Journal of Preventive Medicine and Public Health

Original Articles

Association Between Non-adherence to Diabetes Management and Poor Sleep Quality Based on the Korean Community Health Survey: Horim A. Hwang, Hyunsuk Jeong, Hyeon Woo Yim; J Prev Med Public Health. 2025;58(3):260-268. Published online January 14, 2025; DOI: https://doi.org/10.3961/jpmph.24.486

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Objectives
Adhering to management guidelines, including routine follow-up and education, is crucial for the effective management of chronic diseases such as diabetes. Uncontrolled diabetes is linked to poor sleep quality. We used nationally representative data from community-dwelling Koreans to investigate potential associations between non-adherence to diabetes management and poor sleep quality.
Methods
Of the 228 340 participants in the 2018 Korea Community Health Survey, we analyzed data from 68 246 participants aged 65 years and older. Based on their diabetes status and adherence to diabetes-related tests (glycated hemoglobin, fundus examination, and urine microalbuminuria) and management education, study participants were divided into 3 groups: no diabetes, adherence, and non-adherence. Outcome variables included poor overall sleep quality and sleep disturbances, as measured by the Pittsburgh Sleep Quality Index.
Results
The study included 934 participants in the adherence group (2.0%) and 13 420 in the non-adherence group (20.2%). Participants displaying non-adherence were significantly more likely to report poor overall sleep quality (adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 1.04 to 1.13) and to experience sleep fragmentation, nocturia, pain during sleep, and difficulty falling asleep compared to participants without diabetes. Even in the earlier stage of diabetes, non-adherent participants were more likely to report poor sleep quality (aOR, 1.06; 95% CI, 1.00 to 1.18).
Conclusions
Patients with diabetes who do not follow management guidelines are more likely to experience poor sleep quality than those without diabetes. Emphasizing diabetes management and increasing awareness of management strategies may improve sleep quality among patients with this disease.

Summary

Korean summary
혈당조절이 되지 않는 당뇨병이 수면 관련 문제의 발생 위험을 높이는 것은 기존 연구에서 알려져 있었으나, 당뇨관리 여부가 지역사회에 거주하는 당뇨환자들의 수면의 질에 미치는 영향은 충분히 탐구 되지 않았었다. 당뇨 관리 (연 2회 이상 당화혈색소 검사, 매년 당뇨합병증 검사, 당뇨관리교육 이수)에 순응하지 않는 당뇨환자들은 당뇨가 없는 일반인들에 비해 수면 문제를 호소할 가능성이 유의하게 높은 것이 확인되었다. 이는 당뇨 유병기간으로 층화분석하였을때도 일관되게 확인되었다.

Key Message
Uncontrolled diabetes is associated with increased risk of sleep-related problems, but the knowledge on the impact of poor diabetes management on the sleep quality of community dwelling patients with diabetes is limited. Diabetes patients who did not adhere to diabetes management (<2 hemoglobin A1c tests, did not take diabetes complication test, or received diabetes management education) were more significantly more likely to report overall poor sleep quality than those without diabetes. The above association remained significant when the patients were stratified by diabetes duration.

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Assessment of Sleep Quality and Its Determinants Among Patients with Type 2 Diabetes Mellitus in Mogadishu, Somalia: A Cross-Sectional Study
Nur Mohamed, Rahma Haji Mohamud, Fadumo Hilowle, Tigad Ali, Yusuf Abdirisak Mohamed, Adan Gabow, Hawa Mohamed, Nor Sidow, Mohamed Sheikh Hassan, Mohamud Waberi
Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 1949. CrossRef

Health Effects of Heavy Metal Exposure Among E-waste Workers and Community-dwelling Adults in Thailand: A Cross-sectional Study: Chonyitree Sangwijit, Parichat Ong-artborirak, Warangkana Naksen, Kraiwuth Kallawicha, Pallop Siewchaisakul; J Prev Med Public Health. 2025;58(2):156-166. Published online November 21, 2024; DOI: https://doi.org/10.3961/jpmph.24.415

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Abstract Summary PDF Supplementary Material: Objectives
Global concern is increasing about the health effects of electronic waste (e-waste). This study examines the health impacts of heavy metal (HM) exposure among e-waste workers (EWWs) and community-dwelling adults (CDAs) in Northeastern Thailand and identifies factors associated with adverse health outcomes.
Methods
A cross-sectional study was conducted of 164 EWWs and 164 CDAs. A survey was employed to collect data on participant characteristics, symptoms, anxiety, depression, and sleep quality. Urine samples were analyzed for lead (Pb) and cadmium (Cd) levels using atomic absorption spectrometry. Multiple logistic regression analysis was used to identify factors impacting health.
Results
Across all participants, urinary Pb and Cd levels ranged from 5.30 µg/g to 29.50 µg/g creatinine and from 0.60 µg/g to 4.00 µg/g creatinine, respectively. The most frequently reported health issues pertained to musculoskeletal disorders (MSDs) at 38.70%, central nervous system (CNS) issues at 36.60%, and skin disorders at 31.10%. Multivariable analysis indicated that the presence of MSDs was significantly associated with exposure to Pb and Cd. Poor sleep quality (PSQ) was significantly linked to CNS problems, while body mass index was significantly related to skin disorders. Factors including primary education level or below, smoking, cleaning the house more than 3 times weekly, and PSQ were significantly linked to depression. Anxiety was significantly associated with PSQ.
Conclusions
Environmental exposure to Pb and Cd can have adverse health impacts in the form of MSDs. Depression and anxiety are common conditions among CDAs. Public health officials should monitor HM exposure and mental health within the community.; Summary

Key Message
- Pb and Cd level was not significant difference between e-waste workers and community-dwelling adults. - Pb and Cd can adversely affect symptoms in the MSD and PSQ affects the CNS in e-waste workers. - E-waste workers had a higher chance of having musculoskeletal disorder, central nervous system disorder, and skin disorder problems than community-dwelling adults but a lower chance of having depression and anxiety than community-dwelling adults.

Systematic Review

Effects of Physical and Mind-body Exercise on Sleep Quality in Individuals With Diabetes Mellitus: A Systematic Review and Meta‐analysis: Yohanes Andy Rias, Renny Wulan Apriliyasari, Made Satya Nugraha Gautama, Faizul Hasan, Margareta Teli, Hsiao-Yean Chiu, Ratsiri Thato; J Prev Med Public Health. 2025;58(1):1-10. Published online October 7, 2024; DOI: https://doi.org/10.3961/jpmph.24.354

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Abstract Summary PDF Supplementary Material

Objectives
Physical and mind-body exercises represent distinct intervention strategies that may improve sleep quality by influencing physiological and psychological factors. Nevertheless, their effectiveness in individuals with diabetes is not well-established. This systematic review and meta-analysis aimed to examine the impacts of physical and mind-body exercise interventions on sleep quality in patients with diabetes mellitus.
Methods
Six randomized controlled trials (RCTs) that met the inclusion criteria were identified from PubMed, CINAHL, Embase, Scopus, Web of Science, Cochrane, and Ovid-Medline Library. The effect size for sleep quality was calculated using the standardized mean difference (SMD) with a 95% confidence interval (CI), employing a random-effects model. Heterogeneity and publication bias were also examined, and subgroup, meta-regression, and sensitivity analyses were performed.
Results
Physical and mind-body exercise interventions significantly improved sleep quality, with an SMD of -1.040 (95% CI, -1.686 to -0.394). Subgroup analysis revealed significant differences with respect to the type of intervention (p=0.047), or its duration (p=0.282). Meta-regression analysis indicated that mean hemoglobin A1c level was the only factor to be significantly related to the effect size for sleep quality, demonstrating a negative association (p=0.033). The assessment of publication bias and the sensitivity analysis suggested that the findings were reliable and robust.
Conclusions
Physical and mind-body exercises may serve as effective interventions for patients with diabetes mellitus who experience poor sleep quality. However, to substantiate these findings, additional rigorous RCTs with larger sample sizes, longer follow-up periods, and standardized interventions are required.

Summary

Key Message
This systematic review and meta-analysis reviewed the impact of physical and mind-body exercise interventions on sleep quality in individuals with diabetes mellitus, examining six randomised, controlled trials. The results indicated a notable enhancement in sleep quality. A meta-analysis revealed a negative correlation between haemoglobin A1c levels and improvements in sleep quality. The findings suggest that physical and mind-body exercise are effective methods for improving sleep quality; however, additional rigorous research with larger sample sizes and standardised protocols is necessary.

Citations

Citations to this article as recorded by

Assessment of Sleep Quality and Its Determinants Among Patients with Type 2 Diabetes Mellitus in Mogadishu, Somalia: A Cross-Sectional Study
Nur Mohamed, Rahma Haji Mohamud, Fadumo Hilowle, Tigad Ali, Yusuf Abdirisak Mohamed, Adan Gabow, Hawa Mohamed, Nor Sidow, Mohamed Sheikh Hassan, Mohamud Waberi
Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 1949. CrossRef
Acute and chronic effects of inspiratory muscle training in patients with type 2 diabetes mellitus: a systematic review of randomized controlled trials
Zoé Breuil-Marsal, Clémence Godek, Amandine Lotti, Patrick Feiereisen, Isabela Roque Marçal, Patricia Rehder-Santos, Juliana Cristina Milan-Mattos, Raphael Martins de Abreu
Frontiers in Sports and Active Living.2024;[Epub] CrossRef

Original Articles

Sleep Quality and Associated Factors Among Firefighters in Bangkok, Thailand: A Cross-sectional Study: Nunnapat Piyachaiseth, Pornchai Sithisarankul, Jate Ratanachina; J Prev Med Public Health. 2024;57(1):83-90. Published online December 9, 2023; DOI: https://doi.org/10.3961/jpmph.23.305

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Abstract Summary PDF Supplementary Material: Objectives
Professional firefighters face various health hazards and are required to maintain both physical and mental fitness to effectively mitigate crises and respond to emergencies. Moreover, the long working hours and shift work of this profession impact sleep quality. This study investigated the quality of sleep and its associated factors among firefighters in Bangkok, Thailand.
Methods
This was a cross-sectional study of firefighters affiliated with the Bangkok Fire and Rescue Department, Bangkok Metropolitan Administration, Thailand between January 2023 and March 2023. A cluster random sampling technique was utilized to distribute 600 questionnaires to firefighters in 15 fire stations. The questionnaire addressed demographic, work-related, and environmental factors. Sleep quality was assessed using the Thai version of the Pittsburgh Sleep Quality Index (PSQI). Data analysis involved both descriptive and inferential statistics. Bivariate and multiple logistic regressions were performed.
Results
The response rate was 78.7% (n=472), and 44.1% of the firefighters reported poor sleep quality (PSQI score >5). Sleep quality was statistically associated with conflicting family relationships (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1 to 2.9), additional part-time jobs (daytime, OR, 2.4; 95% CI, 1.3 to 4.4; or nighttime, OR, 4.3; 95% CI, 1.1 to 16.7), noisy sleeping areas (OR, 1.7; 95% CI, 1.1 to 2.8), and the availability of adequate bedding (OR, 3.0; 95% CI, 1.8 to 4.9).
Conclusions
Poor sleep quality among firefighters was associated with various personal, work-related, and environmental factors. Organizations should promote policies that improve sleep quality through good sleep hygiene practices and facilities.; Summary

Key Message
This cross-sectional study aimed to investigate sleep quality among firefighters in Bangkok, Thailand its associated factors. 44.1% of the firefighters reported poor sleep quality (the Pittsburgh Sleep Quality Index: PSQI score >5). Sleep quality was statistically associated with conflicting family relationships, additional part-time jobs (daytime or nighttime), noisy sleeping areas, and the availability of adequate bedding.

Sleep Quality and Poor Sleep-related Factors Among Healthcare Workers During the COVID-19 Pandemic in Vietnam: Thang Phan, Ha Phan Ai Nguyen, Cao Khoa Dang, Minh Tri Phan, Vu Thanh Nguyen, Van Tuan Le, Binh Thang Tran, Chinh Van Dang, Tinh Huu Ho, Minh Tu Nguyen, Thang Van Dinh, Van Trong Phan, Binh Thai Dang, Huynh Ho Ngoc Quynh, Minh Tran Le, Nhan Phuc Thanh Nguyen; J Prev Med Public Health. 2023;56(4):319-326. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.22.528

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Abstract PDF

Objectives
The coronavirus disease 2019 (COVID-19) pandemic has increased the workload of healthcare workers (HCWs), impacting their health. This study aimed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and identify factors associated with poor sleep among HCWs in Vietnam during the COVID-19 pandemic.
Methods
In this cross-sectional study, 1000 frontline HCWs were recruited from various healthcare facilities in Vietnam between October 2021 and November 2021. Data were collected using a 3-part self-administered questionnaire, which covered demographics, sleep quality, and factors related to poor sleep. Poor sleep quality was defined as a total PSQI score of 5 or higher.
Results
Participants’ mean age was 33.20±6.81 years (range, 20.0-61.0), and 63.0% were women. The median work experience was 8.54±6.30 years. Approximately 6.3% had chronic comorbidities, such as hypertension and diabetes mellitus. About 59.5% were directly responsible for patient care and treatment, while 7.1% worked in tracing and sampling. A total of 73.8% reported poor sleep quality. Multivariate logistic regression revealed significant associations between poor sleep quality and the presence of chronic comorbidities (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.17 to 5.24), being a frontline HCW directly involved in patient care and treatment (OR, 1.59; 95% CI, 1.16 to 2.16), increased working hours (OR, 1.84; 95% CI,1.37 to 2.48), and a higher frequency of encountering critically ill and dying patients (OR, 1.42; 95% CI, 1.03 to 1.95).
Conclusions
The high prevalence of poor sleep among HCWs in Vietnam during the COVID-19 pandemic was similar to that in other countries. Working conditions should be adjusted to improve sleep quality among this population.

Summary

Citations

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A cross‐sectional study of sleep disturbance among middle‐aged cancer patients at Vietnam National Cancer Hospital
Anh Tuan Pham, Mai Tuyet Do, Huong Thi Thanh Tran
Cancer Reports.2024;[Epub] CrossRef
Poor sleep quality and associated factors among healthcare professionals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia
Winta Tesfaye, Ayechew Adera Getu, Baye Dagnew, Alemu Lemma, Yigizie Yeshaw
Frontiers in Psychiatry.2024;[Epub] CrossRef

Association Between Sleep Quality and Anxiety in Korean Adolescents: Hyunkyu Kim, Seung Hoon Kim, Sung-In Jang, Eun-Cheol Park; J Prev Med Public Health. 2022;55(2):173-181. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.498

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Abstract Summary PDF

Objectives
Anxiety disorder is among the most prevalent mental illnesses among adolescents. Early detection and proper treatment are important for preventing sequelae such as suicide and substance use disorder. Studies have suggested that sleep duration is associated with anxiety disorder in adolescents. In the present study, we investigated the association between sleep quality and anxiety in a nationally representative sample of Korean adolescents.
Methods
This cross-sectional study was conducted using data from the 2020 Korea Youth Risk Behavior Web-based Survey. The Generalized Anxiety Disorder-7 questionnaire was used to evaluate anxiety. The chi-square test was used to investigate and compare the general characteristics of the study population, and multiple logistic regression analysis was used to analyze the relationship between sleep quality and anxiety.
Results
In both sexes, anxiety was highly prevalent in participants with poor sleep quality (adjusted odds ratio [aOR], 1.56; 95% confidence interval [CI], 1.43 to 1.71 in boys; aOR, 1.30; 95% CI, 1.19 to 1.42 in girls). Regardless of sleep duration, participants with poor sleep quality showed a high aOR for anxiety.
Conclusions
This study identified a consistent relationship between sleep quality and anxiety in Korean adolescents regardless of sleep duration.

Summary

Korean summary
청소년건강행태조사를 이용하여 청소년들의 수면의 질과 불안과의 연관성을 분석하였다. 좋지 않은 수면의 질은 불안감과 연관성이 있었으며 이 연관성은 대상자들의 수면시간과 상관없이 나타났다.

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Association Between Cohabitation Status and Sleep Quality in Families of Persons With Dementia in Korea: A Cross-sectional Study: Seung Hoon Kim, Minah Park, Sung Hoon Jeong, Sung-In Jang, Eun-Cheol Park; J Prev Med Public Health. 2021;54(5):317-329. Published online August 14, 2021; DOI: https://doi.org/10.3961/jpmph.21.077

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs).
Methods
Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales.
Results
Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively.
Conclusions
The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.

Summary

Korean summary
2018년 지역사회건강조사를 이용하여 190 365명을 대상으로 가족 중 치매환자 유무 및 치매환자와의 동거여부와 수면의 질 사이의 연관성을 분석하였다. 치매환자와의 동거여부와 상관없이 가족 중 치매환자가 존재하는 것은 낮은 수면의 질과 유의한 연관성이 있었다. 가족 중 치매환자가 있지만 동거하지 않는 가족 구성원의 경우 치매환자가 혼자 살 때 낮은 수면의 질과의 연관성이 가장 높게 나타났다.

Citations

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Jieyu Mao, Miyae Yamakawa, Xujing Hu, Hitomi Chikama, Toshiyuki Swa, Yasushi Takeya
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