Iran Journal of Nursing

Introduction
The increase in the aged population has made challenges for the health care systems. One of these challenges is the increase in the prevalence of chronic diseases, including the metabolic syndrome. With the increase in the number of older people suffering from metabolic syndrome, the quality of sleep of these people has become a worrying issue which has less been addressed. Complaining about poor sleep quality is one of the most important problems in these people. By examining the sleep quality status of this group of people and the related factors we can obtain valuable information that is useful for the decision makers and policy makers of the health sector; by knowing these factors, they can better plan and adopt the necessary interventions. Therefore, the current study aims to investigate the prevalence of metabolic syndrome indicators, sleep disorders and related factors in older adults with metabolic syndrome in Iran.

Methods
This is a cross-sectional study that was conducted in 2022 (June-September). Using a multi-stage cluster sampling method, 298 patients with metabolic syndrome referred to urban health centers in Baghmalek were selected. The inclusion criteria were age at least 60 years old, diagnosis with metabolic syndrome, having acceptable cognitive and communication ability, having an electronic health record in health center, and declaring written informed consent. The occurrence of traumatic events such as the death of loved ones in the past 6 months and having a history of hospitalization in the past month were the exclusion criteria. 
A demographic form and the Pittsburgh sleep quality index were used to collect data. They were completed by an interview, considering that the majority of participants were illiterate or poorly educated. The data were described using frequency, percentage, mean and standard deviation. The normality of data distribution was checked using the Kolmogorov-Smirnov test. To compare the mean scores of sleep quality in two groups, t-test and analysis of variance were used. Chi-square test was used to examine the difference in the scores based on the qualitative variables. P<0.05 was considered statistically significant. The data analysis was done in SPSS software, version 22.

Results
The mean age of participants was 68.65 years. Most of the participants were female (54.4%), housekeeper (54.4%), illiterate (51.3%), married (91.9%), with health insurance (64.8%) and body mass index (BMI) ≥30 kg/m2 (46.3%). Almost all participants had high blood sugar. About 86% of them had high blood pressure, and about 73% had abdominal obesity. Also, about 44% had high levels of triglycerides and about 33% had low level of high-density lipoprotein. 
It was found that 55% of participants had poor sleep quality. The prevalence of poor sleep quality in women and men was 59% and 51%, respectively. There was a significant difference in sleep quality in terms of age, gender, marital status, life arrangement, and BMI (P<0.05). With the increase of age, the sleep quality decreased significantly, such that the mean score of sleep quality in the age group of ≥80 years was higher than in other age groups (P<0.001). The sleep quality in older women was more unfavorable than in men (P=0.001). Also, a more unfavorable sleep quality was observed in widow/widowed participants (P=0.032). Those who were living alone had a higher mean score than other groups, while those who were living with spouse had a more favorable sleep quality (P=0.002). Moreover, the obese older patients (BMI ≥30 kg/m2) had a more unfavorable sleep quality (P=0.001).

Conclusion
The poor sleep quality in older people with metabolic syndrome living in Baghmalek city in Iran is high. In the future plans and interventions at the national and local levels for these patients, older age groups, women, widow/widowed people, obese people and those living alone should be prioritized. also, considering the prevalence of metabolic syndrome indicators, health and therapeutic interventions should be focused on controlling diabetes, hypertension, and abdominal obesity in the patients.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from the Islamic Azad University, Science and Research Branch (Code: IR.IAU.SRB.REC.1401.132). The necessary explanations were given to the participants and their informed consent was obtained. They had the right to leave the study at any time. The procedures were in accordance with the Declaration of Helsinki. 

Funding
This article was extracted from a master's thesis in geriatric health. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors' contributions
The authors contributed equally to preparing this paper.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the seniors participated in this study for their cooperation.

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