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JKM > Volume 45(1); 2024 > Article
Mun, Park, Bae, Baek, and Lee: Association of Cold/Heat Sensation with Sleep Quality and Insomnia in Middle-aged Women

Abstract

Objectives

Cold extremities have been suggested to correlate with sleep disturbances. This study aims to explore the relationship between thermal sensations in body, encompassing both cold and heat sensations, with sleep quality and insomnia.

Methods

Self-administered questionnaires were utilized to assess thermal sensations in body, sleep quality and symptoms of insomnia in middle-aged women. A multiple logistic regression analysis was performed to ascertain the association between thermal sensations in body and both sleep quality and insomnia symptoms.

Results

Among 899 participants, 255 (28.4%) were categorized in the cold sensation group, 95 (10.6%) in the heat sensation group, 70 (7.8%) in the group with both cold and heat sensations, and 479 (53.3%) in the no-sensation group. Pittsburgh Sleep Quality Index and Insomnia Severity Index were notably higher in the group experiencing both sensations when compared to the no-sensation group. After adjustments for covariates, the odds ratios for poor sleep quality, moderate/severe insomnia, and long sleep latency were significantly elevated in the group with both sensations when compared to the no-sensation group. The odds ratios for poor sleep quality in the cold sensation group and for moderate/severe insomnia and low sleep efficiency in the heat sensation group were significantly higher when compared to the no-sensation group.

Conclusions

The risk for sleep disturbances varied depending on the presence of thermal sensations in body, with the greatest risk observed for low sleep quality and insomnia in individuals experiencing both cold and heat sensations.

Fig. 1
Distribution of Pittsburgh Sleep Quality Index component scores according to group
None, no-sensation group; Cold, cold sensation; Heat, heat sensation; Both, cold and heat sensations; PSQI, Pittsburgh sleep quality index
jkm-45-1-125f1.gif
Fig. 2
Distribution of Insomnia Severity Index item scores according to group
None, no-sensation group; Cold, cold sensation; Heat, heat sensation; Both, cold and heat sensations; ISI, insomnia severity index.
jkm-45-1-125f2.gif
Fig. 3
Odds ratios for sleep disturbances
CI, confidence interval; *, P < 0.05; **, P < 0.01; ***, P < 0.001; Model 1: adjusted for age, body mass index; Model 2: adjusted for variables in Model 2, smoking, alcohol consumption, physical activity, education, household income, marital status, and menopause; Model 3: adjusted for variables in Model 2, EuroQol-visual analogue scales, Beck Depression Inventory score, and use of sleeping medication; Reference group: no-sensation group.
jkm-45-1-125f3.gif
Table 1
Characteristics of Study Participants
No sensation (N=479) Cold sensation (N=255) Heat sensation (N=95) Both sensations (N=70) P
Age (years) 47.7 ± 6.5 45.5 ± 6.5 48.8 ± 6.3 47.8 ± 6.4 < 0.001

BMI (kg/m2) 23.9 ± 3.3 23.0 ± 3.3 25.2 ± 4.3 24.0 ± 3.2 < 0.001

PSQI global score 4.9 ± 2.9 5.8 ± 3.1 6.3 ± 3.3 7.3 ± 3.9 < 0.001

ISI score 4.8 ± 4.6 6.6 ± 5.2 7.1 ± 6.0 9.4 ± 6.4 < 0.001

Sleep duration (hours) 6.6 ± 1.1 6.5 ± 1.3 6.1 ± 1.4 6.2 ± 1.3 0.006

Sleep latency (min) 22.3 ± 24.0 25.1 ± 28.0 27.6 ± 30.6 39.4 ± 41.8 < 0.001

Sleep efficiency (%) 92.8 ± 9.3 91.5 ±10.7 88.6 ±13.2 88.6 ±12.0 < 0.001

Physical activity Low 165 (34.4%) 87 (34.1%) 25 (26.3%) 28 (40.0%) 0.361
Moderate 153 (31.9%) 95 (37.3%) 34 (35.8%) 22 (31.4%)
High 161 (33.6%) 73 (28.6%) 36 (37.9%) 20 (28.6%)

Smoke Never 459 (95.8%) 239 (93.7%) 94 (98.9%) 63 (90.0%) 0.115
Former 10 (2.1%) 6 (2.4%) 0 (0.0%) 2 (2.9%)
Current 10 (2.1%) 10 (3.9%) 1 (1.1%) 5 (7.1%)

Drink Abstainers 237 (49.5%) 148 (58.0%) 42 (44.2%) 30 (42.9%) 0.123
Responsible drinking 216 (45.1%) 91 (35.7%) 46 (48.4%) 34 (48.6%)
Hazardous drinking 17 (3.5%) 14 (5.5%) 4 (4.2%) 4 (5.7%)
Harmful drinking 9 (1.9%) 2 (0.8%) 3 (3.2%) 2 (2.9%)

Education ≤ High school 188 (39.2%) 85 (33.3%) 45 (47.4%) 28 (40.0%) 0.337
University 270 (56.4%) 158 (62.0%) 48 (50.5%) 39 (55.7%)
Graduate school 21 (4.4%) 12 (4.7%) 2 (2.1%) 3 (4.3%)

Household Income (10,000 won/month) <300 132 (27.6%) 75 (29.4%) 32 (33.7%) 21 (30.0%) 0.433
300–399 79 (16.5%) 40 (15.7%) 15 (15.8%) 5 (7.1%)
400–499 75 (15.7%) 42 (16.5%) 19 (20.0%) 16 (22.9%)
≥ 500 193 (40.3%) 98 (38.4%) 29 (30.5%) 28 (40.0%)

Marital status Married 412 (86.0%) 215 (84.3%) 85 (89.5%) 62 (88.6%) 0.407
Unmarried 23 (4.8%) 18 (7.1%) 7 (7.4%) 3 (4.3%)
Others 44 (9.2%) 22 (8.6%) 3 (3.2%) 5 (7.1%)

Menopause 160 (33.4%) 59 (23.1%) 43 (45.3%) 25 (35.7%) < 0.001

EQ VAS 73.9 ± 13.9 70.1 ± 14.6 71.5 ± 13.4 66.3 ± 17.7 < 0.001

BDI score 7.0 ± 6.1 9.0 ± 7.4 10.6 ± 7.8 13.1 ± 9.4 < 0.001

Data are presented as mean ± standard deviation or number (%). BMI, body mass index; PSQI, Pittsburgh sleep quality index; ISI, insomnia severity index, EQ-VAS, EuroQol-visual analogue scales; BDI, Beck Depression Inventory.

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