Abstract
Introduction: This study aimed to identify the latent classes of sleep quality among older adults and investigate the determinants of class membership.
Methods: This cross-sectional study included 1,093 community-dwelling older adults in Babol City, Iran, who were selected using cluster sampling. All health centers in Babol County were considered as the sampling frame, and the health centers were stratified into urban and rural areas. To ensure adequate representation of both settings, an equal number of health centers was randomly selected from the urban and rural strata, resulting in a total of 10 selected health centers (five urban and five rural). The required sample size was determined using the appropriate sample size formula, taking into account findings from previous studies. Within each selected health center, the number of participants to be recruited was determined proportionally according to the population of older adults covered by that health center. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and depression, anxiety, and stress were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). Latent class analysis was performed to identify distinct sleep quality patterns and examine their associations with depression, anxiety, and stress.
Results: Three latent classes were identified: (1) moderate (65.4%), (2) poor sleep quality with sufficient sleep duration (19.0%), and (3) poor sleep quality with insufficient sleep duration (15.6%). After adjusting for the other studied covariates, depression was associated with higher odds of membership in class 3 compared with class 1 (OR=5.39). Anxiety and stress were also associated with higher odds of membership in class 2 compared with class 1 (OR=2.50 and 4.17, respectively) and class 3 compared with class 1 (OR=10.21 and 4.10, respectively).
Conclusion: Results from the present study indicate that 34.6% of the participants fell under poor with sufficient sleep duration or poor with insufficient sleep duration class. Focusing on the treatment of depression, anxiety, and stress while considering other comorbid factors may help design and execute effective programs to reduce sleep quality problems among the older adults.