Sleep pattern, obesity and healthcare expenditures in Brazilian adults

Silva, Eduardo Pereira da; Rocha, Ana Paula Rodrigues; Araujo, Monique Yndawe Castanho; Turi, Bruna Camilo; Fernandes, Rômulo Araújo; Codogno, Jamile Sanches

doi:10.1590/1413-812320182411.26972017

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ARTICLE • Ciênc. saúde coletiva 24 (11) • Nov 2019 • https://doi.org/10.1590/1413-812320182411.26972017 copy

Sleep pattern, obesity and healthcare expenditures in Brazilian adults

Padrões do sono, obesidade e despesas em saúde com brasileiros adultos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to analyze the relationship between sleep pattern and healthcare expenditures in adults, as well as to identify whether physical activity, biochemical markers and obesity affect this relationship. The sample was composed of 168 adults aged ≥ 50 years attended by two Basic Healthcare Units in Presidente Prudente, SP, Brazil. Health expenditure, sleep pattern, anthropometry, adiposity index, physical activity, metabolic and cardiovascular variables were assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney and Spearman tests. Sleep disorders were positively correlated to higher costs with medicines and negatively correlated to costs with laboratory tests, even after adjusts by confounders. In addition, healthcare costs were also correlated to physical activity score, blood pressure, obesity and metabolic variables. Severe sleep disorders and high percentage of body fat were associated with increased use of medications. Sleep pattern is correlated to primary care healthcare costs, obesity and physical activity level.

Key words
Healthcare costs; Sleep wake disorders; Body fat distribution

	Descriptive statistics (n = 168)
	Mean (95%CI)	Median (IR)
MSQ score	30.7 (28.8; 32.5)	30 (17)
Physical activity (score)
Occupational	2.2 (2.1; 2.4)	2.6 (1.1)
Exercise / Sports	1.9 (1.8; 2.1)	1.7 (1.2)
Leisure-time / locomotion	2.1 (2.1; 2.2)	2.2 (0.8)
Overall	6.4 (6.1; 6.6)	6.3 (1.9)
Blood pressure (mmHg)
Systolic blood pressure	129.8 (126.7; 132.8)	128 (23)
Diastolic blood pressure	76.1 (74.4; 77.9)	75 (14)
Anthropometry / adiposity
Weight (kg)	72.1 (69.6; 74.5)	72.6 (19.6)
Height (cm)	157.2 (155.9; 158.6)	156.5 (11.5)
BMI (kg/m²)	29.1 (28.2; 30.1)	28.18 (6.4)
WC (cm)	95.3 (93.1; 97.5)	95.5 (15.5)
BF (%)	38.5 (37.2; 39.8)	38.2 (12)
Metabolic variables (mg/dL)
Total cholesterol	198.5 (193.1; 204.1)	198.50 (45.4)
HDL-C	45.2 (43.6; 46.8)	43.8 (12.1)
VLDL-C	30.5 (28.1; 32.8)	27.2 (17.6)
LDL-C	122.8 (117.9; 127.6)	121 (38.5)
Triglycerides	151.2 (139.6; 162.9)	131.4 (88.1)
Fasting glucose	106.2 (98.6; 113.8)	91.40 (29.3)
Health care costs (US$)
Consultations	16.62 (15.7; 18.1)	17.00 (11.3)
Exams	8.03 (5.8; 10.1)	0.00 (17.8)
Medicines	30.01 (24.1; 35.8)	17.8 (29.1)
Overall	54.6 (48.1; 61.3)	44.71 (41.4)

	Sleep Quality (level of difficult to sleep)
	Normal (n = 59)	Lightly-Moderately (n = 29)	Severely (n = 80)
Physical activity and blood pressure	Median (IR)	Median (IR)	Median (IR)	p-value^* * Kruskal-Wallis test;
Occupational (score)	2.37 (0.91)	2.62 (0.69)	2.87 (3.13)	0.114
Leisure PE (score)	1.37 (1.31)	1.75 (1.00)	2.00 (1.19)	0.343
Leisure / locomotion (score)	2.37 (0.80)	2.25 (1.00)	2.00 (0.80)^a a denotes difference with normal;	0.049
Overall (score)	6.12 (1.40)	6.75 (2.2)	6.62 (2.20)	0.754
Systolic	129.00 (22.00)	133.00 (26.00)	126.00 (25.00)	0.510
Diastolic	74.50 (16.00)	74.00 (14.00)	77.00 (15.00)	0.429
Anthropometry, adiposity and metabolic variables
Weight (Kg)	72.20 (20.00)	63.90 (19.40)	73.25 (20.70)	0.159
BMI (kg/m²)	26.89 (5.30)	26.80 (5.30)	30.16 (7.60)^a a denotes difference with normal; .^b b difference with lightly-moderately.	0.003
WC (cm)	94.30 (16.10)	91.50 (17.30)	98.35 (15.80)	0.081
Body fatness (%)	34.45 (11.90)	38.20 (9.80)	40.80 (11.40)^a a denotes difference with normal;	0.002
Total cholesterol (mg/dL)	200.50 (49.30)	181.7 (36.30)	204.40 (39.40)^b b difference with lightly-moderately.	0.015
HDL-C (mg/dL)	41.55 (9.10)	47.00 (11.00)	45.05 (14.30)	0.362
VLDL-C (mg/dL)	28.10 (17.70)	23.50 (12.50)	28.35 (20.60)	0.119
LDL-C (mg/dL)	121.50 (42.10)	108.20 (30.40)	124.55 (34.40)	0.076
Triglycerides (mg/dL)	140.70 (88.70)	117.30 (62.30)	141.10 (101.80)	0.342
Fasting glucose (mg/dL)	90.75 (29.00)	99.90 (41.40)	91.05 (27.50)	0.898
Health care costs (US$)
Consultations	51.00 (33.57)	51.00 (29.75)	51.00 (34.00)	0.657
Exams	0.00 (21.82)	00.00 (67.66)	0.00 (12.49)	0.083
Medicines	35.91 (66.71)	69.92 (114.09)^a a denotes difference with normal;	62.94 (93.51)^a a denotes difference with normal;	0.011
Overall	136.85 (121.99)	118.57 (136.26)	146.21 (146.82)	0.355

	Health care costs (US$)
	Consultations	Exams	Medicines	Overall
MSQ score	0.088	-0.152^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.245^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.142
Physical Activity (score)
Occupational	0.162^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.043	0.112	0.128
Leisure physical exercise	0.008	-0.045	0.078	0.009
Leisure and locomotion	0.025	0.085	-0.118	-0.075
Overall	0.144	0.088	0.078	0.096
Blood pressure (mmHg)
Systolic	-0.060	-0.164^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.123	-0.012
Diastolic	-0.046	-0.096	0.034	-0.049
Anthropometry / adiposity
Weight (kg)	-0.009	-0.023	0.034	0.055
BMI (kg/m²)	0.076	0.023	0.147	0.182
WC (cm)	-0.004	-0.073	0.083	0.050
BF (%)	0.104	-0.052	0.126	0.145
Metabolic (mg/dL)
Total cholesterol	0.085	-0.075	-0.035	-0.083
HDL-C	0.036	-0.024	-0.126	-0.088
VLDL-C	0.112	0.076	0.273^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.252^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.
LDL-C	0.046	-0.111	-0.132	-0.175^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.
Triglycerides	0.119	0.092	0.264^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.239^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.
Fasting glucose	-0.022	0.075	0.181^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.	0.184^* * p-value < 0,005; MSQ = mini-sleep questionnaire; BMI = body mass index; WC = waist circumference; BF = body fatness; HDL-C = high-density lipoprotein; LDL-C = low-density lipoprotein; VLDL-C = very low-density lipoprotein.

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[1] Collaborations

EP Silva, APR Rocha, MYC Araujo, BC Turi, RA Fernandes and JS Codogno participated in all stages of article elaboration, from study design, data collection, analysis and interpretation, until the final writing and consequent approval of the final version to be published.