OALibJ  Vol.2 No.10 , October 2015
The Impact of Insomnia Symptoms on Risk Factors of Metabolic Syndrome among the Urban Elderly in Northern Taiwan
Abstract: Sleep complaints played a role in predicting the development of metabolic syndrome (MetS) in the general population. This cross-sectional survey was performed among elderly people (age ≥ 65 years) who underwent a health examination for senior citizens since March 2009 to November 2009. 1181 participants were surveyed, including 433 men (36.7%) and 748 women (63.3%). We aimed at the association between self-reported insomnia symptoms and risk factors of MetS in the elderly population living in northern Taiwan. The modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) was used for criteria of MetS. Logistic regression examined the impact on the MetS and its components according to individual insomnia symptoms and syndrome. The result showed that difficulty falling asleep (DFA), a specific symptom of insomnia, was significantly associated with MetS (OR: 1.42, 95% CI = 1.09 - 1.86). DFA increased the risk of abdominal obesity, hyperglycemia, and hypertriglycemia. Frequent waking from sleep or dreamy increased the risk of abdominal obesity. Difficulty staying sleep increased the risk of hypertension. Other insomnia symptoms (non-refreshing sleep) were not associated with the increased risk of any MetS factors. Insomnia symptoms, including DFA, difficulty staying sleep, and frequent waking from sleep or dreamy increased the odds ratio of risk factors. Evaluating insomnia symptoms can help identify individuals that are at risk of MeS.
Cite this paper: Tsou, M. (2015) The Impact of Insomnia Symptoms on Risk Factors of Metabolic Syndrome among the Urban Elderly in Northern Taiwan. Open Access Library Journal, 2, 1-10. doi: 10.4236/oalib.1102013.

[1]   Department of Health (2011) The Executive Yuan. Statistics Report, Taiwan.

[2]   Yao, C.A., Lee, L.T., Chen, C.Y. and Huang, K.C. (2005) The Study of Metabolic Syndrome in Elderly Receiving Health Check-Up. Taiwan Geriatrics & Gerontology, 1, 18-25.

[3]   Lakka, H.M., Laaksonen, D.E., Lakka, T.A., Niskanen, L.K., Kumpusalo, E., Tuomilehto, J. and Salonen, J.T. (2002) The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-Aged Men. JAMA, 288, 2709-2716.

[4]   Hung, T.C., Chen, C.Y., Cheng, S.J., Liu, C.H. and Yeh, H.I. (2009) Comparison of the Prevalence of Metabolic Syndrome between the Criteria for Taiwanese and Japanese and the Projected Probability of Stroke in Elderly Hypertensive Taiwanese. International Journal of Gerontology, 3, 233-240.

[5]   Lin, Y.H., Chang, H.T., Tseng, Y.H., Lin, M.H., Chen, Y.C., Yang, H.W. and Hwang, S.J. (2013) Characteristics and Health Behavior of Newly Developed Metabolic Syndrome among Community-Dwelling Elderly in Taiwan. International Journal of Gerontology, 7, 90-96.

[6]   Huang, K.C., Lee, M.S., Lee, S.D., Chang, Y.H., Lin, Y.C., Tu, S.H. and Pan, W.H. (2005) Obesity in the Elderly and Its Relationship with Cardiovascular Risk Factors in Taiwan. Obesity Research, 13, 170-178.

[7]   Tsai, H.J. and Tsai, A.C. (2012) Prevalence of Metabolic Syndrome in Elderly Taiwanese: Results from the Nutrition and Health Survey in Taiwan (1999-2000).

[8]   Reichmuth, K.J., Austin, D., Skatrud, J.B. and Young, T. (2005) Association of Sleep Apnea and Type 2 Diabetes: A Population-Based Study. American Journal of Respiratory and Critical Care Medicine, 172, 1590-1595.

[9]   Ayas, N.T., White, D.P., Al-Delaimy, W.K., Manson, J.E., Stampfer, M.J., Speizer, F.E. and Hu, F.B. (2003) A Prospective Study of Self-Reported Sleep Duration and Incident Diabetes in Women. Diabetes Care, 26, 380-384.

[10]   Gangswich, J.E., Heymsfield, S.B., Boden-Albala, B., Buijs, R.M., Kreier, F., Pickering, T.G. and Malaspina, D. (2007) Sleep Duration as a Risk Factor for Diabetes Incidence in a Large U.S. Sample. Sleep, 30, 1667-1673.

[11]   Kawakami, N., Takatsuka, N. and Schimizu, H. (2004) Sleep Disturbance and Onset of Type 2 Diabetes. Diabetes Care, 27, 282-283.

[12]   Nilsson, P.M., Roost, M., Engstrom, G., Hedblad, B. and Berglund, G. (2004) Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances. Diabetes Care, 27, 2464-2469.

[13]   O’Connor, G.T., Caffo, B., Newman, A.B., Quan, S.F., Rapoport, D.M., Redling, S. and Shahar, E. (2009) Prospective Study of Sleep-Disordered Breathing and Hypertension. American Journal of Respiratory and Critical Care Medicine, 179, 1159-1164.

[14]   Troxel, W.M., Buysse, D.J., Matthews, K.A., Kip, K.E., Strollo, P.J., Hall, M. and Reis, S.E. (2010) Sleep Symptoms Predict the Development of the Metabolic Syndrome. Sleep, 33, 1633-1640.

[15]   Gruber, A., Howrwood, F., Sithole, J., Ali, N.J. and Idris, I. (2006) Obstructive Sleep Apnoea Is Independently Associated with the Metabolic Syndrome but Not Insulin Resistance State. Cardiovascular Diabetology, 5, 1-7.

[16]   Hall, M.H., Muldoon, M.F., Jennings, J.R., Buysse, D.J., Flory, J.D. and Manuck, S.B. (2008) Self-Reported Sleep Duration Is Associated with the Metabolic Syndrome in Midlife Adults. Sleep, 31, 635-643.

[17]   Jennings, J.R., Muldoon, M.F., Hall, M., Buysse, D.J. and Manuck, S.B. (2007) Self-Reported Sleep Quality Is Associated with the Metabolic Syndrome. Sleep, 30, 219-223.

[18]   Leineweber, C., Kecklund, G., Åkerstedt, T., Janszky, I. and Orth-Gomér, K. (2003) Snoring and the Metabolic Syndrome in Women. Sleep Medicine, 4, 531-536.

[19]   Tsou, M.T. (2012) Sleep Duration and Obesity among Adults under 65 Years of Age and the Elderly in Taiwan. International Journal of Gerontology, 6, 27-32.

[20]   Tsou, M.T. (2014) The Association between Metabolic Syndrome and Sleep Symptoms and Sleep Hygiene in the Elderly in Northern Taiwan. AAR, 3, No. 1.

[21]   Chiang, H.L., Chen, H.C., Bai, C.H., Che, H.H., Lee, M.B., Lai, S.H. and Chou, P. (2009) A Validation Study of the Chinese Version of the Athens Insomnia Scale. Taiwan Journal of Psychology, 23, 43-52.

[22]   Bureau of Health Promotion Database (2014) The Criteria of Metabolic Syndrome.

[23]   Hwang, L.C., Bai, C.H. and Chen, C.J. (2006) Prevalence of Obesity and Metabolic Syndrome in Taiwan. Journal of the Formosan Medical Association, 105, 626-635.

[24]   Bureau of Health Promotion, Department of Health, Taiwan (2015) The Method of Measuring Waist Circumference of Adult.

[25]   Lee, M.B., Liao, S.C., Lee, Y.J., Wu, C.H., Tseng, M.C., Gau, S.F. and Rau, C.L. (2003) Development and Verification of Validity and Reliability of a Short Screening Instrument to Identify Psychiatric Morbidity. Journal of the Formosan Medical Association, 102, 687-694.

[26]   Chen, H.C., Wu, C.H., Lee, Y.J., Liao, S.C. and Lee, M.B. (2005) Validity of the Five-Item Brief Symptom Rating Scale among Subjects Admitted for General Health Screening. Journal of the Formosan Medical Association, 104, 824-829.

[27]   Ainsworth, B.E., Jacobs, D.R. and Leon, A.S. (1993) Validity and Reliability of Self-Reported Physical Activity Status: The Lipid Research Clinics Questionnaire. Medicine & Science in Sports & Exercise, 25, 92-98.

[28]   Zhan, Y., Zhang, F., Lu, L., Lu, L., Wang, J., Sun, Y., Ding, R. and Yu, J. (2014) Prevalence of Dyslipidemia and Its Association with Insomnia in a Community Based Population in China. BMC Public Health, 14, 1050.

[29]   Vgontzas, A.N. and Chrousos, G.P. (2002) Sleep, the Hypothalamic-Pituitary-Adrenal Axis, and Cytokines: Multiple Interactions and Disturbances in Sleep Disorders. Endocrinology Metabolism Clinics of North America, 31, 15-36.

[30]   Palagini, L., Bruno, R.M., Gemignani, A., Baglioni, C., Ghiadoni, L. and Riemann, D. (2013) Sleep Loss and Hypertension: A Systematic Review. Current Pharmaceutical Design, 19, 2409-2419.

[31]   Irwin, M.R., Wang, M., Ribeiro, D., Cho, H.J., Olmstead, R.M., Breen, E.C. and Cole, S. (2008) Sleep Loss Activates Cellular Inflammatory Signaling. Biological Psychiatry, 64, 538-540.

[32]   Dew, M.A., Hoch, C.C., Buysse, D.J., Monk, T.H., Begley, A.E., Houck, P.R. and Reynolds III, C.F. (2003) Healthy Older Adults’ Sleep Predicts All-Cause Mortality at 4 to 19 Years of Follow-Up. Psychosomatic Medicine, 65, 63-73.

[33]   Bruno, R.M., Palagini, L., Gemignani, A., Virdis, A., Di, G.A., Ghiadoni, L. and Taddei, S. (2013) Poor Sleep Quality and Resistant Hypertension. Sleep Medicine, 14, 1157-1163.

[34]   Lallukka, T., Haario, P., Lahelma, E. and Rahkonen, O. (2012) Associations of Relative Weight with Subsequent Changes over Time in Insomnia Symptoms: A Follow-Up Study among Middle-Aged Women and Men. Sleep Medicine, 13, 1271-1279.

[35]   Theorell-Haglöw, J., Berglund, L., Janson, C. and Lindberg, E. (2012) Sleep Duration and Central Obesity in Women—Differences between Short Sleepers and Long Sleepers. Sleep Medicine, 13, 1079-1085.

[36]   Theorell-Haglöw, J., Berne, C., Janson, C., Sahlin, C. and Lindberg, E. (2010) Associations between Short Sleep Duration and Central Obesity in Women. Sleep, 33, 593-598.

[37]   Kaneita, Y., Uchiyama, M., Yoshiike, N. and Ohida, T. (2008) Associations of Usual Sleep Duration with Serum Lipid and Lipoprotein Levels. Sleep, 31, 645-652.

[38]   Nakajima, H., Kaneita, Y., Yokoyama, E., Tamak, T., Munezawa, T., Matsuzaka, M. and Ohida, T. (2010) Insomnia Symptoms Associated with Hyperglycemia. Sleep and Biological Rhythms, 8, 203-211.

[39]   Hjemdahil, P. (2002) Stress and Metabolic Syndrome. Circulation, 106, 2634-2636.

[40]   Spiegel, K., Knutson, K., Leproult, R., Tasali, E. and Cauter, E.V. (2005) Sleep Loss: A Novel Risk Factor for Insulin Resistance and Type 2 Diabetes. Journal of Applied Physiology, 99, 2008-2019.

[41]   Mallon, L., Broman, J.E. and Hetta, J. (2005) High Incidence of Diabetes in Men with Sleep Complaints or Short Sleep Duration: A 12-Year Follow-Up Study of a Middle-Aged Population. Diabetes Care, 28, 2762-2767.

[42]   Markku, T. and Hyyppa, E.K. (1989) Quality of Sleep and Chronic Illnesses. Journal of Clinical Epidemiology, 42, 633-638.

[43]   Gottlieb, D.J., Punjabi, N.M., Newman, A.B., Resnick, H.E., Redline, S., Baldwin, C.M. and Nieto, F.J. (2005) Association of Sleep Time with Diabetes Mellitus and Impaired Glucose Tolerance. Archives of Internal Medicine, 165, 863-867.

[44]   Knol, M.J., Twisk, J.W.R., Beekman, A.T.F., Heine, R.J., Snoek, F.J. and Pouwer, F. (2006) Depression as a Risk Factor for the Onset of Type 2 Diabetes: A Meta-Analysis. Diabetologia, 49, 837-845.

[45]   Harvey, A.G. and Greenall, E. (2003) Catastrophic Worry in Primary Insomnia. Journal of Behavior Therapy and Experimental Psychiatry, 34, 11-23.

[46]   Vgontzas, A.N., Liao, D., Bixler, E.O., Chrousos, G.P. and Vela-Bueno, A. (2009) Insomnia with Objective Short Sleep Duration Is Associated with a High Risk for Hypertension. Sleep, 32, 491-497.