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Specific disparities exist in the association of sleep quality with sleep duration and QOL in T2DM patients. Failures to take into account the effect of sleep quality when evaluating the impact of sleep on QOL significantly bias the results. It is important to integrate duration and quality of sleep as a composite sleep index when assessing sleep of patients with T2DM.

Background Smartphone use has become an increasingly pervasive part of our daily lives, and as a portable media device, smartphones provide good support for cognitive training during aging. However, little is known about the joint association of smartphone use and gender on the cognitive health of older adults, particularly with regard to multi-domain cognition. Methods A face-to-face survey of 3230 older adults aged 60+ years was conducted in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) score was used to measure both general and multi-domain cognition. Smartphone use was self-reported and the number of the smartphone functions used (NSFU) was classified as 0, 1, and 2+. General and subdomain cognitive functions were modelled on NSFU only, gender only, and NSFU and gender combined by using a series of proportional-odds cumulative logit models. Furthermore, joint associations of gender and NSFU on both general and multi-domain cognition were estimated, and a four-category quantile classification was used to evaluate the total MoCA score. Results Among all 3230 respondents, 2600 remained after exclusion of respondents with very low MoCA scores (below the education-adjusted cut-offs for dementia). Only 29.96% of older adults used smartphones, 473 (60.72%) of which were men. Respondents who had a higher NSFU maintained a better general and sub-domain cognition except for memory and orientation. Although women had lower values compared to men in visuospatial ability (OR (95% CI): 0.46 (0.37–0.57)), they outperformed their male counterparts in memory (OR (95% CI): 1.38 (1.10–1.73)). The results of the joint association showed that women’s inferiority in visuospatial ability diminished when they had a NSFU of 2+. However, a significantly better improvement in memory for male was achieved when they had a NSFU of 1 rather than 2 + . Conclusions A higher NSFU was positively associated with increased general and partial subdomain cognitive functions. However, gender differences were found in visuospatial ability and memory, which could be alleviated by smartphone use.

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