Original ArticleIncreasing trends of sleep complaints in the city of Sao Paulo, Brazil
Introduction
Sleep disorders are recognized as a major public health concern [1]. Population surveys that address sleep complaints and disorders to assess secular trends are still limited. The literature shows a scarcity of data from South America, as opposed to the number of studies conducted in North America, Europe, Australia, and Asia [2]. Also, previous epidemiological studies applied different sampling and recruitment procedures, making comparison of prevalence estimates difficult [2], [3]. Most studies evaluated a portion of the population of interest and extrapolated that prevalence to the entire population [2], introducing a potential selection bias between results from the sampled populations vs. results applied to the entire group. Despite these limitations in earlier estimates of the prevalence of sleep complaints and disorders, some cohort studies evaluating sleep disorders in clinical populations have already been published [4], [5].
Sao Paulo is the capital of the state of Sao Paulo and is located in southeast Brazil. The city is the largest in the southern hemisphere, with an area of 1523 square kilometers. National censuses have shown that in the last three decades, the mean rate of geometric annual population growth of Sao Paulo was 1.1, while the population grew from 8.5 to 11 million [6]. Sao Paulo is one of the most ethnically diverse cities of Brazil because of its history of European and Asian immigration as well as a slave trade with Africa. Previous studies have demonstrated high levels of ethnic admixture in this population, as measured by ancestry-informative genetic markers [7].
Two household surveys were performed in 1987 and 1995 to estimate the prevalence of sleep complaints in adults living in the city of Sao Paulo and showed a tendency of increase in most frequencies compared [8]. To confirm these trends, a third survey was carried out in 2007 using similar methodology [9]. A comparison of these three population-based surveys allows the establishment of secular trends of sleep complaints in the same large population over the last three decades. Hence, the aim of this study was to compare the prevalence of sleep complaints and to describe secular trends of three population-based surveys carried out in 1987, 1995, and 2007 in a probabilistic sample of the adult inhabitants of the city of Sao Paulo, Brazil.
Section snippets
Sampling procedures
Surveys were performed in three consecutive decades: 1987, 1995, and 2007. All of them utilized a three-stage cluster-sampling technique to obtain representative samples of the inhabitants of Sao Paulo, using a conceptual framework similar to that used for the North American National Health Surveys [10]. Households were selected if they were permanently occupied private homes, thus excluding clinics, schools, and other commercial and non-commercial establishments. Pregnant or lactating women,
Results
Gender proportions and age group distributions were similar throughout the decades evaluated (Table 1).
Table 2 shows the time of going to bed, time of waking up, and sleep duration during weekdays in each survey. Compared to the 1987 results, a tendency of going to bed and waking up later on all weekdays was observed over the last two decades. But significant decrease in sleep duration was seen only during weekends (Saturday and Sunday).
The prevalence of complaints of difficulty initiating
Discussion
This is the first study that compares three consecutive decades of sleep complaints using the same data-gathering methodology in a large, representative sample of the adult inhabitants of one of the world’s largest cities. Our results showed a progressive increase of sleep complaints throughout the decades represented in our 1987, 1995, and 2007 surveys.
In recent decades, the hectic lifestyle of industrialized societies has wrought detrimental effects on sleep quality and duration. Regular
Acknowledgments
This work was supported by grants from the Associaçao Fundo de Incentivo a Psicofarmacologia (AFIP) and FAPESP (#07/50525-1 to R.S.-S., and CEPID No. 98/14303-3 to S.T.). M.T.M., J.A.T., S.T., and L.R.A.B. are recipients of the CNPq fellowship. The authors thank Fernando Colugnati for his valuable suggestions and statistical analyses. All the efforts of AFIP’s staff, in particular Roberta Siuffi, are deeply appreciated.
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