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The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies

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Abstract

Background

The high prevalence of poor sleep quality (PSQ) in the general population leads to negative health outcomes. Since estimates of PSQ prevalence in the Chinese general population vary widely, this meta-analysis aimed to refine these estimates and to identify moderating factors.

Methods

A comprehensive literature search was undertaken in both international (PubMed, PsycINFO, Web of Science, and EMBASE) and Chinese (Wanfang, and the China National Knowledge Infrastructure databases) databases from inception to 23 November 2023. Studies were required to have used standard scales such as the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). The pooled prevalence of PSQ and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify sources of heterogeneity.

Results

In 32 studies with a combined 376,824 participants, the pooled prevalence of PSQ was 19.0% (95% CI 15.8–22.8%; range 6.6–43.6%). Across 22 studies that reported PSQI data, the pooled mean score was 4.32 (95%CI 3.82–4.81; SD = 0.502). The pooled mean sleep duration across 8 studies was 7.62 (95% CI 7.23–8.00; SD = 0.194) hours. Subgroup analyses showed that lower education (Q = 4.12, P = 0.042), living in less developed regions (Q = 60.28, P < 0.001), and lower PSQI cutoff values (Q = 9.80, P = 0.007) were significantly associated with PSQ. Meta-regression analyses showed that study quality was inversely associated with estimated PSQ prevalence (β = − 0.442, P = 0.004).

Limitations

Although measures such as subgroup and meta-regression analyses were performed, substantial heterogeneity remained. Information related to sleep quality, such as comorbid physical diseases or psychiatric disorders, substance use, occupational types, and employment status, were not reported in most studies.

Conclusion

One in five people in the general population of China may have PSQ and people with lower education or living in western regions may be more susceptible.

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Data availability

The data used and/or analyzed in this study have been presented in Tables/Figures.

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Acknowledgements

The authors are grateful to all participants and clinicians involved in this study.

Funding

The study was supported by the National Science and Technology Major Project for investigational new drug (2018ZX09201-014), the Beijing Hospitals Authority Clinical Medicine Development of special funding support (XMLX202128), and the University of Macau (MYRG2019-00066-FHS; MYRG2022-00187-FHS).

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Author notes

  1. Pan Chen, Mei Ieng Lam, Tong Leong Si and Ling Zhang contributed equally to this work.

Authors and Affiliations

  1. Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, 1/F, Building E12, Macao SAR, China

    Pan Chen, Mei Ieng Lam, Tong Leong Si & Yu-Tao Xiang

  2. Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China

    Pan Chen & Yu-Tao Xiang

  3. Kiang Wu Nursing College of Macau, Macau SAR, China

    Mei Ieng Lam

  4. Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China

    Ling Zhang & Sha Sha

  5. Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada

    Lloyd Balbuena

  6. School of Public Health, Southeast University, Nanjing, China

    Zhaohui Su

  7. School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China

    Teris Cheung

  8. Psychiatry Section, University of Notre Dame Australia, Fremantle, Australia

    Gabor S. Ungvari

  9. Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia

    Gabor S. Ungvari

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  1. Pan Chen
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  10. Yu-Tao Xiang
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Contributions

Study design: PC, SS, Y-TXiang. Data collection, analysis, and interpretation: PC, MIL, TLS, LZ, LB, ZS, TC, GSU. Drafting of the manuscript: PC, Y-TX. Critical revision of the manuscript: LB. Approval of the final version for publication: all co-authors.

Corresponding authors

Correspondence to Sha Sha or Yu-Tao Xiang.

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Chen, P., Lam, M.I., Si, T.L. et al. The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies. Eur Arch Psychiatry Clin Neurosci (2024). https://doi.org/10.1007/s00406-024-01764-5

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