Impact of multimorbidity on the use of sleep medications among women: a population-based study in Southern Brazil

Abstract

Objective: To investigate the association between multimorbidity and sleep medication use in women.

Methods: A population-based cross-sectional study was conducted on women (20-69 years) in Southern Brazil. Sleep medications were identified using the Therapeutic and Chemical Anatomical Classification. Multimorbidity was operationalized according to two cutoff points: diagnosis of either two or more or three or more chronic conditions and presence or absence of obesity. Explanatory variables included sociodemographic, behavioral, and health factors including obesity and common mental disorders (CMD) (assessed using the Self-Reporting Questionnaire 20 for CMD). Crude and adjusted prevalence ratios (PR) and 95% confidence intervals (95%CIs) were estimated with Poisson regression with robust variance using various adjustment models.

Results: In a sample of 1128 women, the prevalence of sleep medications was 14.3% (95%CI 12.2-16.3). After adjustments, the association between multimorbidity and sleep medication use yielded the following PR: multimorbidity ≥ 2:1.78 (95%CI, 1.23-2.56) and multimorbidity ≥ 3:1.90 (95%CI, 1.36-2.68). When obesity was included in the model, the effect was in the same direction but smaller, indicating that the presence of multimorbidity had an independent effect on the use of sleep medications, even after adjusting for CMD.

Conclusion: The presence of multimorbidity increased the probability of using sleep medications by approximately 80%, regardless of the observed cutoff point, inclusion of obesity in multimorbidity, and adjustment for CMD. Specific aspects of some chronic conditions may interfere with sleep quality, predisposing women to begin use of these medications at early ages and, consequently, to continue their use throughout later life.

Keywords: Multimorbidity; Multiple chronic diseases; Pharmacoepidemiology; Risk factors; Sleep medications; Women.