Sleepless in Beirut: Sleep Difficulties in an Urban Environment With Chronic Psychosocial Stress

STUDY OBJECTIVES: The prevalence of sleep disorders in the Lebanese population is unknown. We assessed the prevalence of insomnia and sleep apnea risk and examined their relationship with sociodemographic, lifestyle, and health characteristics in a sample from Greater Beirut. METHODS: This cross-sectional pilot survey included 501 adults from the community (age 45.2 ± 15.2 years, 64% females). Insomnia symptoms, insomnia disorder, and sleep apnea risk were assessed using the Sleep Heart Health Study and Berlin Questionnaire. Characteristics were compared between individuals with and without insomnia symptoms, insomnia disorder, and sleep apnea. Correlates were assessed using multivariate regression. RESULTS: A total of 44.5% of participants reported insomnia symptoms > 15 nights/mo and 34.5% reported insomnia. Predictors of insomnia symptoms and disorder included female sex (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.01–2.27 and OR 1.76, 95% CI 1.13–2.75, respectively), education level below high school (OR 1.96, 95% CI 1.31–2.95 and OR 2.40, 95% CI 1.52–3.77, respectively) and medical comorbidities (OR 2.27, 95% CI 1.30–3.95 and OR 3.02, 95% CI 1.3–5.27, respectively). Although 31% of participants were at high risk for sleep apnea, only 5% received the diagnosis from a physician. Increased sleep apnea risk was associated with unemployment (OR 1.96, 95% CI 1.11–3.49), high body mass index (OR 1.17, 95% CI 1.11–1.24), snoring (OR 16.7, 95% CI 9.0–31.0), hypertension (OR 4.33, 95% CI 2.28–8.22), arthritis (OR 2.00, 95% CI 1.01–4.01), and other medical comorbidities (OR 2.65, 95% CI 1.24–5.68). CONCLUSIONS: Insomnia and sleep apnea are highly prevalent and likely underdiagnosed in this cohort from Lebanon and are associated with disadvantaged socioeconomic status and medical comorbidities. This alarming prevalence of sleep difficulties and disorders calls for future research exploring the causes including the potential effect of social, economic, and political instability, mental and psychological stress, local customs, and environmental factors. CITATION: Chami HA, Bechnak A, Isma'eel H, Talih F, Nasreddine L, Nasrallah M, Tamim H. Sleepless in Beirut: sleep difficulties in an urban environment with chronic psychosocial stress. J Clin Sleep Med. 2019;15(4):603–614.