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Sleep Problems in the Elderly
Abstract
Epidemiologic studies have shown that approximately 50% of older adults have sleep problems, many of which carry deleterious consequences that affect physical and mental health and also social functioning. However, sleep problems in late life are often unrecognized, and are inadequately treated in clinical practice. This article focuses on the diagnosis and treatment of the 2 most common sleep problems in older patients: sleep apnea and insomnia.
Copyright © 2015 Elsevier Inc. All rights reserved.
... It is expected that this population will reach its peak around 2050, with a total of approximately 580 million people. By 2050, 26.9% of China's population will be over 65 years old (8)(9)(10). In recent years, the rapid growth of the Chinese economy has triggered changes in the social structure (11). ...
... Compared to young people and children, elderly people are more likely to experience sleep disorders (24,25). In summary, common sleep disorders among elderly people include insomnia, early awakening, frequent nighttime awakenings, obstructive sleep apnea, restless leg syndrome, and so on (14,(26)(27)(28). But not all elderly people will experience sleep disorders, and the frequency of sleep disorders varies in different regions. ...
... The survey results further indicated that health status and adaptation to the migration environment were independent factors influencing sleep quality, with statistically significant differences (P < 0.05).This result is consistent with previous results. The influencing factors of sleep include health, mental, social support, aging, and so on (26). These influencing factors are also applicable to MEFCs. ...
Objective
To investigate the sleep status and mental health of migrants elderly who followed their children (MEFC) and analyze the influencing factors.
Methods
A total of 583 MEFCs were surveyed using a general demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) scale, and the Symptom Checklist 90 (SCL90) scale.
Results
The mean PSQI score for MEFCs was 6.98 ± 0.17, and the average SCL90 score was 64.06 ± 2.03. Multiple linear regression analysis indicated that health status and adaptation to the migration destination were associated with PSQI scores (P < 0.05). Health status, adaptation to the migration destination, and family harmony were associated with SCL90 scores (P < 0.05). The association coefficient between the total PSQI and SCL90 scores was r=0.462 (P < 0.05).
Conclusion
The sleep and mental health of MEFCs were at a normal level. Health status and adaptation influenced sleep status, while health status, adaptation, and family harmony impacted mental health. However, the association between mental health and sleep status was weak.
... Age-related changes in sleep lead to a decline in both sleep quality and duration [11,12]. Research indicates that approximately 60% of older adults experience sleep disorders [13]. ...
... Many older adults do not receive adequate sleep, which can increase the risk of accidents and contribute to various physical and mental health issues [14]. The quality and quantity of sleep significantly impact human health, social relationships, and overall well-being [11,12]. One effective approach to preventing and managing physical and mental health problems is through self-care practices [15]. ...
Background
Population aging presents a significant challenge that requires comprehensive planning. Limited research has been done on the interconnections between happiness, sleep, and self-care in older adults. This study aimed to determine the Happiness, Sleep quality, and Self-care ability among community-dwelling older adults in Tehran, 2023.
Methods
This is a cross-sectional study. We selected 306 eligible, community-dwelling older adults through multistage sampling. Participants were recruited from comprehensive health service centers. We employed three assessments: the Oxford Happiness Inventory (OHI), the Pittsburgh Sleep Quality Index (PSQI), and the Self-Care Ability Scale for the Elderly (SASE). Data analysis was conducted using SPSS version 27, the Spearman correlation test, and univariate and multivariate linear regression analyses.
Results
The results indicated that 58% of older adults were male, 67.6% were married, and 44% were retired. A multivariate linear regression analysis revealed a significant association with happiness. Self-care ability had a negative impact (β = -1.50, p < 0.001), while sleep quality had a positive effect (β = 0.50, p < 0.001).
Conclusion
Self-care and sleep quality are associated with overall happiness. Policymakers and planners should prioritize happiness enhancement by addressing its relationship with sleep and self-care practices.
... Age-related changes in sleep include decreasing sleep quality and duration [11,12]. According to the research conducted, about 60% of older adults have sleep disorders [13]. ...
... Many older adults are deprived of enough sleep, and this problem can lead to an increase in the risk of accidents and suffering from various physical and mental diseases [14,15]. The quality and quantity of sleep affect human health, social relations, and well-being [11,12]. One of the ways to prevent and manage physical and mental problems is self-care [16]. ...
Background
Population aging is one of the challenges of the future, which requires large-scale planning. Examining happiness and its relationship with the quality of sleep and self-care is an aspect that has received less attention in old age. Therefore, this study aimed to determine the relationship between happiness with sleep quality and self-care ability in community-dwelling older adults.
Methods
This is a cross-sectional correlation descriptive research. We selected 306 eligible community-dwelling older adults by multistage sampling referring to comprehensive health service centers. The Oxford Happiness Inventory (OHI), Pittsburgh Sleep Quality Questionnaire (PSQI), and The Self-care Ability Scale for the Elderly (SASE) were used to collect data. Data were analyzed using SPSS v.27 software by Spearman test, univariate and multivariate regression.
Results
The findings showed that 58% of older adults were male, 67.6% were married, and 44% were retired. Multivariate logistic regression showed a significant relationship between self-care ability (β = -1.50, p < 0.001) and sleep quality (β = 0.50, p < 0.001) with happiness.
Conclusion
The level of happiness is directly affected by the self-care ability and sleep quality. Therefore, policymakers and planners should pay more attention to the importance of happiness and its relationship to sleep and self-care ability.
... Good sleep is necessary for health. Sleep disorders in the elderly are associated with serious negative physical, psychological, and social consequences (4).A recent research shows that insufficient sleep, sleep disturbance, and sleep disorders affect many aspects of human health, including cognitive decline, Alzheimer's disease risk(5-7) dementia (8) polypharmacy (1), sexual performance [9], and consequently the quality of life [10,11] and morbidity and mortality rate (1).Also the results of studies showed that other common medical problems in old age, such as high blood pressure, diabetes mellitus, kidney failure, immune system disorders, gastroesophageal reflux disease, respiratory diseases such as asthma, physical disability, depression, and anxiety and dementia are all associated with sleep disorders (12). Researchers proposed several approaches to deal with sleep disorders in the elderly, such as physiological and pharmacological methods (4).Some of the nonpharmacological interventions are: natural light therapy (13,14), brain exercise(15)cognitive behavioral (16) physical activity(17) aromatherapy (18)medicinal Plants (19), auditory stimulation (20)like several types of music therapy (21), include analytical music therapy, cognitive behavioral music therapy (CBMT), community music therapy, Benenson music therapy, vocal psychotherapy and Nordoff-Robbins music therapy, (22), and probably natural sounds (23). ...
... Sleep disorders in the elderly are associated with serious negative physical, psychological, and social consequences (4).A recent research shows that insufficient sleep, sleep disturbance, and sleep disorders affect many aspects of human health, including cognitive decline, Alzheimer's disease risk(5-7) dementia (8) polypharmacy (1), sexual performance [9], and consequently the quality of life [10,11] and morbidity and mortality rate (1).Also the results of studies showed that other common medical problems in old age, such as high blood pressure, diabetes mellitus, kidney failure, immune system disorders, gastroesophageal reflux disease, respiratory diseases such as asthma, physical disability, depression, and anxiety and dementia are all associated with sleep disorders (12). Researchers proposed several approaches to deal with sleep disorders in the elderly, such as physiological and pharmacological methods (4).Some of the nonpharmacological interventions are: natural light therapy (13,14), brain exercise(15)cognitive behavioral (16) physical activity(17) aromatherapy (18)medicinal Plants (19), auditory stimulation (20)like several types of music therapy (21), include analytical music therapy, cognitive behavioral music therapy (CBMT), community music therapy, Benenson music therapy, vocal psychotherapy and Nordoff-Robbins music therapy, (22), and probably natural sounds (23). Researchers have recently demonstrated that the sounds of nature induce a state of relaxation by modulating the central and autonomic nervous systems (24). ...
... Restful and healthy sleep is essential for health and wellbeing, and necessary for physical and psychological functioning [1,2]. Sleep basically consists of two stages: rapid eye movement (REM) and non-REM (NREM) sleep. ...
... With increasing age, REM sleep is often reduced, while the first stage of light NREM sleep is increased. Therefore, older people tend to sleep less and less deeply [1,4]. Sleep disturbances in older people include difficulty falling asleep, frequent nocturnal awakenings, early morning awakenings and daytime sleepiness [5]. ...
Background
Sleep disturbances are common in nursing home residents and challenging for their nurses. Knowledge about sleep and sleep promoting factors is essential to provide adequate sleep management, where nurses play a key role. Therefore, nurses’ knowledge and attitudes towards sleep and sleep promoting interventions is important as enabling or inhibiting factor for successful sleep management.
Methods
A multicenter cross-sectional study was conducted among nurses working wholly or partially at night in nursing homes in Germany. Data were collected between February and April 2021 via online or paper and pencil questionnaires, comprising 56 items. Nursing homes were recruited through existing cooperation with the study centers as well as via nursing home registers.
Results
Finally, 138 nursing homes participated and 271 nurses completed the survey. Nurses agreed that sleep disturbances are an important topic with important impact on resident’ health. Although, the assessment of sleep was seen as nurses’ responsibility, only 40 nurses (14.7%) stated that residents’ sleep was always documented. Only 21.7% reported the availability of policy documents providing guidance regarding the management of sleep disturbances. The vast majority (93.2%) reported never having received training about sleep and management of sleep disturbances after their basic nursing training.
Conclusions
Our results indicate that nurses working at night can play an important role in residents’ sleep promotion. The findings indicate nurses’ educational needs regarding sleep and sleep promotion. Nursing homes should implement institutional guidelines in order to promote residents’ sleep based on adequate evidence-based non-pharmacological interventions.
... 38 Epidemiological studies have shown that about 50% of the elderly have sleep problems, but it is often not fully appreciated in elderly people in clinical practice. 39 The general anesthesia can change postoperative sleep architecture, especially in elderly patients with a high incidence of postoperative sleep disorders; general anesthesia can cause deleterious effects such as increased risk of delirium and cardiovascular events, and poor recovery. 16 It may take a week or more to recover after surgery due to decreased subjective sleep quality and efficiency and increased daytime fatigue. ...
Purpose
To comprehensively evaluate the impact of bispectral index (BIS) monitoring-guided anesthesia depth on the early recovery quality in elderly patients undergoing laparoscopic surgery.
Methods
Ninety patients aged ≥60 years scheduled for laparoscopic surgery under general anesthesia were randomized into three groups: Group C (empirically guided anesthesia), Group B1 (BIS-guided, target range 40–60), and Group B2 (BIS-guided, target range 50–60). Blinded researchers evaluated recovery quality (QoR-15), pain (VAS), and sleep (RCSQ) preoperatively and on postoperative days 1, 2, 3, and 7 (POD1,2,3,7). Postoperative delirium was assessed with CAM (POD1–POD3), and cognitive function (MMSE) was measured preoperatively, POD3, and POD7. Intraoperative data included vital signs, BIS values, anesthetic dosage, emergence/extubation times, PACU stay, and adverse events within three days post-surgery. Time to first ambulation and hospital stay were also recorded.
Results
Compared with Group C, Group B1 and B2 had lower propofol consumption, shorter emergence/extubation times, and higher BIS values (T2-T5 and overall mean) (P<0.05). QoR-15 scores improved on POD2 in Group B1 and on both POD1 and POD2 in Group B2 (P<0.05). The RCSQ scores increased on POD1 and POD3 in Group B1 (P<0.05) and on POD1, POD2 and POD3 in Group B2 (P<0.05). In addition, Group B2 had a shorter PACU stay and time to first postoperative ambulation (P<0.05). No differences were found in the incidence of postoperative delirium, POCD, or MMSE scores among the three groups. Compared to Group B1, Group B2 exhibited shorter emergence and extubation times, elevated BIS values at T3 and T5, a higher mean BIS value throughout surgery, and enhanced QoR-15 scores on POD1 and POD2 (P<0.05).
Conclusion
BIS monitoring-guided anesthesia management can enhance early recovery from laparoscopic surgery in elderly patients with BIS values within a safe range, which may be particularly advantageous for this demographic during laparoscopic procedures.
... "The National Sleep Foundation recommends 7-8 hours of sleep for those aged 65 and older" (Hirshkowitz et al., 2015). However, age-related changes in sleep architecture, such as reduced slowwave sleep and advanced circadian rhythms, lead to increased vulnerability to sleep disturbances, including insomnia (Bliwise & Scullin, 2017;Pacheco & Rehman, 2024;Rodriguez et al., 2015;Sateia, 2014). These sleep issues can adversely affect quality of life, as experiences of neglect and abuse often heighten anxiety and emotional instability, further disrupting sleep patterns (Olofsson et al., 2012). ...
Background: Assessing sleep quality and patterns in later life is essential for accurately diagnosing and effectively treating sleep problems and their associated consequences. The Geriatric Sleep Questionnaire-6 (GSQ-6) is a widely used self-report questionnaire that assesses sleep quality and disturbances specifically among older adults. This study aimed to translate the scale into Arabic and evaluate its psychometric properties in an older Arabic-speaking adults’ population.
Methods: The GSQ-6 was translated into Arabic using forward and backward translation procedures, and was administered to a convenience sample of 539 older adults.
Results: The CFA results supported the unidimensional factor structure proposed by the developers (CFI=0.967, TLI=0.945, RMSEA=0.077. The McDonald’s omega value was of 0.70, indicating acceptable internal consistency. The measurement model had an equivalent factor structure, loadings, intercepts, and residuals across sex. GSQ-6+ scores correlated negatively with quality of life and resilience, and positively with neglect and abuse scores, supporting the validity of our Arabic translation.
Conclusion: The Arabic version of the GSQ-6 demonstrated good psychometric properties. The findings support its use as a valid and reliable measure for evaluating sleep quality among the Arabic-speaking older adult population.
... 3,4 This can be influenced by a decline in mental and physical health, disease-comorbid factors, life satisfaction, and socioeconomic status. 5,6 This multifactorial condition can occur in geriatric patients who are over the age of 60 years so it can cause damage to organ systems resulting in geriatric patients suffering from more than one chronic or degenerative disease and experiencing a decrease in functional status. 7 In this multi-pathological condition, the administration of drugs such as benzodiazepines, diphenhydramine, and antidepressants can have unwanted side effects. ...
Background: Life expectancy continues to grow gradually in developed countries up to 120. The elderly often complain of insomnia which is influenced by mental health, physical illness, comorbid diseases, and life satisfaction. Moreover, multi-pathological conditions can occur in geriatric patients over the age of 60 with insomnia. In this case, the drugs used can have unwanted side effects. Objective: This study aimed to compare the effect of acupuncture with sham on the difference in Pittsburgh Sleep Quality Index (PSQI) scores after the 8 th session in geriatric patients with insomnia. Methods: This single center, randomized, controlled, single-blind clinical trial on geriatric patients who experienced insomnia at the geriatric and acupuncture polyclinic of RSUPN dr. Cipto Mangunkusumo. Thirty-six (36) eligible subjects with consecutive sampling methods were randomly assigned 1:1 into acupuncture and sham groups. PSQI test was conducted at the beginning and end of treatment which will result scores that will be analyzed using the T-Test if they are normally distributed. Otherwise, the Mann-Whitney Test is used. Result: Thirty-four (34) participants completed the trial and two dropped out. Based on the data analysis result, the average of initial PSQI scores between the acupuncture and sham acupuncture groups were not significantly different (p=0,488). Meanwhile, the difference in PSQI scores after 8 th session in the acupuncture group was greater than sham acupuncture (p=0,013). Conclusion: Based on the study results, it was concluded that acupuncture had a greater PSQI score reduction effect than sham acupuncture in geriatric patients with insomnia.
... Studies have found that older adults report sleep difficulty more commonly than younger adults 14,15 . Sleep difficulty among older adults results from a combination of age and disease 16 . For middle-aged and older adults, chronic diseases are also an important factor contributing to the occurrence of sleep difficulty [17][18][19] . ...
Middle-aged and older adults with chronic diseases are more likely to encounter sleep difficulty and have a reduced Health-Related Quality of Life (HRQoL), but there is little research on their possible mechanisms. Therefore, the main objective of this study was to explore how sleep difficulty mediates the impact of chronic diseases on the HRQoL of middle-aged and older adults. The survey data were from a cross-sectional study carried out in 2019 in Hangzhou, China. We used a multi-stage cluster random sampling method to recruit participants from seven districts in Hangzhou. Multiple regression was used to analyze the relationship between chronic diseases, sleep difficulty and HRQoL. And the mediate package in the R language was used to analyze the mediating effect. A total of 3,550 middle-aged and older adults were enrolled, including 2,273 patients with chronic diseases and 1,277 patients without them. Patients with chronic diseases had lower health utility values (β=-0.0084, P < 0.01) and were more likely to suffer from sleep difficulty (β = 0.5737, P < 0.001). After correcting for demographic and life characteristics, the mediation analysis results indicated that sleep difficulty mediated the relationship between chronic diseases and HRQoL (β=-0.0022, 95% Bca CI: -0.0034 -0.0014). Additionally, sleep difficulty influenced the association between chronic diseases and daily activities as well as pain (or discomfort) (β = 0.0083, 95% Bca CI: 0.0042–0.0111; β = 0.0162, 95% Bca CI: 0.0107–0.0225) in the analysis of the dimensions. Sleep difficulty partially mediated the relationship between chronic diseases and HRQoL, and primarily in the daily activities and pain (or discomfort) dimensions in middle-aged and older adults.
... Sömnsvårigheter kan också behandlas med psykologiska beteendeförändringar och aktiverande sysselsättning (Morgenthaler et al., 2006;Gibson et al., 2014). Icke-farmakologisk behandling innefattar även kognitiv beteendeterapi för insomni (KBT-I), sömnhygien, avslappningsövningar och fysisk aktivitet (Rodriguez et al., 2015;Okajima, 2017;Gooneratne & Vitiello, 2014;Montgomery & Dennis, 2004). ...
Bakgrund: Sömnsvårigheter är ett vanligt problem hos äldre, vilket har en negativ inverkan på aktiviteter i det dagliga livet och leder till psykologiska och sociala begränsningar. För att förbättra sömnen behöver äldre utföra meningsfulla aktiviteter. Trots detta förbises ofta fritidsaktiviteter. Syfte: Syftet med studien var att beskriva effekten av fritidsaktivitet för att förbättra sömnen hos äldre. Metod: Studien genomfördes som en systematisk litteraturöversikt. Resultat: De 18 studier som ingick var av randomiserad kontrollerad design (RCT). Åldern på studiedeltagarna varierade mellan 65 och 97 år. De inkluderade studierna beskriver vilka fritidsaktiviteter som har haft effekt på sömnen hos äldre: Tai Chi/ Hatha Yoga/ Pilates (n=6); Promenader/ Styrketräning/ Hemmagym (n=5); Hushållsarbete/ Social gruppaktivitet och fysisk aktivitet (n=2); Vattenaerobics/handmassage (n=2); Dansa/ stretcha/ datorspel (n=3). Konklusion: Delaktighet i fritidsaktiviteter kan vara en icke-farmakologisk hälsofrämjande Intervention för äldre personer med sömnproblem. Därför bör fritidsaktiviteter prioriteras mer i det hälsofrämjande arbetet vid behandling av sömnproblem.
... For example, with the increase in age, there will be an increase in sleep latency and awakening times. 34 Some drugs can also affect the sleep structure, such as benzodiazepines, inhibit REM sleep, re- adverse effects of anti-PD drugs, age-related sleep changes, and the influence of motor symptoms. 35 On the other hand, many studies revealed "sleep benefit" for motor symptoms in PD patients. ...
Objective
Levodopa‐induced dyskinesia (DYS) adversely affects the quality of life of Parkinson's disease (PD) patients. However, few studies have focused on the relationship between DYS and sleep and electroencephalography (EEG). Our study aimed to establish the objective physiological indicators assessed by polysomnography (PSG) that are associated with DYS in PD patients.
Methods
We enrolled 122 patients with PD, divided into two groups: PD with DYS (n = 27) and PD without DYS group (non‐DYS, n = 95). The demographics and clinical characteristics and sleep assessment in the two groups were collected. More importantly, overnight six‐channel PSG parameters were compared in the two groups. We also compared different bands and brain regions of average power spectral density within each group.
Results
Compared with the non‐DYS group, the DYS group tended to have a significantly higher percentage of nonrapid eye movement sleep (NREM). Gender, levodopa equivalent daily dose (LEDD), rapid eye movement (REM) sleep (min), and the NREM percentage were positively correlated with the occurrence of DYS. After adjusting for gender, disease duration, LEDD, taking amantadine or not, and Montreal Cognitive Assessment (MoCA), NREM%, N3%, and REM (min), the percentage of NREM sleep (p = 0.035), female (p = 0.002), and LEDD (p = 0.005), and REM sleep time (min) (p = 0.012) were still associated with DYS. There was no significant difference in whole‐night different bands of average power spectral density between two groups. There was no significant difference in normalized average power spectral density of slow wave activity (SWA) (0.5–2 Hz, 0.5–4 Hz, and 2–4 Hz) of early and late NREM sleep in the DYS group. Dynamic normalized average power spectral density of SWA of low‐frequency (0.5–2 Hz) reduction in the frontal region (p = 0.013) was associated with DYS in logistic regression after adjusting for confounding factors.
Conclusion
PD patients with DYS have substantial sleep structure variations. Higher NREM percentage and less REM percentage were observed in PD patients with DYS. Dynamic normalized average power spectral density of low‐frequency (0.5–2 Hz) SWA reduction in the frontal area could be a new electrophysiological marker of DYS in PD.
... The meta-regression analysis indicated an increasing trend in the global prevalence of depression, anxiety, and stress with age among the elderly. Reasons for this trend may include excessive weight gain [85], tobacco consumption [86,87], excessive consumption of alcoholic beverages and coffee [86], inadequate and irregular sleep patterns [88], diseases such as Alzheimer's and dementia [89], loneliness [90], fear of falling from bed [91], and various physical illnesses such as stroke [92] and heart diseases [93]. Therefore, health authorities and policymakers need to take action to address and prevent cognitive, physical, and mental health issues in the elderly. ...
Background
Several preliminary studies have been conducted in the field of the prevalence of depression, anxiety, and stress in the elderly population. These studies have examined the prevalence in limited geographic areas with small sample sizes. Also, there are many limitations in the meta-analysis studies. The objective of the present study was to synthesize the global prevalence statistics of depression, anxiety, and stress in the elderly population through a systematic review and meta-analysis.
Methods
The present systematic review included retrieval of primary studies from the oldest relevant study up to 2023. To find the relevant studies, international databases such as Scopus, Embase, PubMed, and Web of Science (WoS) were systematically searched. Also, a manual search was performed through the Google Scholar search engine and a review of the sources of related articles. The qualitative assessment of the studies was conducted using the Joanna Briggs Institute (JBI) checklist. Due to a high heterogeneity among the study results, a Random Effects model was chosen.
Results
A total of 42 articles on depression, 47 articles on anxiety and 13 articles on stress were included in the meta-analysis. The overall estimates for prevalence based on a random-effects model were as follows: depression, 19.2% (95% CI: 13.0 − 27.5%); anxiety, 16.5% (95% CI: 11.1 − 22.8%); and stress, 13.9% (95% CI: 5.5 − 30.9%). The highest prevalence of depression and anxiety was recorded in Africa. The prevalence of depression was higher in nursing homes, and stress was more prevalent in individuals with COVID-19 compared to other populations.
Conclusion
The findings revealed a high prevalence of depression, anxiety, and stress in the elderly population. Therefore, it is recommended that healthcare professionals and policymakers pay more attention to the prevention and management of these disorders in the elderly population.
... 20 Diet is another variable that has been identified as a preventive factor for depression. 21,22 The prevalence of insomnia among the elderly is approximately 50%, 23 which is an elevated risk in this age group. ...
Objectives: The present study aims to identify the prevalence and factors associated with depression in older adults attending day care centers in Quito, Ecuador. Methods: This study is a correlational study with a non-experimental cross-sectional design. The study was applied in the 8 "Centros de Experiencia del Adulto Mayor" in the city of Quito, Ecuador. A total of 463 older adults with a mean age of 70.15 years were evaluated. All participants were administered a sociodemographic and health questionnaire, cognitive functioning, levels of depression, autonomy, and physical activity were measured. Results: Using linear regressions, direct relationships were identified between depression scores with marital status (B=0.276, p=0.04) and renal impairment (B=1.257, p=0.007); and inverse relationships with educational level (B=-0. 537, p=0.002), sleep hours (B=-0.342, p<0.001), fish consumption (B=-0.318, p=0.021), physical activity (B=-0.454, p=0.002) and cognitive impairment (B=-0.091, p<0.001). Conclusions: The results reflect the importance of considering a holistic approach in addressing depression in the older adult, including health, functional status and cognitive status together to prevent and or address depression in older adults. This study contributes to the implementation of public health policies related to the variables associated with depression in adults.
... In addition, many benzodiazepine and nonbenzodiazepine hypnotics pose safety concerns for older adults, including impaired cognitive and psychomotor function, postural instability, and increased risk of falls and motor vehicle accidents [3,[9][10][11] and are not recommended for insomnia therapy on the Beers list [11]. ...
Insomnia is more common as people age. Several common hypnotics used to treat insomnia often do not adequately alleviate sleep issues in older adults and may be associated with negative residual effects such as an increased risk of falls, cognitive impairment, automobile accidents, and lack of response to auditory stimuli. The objective of these analyses of three clinical studies was to investigate the efficacy and safety of the dual orexin-receptor antagonist lemborexant (LEM) in older adults.
Study E2006-G000-304 (Study 304; NCT02783729) was a randomized, double-blind, placebo (PBO)-controlled, active-comparator trial where subjects with insomnia disorder received LEM 5 mg (LEM5), LEM 10 mg (LEM10), zolpidem tartrate extended-release 6.25 mg (ZOL), or PBO for 30 days. In crossover Study E2006-E044-106 (Study 106; NCT02583451), healthy subjects (good sleepers) received LEM 2.5 mg, LEM5, LEM10, or PBO for eight nights or zopiclone on days 1 and 8 (and PBO on days 2–7). In crossover Study E2006-A001-108 (Study 108; NCT03008447), healthy subjects received a single dose of LEM5, LEM10, PBO, or ZOL. Sleep assessments included polysomnography-based latency to persistent sleep (LPS), wake after sleep onset (WASO), WASO in the second half of the night (WASO2H), sleep efficiency, postural stability, middle-of-the-night and next-day cognitive performance, middle-of-the-night auditory awakening threshold and return-to-sleep latency, and driving performance.
Overall, 453 of 1006 (45%; Study 304), 24 of 48 (50%; Study 106), and 28 of 56 (50%; Study 108) subjects were aged ≥ 65 years. In Study 304, LEM decreased (improved) LPS, WASO, and WASO2H from baseline more than ZOL and PBO; subjects treated with LEM had greater increases in sleep efficiency (improved) than with ZOL or PBO. In both Studies 304 and 108, postural stability was not impaired at waketime in subjects who received LEM compared with PBO. At waketime, LEM did not impair memory compared with PBO. In Study 108, following middle-of-the-night awakening, LEM and ZOL did not affect subjects’ ability to awaken to auditory stimuli; LEM did not affect tests of memory and attention. In Study 106, LEM did not impair next-day driving performance in healthy elderly compared with PBO. LEM was well tolerated in subjects aged ≥ 65 years.
LEM provided benefits on sleep variables without next-morning residual effects in subjects aged ≥ 65 years, supporting LEM as a treatment option for older adults with insomnia.
Study 304: ClinicalTrials.gov identifier, NCT02783729, date of registration, 26 May 2016. Study 106: ClinicalTrials.gov identifier, NCT02583451, date of registration, 22 October 2015. Study 108: ClinicalTrials.gov identifier, NCT03008447, date of registration, 2 January 2017.
... This paper highlights important directions for future research. First, there is a lack of qualified interventions to address sleep problems, although many older adults report sleep deprivation or sleep problems [97], and there is a growing recognition that exercise behaviors (such as PA), SB, and sleep are interdependent. Second, there is a general lack of follow-up analyses in intervention designs. ...
Background
Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors.
Objective
The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years.
Methods
The literature search was conducted in 6 electronic databases—PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus—from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep.
Results
A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD –0.23, 95% CI –0.33 to –0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework.
Conclusions
eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult–oriented research is needed to develop eHealth interventions that can change multiple behaviors.
Trial Registration
PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418
... It can be noted that across the world, the most common sleep disorder is insomnia, followed by sleep apnea [4]. Several studies have shown that insomnia generally tends to be higher in females, while sleep-disordered breathing is higher in the elderly. ...
Background
Atrial fibrillation (AF) is characterized by the absence of p-waves on ECG and irregular rhythm. It often presents with palpitations either palpitations may occur acutely over a short period or intermittently over several years. Other cardinal symptoms of atrial fibrillation include fatigue, dyspnea, and lightheadedness; it is important however to note that most affected individuals are asymptomatic. Concurrently, sleep disorders such as obstructive sleep apnea (OSA), insomnia, narcolepsy, and circadian rhythm disorders which are a group of conditions associated with the body’s internal clock that affect the timing of sleep and alertness, are raising concerns due to their potential associations to arrhythmias. This review explores the bidirectional relationship between AF and sleep disorders, highlighting their implications for risk stratification and management strategies.
Main body
The narrative approach of this review synthesizes evidence from numerous studies obtained through meticulous literature searches. Specific sleep disorders with a bidirectional relationship with AF are the focus, with scrutiny on the prevalence of this connection. The examination delves into the pathophysiology of sleep-related autonomic dysregulation and inflammation, emphasizing potential management modalities. Various meta-analysis cohorts have highlighted a strong connection between sleep disorders and atrial fibrillation (AF). Patients with sleep disorders, especially OSA, have a higher likelihood of developing AF, and conversely, those with AF are more prone to sleep disorders. This impact is not limited to development, as sleep disorders also contribute to the progression of AF, with AF, in turn, negatively impacting sleep duration and quality. Sleep disorders may play an important role in atrial remodeling as well as electrophysiological abnormalities, rendering the atrial tissue more susceptible to arrhythmogenesis. The narrative review suggests that treating sleep disorders could not only improve sleep quality but also reduce risk factors associated with atrial fibrillation. The effective management of sleep disorders emerges as a potential challenge in preventing and treating atrial fibrillation.
Conclusion
In conclusion, this narrative study highlights the bidirectional relationship between sleep disorders and atrial fibrillation. There is a positive correlation, affecting the development, progression, and management of atrial fibrillation. The detrimental impact of sleep disorders on atrial remodeling and electrophysiological abnormalities underscores the significance of their diagnosis and treatment. Education about the importance of sleep and the benefits of sleep disorder treatment becomes imperative for patients with AF and sleep disorders.
... Sleep issues not only have a strong bidirectional relationship with mood disorders such as depression and anxiety but are also associated with cognitive decline, physical health problems, and decreased work efficiency (18)(19)(20)(21). Particularly among the elderly, over 50% suffer from sleep issues, impacting their physical and mental well-being (22). Furthermore, approximately 80% of individuals with clinical depression experience sleep disturbances (23). ...
Introduction
Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi.
Methods
Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity.
Results
Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes.
Discussion
The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits.
Systematic review registration
PROSPERO, ID: CRD42024506393.
... With aging, sleep becomes more fragmented; for example, lighter sleep, lesser slow-wave sleep, and rapid eye movement, which disadvantage rest and recovery. 24 In critically ill patients, moreover, sleep quality is compromised by several disruptions including sleep disorders, pain, anxiety, acute illness, noise, nursing interruptions, uncomfortable beds, bright light, and unfamiliar surroundings. 25,26 While not yet substantiated, the potential impact of sleep deprivation on specific areas of the central nervous system linked to delirium is considered significant. ...
Aims and background
The efficacy of dexmedetomidine and propofol in preventing postoperative delirium is controversial. This study aims to evaluate the efficacy of dexmedetomidine and propofol for preventing postoperative delirium in extubated elderly patients undergoing hip fracture surgery.
Materials and methods
This randomized controlled trial included participants undergoing hip fracture surgery. Participants were randomly assigned to receive dexmedetomidine, propofol, or placebo intravenously during intensive care unit (ICU) admission (8 p.m. to 6 a.m.). The drug dosages were adjusted to achieve the Richmond Agitation Sedation Scale (RASS) of 0 to –1. The primary outcome was postoperative delirium. The secondary outcomes were postoperative complications, fentanyl consumption, and length of hospital stay.
Results
108 participants were enrolled (n = 36 per group). Postoperative delirium incidences were 8.3%, 22.2%, and 5.6% in the dexmedetomidine, propofol, and placebo groups, respectively. The hazard ratios of dexmedetomidine and propofol compared with placebo were 1.49 (95% CI, 0.25, 8.95; p = 0.66) and 4.18 (95% CI, 0.88, 19.69; p = 0.07). The incidence of bradycardia was higher in the dexmedetomidine group compared with others (13.9%; p = 0.01) but not for hypotension (8.3%; p = 0.32). The median length of hospital stays (8 days, IQR: 7, 11) and fentanyl consumption (240 µg, IQR: 120, 400) were not different among groups.
Conclusion
This study did not successfully demonstrate the impact of nocturnal low-dose dexmedetomidine and propofol in preventing postoperative delirium among elderly patients undergoing hip fracture surgery. While not statistically significant, it is noteworthy that propofol exhibited a comparatively higher delirium rate.
How to cite this article
Ekkapat G, Kampitak W, Theerasuwipakorn N, Kittipongpattana J, Engsusophon P, Phannajit J, et al. A Comparison of Efficacy between Low-dose Dexmedetomidine and Propofol for Prophylaxis of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial. Indian J Crit Care Med 2024;28(5):467–474.
... The number increased to 3/4 in individuals after the COVID-19 disease (Dvořáková et al. 2022). However, it is important to distinguish between sleep problems and natural agerelated sleep changes, as there is no causality between older age and sleep disturbance (Rodriguez et al. 2015). Most studies agree on the following natural changes in sleep architecture caused by aging: reduction in sleep efficiency (SE), increase in NREM phase 1 and reduction in NREM phase 3, reduction in REM phase, as well as REM latency in the first cycle (Feinsilver 2021). ...
Sleep and light education (SLE) combined with relaxation is a potential method of addressing sleep and affective problems in older people. 47 participants took part in a four-week sleep education program. SLE was conducted once a week for 60-90 minutes. Participants were instructed on sleep and light hygiene, sleep processes, and practiced relaxation techniques. Participants were wearing actigraphs for 6 weeks, completed daily sleep diaries, and wore blue light-blocking glasses 120 minutes before bedtime. Measures included scores of the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISS), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI) and actigraphy measurements of sleep latency, sleep efficiency, and sleep fragmentation. Sleep quality increased after SLE based on the subjective assessment and in the objective measurement with actigraphy. PSQI scores were statistically reduced indicating better sleep. Scores after the intervention significantly decreased in ESS and ISS. Sleep latency significantly decreased, whereas sleep efficiency and fragmentation index (%), did not improve. Mood significantly improved after SLE, with lower scores on the BDI-II and STAI. SLE combined with relaxation proved to be an effective method to reduce sleep problems and the incidence of depressive and anxiety symptoms.
... orang yang lebih muda, orang lanjut usia menunjukkan perubahan tidur yang berkaitan dengan usia, termasuk fase tidur lanjut dan penurunan tidur gelombang lambat, yang mengakibatkan tidur terfragmentasi dan terbangun lebih awal(Suzuki, Miyamoto, & Hirata, 2017).Gangguan tidur sering terjadi namun masih kurang dieksplorasi pada lansia. Sleep Apneu dan insomnia merupakan masalah tidur yang didapatkan pada lansia(Rodriguez, Dzierzewsk, & Alessi, 2015). Susah tidur atau insomnia merupakan salah satu masalah kesehatan yang sering dikeluhkan lansia, padahal tidur adalah waktu penting bagi tubuh untuk mengisi ulang energy agar bisa bekerja dengan normal(Agustina, 2022).Berdasarkan salah satu hasil review terkait insomnia pada lansia, dikemukakan bahwa salah satu gangguan tidur yang paling umum terjadi pada populasi lanjut usia adalah insomnia dan sebanyak 50% orang lanjut usia mengeluhkan kesulitan memulai atau mempertahankan tidur(Patel, Steinberg, & Patel, 2018). ...
Gangguan tidur merupakan suatu hal yang sangat mengganggu bagi kesehatan. Gangguan tidur paling sering terjadi pada lansia, hal ini terjadi lantaran terdapat banyak perubahan fisiologi pada lansia yang dapat membuat lansia lebih rentan terhadap beberapa penyakit. Perubahan ini akan terjadi terus menerus seiring pertambahan usia. Dalam mengatasi insomnia, berolahraga secara teratur merupakan salah satu upaya yang dapat dilakukan. Salah satu olahraga yang dapat dilakukan yaitu Senam Lansia. Salah satu review menjelaskan bahwa senam lansia memiliki beberapa manfaat, antara lain manfaat pada psikologis yaitu meningkatkan kualitas tidur dan menurunkan tingkat Insomnia. Metode yang digunakan dalam kegiatan ini yaitu demonstrasi pelaksanaan senam lansia sebagai upaya pencegahan insomnia yang sasarannya adalah kelompok lansia di Panti Sosial Almarhama Kota Tarakan. Hasil kegiatan ini menunjukkan antusiasme para lansia untuk melakukan aktivitas senam lansia untuk meningkatkan kualitas tidurnya. Sehingga, diharapkan pihak panti social melakukan aktivitas senam lansia secara rutin sekali seminggu. Adapun luaran dari kegiatan ini yaitu publikasi artikel hasil kegiatan dalam jurnal nasional terindeks/bereputasi, dan menjadi bahan kajian dalam mata kuliah terkait.
... Another problem and discomfort that typically occur during aging and are associated with the natural process of aging are sleep disorders [7]. Since the importance of sleep for the health and well-being of the elderly is well-known, sleep disorders and the consequences of inadequate and inappropriate sleep can significantly affect their quality of life [8,9]. More than half of elderly individuals suffer from insomnia, and an annual incidence of 5-8% of insomnia has been reported among the elderly [10]. ...
Entering old age is associated with various physical and psychological disabilities. Therefore, the aim of this study is to determine the effect of mindfulness-based stress reduction program on emotion regulation and sleep problems in depressed elderly.
... Medicinal treatments and non-medicinal treatment methods, such as sleep hygiene, stimulus control, limited sleep, relaxation, and cognitive behavioral therapy, could be used to manage difficulties in low-quality sleep. These methods may suit various sleeping disorders (12,20). In managing and treating sleeping disorders, most studies carried out have been based on sleep hygiene methods (21), logotherapy (22), medicinal therapy and acupuncture (23), regular moderate physical activity (24), hydrotherapy (25), cognitive behavioral therapy and tai chi (26,27) and limited research has been done in the field of emotional freedom techniques (28,29). ...
Background: Various physical and mental problems and diseases may develop with aging. Poor sleep quality is the third most common major problem in older adults, affecting all aspects of life. Emotional Freedom Techniques (EFT) can be used to treat the disease in older adults. Objectives: This interventional study attempted to investigate the effect of EFT on sleep quality, sleepiness, and quality of life of older adults. Methods: This was a quasi-experimental study. The selection of the participants was based on the convenience sampling method. Twenty-one people participated in the study and were divided into two groups of interventions. The study was conducted in the adult day-care center. In one group, 11 people and in the other group, 10 people were included. First, an educational session regarding sleep hygiene was held. Then, the EFT was administered for 4 weeks, 2 sessions per week, and each session lasted for 30 - 45 minutes in the intervention group by the student (first author); sleep hygiene training was also provided for the second group. Study measures included the PSQI (Pittsburgh Sleep Quality Index), the Epworth Sleepiness Scale (ESS), and the quality-of-life scale. Follow-ups were performed after the intervention and one month later. The statistical tests used were repeated measures and chi-Square tests. A P-value < 0.05 was considered as statistically significant. Results: The trend of changes in sleep quality (P = 0.001, P = 0.001, respectively) and sleepiness (P = 0.023, P = 0.001, respectively) was incremental and significant before and after the intervention and one month later in each of the groups, but results show that there was no significant interaction effect for any subscale, including subjective sleep quality (P = 0.786), sleepiness (P = 0.568), and quality of life (P = 0.289). Conclusions: According to the results, the EFT was effective on sleep quality, sleepiness, and quality of life of older adults in the adult day-care center, and sleep hygiene was influential.
... Concerning the consequences of sleep disorders, participating SLHP reached a consensus (95.7%) that sleep problems interfere with memory, learning, behavior, emotional regulation, and communication skillshence, the assessments of symptoms, complaints, and sleep disorders are part of the SLHP's responsibilities. [51][52][53][54][55] Participants also reached a consensus that sleep-focused SLHP assess and diagnose orofacial myofunctional disorders regarding SDB (97.9%) and that this competence is exclusive to sleep-focused SLHP (72.3%). Considering that SLHP are the professionals officially trained to assess and diagnose orofacial myofunctional conditions, 34 a consensus was reached that, in the case of SDB, this responsibility is exclusive to sleep-focused SLHPhence, other health professionals should not conduct this assessment. ...
Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach.
Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either “agree” or “disagree”).
Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services.
Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.
... It has been estimated that up to 50% of elderly people report problems related to sleep onset (difficulty falling asleep) and sleep development, such as frequent awakening episodes [6]. Sleep disturbances are common in the elderly [7] and institutionalization in nursing care homes may contribute to increasing the risk of sleep disorders in this population [8]. Sleep disruption and fatigue have been found to predict cognitive impairment [5] or worsen it [9]. ...
Sleep disorders are common in older individuals and are most prevalent in those who are institutionalized. Sleep complaints are often comorbid with medical and neuro-psychiatric illness and associated with polypharmacy. Various studies show an association between sleep disorders and altered levels of inflammatory cytokines, especially IL-6. In this study, an objective sleep analysis was performed using actigraphy, and IL-6 measurements in saliva in 61 older people residing in long-term nursing homes (72.1% women). Almost half (49.2%) of the people had no or mild cognitive impairment, and the rest suffered from moderate to severe dementia, mainly due to Alzheimer’s disease (25 out of 31 individuals). A significant correlation was found between salivary IL6 and sleep parameters; e.g., less salivary IL-6 had significantly (p < 0.05) worse sleep efficiency and more night awakenings. In turn, actigraphy detected alterations in people with dementia in average sleep time, daily bedtime, and average daily time out of bed. There was no significant correlation between these sleep patterns and the total number of psychotropic drugs. No significant differences were found in salivary IL-6 between individuals with or without dementia. These results should be considered in future research with institutionalized people to detect sleep disturbances and to establish interventions aimed to improve sleep quality.
... However, some evidence revealed that the sleep quality significantly improves physical health [16,17], but there is no consensus regarding the association between sleep quality and lipid profile [8,[18][19][20]. The results of some studies have suggested that sleep problems are common during aging and many elderly individuals experience sleep problems during normal aging process [21,22]. Therefore, poor sleep quality in the elderly individuals are frequently untreated and underexplored [23,24]. ...
Background:
Abnormal lipid profile as one of reversible cardiovascular disease risk factors might be affected by poor sleep quality.
Aim:
This study aimed to assess the association between poor sleep quality and serum concentration of lipid profile in Iranian elderly population.
Methods:
The study was performed on a representative sample of 3452 Iranian older people (≥60 years) who contributed in the Iranian Longitudinal Study on Ageing (IRLSA). Sleep quality was measured through the validated Persian version of Pittsburgh Sleep Quality Index (PSQI). Fasting blood samples were collected from the participants to measure plasma levels lipid profile. We used multiple linear regression model to evaluate the independent association of poor sleep quality with lipid profile.
Results:
The mean age of participants was 68.0±6.7 years and 52.5% of them were male. In total, 52.4% of study population reported poor sleep quality (PSQI>5). Mean serum concentration of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was 143.2±74.2 mg/dl, 195.6±43.2 mg/dl, 112.9±31.0 mg/dl, and 57.3±12.4 mg/dl, respectively. Poor sleep quality was significantly associated with serum levels of TG (β=17.85; P=0.006), LDL-C (β=5.45; P=0.039) and HDL-C (β=-2.13; P=0.039) after adjusting for studied covariates.
Conclusion:
Our study illustrates that poor sleep quality is a risk factor for poorer lipid profile. Therefore, early behavioral or pharmacological interventions that improve sleep quality are necessary to modify lipid profile in elderly population.
... 3 Sleep disorders include several types such as insomnia and sleep-disordered breathing (SDB). For example, SDB is reported to be a problem in approximately 50% of the elderly 4 and is twice as common in men than in premenopausal women. 5 In the Wisconsin Sleep Cohort Study, the prevalence of SDB was increasing in both men and women, and one possible cause for this is the increase in obesity in the general population. ...
Sleep is involved in many physiological processes and is essential for both physical and mental health. Obesity and sleep deprivation due to sleep disorders are major public health issues. Their incidence is increasing, and they have a wide range of adverse health-related consequences, including life-threatening cardiovascular disease. The impact of sleep on obesity and body composition is well-known, and many studies have shown an association between insufficient or excessive sleep duration and obesity, body fat percentage, and weight gain. However, there is growing evidence of the effects of body composition on sleep and sleep disorders (particularly sleep disordered breathing) through anatomical and physiological mechanisms (nocturnal fluid shift, core body temperature, or diet). Although some research has been conducted on the bidirectional effects of sleep-disordered breathing and body composition, the specific effects of obesity and body composition on sleep and the underlying mechanisms that explain these effects remain unclear. Therefore, this review summarizes the findings on the effects of body composition on sleep and draws conclusions and proposals for future research in this field.
... 11 Anxiety and depression symptoms are two important and most reported neuropsychiatric symptoms that are strongly related to and intensified by sleep-related symptoms such as circadian rhythm, sleepwalking, and feeling unrested after sleep. 17 A systematic review including nine research studies found that SP significantly predicted higher levels of depression and combined depression/anxiety, although there was a possibility of bi-directionality. 18 Fang et al. 47 concluded that sleep disturbance is not only a comorbidity of depression but also a prodromal symptom, which can predict the occurrence and outcome of depression. ...
Objective: Sleep problems (SP) are highly prevalent and seriously affect health and well-being in old age. The aim of this study was to examine the association between SP and happiness in an urban-dwelling older sample. We further explore the effects of generalized anxiety and depressive symptoms in the SP-happiness link using serial mediating modeling.
Methods: Data came from the 2016-2018 Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (n=661). We measured happiness with the cross-culturally validated item on a five-point scale. The GAD-7 and the CESD-8, respectively, assessed generalized anxiety and depressive symptoms. Participants reported nighttime and daytime SP in the last 30 days. The SPSS-based Hayes' PROCESS macro-program (Model 6) was constructed to quantify the hypothesized mediation effect.
Results: The analysis included 661 adults aged ≥50 years (mean age=65.53 [SD]=11.89 years; 65.20% women). After full adjustment, path models showed that SP was negatively associated with happiness (β=−.1277, 95%CI=−.15950 to −.096). Bootstrapping estimates revealed that SP–happiness link was serially mediated via generalized anxiety representing 8.77%, depressive symptoms yielding 18.95%, and anxiety symptoms→depressive symptoms accounting for 26.70% of the total effect.
Conclusions: Generalized anxiety and depressive symptoms may explain the negative association between SP and happiness in urban-dwelling older adults in the SSA context. Interventions to improve happiness through sleep quality should include mental health. Longitudinal and cross-cultural data are warranted to assess the bi-directionality of this relationship.
... The aging population experiences age-related symptoms, such as slowed metabolism, decreased resistance, and decreased physiological functions, and may even develop age spots and memory loss (1). With the increase in age, many older adults have difficulties in falling asleep, short sleep durations, and problems waking up too early, leading to insomnia, which severely affects sleep quality and the physical and mental health of older adults (2). ...
Background
Sleep problems severely affect the quality of life in the elderly and have gradually gained attention among scholars. As a major hot spot of current research, sleep in older adults is highly exploratory and of great significance for human health.
Objective
Therefore, in this study, the current state of the art of sleep research in older adults was analyzed through the visual mapping function of CiteSpace software. Using this software, we analyzed popular research questions and directions and revealed the development trends and research frontiers of this field.
Methods
In this paper, we searched the Web of Science database for sleep-related studies focusing on older adults and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by using CiteSpace software.
Results
Our results revealed that the number of publications concerning sleep in older adults has gradually increased; after 2017, this field underwent rapid development. The journal Sleep has published the majority of the articles on sleep in older adults and has the highest citation frequency. The Journal of the American Geriatrics Society has the highest impact factor and CiteScore among the top 10 journals in terms of the number of published articles. The United States has the highest number of publications and most of the leading institutions in this field are located in the United States, with the University of California, Los Angeles, and the University of Pittsburgh having the highest number of publications. Dzierzewski JM is the most published author and has played an important role in guiding the development of this field. Research in this area is focused on insomnia, sleep quality, depression, and sleep duration.
Conclusion
The rapid development of sleep research in older adults, which shows a yearly growth trend, indicates that this field is receiving increasing attention from researchers. Insomnia in older adults is the most concerning problem in this field. At the same time, future research should continue to focus on the impact of sleep disorders on older adults to improve sleep and quality of life in older adults.
Cherries are well known to be a rich source of (poly)phenols, especially anthocyanins, with exhibited antioxidant and anti-inflammatory properties. The aim of this review is to describe the effects of cherry extract observed in clinical trials and the respective tolerability indications, highlighting the differences in efficacy depending on the type of extract, cherry, formulation, and dosage used. In particular, the supplementation of standardized tart cherry extracts has been shown to improve different markers of human health, exercise performance, and quality of sleep. Most clinical studies conducted to date have reported the total (poly)phenol and anthocyanin doses administered that were contained in cherry extracts, which ranged from 143 to 2140 mg/day and 15 to 547 mg/day, respectively, as well as the duration of treatments, which ranged from acute supplementation to 84 days. Although cherry extracts are currently prescribed as dietary supplements in several areas of medicine, further investigations of the mechanisms of action and long-term randomized clinical trials (RCTs) are required in order to validate the efficacy and safety of clinical applications. In addition, a real challenge for the next few years is the standardization of cherry’s (poly)phenolic fractions. In this context, the optimization of the extraction procedure and downstream processing represents a key point in reliable active guiding principles for the formulation of food supplements. In fact, due to the different extraction methods of cherries, the relative efficacy is closely related to the specific (poly)phenol profile obtained, which cannot be extrapolated from the literature. Future research should include an analysis reporting the total (poly)phenol content and the specific analytical methods used to quantify total and individual anthocyanin contents.
Objectives
To assess the impact of hypoglossal nerve stimulation (HNS) on neurocognitive, psychological, and sleep outcomes in older adults with obstructive sleep apnea (OSA).
Methods
A retrospective analysis of 42 patients aged 50 years and older who underwent HNS for OSA was conducted. Patient-reported outcomes were collected using validated tools, including the Insomnia Severity Index (ISI), PROMIS measures (Sleep-Related Impairment, Cognitive Function, Depression, Anxiety, Anger, Physical Function), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-10), and NIH Toolbox Loneliness survey. Pre- and post-HNS scores were compared using paired t-tests and Wilcoxon tests.
Results
Significant improvements were observed in apnea–hypopnea index (AHI) (−17.6, P < .0001), ISI (−7.02, P < .0001), ESS (−3.4, P < .0001), and FOSQ (4.05, P < .0001). PROMIS measures showed significant posttreatment improvements in sleep impairment, cognitive function, depression, anxiety, anger, and loneliness (all P < .01). Physical function and pain did not change.
Conclusion
HNS significantly improves sleep characteristics, cognitive function, and psychosocial outcomes in older adults with OSA. Future studies should include larger and more diverse samples with longer follow-up, as well as a control condition.
Study Objectives
While alterations in rest-activity rhythms are common in older adults ‘at risk’ for dementia, it is unclear how rest-activity rhythms relate to underlying brain integrity.
Methods
Older adults aged > 50 years (n=143, mean age=67) with subjective and/or objective cognitive impairment underwent MRI scanning and 14-days of actigraphy. The following non-parametric measures were computed: intra-daily variability (IV), inter-daily stability (IS), relative amplitude (RA), and average activity during the least active 5-hour period (L5). A vertex-wise analysis correcting for age, sex and clinical variables examined the association between nonparametric actigraphy measures and cortical thickness.
Results
When controlling for age, sex, and body mass index (BMI), lower IV was associated with greater cortical thickness in the right cuneus (CWP< 0.001), left middle frontal gyrus (CWP< 0.001) and lateral orbital frontal cortex (CWP= 0.004). When controlling for age, sex, medical burden (CIRS-G), BMI and antidepressant use, lower IS was associated with lower cortical thickness in the left (CWP= 0.002) and right superior frontal gyrus (CWP< 0.001), left superior temporal gyrus (CWP= 0.043) and left post-central gyrus (CWP= 0.033). There were no significant associations between RA or L5 and cortical thickness.
Conclusions
In older adults ‘at risk’ for dementia, variability and stability of rest-activity rhythms were associated with reduced cortical thickness in frontal, temporal, parietal and occipital regions. Studies are now required to determine the prognostic utility of such markers longitudinally.
Background: Poor sleep quality in the elderly is a prevalent issue that can significantly impact overall health and quality of life. This study aimed to assess the prevalence of sleep disorders and the factors contributing to poor sleep quality among older adults in Western Iran.
Study Design: This is a cross-sectional study.
Methods: This study involved 403 elderly people. The following tools were employed to collect data: the Pittsburgh Sleep Quality Index (PSQI), the Leisure and Pleasure Activities Database (a quality-of-life tool), the standardized Depression, Anxiety and Stress Scale (DASS-21), and the Abbreviated Mental Test (AMT)for cognitive assessment. A backward stepwise selection method was employed to finalize the variables for multiple logistic regression analysis.
Results: The overall prevalence of poor sleep quality was 44.7%. With each one-point increase in stress, the likelihood of experiencing poor sleep quality increases significantly (adjusted OR: 1.09, P<0.001). The number of children in the household was found to have a protective effect against poor sleep quality (adjusted OR=0.63, P=0.008). Furthermore, elderly individuals working as housekeepers had higher odds of poor sleep quality than those employed elsewhere (adjusted OR=7.45, P=0.005).
Conclusion: A significant association was observed between elevated stress levels and poor sleep quality. Interestingly, the presence of children in the household appeared to offer a protective effect. Conversely, individuals in household management roles faced a dramatically increased risk of poor sleep quality. These findings offer preliminary evidence for the potential effectiveness of early interventions and prevention strategies designed to improve sleep quality and reduce social frailty in the elderly.
Traumatic brain injuries (TBI) are increasingly common in older adults and represent a substantial source of morbidity and mortality for this population. In addition to the impact from the primary insult, TBI can lead to a variety of chronic neurocognitive conditions including dementia, depression, and sleep disturbances. When caused by TBI, these conditions differ importantly from their non-TBI-related counterparts. Much about how TBI relates to the development of these conditions is unknown, and more research is needed to further elucidate optimal treatment strategies.
Background
Sleep apnea (SA) and insomnia (INS) are prevalent sleep disorders among referrals to sleep clinics. People with comorbid insomnia and sleep apnea (COMISA) suffer both disorders simultaneously. The epidemiology of COMISA is not well known in the Middle East including Iran. We hypothesized that COMISA is prevalent in metropolitan sleep clinic cohorts in Iran.
Method
The records of patients aged < 95 years referred to sleep disorders centers in four large metropolitan areas including Kermanshah, Tabriz, Shiraz, and Ahvaz were examined. Polysomnography (PSG) was performed in all these patients in specialized centers and the results were scored by a trained technician and interpreted by a sleep specialist. SA was defined as an Apnea-Hypopnea Index (AHI ≥ 5), INS was defined by psychiatrists according to self-report and clinical interviews, and COMISA was defined if both disorders were present. Participants with neither condition were included in as comparator group. One-way ANOVAs, correlation, and linear/logistic regression analyses were used.
Results
This study included 1807 patients (Mean age 49.3, SE ± 13.7; 38.8% Female). Comparator, INS, SA and COMISA made up 7.2%, 16%, 50.2% and 26.6% of the sample, respectively. Logistic regression analyses showed that male gender, older age, and increasing neck circumference, but not BMI, were associated with COMISA. Epworth Sleepiness Scale scores were lower in INS (5.39 ± 5.78) compared to the other three groups.
Conclusion
COMISA is a prevalent condition in metropolitan sleep centers in Iran among participants referred to sleep centers. The data showed that male gender and age were associated significantly with COMISA.
Older adults have sleep disorders that lead to decreased quality of life and risk of chronic disease complications. Older adults need to improve their sleep quality to gain a better quality of life. They aimed to investigate the effectiveness of Crocus-sativus-Linnaeus and Clitoria-Ternatea in enhancing the quality of life and sleep of older adults. The quasi-experiment with a control group design was used. The 40 elder adults with hypertension, without dementia, severe cardiovascular disease, and hypersensitivity to compounds; were recruited. The tools were PSQI and WHO-QL. Analysis used t-test and Wilcoxon test. Crocus-sativus-Linnaeus and Clitoria-Ternatea were insignificant in improving sleep quality p = 0.264 (p0.05) and physical domain in quality-of-life p = 0.075. It significantly improved the quality of life in the psychological, social relationships, and the environment, with p = 0.007, p = 0.003, and p = 0.041. For Future research increasing the number of samples is needed.
Background
The importance of sleep has become increasingly recognized in geriatric research. There is a growing body of evidence that links poor sleep with numerous adverse health outcomes in older adults. As a result, assessing sleep quality and patterns in later life has become essential for accurately diagnosing and effectively treating sleep problems and their associated consequences. The Geriatric Sleep Questionnaire-6 (GSQ-6) is a widely used self-report questionnaire that assesses sleep quality and disturbances specifically among older adults. This study aimed to translate the scale into Arabic and evaluate its psychometric properties in an older Arabic-speaking adults’ population.
Methods
The GSQ-6 was translated into Arabic using forward and backward translation procedures, and was administered to a convenience sample of 539 older adults along with the 13-item Older People Quality of Life-Brief (OPQOL-brief), the 15-item Resilience Scale of Older Adults (RSOA), and the 11-item Older Adult Neglect and Abuse Scale (NAS) for validation purposes. Reliability was examined using Cronbach’s alpha and McDonald’s omega coefficients. Confirmatory factor analysis (CFA) was also conducted to test the unidimensional factor structure.
Results
The CFA results supported the unidimensional factor structure proposed by the developers (CFI = 0.967, TLI = 0.945, RMSEA = 0.077. The McDonald’s omega values for the Arabic GSQ-6 was 0.70, indicating acceptable internal consistency. The measurement model had an equivalent factor structure, loadings, intercepts, and residuals across sex. correlated negatively with quality of life and resilience, and positively with neglect and abuse scores, supporting the validity of our Arabic translation.
Conclusion
The Arabic version of the GSQ-6 demonstrated good psychometric properties. The findings support its use as a valid and reliable measure for evaluating sleep quality among the Arabic-speaking older adult population.
A insônia em idosos é uma questão complexa que demanda uma abordagem cuidadosa, especialmente do ponto de vista da psiquiatria. Este distúrbio do sono é comum na população geriátrica e pode ser influenciado por uma variedade de fatores, incluindo mudanças biológicas relacionadas à idade, condições médicas coexistentes, uso de medicamentos e questões psicológicas. Conforme acontece o envelhecimento, ocorrem alterações naturais nos padrões de sono. Os idosos tendem a ter um sono mais fragmentado e menos profundo, o que pode contribuir para a insônia. A diminuição na produção de melatonina, um hormônio que regula o ciclo sono-vigília, também é uma realidade comum nessa fase da vida e pode afetar significativamente a qualidade do sono. Logo, esta revisão narrativa de literatura reuniu artigos das principais bases de dados objetivando indicar opções terapêuticas não medicamentosas para a insônia em idosos. Concluiu-se que as principais opções de tratamentos não medicamentosos para o manejo de insônia em idosos incluem a educação em higiene do sono, a terapia comportamental e a terapia cognitivo comportamental.
The current study aimed to determine the association between sleep duration and quality with health-related quality of life (HRQoL) among the Iranian older persons.
This study was conducted on a representative sample of 3452 Iranian older people (≥ 60 years) who participated in the Iranian Longitudinal Study on Ageing (IRLSA) launched in Neyshabur (Razavi Khorasan province, northeastern Iran). The Persian versions of 12-Item Short Form Survey (SF-12) and Pittsburgh Sleep Quality Index (PSQI) were utilized to measure the level of HRQoL and the level of sleep duration and quality, respectively. Multiple linear regression model was performed to analyze the data and clarify the independent association of sleep duration and quality with HRQoL.
More than half of the study population (52.4%) suffered from poor sleep quality. 57.3% and 3.9% of individuals were short sleepers (< 7 h) and long sleepers (equal or more than 9 h), respectively. The total score of HRQoL was achieved 65.87 ± 20.55. After adjusting the covariates, the results indicated that short sleep duration was negatively associated with HRQoL (P < 0.05), whereas no significant associations were found between long sleep duration and HRQoL (P > 0.05). Interestingly, the results of multiple linear regression model revealed a significant negative association between poor sleep quality and HRQoL (P < 0.001).
The current study confirmed that short sleep duration and poor sleep quality were independently associated with lower HRQoL in the older persons. Therefore, interventional courses should be planned to enrich sleep-related healthcare and general HRQoL in the older persons.
Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep–wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students’ health and wellbeing.
Background
Entering old age is associated with various physical and psychological disabilities. Therefore, the aim of this study is to determine the effect of mindfulness-based stress reduction program on emotion regulation and sleep problems in depressed elderly.
Methods
This study was a clinical trial conducted on 60 elderly individuals with depression using purposive sampling. These elderly were referred by geriatricians and were included in the study based on the inclusion criteria. The participants were randomly assigned to two groups: the Mindfulness-Based Stress Reduction (MBSR) group and the control group. Both groups completed the Geriatric Depression Scale (GDS), the Gratz and Roemer Emotion Regulation Questionnaire, and the Pittsburgh Sleep Quality Index before and after the intervention. The MBSR sessions were held for the experimental group in 8 sessions of 90 min each, once a week. Finally, all the data were analyzed using SPSS software version 26 through descriptive and analytical statistics such as mean and standard deviation, t-tests and mixed analysis of covariance (ANCOVA) with repeated measures.
Results
The results showed that the MBSR intervention led to a significant reduction in depression symptoms (p < 0.001) and improvement in emotion regulation and sleep quality (p < 0.001) among the elderly participants with depression in the intervention group.
Discussion
The results of this study showed that MBSR can be effective in reducing depression levels, improving emotion regulation, and sleep quality among depressed elderly individuals compared to the control group. Caregivers and psychotherapists of nursing homes can use care programs such as MBSR program to improve the physical and mental condition of the elderly.
Trial registration
First Registration: 13/01/2022, Registration Number: IRCT20211118053099N1, Access: https://www.irct.ir/trial/61207.
Purpose: This study aimed to investigate the relationship of sleep quality and insomnia with metabolic/anthropometric parameters in elderly individuals. Materials and Methods: This cross-sectional study was conducted with 474 elderly individuals. Their fasting blood glucose, haemoglobin A1c, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, cortisol, C-reactive protein, weight, waist circumference, waist-to-hip ratio, skeletal muscle mass, body fat mass and body mass index were measured. Their sleep quality was evaluated using the Pittsburgh Sleep Quality Index, and insomnia was assessed using the Insomnia Severity Index. Results: The mean age of the 474 elderly individuals included in the study was 71.02±4.90 years. Poor sleep quality prevalence was found to be 71.1% among the elderly participants and the prevalence of mild to moderate insomnia was 55.1%. The sleep quality score was positively correlated with the postprandial blood glucose level (r=0.121, p
EVT201 is a partial GABAA receptor agonist, which inhibits nervous system to treat insomnia. EVT201 can form a variety of metabolites in vivo including Ro46-1927, Ro18-5528, Ro40-9970, Ro66-9196 and Ro66-5448. This study developed a simple method to realize the simultaneous determination of EVT201 and its five metabolites by HPLC-MS/MS with an electrospray ion source (ESI). The deuterium substitute of EVT201 was chosen as the internal standard and the multiple reaction monitoring (MRM) was used for the quantification. The separation of the six compounds was accomplished with an ACE Excel 3 AQ column (50 × 2.1 mm, 3 µm, ACE). The process of protein precipitating-transferring-nitrogen blowing-reconstituting was adopted for the sample pretreatment. This method was successfully validated according to the FDA guidance. Calibration curves were linear over the concentration range of 0.100-100 ng/mL for EVT201, 0.0300-30.0 ng/mL for Ro46-1927, 0.0600-6.00 ng/mL for Ro18-5528, 0.0200-4.00 ng/mL for Ro40-9970, 0.100-20.0 ng/mL for Ro66-9196 and 0.100-20.0 ng/mL for Ro66-5448. The intra-run and inter-run precisions and accuracies were all within 14.5%. This fully validated method was successfully applied to a clinical pharmacokinetic study of EVT201 and its five metabolites in Chinese healthy subjects after the single (2.5 mg and 5 mg, N = 12) and multiple dose (2.5 mg, N = 13) administration of EVT201 capsules. The test results of 2.5 mg dose group showed that for EVT201, Ro46-1927, Ro18-5528, Ro40-9970, Ro66-9196 and Ro66-5448, the Cmax values (ng/mL) were 39.2 ± 9.2, 10.3 ± 1.4, 0.218 ± 0.044, 0.128 ± 0.051, 7.01 ± 1.51, 8.73 ± 3.69, respectively; the AUC0-t values (h·ng/mL) were 231 ± 79, 143 ± 72, 10.9 ± 2.1, 1.84 ± 0.78, 55.9 ± 18.7, 135 ± 40 respectively. For EVT201, Ro46-1927, Ro66-5528, Ro66-9196 and Ro40-5448, the results of Cmax and AUC0-t proved that the five compounds showed linear pharmacokinetic profile over the dose ranges of 2.5 mg to 5 mg. Meanwhile, it is the first report to evaluate the pharmacokinetic characteristics of Ro40-9970, Ro66-9196 and Ro66-5448 in human plasma. It provided meaningful parameters for the safety and tolerability evaluation of EVT201 capsules in human.
Aims
The aims of the study were to describe sleep quality among community‐dwelling older people; determine the association between sleep quality (total and multidimensional), frailty and overall health; study frailty as a mediator in the association between sleep quality and overall health.
Design
This longitudinal, correlative study used data from 2020 to 2022.
Methods
A total of 181 community‐dwelling older people in a city in Southeast China were assessed twice. Sleep quality was measured using the Pittsburgh Sleep Quality Index at Time 1 (year 2020); frailty was measured using the FRAIL scale, and overall health was measured using the EuroQol visual analogue scale at Time 1 and 2 (1 year later). Associations and indirect effects were examined using linear regression analyses using the PROCESS Macro (Model 4).
Results
Poor sleep quality (higher scores) was associated with increased frailty over time (total scale), as well as subjective sleep quality, sleep duration, sleep efficiency and daytime dysfunction. Mediation analyses indicated that frailty change had an indirect effect on the association between sleep quality total score Time (T) 1 and overall health T2 and between the dimensions subjective sleep quality, sleep duration, sleep efficiency and daytime dysfunction and overall health. All analyses were adjusted for age, multimorbidity and overall health T1.
Conclusions
Poor sleep quality is a common problem associated with poor overall health after 1 year, and the progression of frailty mediates this association.
Impact
The findings provide a better understanding of the association between sleep quality and overall health and elucidate the mediating effect of frailty. Regular screening and effective treatment by healthcare providers for sleep problems and frailty in older people are necessary to improve their overall health and enhance healthy ageing.
Patient or Public Contribution
Participants in the study provided the data used for all data analysis in the manuscript. Patient or public were not involved in data analysis, interpretation or manuscript preparation. Staff in the community health centre helped with data collection.
Objective:
To investigate the association of baseline nocturnal sleep duration and sleep changes with functional disability in middle-aged and elderly Chinese.
Methods:
Data for this study were collected from the China Health and Retirement Longitudinal Study (CHARLS) from baseline (2011) to the Wave 3 follow-up (2018). 8361 participants free of IADL disability in 2011 and aged ≥ 45 years old were recruited and prospectively followed till 2018 to analyze the association between baseline nocturnal sleep duration and IADL disability. Of these 8361 participants, a total of 6948 participants had no IADL disability at the first three follow-up visits and completed the 2018 follow-up to analyze the association between nocturnal sleep changes and IADL disability. Nocturnal sleep duration (hours) was self-reported at baseline. The coefficient of variation (CV) of nocturnal sleep duration at baseline and three follow-up visits was used to calculate sleep changes and classified into mild, moderate, and severe degrees by the quantiles. Cox proportional hazards regression model was used to analyze the association of baseline nocturnal sleep duration with IADL disability, and the binary logistic regression model was used to analyze the association of nocturnal sleep changes with IADL disability.
Results:
Among the 8361 participants of 50237.5 person-years follow-up with a median follow-up of 7 years, 2158 (25.81%) participants developed IADL disabilities. Higher risks of IADL disability were observed among participants with sleep duration <7 h [HR(95%): 1.23(1.09-1.38)], 8∼<9 h [HR(95%): 1.05(1.00-1.32)] and ≥9 h [HR(95%): 1.21(1.01-1.45)] compared to those with 7∼<8 h. Among the 6948 participants, a total of 745 (10.72%) participants finally developed IADL disabilities. Compared with mild nocturnal sleep changes, moderate [OR(95%): 1.48(1.19-1.84)] and severe [OR(95%): 2.43(1.98-3.00)] sleep changes increased the probability of IADL disability. The restricted cubic spline model showed that a higher degree of nocturnal sleep changes was associated with a greater probability of IADL disability.
Conclusion:
Both insufficient and excessive nocturnal sleep duration were associated with higher risk of IADL disability in middle-aged and elderly adults, independent of the participants' gender, age, and napping habits. Higher nocturnal sleep changes were associated with a higher probability of disability in IADL. These findings highlight the importance of appropriate and stable nocturnal sleep, and the need to pay attention to population differences in the impact of nocturnal sleep duration on health.
Objectives:
To determine whether longitudinal trajectories of nighttime sleep duration and daytime napping duration are related to subsequent multimorbidity risk. To explore whether daytime napping can compensate for negative effects of short nighttime sleep.
Methods:
The current study included 5262 participants from China Health and Retirement Longitudinal Study. Self-reported nighttime sleep duration and daytime napping duration were collected from 2011 to 2015. The 4-year sleep duration trajectories were conducted by group-based trajectory modeling. The 14 medical conditions were defined by self-reported physician diagnoses. Multimorbidity was diagnosed as participants with 2 or more of the 14 chronic diseases after 2015. Associations between sleep trajectories and multimorbidity were assessed by Cox regression models.
Results:
During 6.69 years of follow-up, we observed multimorbidity in 785 participants. Three nighttime sleep duration trajectories and three daytime napping duration trajectories were identified. Participants with persistent short nighttime sleep duration trajectory had the higher risk of multimorbidity (hazard ratio = 1.37, 95% confidence interval: 1.06-1.77), compared with those with persistent recommended nighttime sleep duration trajectory. Participants with persistent short nighttime sleep duration and persistent seldom daytime napping duration had the highest risk of multimorbidity (hazard ratio = 1.69, 95% confidence interval: 1.16-2.46).
Conclusions:
In this study, persistent short nighttime sleep duration trajectory was associated with subsequent multimorbidity risk. Daytime napping could compensate for the risk of insufficient night sleep.
Background and objective:
Autotitrating positive airway pressure (APAP) is an accepted titration method to determine the optimal positive airway pressure (PAP), for the treatment of obstructive sleep apnea (OSA). The required duration of APAP monitoring to determine a fixed continuous positive airway pressure level still remains to be established. We aimed to evaluate the variation in PAP level, delivered by APAP devices, at different periods of treatment, to determine the APAP treatment duration required to reach an effective and stable PAP level.
Methods:
A cross-sectional study of 62 patients newly diagnosed with OSA were evaluated after 3 months of APAP therapy. APAP data corresponding to the first day (D1), first week (W1), seventh week (W7) and twelfth week (W12) under APAP therapy was collected. For the analysis of the pressure behaviour, the difference of P95th pressure level between W12 and W7 (P W12-W7), W12 and W1 (P W12-W1) and W12 and D1 (P W12-D1) was calculated.
Results:
There was a high correlation in P95th pressure level between D1 and W12 (r=0.771; p>0.0001), W1 and W12 (r=0.817; p>0.0001), and W7 and W12 (r=0.926; p>0.0001). This correlation progressively increased with APAP use. A significance difference was found in concordance between P W12-W7 and P W12-D1 (p=0.046) within the pressure range ±2cmH2O. However there was no significant difference in concordance between P W12-W7 and P W12-W1.
Conclusions:
One week of APAP therapy seems sufficient to determine an effective and stable PAP level, within the pressure range ±2cmH2O.
Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care.
This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA.
The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique.
Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome measures and long-term follow-up are described.
The frequencies of five common sleep complaints--trouble falling asleep, waking up, awaking too early, needing to nap and not feeling rested--were assessed in over 9,000 participants aged 65 years and older in the National Institute on Aging's multicentered study entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE). Less than 20% of the participants in each community rarely or never had any complaints, whereas over half reported at least one of these complaints as occurring most of the time. Between 23% and 34% had symptoms of insomnia, and between 7% and 15% percent rarely or never felt rested after waking up in the morning. In multivariate analyses, sleep complaints were associated with an increasing number of respiratory symptoms, physical disabilities, nonprescription medications, depressive symptoms and poorer self-perceived health. Sleep disturbances, particularly among older persons, oftentimes may be secondary to coexisting diseases. Determining the prevalence of specific sleep disorders, independent of health status, will require the development of more sophisticated and objective measures of sleep disturbances.
Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients.Methods: The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians.Results: The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions.Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.
Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the effects of these treatments are lacking.
To examine short- and long-term clinical efficacy of cognitive behavioral therapy (CBT) and pharmacological treatment in older adults experiencing chronic primary insomnia.
A randomized, double-blinded, placebo-controlled trial of 46 adults (mean age, 60.8 y; 22 women) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients.
CBT (sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation; n = 18), sleep medication (7.5-mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months.
Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography) on all 3 assessment points.
CBT resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures. For most outcomes, zopiclone did not differ from placebo. Participants receiving CBT improved their sleep efficiency from 81.4% at pretreatment to 90.1% at 6-month follow-up compared with a decrease from 82.3% to 81.9% in the zopiclone group. Participants in the CBT group spent much more time in slow-wave sleep (stages 3 and 4) compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all 3 groups; at 6 months, patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone.
These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults.
clinicaltrials.gov Identifier: NCT00295386.
Insomnia is highly prevalent, has associated daytime consequences which impair job performance and quality of life, and is associated with increased risk of comorbidities including depression. These practice parameters provide recommendations regarding behavioral and psychological treatment approaches, which are often effective in primary and secondary insomnia. These recommendations replace or modify those published in the 1999 practice parameter paper produced by the American Sleep Disorders Association. A Task Force of content experts was appointed by the American Academy of Sleep Medicine to perform a comprehensive review of the scientific literature since 1999 and to grade the evidence regarding non-pharmacological treatments of insomnia. Recommendations were developed based on this review using evidence-based methods. These recommendations were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Psychological and behavioral interventions are effective in the treatment of both chronic primary insomnia (Standard) and secondary insomnia (Guideline). Stimulus control therapy, relaxation training, and cognitive behavior therapy are individually effective therapies in the treatment of chronic insomnia (Standard) and sleep restriction therapy, multicomponent therapy (without cognitive therapy), biofeedback and paradoxical intention are individually effective therapies in the treatment of chronic insomnia (Guideline). There was insufficient evidence to recommend sleep hygiene education, imagery training and cognitive therapy as single therapies or when added to other specific approaches. Psychological and behavioral interventions are effective in the treatment of insomnia in older adults and in the treatment of insomnia among chronic hypnotic users (Standard).
To compare age-group differences in somatic/psychiatric comorbidity, impact, and pharmacotherapy associated with sleep disturbance across a broad adult age range.
Cross-sectional national mental health survey.
Adults living in private households in England, Scotland, and Wales.
8,580 people aged 16 to 74 years.
Insomnia (4 symptom/syndrome definitions), depression, generalized anxiety disorder, and daytime fatigue were defined from the revised Clinical Interview Schedule. Any insomnia was reported by 37% of the sample, moderate insomnia by 12%, insomnia with fatigue by 13%, and symptoms fulfilling diagnostic criteria for primary/secondary insomnia by 5%. All categories of insomnia were associated with mental disorders, worse physical health, and fatigue to a similar degree in all decade age groups. The associations between insomnia categories and separated, divorced, or widowed marital status were strongest in younger participants. Insomnia categories were of longer reported duration and more strongly associated with worse physical health-related quality of life (SF-12) in older age groups. For participants with any definition of insomnia, benzodiazepine hypnotics were more commonly reported in older age groups.
The association between insomnia and impaired quality of life is most pronounced in older age groups. Associations with physical and mental health status and those with daytime fatigue do not vary in strength between age groups. Older people with insomnia in this population were more likely to be taking benzodiazepine hypnotics.
The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future.
Obstructive sleep apnea (OSA) is a major risk factor for perioperative adverse events. However, no screening tool for OSA has been validated in surgical patients. This study was conducted to develop and validate a concise and easy-to-use questionnaire for OSA screening in surgical patients.
After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. After a factor analysis, reliability check, and pilot study; four yes/no questions were used to develop this screening tool. The four questions were respectively related to snoring, tiredness during daytime, observed apnea, and high blood pressure (STOP). For validation, the score from the STOP questionnaire was evaluated versus the apnea-hypopnea index from monitored polysomnography.
The STOP questionnaire was given to 2,467 patients, 27.5% classified as being at high risk of OSA. Two hundred eleven patients underwent polysomnography, 34 for the pilot test and 177 for validation. In the validation group, the apnea-hypopnea index was 20 +/- 6. The sensitivities of the STOP questionnaire with apnea-hypopnea index greater than 5, greater than 15, and greater than 30 as cutoffs were 65.6, 74.3, and 79.5%, respectively. When incorporating body mass index, age, neck circumference, and gender into the STOP questionnaire, sensitivities were increased to 83.6, 92.9, and 100% with the same apnea-hypopnea index cutoffs.
The STOP questionnaire is a concise and easy-to-use screening tool for OSA. It has been developed and validated in surgical patients at preoperative clinics. Combined with body mass index, age, neck size, and gender, it had a high sensitivity, especially for patients with moderate to severe OSA.
As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.
(JAMA. 1989;262:1479-1484)
Objective: The more recent epidemiological studies of sleep complaints have shown that when factors such as physical and psychiatric illness, medication use and drug and alcohol use are accounted for, the age-related increase in prevalence of sleep complaints is strikingly less than in those earlier studies without such controls. In an effort to support this finding, we examined the relationships between clinical health screenings and sleep complaints and disorders in two large groups of potential research volunteers (total N=2954). Methods: As part of a study of older adults at risk for Alzheimer's disease, two large groups of potential research volunteers (n=1619 and 1335, respectively) replied to advertisements that made no mention of sleep and underwent three increasingly rigorous levels of health screening. At each level of screening, medical and psychiatric health and history were assessed and, where appropriate, subjects were excluded from further study participation before any mention of sleep quality or sleep complaint was made. The remaining subjects then underwent polysomnography. Results: Of 1619 elderly adult volunteers screened in this manner, only 51 (3.14%) were found to have significant sleep complaints or disorders. The second group of 1335 screened in this manner revealed a similar pattern with only 18 (1.35%) having significant sleep complaints or disorders. Conclusions: These findings indicate that careful health assessments will screen out most sleep complaints and disorders in the older population and lend further support to the epidemiological evidence demonstrating that the bulk of geriatric sleep complaints and disorders is not the result of age per se, but rather cosegregates with medical and psychiatric disorders and related health burdens.
This paper provides a broad review of the extant literature involving the treatment of sleeplessness in older adults with insomnia. First, background information (including information regarding key issues in late-life insomnia and epidemiology of late-life insomnia) pertinent to achieving a general understanding of insomnia in the elderly is presented. Next, theories of insomnia in older adults are examined and discussed in relation to treatment of insomnia in late-life. With a general knowledge base provided, empirical evidence for both pharmacological (briefly) and psychological treatment options for insomnia in late-life are summarized. Recent advances in the psychological treatment of insomnia are provided and future directions are suggested. This review is not meant to be all-inclusive; however, it is meant to provide professionals across multiple disciplines (physicians; psychologists; applied and basic researchers) with a mix of breadth and depth of knowledge related to insomnia in late-life. It is our hope that readers will see the evidence in support of psychological treatments for late-life insomnia, and the utility in continuing to investigate this treatment modality.
As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.
Data for this report come from a nationally representative probability sample survey of noninstitutionalized adults, aged 18 to 79 years. The survey, conducted in 1979, found that insomnia afflicts 35% of all adults during the course of a year; about half of these persons experience the problem as serious. Those with serious insomnia tend to be women and older, and they are more likely than others to display high levels of psychic distress and somatic anxiety, symptoms resembling major depression, and multiple health problems. During the year prior to the survey, 2.6% of adults had used a medically prescribed hypnotic. Typically, use occurred on brief occasions, one or two days at a time, or for short durations of regular use lasting less than two weeks. The survey also found a small group of hypnotic users (11% of all users; 0.3% of all adults) who reported using the medication regularly for a year or longer. If we include anxiolytics and antidepressants, 4.3% of adults had used a medically prescribed psychotherapeutic drug that was prescribed for sleep; 3.1% had used an over-the-counter sleeping pill. The majority of serious insomniacs (85%) were untreated by either prescribed or over-the-counter medications.
The major behavioral treatments of insomnia--progressive relaxation, biofeedback, cognitive approaches, stimulus control instructions, chronotherapy, and sleep restriction therapy--are described. The basis of these interventions are conceptualized as issuing from the interdependence of sleep and wakefulness, the temporal organization of sleep-wake processes, cognitive effects on arousal, the role of perpetuating factors in chronic insomnia, and conditioning. A pilot study of the conditioning of rapid sleep onset with the aid of a hypnotic provides a preliminary demonstration of the application of conditioning to the pharmacotherapy of sleep. It is predicted that the commonly accepted view of sleep latency as solely reflecting physiological sleep tendency, will require modification to include the effects of conditioning. The current pattern of hypnotic usage, an issue of widespread concern, is subjected to a behavioral analysis based on a new model of conditioned tolerance. The intermittent administration of placebo within a hypnotic regimen is predicted to be especially beneficial in sustaining hypnotic efficacy.
Insomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia.
To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia.
Randomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months.
Seventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia.
Cognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n = 18), pharmacotherapy (temazepam) (n = 20), or both (n = 20) compared with placebo (n = 20).
Time awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians.
The 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach.
Behavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.
The purpose of this meta-analysis was to determine the magnitude of change over the adult life span in four key sleep characteristics and to explore research design features that may account for variability in reported age-related sleep change. Forty-one published studies (combined N = 3293) provided 99 correlational effect sizes. Waking frequency and duration increased with age as previously concluded by narrative reviewers. Although narrative reviewers were less certain whether nighttime sleep amount or the ability to initiate sleep decreased with age, the meta-analysis suggested that both decreased. When sleep variables were measured by polysomnography rather than self-report, larger age-related changes were found. Few researchers who studied normal sleep controlled for important health moderators or studied women.
The more recent epidemiological studies of sleep complaints have shown that when factors such as physical and psychiatric illness, medication use and drug and alcohol use are accounted for, the age-related increase in prevalence of sleep complaints is strikingly less than in those earlier studies without such controls. In an effort to support this finding, we examined the relationships between clinical health screenings and sleep complaints and disorders in two large groups of potential research volunteers (total N=2954).
As part of a study of older adults at risk for Alzheimer's disease, two large groups of potential research volunteers (n=1619 and 1335, respectively) replied to advertisements that made no mention of sleep and underwent three increasingly rigorous levels of health screening. At each level of screening, medical and psychiatric health and history were assessed and, where appropriate, subjects were excluded from further study participation before any mention of sleep quality or sleep complaint was made. The remaining subjects then underwent polysomnography.
Of 1619 elderly adult volunteers screened in this manner, only 51 (3.14%) were found to have significant sleep complaints or disorders. The second group of 1335 screened in this manner revealed a similar pattern with only 18 (1.35%) having significant sleep complaints or disorders.
These findings indicate that careful health assessments will screen out most sleep complaints and disorders in the older population and lend further support to the epidemiological evidence demonstrating that the bulk of geriatric sleep complaints and disorders is not the result of age per se, but rather cosegregates with medical and psychiatric disorders and related health burdens.
The aims of this study were to analyze mortality in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) treated with positive airway pressure (PAP) and to know whether PAP compliance affects survival, as well as to investigate the prognostic value of several pretreatment variables.
A study was made of an historical cohort of 871 patients in whom OSAHS had been diagnosed by sleep study between January 1994 and December 2000 and who had been treated with PAP. Patients were followed up until December 2001. The mean (+/- SD) age of the group was 55.4 +/- 10.6 years, the mean apnea-hypopnea index (AHI) 55.1 +/- 28.7, and 80.9% were men. To assess whether mortality was influenced by PAP therapy compliance, patients were assigned to one of the following compliance categories: < 1 h/d; 1 to 6 h/d; or > 6 h/d. Survival rates were calculated according to the Kaplan-Meier method. Survival curves were compared with the log-rank test and the trend test, when necessary. Univariate and multivariate analyses using a time-dependent Cox model were performed to elicit which variables correlated with mortality.
Outpatient sleep disorders unit.
By the end of the follow-up period (mean duration, 48.5 +/- 22.7 months), 46 patients had died. The 5-year cumulative survival rates were significantly lower in patients who did not use PAP (compliance < 1 h) than in those who used the device for > 6 h/d (85.5% [95% confidence interval (CI), 0.78 to 0.92] vs 96.4% [95% CI, 0.94 to 0.98; p < 0.00005]) and 1 to 6 h/d (85.5% [95% CI, 0.78 to 0.92] vs 91.3% [ 95% CI, 0.88 to 0.94; p = 0.01]), respectively. A trend in survival rates across the groups was identified (p = 0.0004). The main cause of death in 19 cases was cardiovascular disease (CVD). Variables that independently correlated with mortality in the multivariate analysis were the following PAP use categories: compliance for > 6 h/d (odds ratio [OR], 0.10; 95% CI, 0.04 to 0.29); compliance for 1 to 6 h/d (OR, 0.28; 95% CI, 0.11 to 0.69); arterial hypertension (AHT) [OR, 3.25; 95% CI, 1.24 to 8.54]; age (OR, 1.06; 95% CI, 1.01 to 1.10); and FEV1 percent predicted (OR, 0.96; 95% CI, 0.94 to 0.98).
Mortality rates in OSAHS patients who did not receive PAP therapy were higher compared with those treated with PAP and were moderately or highly compliant with therapy. A trend in survival across compliance categories was found. Patients died mainly from CVD. Categories of PAP compliance, AHT, age, and FEV1 percent predicted were the variables that independently predicted mortality.
Continuous positive airways pressure for relieving signs and symptoms of obstructive sleep apnoea Obstructive sleep apnoea is the term used to describe the interruption in normal breathing of individuals during sleep. It is caused by collapse of the upper airways during sleep and is strongly associated with obesity. The mainstay of medical treatment is a machine used at night to apply continuous positive airways pressure (CPAP). The machine blows air through the upper air passages via a mask on the mouth or nose to keep the throat open. We searched and reviewed all randomised controlled trials that had been undertaken to evaluate the benefit of CPAP in adult patients with sleep apnoea. Some of the trials had methodological flaws, although more recent studies have begun to use appropriate forms of control. The overall results demonstrate that in people with moderate to severe sleep apnoea CPAP can improve measures of sleepiness, quality of life and mood and associated daytime sleepiness. CPAP leads to lower blood pressure compared with control, although the degree to which this is achieved may depend upon whether people start treatment with raised blood pressures. Oral appliances are also used to treat sleep apnoea but, whilst some people find them more convenient to use than CPAP, they do not appear to be as effective at keeping the airway open at night. Further good quality trials are needed to define who benefits, by how much and at what cost. Further trials are also needed to evaluate the effectiveness of CPAP in comparison to other interventions, particularly those targeted at obesity.
Continuous positive airways pressure for relieving signs and symptoms of obstructive sleep apnoea Obstructive sleep apnoea is the term used to describe the interruption in normal breathing of individuals during sleep. It is caused by collapse of the upper airways during sleep and is strongly associated with obesity. The mainstay of medical treatment is a machine used at night to apply continuous positive airways pressure (CPAP). The machine blows air through the upper air passages via a mask on the mouth or nose to keep the throat open. We searched and reviewed all randomised controlled trials that had been undertaken to evaluate the benefit of CPAP in adult patients with sleep apnoea. Some of the trials had methodological flaws, although more recent studies have begun to use appropriate forms of control. The overall results demonstrate that in people with moderate to severe sleep apnoea CPAP can improve measures of sleepiness, quality of life and mood and associated daytime sleepiness. CPAP leads to lower blood pressure compared with control, although the degree to which this is achieved may depend upon whether people start treatment with raised blood pressures. Oral appliances are also used to treat sleep apnoea but, whilst some people find them more convenient to use than CPAP, they do not appear to be as effective at keeping the airway open at night. Further good quality trials are needed to define who benefits, by how much and at what cost. Further trials are also needed to evaluate the effectiveness of CPAP in comparison to other interventions, particularly those targeted at obesity.
Sleep complaints among elderly persons -an epidemiological study of 3 communities
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