hosmer–Lemeshow test (P = 0.260) indicated good model calibration. Subgroup analyses yielded similar results.

Nearly three-fifths of patients with concurrent T2DM and hypertension exhibited poor sleep quality. Age, regular physical activity, history of stroke, and anxiety were significantly associated with sleep quality. However, due to the cross-sectional design, causal relationships cannot be established.