Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study

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Sleep difficulties are a major group of disorders affecting one third of the adult population. The present study was taken up to assess the sleep quality and prevalence of sleep disorders among the adult population in the urban slum area of H Siddaiah Road Urban Primary Health Center (UPHC), which is in the Urban Field Practice Area, BMCRI. Methods Stratified random sampling was used to select 821 adults in the population of 18-60 years of age. Ethical clearance was obtained from the Institutional Ethical Committee. A pretested semi-structured questionnaire was used to interview the adults after obtaining their consent. The data was entered in Microsoft Office Excel and analysed using SPSS ver20.0. Results The study population was 52.81% females and 77.5% in the age group of 18-30 years. Most of the study population were Hindus (78.90%), and only 3.8% of the study population were illiterate. Most of them were employed (86.12%). Substance use was present in 82.9% of the study participants and overcrowding was present in 51.3% of the subjects. Female gender, being unemployed, living with relatives, overcrowding, and substance use such as alcohol and smokeless tobacco were the factors associated with poor sleep quality as measured using the Pittsburgh Sleep Quality Index. Among the study participants having poor sleep quality, most of participants needed further clinical assessment for insomnia (86%) followed by assessment for sleep apnoea (50.5%). Conclusions 200 (24.36%) study participants were determined to have poor sleep quality. Gender, marital status and overcrowding were the factors associated with poor sleep quality. A significant number of study participants need further assessment on insomnia, sleep apnoea and psychiatric disorders. 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F1000Research 2024, 12 :1426 ( https://doi.org/10.12688/f1000research.140184.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] Previous title 'An evaluation of quality of sleep and prevalence of sleep disorders among adult population of Urban slum of Bangalore - a cross sectional study' Mithun Rao https://orcid.org/0009-0004-6427-2539 1 , Shobha Bhushan 2 , Ranganath TS 2 Mithun Rao https://orcid.org/0009-0004-6427-2539 1 , Shobha Bhushan 2 , Ranganath TS 2 PUBLISHED 17 May 2024 Author details Author details 1 Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 2 Bangalore Medical College and Research Institute, Bangalore, India Mithun Rao Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Shobha Bhushan Roles: Conceptualization, Data Curation, Methodology, Supervision Ranganath TS Roles: Conceptualization, Data Curation, Supervision, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Background Sleep can be defined as a state of reduced attention from where the person can be woken up by any kind of stimuli. Sleep difficulties are a major group of disorders affecting one third of the adult population. The present study was taken up to assess the sleep quality and prevalence of sleep disorders among the adult population in the urban slum area of H Siddaiah Road Urban Primary Health Center (UPHC), which is in the Urban Field Practice Area, BMCRI. Methods Stratified random sampling was used to select 821 adults in the population of 18-60 years of age. Ethical clearance was obtained from the Institutional Ethical Committee. A pretested semi-structured questionnaire was used to interview the adults after obtaining their consent. The data was entered in Microsoft Office Excel and analysed using SPSS ver20.0. Results The study population was 52.81% females and 77.5% in the age group of 18-30 years. Most of the study population were Hindus (78.90%), and only 3.8% of the study population were illiterate. Most of them were employed (86.12%). Substance use was present in 82.9% of the study participants and overcrowding was present in 51.3% of the subjects. Female gender, being unemployed, living with relatives, overcrowding, and substance use such as alcohol and smokeless tobacco were the factors associated with poor sleep quality as measured using the Pittsburgh Sleep Quality Index. Among the study participants having poor sleep quality, most of participants needed further clinical assessment for insomnia (86%) followed by assessment for sleep apnoea (50.5%). Conclusions 200 (24.36%) study participants were determined to have poor sleep quality. Gender, marital status and overcrowding were the factors associated with poor sleep quality. A significant number of study participants need further assessment on insomnia, sleep apnoea and psychiatric disorders. READ ALL READ LESS Keywords Sleep, Adult, Quality of sleep, Sleep Hygiene, Sleep disturbance. Corresponding Author(s) Mithun Rao ( [email protected] ) Close Corresponding author: Mithun Rao Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Rao M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Rao M, Bhushan S and TS R. Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.12688/f1000research.140184.3 ) First published: 31 Oct 2023, 12 :1426 ( https://doi.org/10.12688/f1000research.140184.1 ) Latest published: 17 May 2024, 12 :1426 ( https://doi.org/10.12688/f1000research.140184.3 ) Revised Amendments from Version 2 As suggested by the reviewer, a limitation of the study has been added in the concluding paragraph. As suggested by the reviewer, a limitation of the study has been added in the concluding paragraph. See the authors' detailed response to the review by Sudhir Prabhu See the authors' detailed response to the review by Pracheth Raghuveer READ REVIEWER RESPONSES Introduction Sleep is defined as unconsciousness from which the person can be aroused by sensory or other stimuli. Sleep is the vital component of health and is essential for mental and physical wellbeing and crucial for rejuvenation of body. 1 Sleep is a recurrent state of reduced attention to the surrounding environment, which is essential to maintain and restore body functions, memory and cognitive performance. Sleep plays a crucial role in maintenance of normal functioning of many systems including endocrine and immune systems. 2 The average adult needs 7 to 9 hours of excellent sleep per day, 3 which translates to sleeping for nearly one-third of their life. Poor sleep can have detrimental impacts on one’s mental and physical health. 3 Theoretically sleep is composed of two physiological phases, namely non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. 1 Adults frequently experience problems with their ability to sleep. According to previous studies, 10 to 40 percent of adults experience different types of sleep disturbances. 4 , 5 Sleep issues can significantly lower people’s quality of life. Sleep hygiene and sleep problems are not well understood by the general public. One of the most prevalent sleep problems is insomnia, which is also a sign of poor mental health in the elderly population. Subjective complaints of trouble falling asleep, staying asleep, and early morning awakenings are its hallmarks. This has serious daytime effects such weariness, low energy, difficulties with cognition (attention and memory), and mood disorders, which can cause serious distress and functional deficits, especially as people age. 6 A wide range of detrimental health effects, such as an increased risk of hypertension, diabetes mellitus, obesity, immunological deficiency, coronary heart disease, and stroke, are linked to poor sleep quality. 6 Conversely, people who have any of these illnesses are more likely to experience sleep-related issues. People who struggle with sleep disturbances have much greater rates of using drugs, low quality of life, depressed mood, anxiety, and panic attacks. These comorbidities will affect an older population more frequently. 7 Good sleep quality is associated with wide range of positive outcomes such as better health, less daytime sleepiness and better psychological functioning. Many factors contribute to sleep patterns, including sleep hygiene practices. 8 Sleep hygiene is the variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness. 9 Regular exercise, regular bedtimes and wake-up times, and no midday naps are all behaviors that promote sleep. The use of stimulants like caffeine or cigarettes, participating in stimulating or unpleasant activities right before bed, and using alcohol are all actions that prevent people from falling asleep. In the history of humanity, sleep issues are a relatively new development. Chronic sleep deprivation was a very uncommon issue for the majority of humanity before the discovery and widespread use of electricity and artificial light. 10 Though there have been studies conducted in the aged population and students in other countries about the quality of sleep and its associated factors, there has been lack of literature on quality of sleep among the adult population and its associated risk factors in India, especially in urban slums of India. Hence the present study has been taken up to assess the quality of sleep and prevalence of sleep disorders among the adult population in the urban slum which is the Urban Field Practice Area of the Department of Community Medicine, Bangalore Medical College and Research Institute (BMCRI), Bengaluru. Objectives 1. To assess the quality of sleep and the factors associated with it among the adult population of the Urban Field Practice Area of BMCRI. 2. To estimate the prevalence of sleep disorders among them. Methods Study design This study had a cross-sectional design. The study took place between November 2018 and May 2020. Study location The study was conducted at the urban slum area of H Siddaiah Road Urban Primary Health Center (UPHC), which is in the Urban Field Practice Area of BMCRI. Being one of the largest slums in Bangalore, it represents the urban slums of Southern India. Study population The study population was adults belonging to the age group between 18 and 60 years and residing in the Urban slum of Bangalore. Inclusion criteria 1. Age 18 to 60 years and is a permanent resident (residing for more than six months in the area) of the area. 2. The individuals who are present in the area at the time of interview. 3. People who are willing to give consent for the study. Exclusion criteria 1. People who are not willing to give consent for the study. 2. Those who are severely ill and/or diagnosed with a mental health condition. 3. Lactating women. Ethics and consent The IEC (Institutional Ethics Committee) of Bangalore Medical College and Research Institute, Bangalore has reviewed the study and has granted approval prior to the onset of the study (BMC/PG/124/2018-19, on 3 rd January 2018). Study subjects had the purpose of the study explained to them and written informed consent was obtained before proceeding. Confidentiality of the present study data was maintained in accordance with the Declaration of Helsinki. Sample size and participant selection There are 3 sectors in the urban field practice area; the total population is around 30,500 and the total number of households is 6045. The study size calculation was conducted by probability proportionate to size sampling (PPS). The sample size for each sector will be derived from formula: n 1 = Household of each sector × sample size Total number of households Example 1st sector has a household of 1712, so, n 1 = 1712 × 820 6045 = 232.23 = 233 The same formula will be applied for other sectors, thus making a total sample size of 821. Systematic random sampling is used for the selection of the study population. After calculating the required number of participants from each sector, a random number is generated and the corresponding household is visited for the interview. The next household is visited by adding the sample interval to the randomly generated number and the interview is continued till we reach the required target. Only one adult member from each household was selected for the interview. Taking the example of the 1st sector, Sample interval is calculated by as using the formula. Sample interval = 1712 233 = 7.34 Let the random number generated be ‘3’. The third household of the sector is visited and interviewed. The next household number to be visited will be 3 + 7 = 10th house (random number + sample interval). If there is a locked house, the adjacent house to the locked house is interviewed. Like this the interview is continued till the adequate sample size is reached. Data collection After obtaining the written informed consent and assuring confidentiality to the study participants, information regarding the sociodemographic factors and the details regarding the quality of sleep were collected, using pre-tested, semi-structured questionnaires (Pittsburgh Sleep Quality Index and Sleep Disorders Questionnaire). 11 , 12 The data collection was done by the researcher by visiting the houses in the community for a duration of 6 months. The study participants were interviewed using the questionnaires described above as well as a sociodemographic questionnaire. Overview of questionnaires Pittsburgh Sleep Quality Index (PSQI) The PSQI is an instrument for the assessment of outcome of sleep quality over the preceding one month which helps in categorizing the subjects based on the quality of sleep. This tool is designed to evaluate self-rated sleep quality. The questionnaire evaluates sleep quality over the past one month with the help of 19 items, which generate seven component scores namely subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep duration, use of sleeping medication and daytime dysfunction. The sum of the component scores yields a global score. It first contains 4 open questions, following which there are questions with 4-point scale. Each component score ranges from 0 to 3 (‘no difficulty’ to ‘severe difficulty’). The global score can range from ‘0’ to ‘21’ and a score >5 suggested poor sleep quality. This questionnaire requires around 10 minutes for completion. The PSQI has adequate psychometric properties. A PSQI tool had sensitivity of 89.6% and 86.5% specificity. The test-retest reliability with scores can be correlated to the polysomnographic results. Sleep Disorders Questionnaire This is a questionnaire developed by Toward Optimized Practice Group to assist physicians in the evaluation of sleep disorders. It helps clinicians to know to screen for sleep related disorders; thus, helping in treating much earlier in primary care settings and early referral where it is needed. The target population of this questionnaire is adults, hence children were excluded from the study. Sleep Disorders Questionnaire has 16 items in total. Each item has a grading scale from 1-5 with 1-being never, 2-rarely, 3-occasionally, 4-most nights/days and 5-always. Diagnostic Domains of Sleep Disorders Questionnaire is as follows: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 Analysis Data collected was then analyzed with SPSS version 20. Results have been expressed in means, proportions and standard deviations. Appropriate parametric and non-parametric tests are applied wherever necessary. Chi square test was used to measure the association between quality of sleep and the socio demographic variables. The student’s t test was used to measure the statistically significant difference among the gender with respect to quality of sleep. Results Demographic profile Among 821 study subjects, 432 were females and 389 were males. 636 (77.5%) study participants belonged to the age group of 18-30 years ( Table 1 ). 17 The mean age of the participants was 30.86 ± 9.25 years among males and 28.92 ± 7.37 years among females. The majority of the population (648; 78.9%) were following Hindu religion, and 102 (12.4%) followed Christian religion. Among the study subjects, only 31 (3.8%) were illiterate, the rest all were literate. Table 1. Distribution of study subjects according to age and sex (n = 821). Age group (years) Female (n = 432) N (%) Male (n = 389) N (%) 18-30 355 (43.24%) 281 (34.23%) 31-40 38 (4.63%) 48 (5.85%) 41-50 29 (3.53%) 37 (4.51%) 51-60 10 (1.22%) 23 (2.79%) Total 432 (52.62%) 389 (47.38%) 707 (86.12%) study participants were employed. Among the total participants surveyed, 482 (58.7%) were unmarried. 329 (40.1%) study participants were living with their parents. 411 (50.1%) study participants were living in a nuclear family, whereas 383 (46.4%) study participants were living in a joint family. Overcrowding was present in 421 (51.3%) houses ( Table 2 ). Table 2. Baseline characteristics of study population (n=821). Variable Category N (%) Religion Hindu 648 (78.90%) Christian 102 (12.50%) Muslim 71 (8.6%) Literacy status Illiterate 31 (3.80%) Primary school 4 (0.50%) Middle school 98 (11.90%) High school 291 (35.40%) PUC/intermediate/PUC 80 (9.70%) Graduate 261 (31.80%) Professional 56 (6.80%) Employment status Unemployed 114 (13.88%) Employed 707 (86.12%) Marital status Married 327 (39.8%) Separated/widow/widower 12 (1.4%) Unmarried 482 (58.7%) Living arrangement Living Alone 94 (11.4%) Living with children 20 (2.4%) Living with parents 329 (40.1%) Living with relatives 118 (14.4%) Living with spouse 60 (7.3%) Living with spouse and children 200 (24.4%) Type of family Joint family 381 (46.40%) Nuclear family 411 (50.10%) Three generation family 29 (3.50%) Overcrowding Present 421 (51.3%) Absent 400 (48.7%) Substance Use Present 681 (82.90%) Absent 140 (17.10%) 681 (82.9%) participants reported substance use of any form. Of 681 participants, 520 (63.3%) of them were consuming coffee/tea, whereas 224 (27.3%) were using smokeless tobacco. 199 (24.2%) of the study population were smokers and 148 (18.0%) were consuming. Based on the global PSQI scores, study participants were divided into two groups. Those who had a global PSQI score of less than or equal to 5 were categorized as having good sleep quality (621, 75.63%). Participants who had a global PSQI score of more than 5 were categorized as having poor sleep quality (200, 24.37%) ( Table 3 ). Table 3. Distribution of study subjects based on quality of sleep (n = 821). Quality of sleep N (%) Good sleep (PSQI ≤ 5) 621 (75.63%) Poor sleep (PSQI > 5) 200 (24.37%) The association was measured using the Chi square test between the quality of sleep and various socio-demographic factors, which have been mentioned above. A statistically significant association (p value < 0.05) was found between quality of sleep and gender (p value = 0.03), marital status (p value = 0.005), living arrangements (p value = 0.000), type of family (p value < 0.0001) and presence of overcrowding (p value < 0.0001) ( Table 4 ). Table 4. Association between quality of sleep and socio-demographic factors. Good sleep (n=621) Poor sleep (n=200) χ 2 Value p value Gender Female 309 (71.53%) 123 (28.47%) 8.365 0.003 * Male 312 (80.21%) 77 (19.79%) Employment status Unemployed 87 (76.32%) 27 (23.68%) 0.033 0.907 Employed 534 (75.53%) 173 (24.47%) Marital status Married 264 (80.73%) 63 (19.27%) 12.788 0.005 * Separated/widow/widower 12 (100.00%) 0 (0.00%) Unmarried 345 (71.58%) 137 (28.42%) Living arrangement Living Alone 75 (79.79%) 19 (20.21%) 29.455 <0.001 * Living with children 20 (100.00%) 0 (0.00%) Living with parents 233 (70.82%) 96 (29.18%) Living with relatives 78 (66.10%) 40 (33.90%) Living with spouse 43 (71.67%) 17 (28.33%) Living with spouse and children 172 (86.00%) 28 (14.00%) Type of family Joint family 286 (75.07%) 95 (24.93%) 29.455 <0.001 * Nuclear family 320 (77.86%) 91 (22.14%) Three generation family 15 (51.72%) 14 (48.28%) Substance use Present 507 (74.45%) 174 (25.5%) 3.070 0.084 Absent 114 (81.43%) 26 (18.57%) Overcrowding Present 247 (58.67%) 174 (41.33%) 135.044 <0.001 * Absent 374 (93.50%) 26 (6.50%) Study participants who had poor sleep quality (200) were further subjected to the sleep disorders questionnaire. Based on their response to the sleep disorders questionnaire, study participants were further categorized into various sleep related disorders. Among those (200), insomnia was observed in 82.5%, sleep apnoea in 50.5%, psychiatric disorders in 39.5%, parasomnias in 36.5%, circadian rhythm disorders in 35.5%, and movement disorders in 8%, which may need further clinical evaluation ( Table 5 ). Table 5. Distribution of study subjects based on the response to the sleep disorders questionnaire. Diagnostic Domain Presence of sleep disorders N (%) Insomnia 165 (82.5%) Psychiatric disorders 79 (39.5%) Circadian rhythm disorder 71 (35.5%) Movement disorders 16 (8%) Parasomnias 73 (36.5%) Sleep apnoea 101 (50.5%) Discussion The present study evaluates the quality of sleep and its related factors along with assessing the prevalence of sleep disorders in the urban slum area of H Siddaiah Road Urban Primary Health center (UPHC), which is the Urban Field Practice Area of BMCRI. The present study explores the importance of various factors affecting the sleep quality and the prevalence of sleep disorders among the adult population of the urban slums. The findings are based on interviews of the 821 participants at the field level. Sociodemographic characteristics of the study subjects Among the 821 subjects, more than half the population is female, 432 (52.6%) and the majority belonged to the age group of 18-30 years, (636; 77.5%) with a mean age of 30.86 ± 9.258 years among males and 28.92 ± 7.373 years among females. A community based cross-sectional study conducted by Berhanu H et al. in Ethiopia had a preponderance of males (60.9%), with mean age of the total population of 38.7 + 12.5 years. 13 A similar study conducted by Madrid-Valero JJ et al. in Spain had 54.7% females with a mean age of the study participants being 53.7 years. 14 Yet another study conducted by Panda S et al. in South India had an even gender distribution (M:F 29:21), with the mean age of the respondents being 35.1±8.7 years having mostly southern India representation. 15 As the study by Berhanu H et al. was in the similar set up as the present study, the socio demographic characteristics were quite similar, whereas the study by Madrid-Valero JJ et al. had a higher mean age, which may be due to the different methodology which was followed. 13 , 14 Factors associated with quality of sleep In the present study, the participants went to bed on average at 10.20 PM with a sleep latency of 15.16, minutes and the total duration of sleep experienced by them was 7.8 hours. While in the study conducted by Berhanu H et al. , participants reported an average night’s sleep duration of 6.8 ± 2.1 hours, with the study participants having gone to bed at 10.20 PM. 13 One more study conducted by Madrid-Valero JJ et al. had assessed the mean sleep duration during night time which was found to be 6.43 + 1.3 hours, and sleep latency was not assessed in the study. 14 In the study conducted by Panda S et al. , average time-to-fall-asleep was 22 minutes (range: 5-90 min), and mean duration of actual sleep was 7 hours (range: 3.5-9.1 hours). 15 All the studies had similar results with respect to total duration of night sleep experienced. In the present study, about one fourth of the study participants (24.36%) reported having poor sleep quality (global PSQI > 5), whereas the study conducted by Panda S et al. had a majority (93.8%) of the population reporting good-quality sleep (global PSQI ≤ 5). In the study conducted by Berhanu H et al. , 4% participants were assessed as poor sleepers by a global PSQI score greater than 5. A similar study done by Madrid-Valero JJ et al. showed 38.2% of the subjects having poor sleep quality (global PSQI > 5). 13 – 15 In the present study, it was seen that female gender, being unmarried, overcrowding and use of substance such as alcohol and tobacco were having a significant impact on the quality of sleep. The study conducted by Berhanu H et al. also reported similar results with female gender, having less monthly income, Khat chewing practices and consumption of alcohol being correlated factors for poor quality of sleep. 13 The present study showed that further evaluation is needed, as insomnia was reported in 82.5% of the 20 participants with poor sleep quality, sleep apnoea in 50.5%, psychiatric disorders in 39.5%, parasomnias in 36.5%, circadian rhythm disorders in 35.5% and movement disorders in 8%. Another study conducted by Ram S et al. 16 in USA, prevalence of sleep disorders was highest for sleep apnoea (4.2%), followed by insomnia (1.2%) and RLS (0.4%). The reported rates of sleep related disorders varied between 20.0% and 34.2% depending on the instrument used in the questionnaire. In the study conducted by Panda S et al. , insomnia, sleep-related breathing disorders, narcolepsy, and restless legs syndrome (RLS) were reported to be 18.6%, 18.4%, 1.04% and 2.9% respectively. 14 – 16 Conclusion The present study indicated that one fourth of the adult population residing in the Urban Field Practice Area of Community Medicine Department, BMCRI reported poor sleep quality. It was observed that the poor quality of sleep is associated with various factors such as gender, marital status, living arrangement, type of family and overcrowding. The present study also observed that among the people having poor sleep quality, insomnia was seen in four fifths, sleep apnoea in half, and psychiatric disorders in two fifths of the study population. They need further evaluation to confirm the sleep disorders. 24% of the study population had poor sleep quality, being a cross sectional study this is one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality). Data availability Underlying data figshare: Masterchart.xlsx. https://doi.org/10.6084/m9.figshare.23997591.v1 17 Extended data figshare: Coding key.xlsx. https://doi.org/10.6084/m9.figshare.23997585.v1 18 figshare: Questionnaire.docx. https://doi.org/10.6084/m9.figshare.23997693.v1 19 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Hall J, Hall M: Guyton And Hall Textbook Of Medical Physiology. 12th ed.Philadelphia: Library of Congress Cataloging-in-Publication Data; 2011; 721–725. 2. Zadeh SS, Khyrunnisa B: Comparison of nutrient intake by sleep status in selected adults in Mysore, India. Nutr. Res. Pract. 2011; 5 (3): 230–235. PubMed Abstract | Publisher Full Text | Free Full Text 3. How much sleep is enough? National Heart Lung and Blood Institute. (Accessed: 16 August 2022). Reference Source 4. Liu X, Uchiyama M, Kim K, et al. : Sleep loss and daytime sleepiness in the general adult population of Japan. Psychiatry Res. 2000; 93 (1): 1–11. PubMed Abstract | Publisher Full Text 5. Asghari A, Farhadi M, Kamrava SK, et al. : Subjective sleep quality in urban population. Arch. Iran. Med. 2012; 15 (2): 95–98. PubMed Abstract 6. Colten HR, Altevogt BM: Sleep disorders and sleep deprivation: An unmet public health problem. Washington DC: National Academies Press; 2006. 7. Culloch M, Espie R: Mental Health Foundation: Impact of poor sleep on the health and happiness of the UK. England (UK): The UK charity; 2011. Reference Source 8. Elmoneem H, Fouad A: The Effect of a Sleep Hygiene Program on Older Adults. IOSR J. Nurs. Health Sci. 2017; 06 (01): 40–51. Publisher Full Text 9. What is Sleep Hygiene? - Sleep Foundation. Sleep Foundation; 2020 [cited 8 December 2020]. Reference Source 10. Shankar A, Syamala S, Kalidindi S: Insufficient Rest or Sleep and Its Relation to Cardiovascular Disease, Diabetes and Obesity in a National, Multiethnic Sample. PLoS One. 2010; 5 (11): e14189. PubMed Abstract | Publisher Full Text | Free Full Text 11. Buysse D, Reynolds C, Monk T, et al. : The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28 (2): 193–213. PubMed Abstract | Publisher Full Text 12. Sleep disorders Questionnaire. Corecarefht.ca.2003 [cited 14 December 2018]. Reference Source 13. Berhanu H, Mossie A, Tadesse S, et al. : Prevalence and Associated Factors of Sleep Quality among Adults in Jimma Town, Southwest Ethiopia: A Community-Based Cross-Sectional Study. Sleep Disorders. 2018; 2018 : 1–10. PubMed Abstract | Publisher Full Text | Free Full Text 14. Madrid-Valero J, Martínez-Selva J, Ribeiro do Couto B, et al. : Age and gender effects on the prevalence of poor sleep quality in the adult population. Gac. Sanit. 2017; 31 (1): 18–22. Publisher Full Text 15. Panda S, Taly A, Sinha S, et al. : Sleep-related disorders among a healthy population in South India. Neurol. India. 2012; 60 (1): 68–74. PubMed Abstract | Publisher Full Text 16. Ram S, Seirawan H, Kumar S, et al. : Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep Breath. 2009; 14 (1): 63–70. PubMed Abstract | Publisher Full Text 17. Rao M: Masterchart.xlsx. Dataset. figshare. 2023. Publisher Full Text 18. Rao M: Coding key.xlsx. Dataset. figshare. 2023. Publisher Full Text 19. Rao M: Questionnaire.docx. Dataset. figshare. 2023. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 31 Oct 2023 ADD YOUR COMMENT Comment Author details Author details 1 Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 2 Bangalore Medical College and Research Institute, Bangalore, India Mithun Rao Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Shobha Bhushan Roles: Conceptualization, Data Curation, Methodology, Supervision Ranganath TS Roles: Conceptualization, Data Curation, Supervision, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 17 May 2024, 12:1426 https://doi.org/10.12688/f1000research.140184.3 version 2 Revised Published: 11 Mar 2024, 12:1426 https://doi.org/10.12688/f1000research.140184.2 version 1 Published: 31 Oct 2023, 12:1426 https://doi.org/10.12688/f1000research.140184.1 Copyright © 2024 Rao M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Rao M, Bhushan S and TS R. Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.12688/f1000research.140184.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 11 Mar 2024 Revised Views 0 Cite How to cite this report: Prabhu S. Reviewer Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.163547.r260733 ) The direct URL for this report is: https://f1000research.com/articles/12-1426/v2#referee-response-260733 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Apr 2024 Sudhir Prabhu , Department of Community Medicine, Father Muller Medical College, Mangalore, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.163547.r260733 "minor comments" 1. "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better ... Continue reading READ ALL "minor comments" 1. "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. 2. Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ? 3. The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality) 4. was the influence of these clinico social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation Summary : overall its a good and novel study as poor quality of sleep has been linked to various social and economical consequences apart from health related adverse events. Studying it on a selected set of community which are vulnerable (slum dwellers) makes it even more important for health care professionals and public health researchers. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Prabhu S. Reviewer Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.163547.r260733 ) The direct URL for this report is: https://f1000research.com/articles/12-1426/v2#referee-response-260733 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 21 Jun 2024 Mithun Rao , Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 21 Jun 2024 Author Response 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research ... Continue reading 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. Author’s Response: Thank you for the comments Sir. The present study is a community based study Sir. Thus, urban slum representation has been done in the study. Action Taken in the manuscript: As per the suggestion, comments have been provided for further clarification. 2. Comment: Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ?. Author’s Response: We respect the comments Sir. Action Taken in the manuscript: The study tool has been validated in Indian settings. 3. Comment: The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality). Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: The mentioned comment will be added as a limitation of our study Sir. 4. Comment: Was the influence of these clinico-social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation. Author’s Response: Thank you for the comments Sir. Action Taken in the manuscript: The possible factors will be considered in the later part of the study sir. 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. Author’s Response: Thank you for the comments Sir. The present study is a community based study Sir. Thus, urban slum representation has been done in the study. Action Taken in the manuscript: As per the suggestion, comments have been provided for further clarification. 2. Comment: Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ?. Author’s Response: We respect the comments Sir. Action Taken in the manuscript: The study tool has been validated in Indian settings. 3. Comment: The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality). Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: The mentioned comment will be added as a limitation of our study Sir. 4. Comment: Was the influence of these clinico-social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation. Author’s Response: Thank you for the comments Sir. Action Taken in the manuscript: The possible factors will be considered in the later part of the study sir. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 21 Jun 2024 Mithun Rao , Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 21 Jun 2024 Author Response 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research ... Continue reading 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. Author’s Response: Thank you for the comments Sir. The present study is a community based study Sir. Thus, urban slum representation has been done in the study. Action Taken in the manuscript: As per the suggestion, comments have been provided for further clarification. 2. Comment: Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ?. Author’s Response: We respect the comments Sir. Action Taken in the manuscript: The study tool has been validated in Indian settings. 3. Comment: The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality). Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: The mentioned comment will be added as a limitation of our study Sir. 4. Comment: Was the influence of these clinico-social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation. Author’s Response: Thank you for the comments Sir. Action Taken in the manuscript: The possible factors will be considered in the later part of the study sir. 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. Author’s Response: Thank you for the comments Sir. The present study is a community based study Sir. Thus, urban slum representation has been done in the study. Action Taken in the manuscript: As per the suggestion, comments have been provided for further clarification. 2. Comment: Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ?. Author’s Response: We respect the comments Sir. Action Taken in the manuscript: The study tool has been validated in Indian settings. 3. Comment: The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality). Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: The mentioned comment will be added as a limitation of our study Sir. 4. Comment: Was the influence of these clinico-social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation. Author’s Response: Thank you for the comments Sir. Action Taken in the manuscript: The possible factors will be considered in the later part of the study sir. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Raghuveer P. Reviewer Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.163547.r254562 ) The direct URL for this report is: https://f1000research.com/articles/12-1426/v2#referee-response-254562 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 Mar 2024 Pracheth Raghuveer , Department of Epidemiology, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.163547.r254562 The authors have addressed all the queries and ... Continue reading READ ALL The authors have addressed all the queries and comments. I hereby approve the manuscript without any reservations. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Mental Health, Geriatrics, Non-Communicable Diseases, Maternal and Child Health, Neuro Sciences, Medical Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Raghuveer P. Reviewer Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.163547.r254562 ) The direct URL for this report is: https://f1000research.com/articles/12-1426/v2#referee-response-254562 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 31 Oct 2023 Views 0 Cite How to cite this report: Raghuveer P. Reviewer Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.153515.r219855 ) The direct URL for this report is: https://f1000research.com/articles/12-1426/v1#referee-response-219855 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Jan 2024 Pracheth Raghuveer , Department of Epidemiology, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.153515.r219855 Overall, it is an important paper that highlights an under-diagnosed issue of sleep. The sample size covered is 821 which is remarkable. It is a community-based study that may be generalizable to the urban slum dwelllers of Bengaluru. I congratulate ... Continue reading READ ALL Overall, it is an important paper that highlights an under-diagnosed issue of sleep. The sample size covered is 821 which is remarkable. It is a community-based study that may be generalizable to the urban slum dwelllers of Bengaluru. I congratulate the team of authors for a commendable job. However, there is scope for improvement to make it an even better draft. There are a few gaps that may have to be plugged before it can be accepted. 1. The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. 2. In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. 3. In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. 4. In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. 4. Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Mental Health, Geriatrics, Non-Communicable Diseases, Maternal and Child Health, Neuro Sciences, Medical Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Raghuveer P. Reviewer Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.153515.r219855 ) The direct URL for this report is: https://f1000research.com/articles/12-1426/v1#referee-response-219855 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 04 Apr 2024 Mithun Rao , Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 04 Apr 2024 Author Response Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of ... Continue reading Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. Author’s Response: We agree with your comment. As per the suggestion title has been modified. Action Taken in the manuscript: As per the suggestion title has been modified in the manuscript. 2. Comment: In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. Author’s Response: We respect the comments. As per the suggestion following details have been added. Action Taken in the manuscript: The details added are mentioned below. Sleep Disorders Questionnaire has 16 items in total. Each item has a grading scale from 1-5 with 1 being never, 2-rarely, 3- occasionally, 4-most nights/days and 5 – always. Diagnostic Domains of Sleep Disorders Questionnaire is as follows: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 3. Comment: In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: "Factors affecting quality of sleep" phrase mentioned in the results part of the manuscript has been modified to "factors associated" as the details deals with association. 4. Comment: In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. Author’s Response: Thank you for the query Sir. The Sleep Disorders Questionnaire screens for the mental health problem. Action Taken in the manuscript: The following detail has been added under methodology which helps in better understanding. Diagnostic Domains of Sleep Disorders Questionnaire: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 5. Comment: Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Author’s Response: Thank you for the suggestions Sir. We shall add the strengths and limitations as per the suggestion given Sir. Action Taken in the manuscript: The following are the strengths and limitations. Strength: This study is one of the kind among Urban slum dwellers of a metropolitan city. Study participants belong to a category of socially vulnerable population. The sample size of the study is more than 800 making it a large sample size. Limitations: Since Bangalore Urban slum dwellers have unique characteristics in comparison to slum dwellers of metropolitan city, the results may not be uniform across the cities. As the data collection used to take place during duty hours, working population would have been missed. Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. Author’s Response: We agree with your comment. As per the suggestion title has been modified. Action Taken in the manuscript: As per the suggestion title has been modified in the manuscript. 2. Comment: In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. Author’s Response: We respect the comments. As per the suggestion following details have been added. Action Taken in the manuscript: The details added are mentioned below. Sleep Disorders Questionnaire has 16 items in total. Each item has a grading scale from 1-5 with 1 being never, 2-rarely, 3- occasionally, 4-most nights/days and 5 – always. Diagnostic Domains of Sleep Disorders Questionnaire is as follows: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 3. Comment: In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: "Factors affecting quality of sleep" phrase mentioned in the results part of the manuscript has been modified to "factors associated" as the details deals with association. 4. Comment: In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. Author’s Response: Thank you for the query Sir. The Sleep Disorders Questionnaire screens for the mental health problem. Action Taken in the manuscript: The following detail has been added under methodology which helps in better understanding. Diagnostic Domains of Sleep Disorders Questionnaire: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 5. Comment: Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Author’s Response: Thank you for the suggestions Sir. We shall add the strengths and limitations as per the suggestion given Sir. Action Taken in the manuscript: The following are the strengths and limitations. Strength: This study is one of the kind among Urban slum dwellers of a metropolitan city. Study participants belong to a category of socially vulnerable population. The sample size of the study is more than 800 making it a large sample size. Limitations: Since Bangalore Urban slum dwellers have unique characteristics in comparison to slum dwellers of metropolitan city, the results may not be uniform across the cities. As the data collection used to take place during duty hours, working population would have been missed. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 04 Apr 2024 Mithun Rao , Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 04 Apr 2024 Author Response Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of ... Continue reading Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. Author’s Response: We agree with your comment. As per the suggestion title has been modified. Action Taken in the manuscript: As per the suggestion title has been modified in the manuscript. 2. Comment: In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. Author’s Response: We respect the comments. As per the suggestion following details have been added. Action Taken in the manuscript: The details added are mentioned below. Sleep Disorders Questionnaire has 16 items in total. Each item has a grading scale from 1-5 with 1 being never, 2-rarely, 3- occasionally, 4-most nights/days and 5 – always. Diagnostic Domains of Sleep Disorders Questionnaire is as follows: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 3. Comment: In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: "Factors affecting quality of sleep" phrase mentioned in the results part of the manuscript has been modified to "factors associated" as the details deals with association. 4. Comment: In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. Author’s Response: Thank you for the query Sir. The Sleep Disorders Questionnaire screens for the mental health problem. Action Taken in the manuscript: The following detail has been added under methodology which helps in better understanding. Diagnostic Domains of Sleep Disorders Questionnaire: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 5. Comment: Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Author’s Response: Thank you for the suggestions Sir. We shall add the strengths and limitations as per the suggestion given Sir. Action Taken in the manuscript: The following are the strengths and limitations. Strength: This study is one of the kind among Urban slum dwellers of a metropolitan city. Study participants belong to a category of socially vulnerable population. The sample size of the study is more than 800 making it a large sample size. Limitations: Since Bangalore Urban slum dwellers have unique characteristics in comparison to slum dwellers of metropolitan city, the results may not be uniform across the cities. As the data collection used to take place during duty hours, working population would have been missed. Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. Author’s Response: We agree with your comment. As per the suggestion title has been modified. Action Taken in the manuscript: As per the suggestion title has been modified in the manuscript. 2. Comment: In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. Author’s Response: We respect the comments. As per the suggestion following details have been added. Action Taken in the manuscript: The details added are mentioned below. Sleep Disorders Questionnaire has 16 items in total. Each item has a grading scale from 1-5 with 1 being never, 2-rarely, 3- occasionally, 4-most nights/days and 5 – always. Diagnostic Domains of Sleep Disorders Questionnaire is as follows: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 3. Comment: In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: "Factors affecting quality of sleep" phrase mentioned in the results part of the manuscript has been modified to "factors associated" as the details deals with association. 4. Comment: In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. Author’s Response: Thank you for the query Sir. The Sleep Disorders Questionnaire screens for the mental health problem. Action Taken in the manuscript: The following detail has been added under methodology which helps in better understanding. Diagnostic Domains of Sleep Disorders Questionnaire: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 5. Comment: Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Author’s Response: Thank you for the suggestions Sir. We shall add the strengths and limitations as per the suggestion given Sir. Action Taken in the manuscript: The following are the strengths and limitations. Strength: This study is one of the kind among Urban slum dwellers of a metropolitan city. Study participants belong to a category of socially vulnerable population. The sample size of the study is more than 800 making it a large sample size. Limitations: Since Bangalore Urban slum dwellers have unique characteristics in comparison to slum dwellers of metropolitan city, the results may not be uniform across the cities. As the data collection used to take place during duty hours, working population would have been missed. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 31 Oct 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 3 (revision) 17 May 24 Version 2 (revision) 11 Mar 24 read read Version 1 31 Oct 23 read Pracheth Raghuveer , National Institute of Mental Health and Neurosciences, India, Bengaluru, India Sudhir Prabhu , Father Muller Medical College, Mangalore, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Prabhu S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Apr 2024 | for Version 2 Sudhir Prabhu , Department of Community Medicine, Father Muller Medical College, Mangalore, India 0 Views copyright © 2024 Prabhu S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions "minor comments" 1. "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. 2. Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ? 3. The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality) 4. was the influence of these clinico social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation Summary : overall its a good and novel study as poor quality of sleep has been linked to various social and economical consequences apart from health related adverse events. Studying it on a selected set of community which are vulnerable (slum dwellers) makes it even more important for health care professionals and public health researchers. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 21 Jun 2024 Mithun Rao, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 1. Comment: "Was this a facility based or community based study? to understand who constituted the study universe and was there a fair representation of the urban slum dwellers as possible research study subjects. This might give better clarity the the readers and scientific community when this paper is being read or used for evidence. Author’s Response: Thank you for the comments Sir. The present study is a community based study Sir. Thus, urban slum representation has been done in the study. Action Taken in the manuscript: As per the suggestion, comments have been provided for further clarification. 2. Comment: Was the study tool standardized for local context and administered after pre testing in a pilot population for ensuring internal validity ?. Author’s Response: We respect the comments Sir. Action Taken in the manuscript: The study tool has been validated in Indian settings. 3. Comment: The study mentions 24% of the study population had poor sleep quality, being a cross sectional study this could be one of the limitations of the research work (ongoing social and medical issues could influence the sleep quality). Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: The mentioned comment will be added as a limitation of our study Sir. 4. Comment: Was the influence of these clinico-social factors considered for multivariate analysis?" use of summary statistics like Odds ratio or adjusted OR with 95% CI may be useful in understanding the potential role of risk factors under evaluation. Author’s Response: Thank you for the comments Sir. Action Taken in the manuscript: The possible factors will be considered in the later part of the study sir. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Prabhu S. Peer Review Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.163547.r260733) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1426/v2#referee-response-260733 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Raghuveer P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Mar 2024 | for Version 2 Pracheth Raghuveer , Department of Epidemiology, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India 0 Views copyright © 2024 Raghuveer P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed all the queries and comments. I hereby approve the manuscript without any reservations. Competing Interests No competing interests were disclosed. Reviewer Expertise Mental Health, Geriatrics, Non-Communicable Diseases, Maternal and Child Health, Neuro Sciences, Medical Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Raghuveer P. Peer Review Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.163547.r254562) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1426/v2#referee-response-254562 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Raghuveer P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Jan 2024 | for Version 1 Pracheth Raghuveer , Department of Epidemiology, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India 0 Views copyright © 2024 Raghuveer P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall, it is an important paper that highlights an under-diagnosed issue of sleep. The sample size covered is 821 which is remarkable. It is a community-based study that may be generalizable to the urban slum dwelllers of Bengaluru. I congratulate the team of authors for a commendable job. However, there is scope for improvement to make it an even better draft. There are a few gaps that may have to be plugged before it can be accepted. 1. The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. 2. In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. 3. In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. 4. In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. 4. Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Mental Health, Geriatrics, Non-Communicable Diseases, Maternal and Child Health, Neuro Sciences, Medical Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 04 Apr 2024 Mithun Rao, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India Point to point response to Reviewer's comments: Dr. Pracheth Raghuveer 1. Comment: The title may be modified to" Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study" as this was the primary objective/ aim. Author’s Response: We agree with your comment. As per the suggestion title has been modified. Action Taken in the manuscript: As per the suggestion title has been modified in the manuscript. 2. Comment: In the methods, please mention the number of items, cut-offs and information about validity of the Sleep Disorders Questionnaire. Author’s Response: We respect the comments. As per the suggestion following details have been added. Action Taken in the manuscript: The details added are mentioned below. Sleep Disorders Questionnaire has 16 items in total. Each item has a grading scale from 1-5 with 1 being never, 2-rarely, 3- occasionally, 4-most nights/days and 5 – always. Diagnostic Domains of Sleep Disorders Questionnaire is as follows: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 3. Comment: In the results, "Factors affecting quality of sleep" may be modified to "factors associated" as the analysis looks at associations. Author’s Response: Thank you for the comment Sir. As per the suggestion, we shall modify the wordings. Action Taken in the manuscript: "Factors affecting quality of sleep" phrase mentioned in the results part of the manuscript has been modified to "factors associated" as the details deals with association. 4. Comment: In the results, it has been mentioned that 39.5% had psychiatric disorders. How was this assessment carried out? Did the Sleep Disorders Questionnaire also assess mental health problems. Please justify. Author’s Response: Thank you for the query Sir. The Sleep Disorders Questionnaire screens for the mental health problem. Action Taken in the manuscript: The following detail has been added under methodology which helps in better understanding. Diagnostic Domains of Sleep Disorders Questionnaire: 1) Insomnia: Q1-5 2) Psychiatric Disorders: Q6-9 3) Circadian Rhythm Disorder: Q10 4) Movement disorders: Q11-12 5) Parasomnias Q13 5. Comment: Discussion needs strengthening. Kindly mention few strengths and limitations of the study in the discussion. Author’s Response: Thank you for the suggestions Sir. We shall add the strengths and limitations as per the suggestion given Sir. Action Taken in the manuscript: The following are the strengths and limitations. Strength: This study is one of the kind among Urban slum dwellers of a metropolitan city. Study participants belong to a category of socially vulnerable population. The sample size of the study is more than 800 making it a large sample size. Limitations: Since Bangalore Urban slum dwellers have unique characteristics in comparison to slum dwellers of metropolitan city, the results may not be uniform across the cities. As the data collection used to take place during duty hours, working population would have been missed. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Raghuveer P. Peer Review Report For: Poor quality of sleep and it's associated factors among urban slum-dwellers of Bengaluru- a cross-sectional study [version 3; peer review: 2 approved] . F1000Research 2024, 12 :1426 ( https://doi.org/10.5256/f1000research.153515.r219855) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1426/v1#referee-response-219855 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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