Behavioral Characteristics and Cardiovascular Disease Risks Associated With Insomnia and Sleep Quality Among Middle-Aged Women in South Korea.

Insomnia is the most common sleep problem in women. Increasing evidence suggests an association between insomnia and cardiovascular disease (CVD). However, information is limited on lifestyle and socio-environmental factors associated with sleep problems in women. In this study directed by Social Cognitive Theory, we examined the personal, behavioral, socio-environmental, and CVD risk factors associated with sleep characteristics (insomnia and sleep quality) in middle-aged women using a cross-sectional design. The study instruments included the Insomnia Severity Index (ISI), the Pittsburg Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), and measures of social support and behavioral characteristics. Blood was drawn to assess serum glucose and lipids, and BMI was measured. Data were analyzed using hierarchical multiple regression and analysis of covariance (ANCOVA). Of 423 middle-aged women, 25% experienced insomnia (ISI ≥ 10) and 41.3% reported poor sleep quality (PSQI ≥ 5). Lesser education (≤middle school), more depressive symptoms, more screen time (≥ 3 hours/day), and severe stress were associated with greater severity of insomnia and/or poorer sleep quality. Total and LDL cholesterol levels were higher in women with insomnia than normal sleepers, whereas the BMI was higher in those who reported poor sleep quality. Because personal, behavioral, and socio-environmental factors were significantly associated with insomnia and poor sleep quality, multifactorial approaches should be considered in developing sleep interventions and reducing cardiovascular risk.