Uncontrolled metabolic syndrome associated with poorer sleep quality in adults in rural areas: A secondary analysis

Abstract Objective To examine whether clinical management of metabolic syndrome (MetS) is associated with sleep health among adults receiving care in rural primary care settings. Methods This cross-sectional analysis used baseline data from adults (age 20–75 years; BMI 30–45 kg/m2) enrolled in the REPOWER trial, a pragmatic behavioral weight-loss intervention implemented in rural primary care clinics. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). MetS was defined according to AHA/NHLBI criteria and categorized as: (1) no MetS, (2) controlled MetS (criteria met via medication use), and (3) uncontrolled MetS (criteria met via abnormal laboratory values). Linear mixed models evaluated whether MetS status predicted global PSQI, PSQI subcomponents, and sleep duration, adjusting for age, sex, and BMI. Results Among 1,406 adults (mean age 54.6 ± 11.8 years; 76.8% female), those with uncontrolled MetS (n=634) had significantly worse global PSQI, sleep latency, and sleep disturbance scores compared with adults without MetS (n=483) (p < 0.05). Sleep outcomes did not differ between adults with controlled MetS (n=289) and those without MetS (p > 0.05). Conclusions Poorly controlled MetS was associated with poorer sleep quality, whereas clinically controlled MetS was not. Future research is needed to determine if effective clinical management of MetS may confer benefits for sleep health in rural populations.