24-hour sleep/wake patterns in healthy elderly persons

Age and objectively measured sleep: investigating associations and interactions by sex and race in middle-aged and older adults

Study Objectives

Few studies of middle-aged and older adults have examined the association between age and sleep using objective sleep measures. We examined these associations in adults aged ≥40 years using wrist actigraphy, and investigated whether these associations differed by sex and race.

Methods

Participants were 468 cognitively normal adults aged ≥40 years enrolled in the Baltimore Longitudinal Study of Aging who completed wrist actigraphy. We used Generalized Least Squares Models to examine the associations of age with actigraphic sleep parameters, including total sleep time (TST), sleep efficiency, sleep onset latency, and wake after sleep onset (WASO). We conducted interaction and stratification analyses to test whether cross-sectional age-sleep associations were modified by sex and race.

Results

In analyses adjusting for sex, body mass index, and individual medical conditions, older age was associated with longer TST from ages 40-70 that plateaued after age 70. Older age also was associated with lower sleep efficiency, longer sleep onset latency, and greater WASO. In men only, after age 70, older age was associated with shorter TST, lower sleep efficiency, longer onset latency, and greater WASO. However, we did not observe any significant interactions of race with age.

Conclusions

Older age was associated with longer TST from ages 40 to 70 and with poorer sleep quality after age 40, and these relationships might vary by sex. Future studies with larger sample sizes are needed to investigate mechanisms that may account for sex differences in the observed age-sleep associations.

Six multidimensional sleep health facets in older adults identified with factor analysis of actigraphy: Results from the Einstein Aging Study

OBJECTIVES

The concept of multi-dimensional sleep health, originally based on self-report, was recently extended to actigraphy in older adults, yielding five components, but without a hypothesized rhythmicity factor. The current study extends prior work using a sample of older adults with a longer period of actigraphy follow-up, which may facilitate observation of the rhythmicity factor.

METHODS

Wrist actigraphy measures of participants (N = 289, Mage = 77.2 years, 67% females; 47% White, 40% Black, 13% Hispanic/Others) over 2 weeks were used in exploratory factor analysis to determine factor structures, followed by confirmatory factor analysis on a different subsample. The utility of this approach was demonstrated by associations with global cognitive performance (Montreal Cognitive Assessment).

RESULTS

Exploratory factor analysis identified six factors: Regularity: standard deviations of four sleep measures: midpoint, sleep onset time, night total sleep time (TST), and 24-hour TST; Alertness/Sleepiness (daytime): amplitude, napping (mins and #/day); Timing: sleep onset, midpoint, wake-time (of nighttime sleep); up-mesor, acrophase, down-mesor; Efficiency: sleep maintenance efficiency, wake after sleep onset; Duration: night rest interval(s), night TST, 24-hour rest interval(s), 24-hour TST; Rhythmicity (pattern across days): mesor, alpha, and minimum. Greater sleep efficiency was associated with better Montreal Cognitive Assessment performance (β [95% confidence interval] = 0.63 [0.19, 1.08]).

CONCLUSIONS

Actigraphic records over 2 weeks revealed that Rhythmicity may be an independent factor in sleep health. Facets of sleep health can facilitate dimension reduction, be considered predictors of health outcomes, and be potential targets for sleep interventions.

Meta-analysis of age and actigraphy assessed sleep characteristics across the lifespan

STUDY OBJECTIVES

Sleep quantity and continuity vary across the lifespan. Actigraphy is a reliable and widely-used behavioral measure of sleep in research and personal health monitoring. This meta-analysis provides a novel examination of whether age (in years) is associated with actigraphy-assessed sleep across the lifespan.

METHODS

A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using "actigraphy" and "sleep" terms provided 7,079 titles/abstracts; studies of individuals with known psychiatric or medical comorbidities were excluded. Ninety-one articles (N = 23,365) provided data for six meta-analyses examining sleep duration (k = 89), sleep efficiency (k = 58), bedtime (k = 19) and waketime (k = 9) for individuals ages 6-21, and bedtime (k = 7) and waketime (k = 7) for individuals ages 22 and older.

RESULTS

At older ages, sleep duration was shorter (r = -0.12) and sleep efficiency was lower (r = -0.05). Older age was associated with later bedtime (r = 0.37) and wake-up time (r = 0.24) from ages 6-21, whereas older age was associated with earlier bedtime (r = -0.66) and wake-up time (r = -0.59) for ages 22 and above. The strength of these associations was modified by study continent, but not by any other moderator.

CONCLUSIONS

Age was negatively associated with actigraphy-assessed sleep duration and efficiency, but the effects were small in magnitude. On the other hand, large associations were observed between age and sleep timing, despite a smaller literature and the absence of analyzable data for ages 30-60. Changes in sleep timing, rather than changes in sleep duration or continuity, may better characterize the effects of age on human sleep.

Practical aspects of actigraphy and approaches in clinical and research domains

Actigraphy involves acquisition of data using a movement sensor worn continuously on the nondominant wrist, typically for a week or more. Computer-based algorithms estimate sleep episodes by analysis of continuous minutes of no to low movement, or spans of time when movement is relatively low compared with movements during presumed ambulatory wakefulness. Inherent advantages of actigraphy over polysomnography include its noninvasive nature, cost-effectiveness, lesser burden on patients/research participants, and ability to collect data over multiple days/nights, thereby allowing examination of sleep-wake patterning. Therefore, actigraphy is emerging as a common method to objectively assess sleep parameters providing estimates of sleep duration and continuity. Modes of actigraphy data collection, scoring algorithms, sleep quality/disturbance measures, validation studies, and clinical and research applications are discussed.

Sleep disorders in the elderly

Sleep disorders are common among elderly people, affecting about 50% compared with about 26% of younger adults. About two-thirds of residents in long-term care have sleep disturbance (Karacan & Williams, 1983; Becker & Jamieson, 1992). This high prevalence of sleep disorders results in excessive daytime napping, fatigue, cognitive impairment, increased psychiatric morbidity and increased prescribing of hypnotics, with an associated increase in mortality (Kripke et al, 1979). Karacan & Williams (1983) quote figures varying from 26 to 100% for the prescribing of hypnotics to residents in institutional care. This has major implications. There is a risk of both accidental and deliberate overdose. There may be interactions with other drugs and a hangover effect can impair daytime functioning. Excessive sedation can make the patient difficult to rouse in an emergency. Dependence may occur and the drugs may further disrupt sleep. They also increase the likelihood of sleep apnoea.

Sleep Patterns and Neuropsychiatric Symptoms in Hospitalized Patients With Dementia

The authors examined 28 dementia inpatients receiving treatment as usual. Beginning-to-end differences in neuropsychiatric symptoms and actigraphic sleep patterns were measured. Using a mixed-model, the authors regressed neuropsychiatric symptoms on average sleep minutes (between-subjects effect) and each night's deviation from average (within-subject effect). Sleep did not significantly differ from beginning to end of participation, whereas neuropsychiatric symptoms did. Average sleep minutes predicted average neuropsychiatric symptoms (p=0.002), but each night's deviation from the average did not predict next day's symptoms (p=0.90). These findings raise questions about the immediate benefits of treating sleep-wake disturbances on neuropsychiatric symptoms in hospitalized inpatients with dementias.

Sick of sitting

Sitting too much kills. Epidemiological, physiological and molecular data suggest that sedentary lifestyle can explain, in part, how modernity is associated with obesity, more than 30 chronic diseases and conditions and high healthcare costs. Excessive sitting--sitting disease--is not innate to the human condition. People were designed to be bipedal and, before the industrial revolution, people moved substantially more throughout the day than they do presently. It is encouraging that solutions exist to reverse sitting disease. Work environments, schools, communities and cities can be re-imagined and re-invented as walking spaces, and people thereby offered more active, happier, healthier and more productive lives.

Sleep and Everyday Functioning in Older Adulthood

As individuals age they report increasing numbers of sleep problems (e.g., increased nighttime wakings) and this poorer sleep quality has been associated with increased risk for various medical conditions; however limited research has focused on the implications of sleep quality on everyday functioning in older adulthood. We compared three methods of sleep data collection (wrist actigraphy, self-report questionnaires, and sleep diary) and evaluated their relationships with three approaches to assessing everyday functioning (direct observation, self-report, and paper-and-pencil-based problem-solving tasks) in cognitively healthy older adults. Consistent with previous research, subjective sleep measures correlated significantly with each other but did not correlate with objective sleep measures. Multiple regression analyses revealed neither objective nor subjective sleep measures predicted everyday functioning. Individual variability in sleep may affect prediction of everyday functioning using a cross-sectional sample. Future research should investigate the combined influence of sleep and cognitive factors on everyday functioning in older adults.

Fatigue and other variables during adjuvant chemotherapy for colon and rectal cancer

PURPOSE/OBJECTIVES

To examine patterns of fatigue and other variables (sleep quality, sleep-wake variables, activity and rest, circadian rhythms, quality of life [QOL], blood counts, and demographic and medical variables) during colon and rectal cancer adjuvant chemotherapy, as well as feasibility of the study.

DESIGN

Longitudinal, descriptive feasibility study.

SETTING

Two oncology clinics in the midwestern region of the United States.

SAMPLE

From April 2006-December 2008, 27% of screened subjects (n = 21) enrolled and 14 completed the study. Participants were middle aged, partnered, and employed and had postsecondary education.

METHODS

Measurements completed during the first week of three two-week cycles (chemotherapy 1-3) and at six weeks (before chemotherapy 4) were the Piper Fatigue Scale, Pittsburgh Sleep Quality Index, wrist actigraphy, Functional Assessment of Cancer Therapy-Colon, blood counts, and demographic and medical data form. Analysis included descriptive statistics and repeated-measures analysis of variance.

MAIN RESEARCH VARIABLES

Fatigue, sleep quality, sleep-wake variables, activity-rest, circadian activity rhythms, and QOL.

FINDINGS

Fatigue was mild at baseline and rose to moderate levels during chemotherapy 1-3. Sleep quality was poor the months prior to chemotherapy 1 and chemotherapy 4. Actigraphy data revealed disturbed sleep, low daytime activity, and impaired circadian activity rhythms during the first week after chemotherapy 1-3. QOL ratings were similar to those in other cancer populations. Fatigue increased, and white blood cell counts decreased significantly over time.

CONCLUSIONS

During adjuvant chemotherapy, patients reported moderate fatigue and poor sleep quality; actigraphs confirmed problems with sleep maintenance as well as low daytime activity and disturbed circadian rhythms. Multiple barriers were encountered during the study.

IMPLICATIONS FOR NURSING

Clinicians should screen for fatigue and sleep-wake variables and use guidelines to select interventions.

Association between nighttime sleep and napping in older adults

STUDY OBJECTIVES

Napping might indicate deficiencies in nighttime sleep, but the relationship is not well defined. We assessed the association of nighttime sleep duration and fragmentation with subsequent daytime sleep.

DESIGN

Cross-sectional study.

PARTICIPANTS

235 individuals (47.5% men, 29.7% black), age 80.1 (2.9) years.

MEASUREMENTS AND RESULTS

Nighttime and daytime sleep were measured with wrist actigraphy and sleep diaries for an average of 6.8 (SD 0.7) nights. Sleep parameters included total nighttime sleep (h), movement and fragmentation index (fragmentation), and total daytime sleep (h). The relationship of total nighttime sleep and fragmentation to napping (yes/no) was assessed using logistic regression. In individuals who napped, mixed random effects models were used to determine the association between the previous night sleep duration and fragmentation and nap duration, and nap duration and subsequent night sleep duration. All models were adjusted for age, race, gender, BMI, cognitive status, depression, cardiovascular disease, respiratory symptoms, diabetes, pain, fatigue, and sleep medication use. Naps were recorded in sleep diaries by 178 (75.7%) participants. The odds ratios (95% CI) for napping were higher for individuals with higher levels of nighttime fragmentation (2.1 [0.8, 5.7]), respiratory symptoms (2.4 [1.1, 5.4]), diabetes (6.1 [1.2, 30.7]), and pain (2.2 [1.0, 4.7]). Among nappers, neither sleep duration nor fragmentation the preceding night was associated with nap duration the next day.

CONCLUSION

More sleep fragmentation was associated with higher odds of napping although not with nap duration. Further research is needed to determine the causal association between sleep fragmentation and daytime napping.

Development of an ambulatory device for monitoring posture change and walking speed for use in rehabilitation

Monitoring of posture change in sagittal plane and walking speed is important for evaluate the effectiveness of rehabilitation program or brace. We have developed a wearable device for monitoring human activity. However, in the previous system, there still remain several drawbacks for practical use such as accuracy in angle measurement, cumbersome cable arrangements, and so on. In order to improve these practical drawbacks, a new sensor system was designed, and its availability was evaluated. The results demonstrated that the accuracy of this system showed superior to that of the previous, and this system appears to be a significant means for quantitative assessment of the patient's motion.

Aging-related sleep changes

Normal aging is accompanied by changes in the sleep quality, quantity, and architecture. Specifically, there appears to be a measurable decrease in the ability of the healthy elderly to initiate and maintain sleep, accompanied by a decrease in the proportion of the deeper, more restorative slow-wave sleep and rapid eye movement sleep. There is epidemiologic evidence that this impaired ability to initiate, maintain, and ultimately achieve good quality, optimal sleep may be a marker of increased mortality and neurocognitive dysfunction. Possible mechanisms related to these age-related changes in sleep include age-related changes in circadian modulation, homeostatic factors, cardiopulmonary function, and endocrine function. This article describes the normal changes in sleep physiology in the elderly.

[Use of telemonitoring by elders at home: actual practice and potential]

DESCRIPTION

The use of telemonitoring services by elders is increasing. In this regard, occupational therapists have been recommending emergency call systems linked to a central monitoring system.

OBJECTIVES

This study sought to document the actual and potential uses of telemonitoring services with an elderly population in a home support context and the impact of these services on occupational therapy practice.

METHODOLOGY

To meet these objectives, a literature review on telemonitoring practices was completed and results were organized according to the Canadian Model of Occupation Performance.

RESULTS

Evidence suggests that new technology and telecommunication is efficacious for monitoring elder's physical and cognitive components, and can have positive impacts on elders' affective component, and social, physical and institutional environment. In regards to monitoring occupations in the home, research and development is promising for personal care such as mobility, sleeping, medication and life routine follow-up.

PRACTICE IMPLICATIONS

The arrival on the market of new products for telemonitoring services will allow easy and continuous monitoring of elder's progress at home in a non invasive manner, and will enable quick intervention when there is a change in day-to-day occupations.

Evaluation of a Wearable Sensor System Monitoring Posture Changes and Activities for Use in Rehabilitation

To evaluate the effectiveness of rehabilitation, physical therapists must assess the posture changes in patients standing-up, walking, etc. Conventional subjective assessment of using direct observation or interviews at rehabilitation centers and of the actual physical condition is difficult, calling for the development of objective measurement of the posture change and activity both at rehabilitation centers, and in the home. One way to do so is to record these using a video camera, but the measurement range is usually limited and not useful in rehabilitation. A wearable system for monitoring angle changes in the trunk, thigh, and calf on the sagittal plane together with walking speed we developed earlier, required that the user carry three sensors for the trunk, thigh, and calf and a data logger, and wear cumbersome cables. To eliminate this practical drawback, we designed a new sensor for rehabilitation and quantitatively assessed posture change during rehabilitation and activity in daily living using the new system. We combined the previous four units into two – a jacket-typed trunk unit holding a data logger and a sensor for measuring trunk angle change and a knee-supporter-typed lower limb sensors containing two angular sensors – greatly simplifying the cumbersome cable assembly. We measured activity in eight rehabilitation subjects and four subjects during daily living using the wearable device. Results demonstrated that our device could measured detailed motion characteristics as angle changes between body segments during rehabilitation, and the rate of four activities – standing, walking, sitting, and lying – during daily living, making it useful in rehabilitation.

Safety Confirmation System Using Mat-Sensor and Power Line Communications for Elderly Person

This paper proposes a safety confirmation system consisting of a mat sensor and a power line communication device that can be installed in small-sized senior citizen welfare facilities without a nurse call and in ordinary households. The proposed system detects when a senior citizen attempts to get out of bed or leave a room, sending an alarm to the control room or a caregiver in another room. The power line communication enables such housing facilities to set up safety confirmation easily and inexpensively. The usefulness of this system has been verified by field examination in the senior citizen welfare facility.

The Reliability and Validity of the Physical Activity Survey in Long-Term Care

The purpose of this study was to develop and test a measure of physical activity for residents in long-term-care facilities, the Physical Activity Survey in Long-Term Care (PAS-LTC). Sixty-six activities are included in the PAS-LTC: routine physical activity, personal-care activities, structured exercise, recreational activities, caretaking activities, and repetitive activities. The study included 13 residents in a long-term-care facility, most of whom were women (62%), with an average age of 84 years (± 6.0) and an average Mini Mental State Examination score of 6 (± 6.9). There was evidence of interrater reliability of the PAS-LTC with intraclass correlations of .83-.94. There was some evidence of validity of the measure with statistically significant correlations between PAS-LTC recorded during the evening and night shifts and the number of counts of activity per the ActiGraph (r= .60 andr= .57, respectively,p< .05) and the calories estimated (r= .58 andr= .60, respectively,p< .05). The PAS-LTC completed during the day shift and total activity based on the PAS-LTC showed nonsignificant correlations of .40 or greater with the ActiGraph activity counts and calories.

Older men's experiences of sleep in the hospital

AIM AND OBJECTIVES

The aim of this study was to examine the sleep experiences of older patients during a period of hospitalization on an extended care ward.

BACKGROUND

Hospital wards have been demonstrated as environments that are not conducive to sleep for patients. Findings highlight the difficulties of falling asleep and getting insufficient sleep as the major causes of sleep disturbances. Such studies limit themselves to patients of Intensive Care Units and acute care settings. Relatively little is known about understanding the sleep experiences of older patients whilst hospitalized on extended care wards.

METHOD

An exploratory qualitative design was used with a convenience sample of six Chinese male informants, recruited from an extended care ward of a Rehabilitation Hospital in Hong Kong. Multiple data collection methods were used, including repeated semi-structured interviews and a one-week sleep diary.

RESULTS

The findings demonstrated that all informants experienced dynamic changes in their sleeping patterns during hospitalization, resulting in sleep disruption and deprivation. The public nature of the ward environment and perceived sense of helplessness significantly interfered with sleep. Some cultural beliefs and practices were perceived by older patients to be associated with the quality of their sleep experiences.

CONCLUSION

The findings contributed to an understanding of the sleep experiences of older patients during hospitalization.

RELEVANCE TO CLINICAL PRACTICE

Implications for nursing practice indicate the significance of including focused sleep assessment of patients during admission into the ward, so strategies perceived by older patients as being able to improve sleep would be included as part of the usual ward routine and nursing practice, where possible.

Effect of Individualized Social Activity on Sleep in Nursing Home Residents with Dementia

OBJECTIVES

To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost.

DESIGN

Pretest/posttest randomized with an experimental and control group.

SETTING

Seven nursing homes.

PARTICIPANTS

One hundred forty-seven residents with dementia.

INTERVENTION

One to 2 hours of individualized social activities for 21 consecutive days.

MEASUREMENTS

Twenty-four-hour sleep/wake patterns using an Actigraph.

RESULTS

The ISAI group had significantly less daytime sleep (P=.001) and a lower day/night sleep ratio (P=.03) than the control group, after adjusting for baseline values. Because 40% of the sample slept 7 or more hours at night, a secondary analysis was conducted. When only those residents with a sleep efficiency of less than 50% (n=50) were included, the ISAI group (n=20) had less daytime sleep (P=.005), a lower day/night sleep ratio (P=.02), fell asleep faster (P=.03), and were awake less at night (P=.04) than the control group (n=30), after adjusting for baseline values. The weekly cost of the ISAI was roughly $70 per participant. Initial training and supply costs were $1,944.

CONCLUSION

The ISAI provides an alternative to medications, without side effects.

Self-Reported Napping and Nocturnal Sleep in Taiwanese Elderly Insomniacs

Abstract The aim of this study was to investigate the relationships between self-reported nocturnal sleep quality and napping patterns in elderly persons with insomnia and to compare the nocturnal sleep quality between napping and non-napping groups. Convenience sampling was used to recruit 60 community-dwelling elderly residents of Taichung City, Taiwan (age range 60-83 years, mean 67.1 years) who reported insomnia. All participants scored greater than 5 on the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Napping prevalence, frequency, and duration were assessed by participant interview. Self-reported sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction were measured with the PSQI. Sixty-four percentage of participants (n = 38) reported napping. There were no age, gender, and ethnicity differences on napping patterns. Global sleep quality, sleep efficiency, and sleep disturbance were significantly associated with prevalence of napping (r = 0.24-0.26, p < 0.05). A significant correlation was also found between global sleep quality and nap duration (r = 0.31, p < 0.05). Elders in the napping group reported better global sleep quality (t = 2.2, p < 0.05) and sleep efficiency (t = 2.1, p < 0.05) than those in the non-napping group. The findings suggest that there is no need for health care providers to restrict elderly insomniacs' daytime napping.

Family caregivers' sleep loss and depression over time

Depression is a normal response when a family member receives a diagnosis of cancer. However, this response may be exacerbated by other factors such as chronic sleep loss that are amenable to intervention. This pilot study described caregiver sleep and depression patterns over time and explored the feasibility of data collection methods and instruments. The stress and coping framework of Lazarus and Folkman guided this study. A descriptive correlational design was used for this 10-week pilot study. Ten adult family caregivers of patients with cancer were recruited from outpatient oncology clinics. Sleep quality and depression were measured weekly. Actigraphs were worn for 72 hours during weeks 1, 5, and 10. Individual sleep quality and depression scores were generated. Actigraph latency, duration, and efficiency scores were generated. Actigraph and sleep quality scores were compared. Individual caregiver sleep and depression plots show large variance over time. Discrepancies were noted between Actigraph and sleep quality latency, duration, and efficiency scores. Sleep and depressive symptoms fluctuate widely over time. Therefore, accurate assessment and treatment of caregiver problems require repeated assessments. Self-reports of sleep and depression appear to underestimate problems and must be evaluated carefully within this context.

Research and commentary: Change in exercise tolerance, activity and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program

PURPOSE/OBJECTIVES

To investigate the feasibility of an exercise program patterned after a phase II cardiac rehabilitation program to improve selected physiologic and psychological parameters of health in patients with cancer.

DESIGN

Prospective, repeated measures study.

SETTING

Two major military medical centers in the southwestern United States.

SAMPLE

62 patients diagnosed with cancer within the previous two years. Ages ranged from 24-83 (meanX = 59). Half of the participants were male and half were female. Minorities made up 29% of the sample. Participants had a wide range of cancer diagnoses and all stages of cancer. Fifteen subjects were undergoing treatment when they enrolled in the study. More than half of the subjects exercised prior to their cancer diagnoses, but fewer than half were able to resume an exercise routine following their cancer diagnoses.

METHODS

Subjects met two days each week for 12 weeks for exercise and education.

MAIN RESEARCH VARIABLES

Exercise tolerance as measured with a graded exercise test, activity and sleep patterns as measured with a wrist actigraph, and quality of life (QOL) as measured with the Cancer Rehabilitation Evaluation System-Short Form.

FINDINGS

Significant improvements were observed over time in exercise tolerance, selected activity and sleep patterns, and QOL among the 46 (74%) subjects who completed the program.

CONCLUSIONS

Patients with various types and stages of cancer can safely exercise using a cardiac rehabilitation model and can realize significant improvements in exercise tolerance, selected activity and sleep patterns, and QOL.

IMPLICATIONS FOR NURSING

Most people are aware that regular exercise is part of a healthy lifestyle. After cancer diagnosis and treatment, patients experience uncertainty regarding how to resume exercise or how to begin an exercise program as part of their rehabilitation. Participation in a structured exercise program can provide patients with a safe environment within which to exercise at an intensity appropriate to their individual needs.

Volitional lifestyle in healthy elderly: its relevance to rest-activity cycle, nocturnal sleep, and daytime napping

Sleep-related problems are prevalent among the aged. The present study examined the influence of a mentally active or "volitional" lifestyle on the rest-activity cycle, nocturnal sleep, and daytime napping in the healthy elderly. 14 aged individuals with a high Volitional lifestyle (M = 74.1 yr. old) and 14 with a Low Volitional lifestyle (M = 73.0 yr. old) were screened by questionnaires including the Philadelphia Geriatric Center Morale scale and the Self-confidence scale. Their activity levels were monitored by a wrist actigraph system for 14 consecutive days. They were also asked to record daily sleep logs. The total times of nocturnal sleep and daytime napping did not differ between the groups. However, the acrophases of circadian (tau = 24 hr.) and circasemidian (tau = 12 hr.) activity cycles were more advanced in the Low Volitional group. In addition, the High Volitional group took a daytime nap with a better timing than did the Low Volitional group: the former started a nap during the phase in which their activity level was going down, whereas the latter when their activity level was going up. These results suggest that high volitional lifestyle may be related to better rest-activity cycle in the healthy elderly.

The role of actigraphy in sleep medicine

During the last decade actigraphy (activity-based monitoring) has become an essential tool in sleep research and sleep medicine. The validity, reliability and limitations of actigraphy for documenting sleep-wake patterns have been addressed. Normative data on sleep-wake patterns across development have been collected. Multiple studies have documented the adequacy of actigraphy to distinguish between clinical groups and to identify certain sleep-wake disorders. Actigraphy has also been shown to be effective in documenting the effects of various behavioral and medical interventions on sleep-wake patterns. Actigraphy is less useful for documenting sleep-wake in individuals who have long motionless periods of wakefulness (e.g. insomnia patients) or who have disorders that involve altered motility patterns (e.g. sleep apnea). Potential users should be aware of a number of pitfalls of actigraphy: (1) validity has not been established for all scoring algorithms or devices, or for all clinical groups; (2) actigraphy is not sufficient for diagnosis of sleep disorders in individuals with motor disorders or high motility during sleep; (3) the use of computer scoring algorithms without controlling for potential artifacts can lead to inaccurate and misleading results.

Actigraphic sleep-wake patterns and urinary 6-sulfatoxymelatonin excretion in patients with Alzheimer's disease

Recent studies suggest melatonin, due to its antioxidant and free-radical-scavenging actions, may play a role in the neuroprotection against amyloid, which is implicated in the pathogenesis of Alzheimer's disease (AD). In this study, we determined urinary 6-sulfatoxymelatonin (aMT6s) excretion together with actigraphic sleep-wake patterns of untreated male patients with AD who lived at home. Results were compared with those obtained from normal age-matched elderly and normal young male subjects. Similar measurements were also performed in another group of patients with AD who were treated with a cholinesterase inhibitor (Donepezil, Aricept). Total 24h aMT6s values were significantly reduced in elderly controls (19.9h +/- 5.2 microg/ 24h), in those with untreated AD (12.7 +/- 4.4 microg/24h), and in patients treated for AD (12.4 +/- 4.4 microg/24h) compared with normal young men (32.8 +/- 3.1 microg/24h). A day-night difference in aMT6s was evident in all young controls, in 50% of elderly controls, in only 20% of patients with untreated AD, and in 67% of those with AD receiving Aricept. Sleep quality (expressed as sleep efficiency, wake time, and long undisturbed sleep duration) was better in young and elderly controls compared with the two groups of patients with AD. There was no significant correlation between aMT6s values or sleep patterns and the severity of cognitive impairment in patients with AD. Taken together, these data suggest that disrupted sleep, decreased melatonin production, and partial lack of day-night difference in melatonin secretion were observed equally in normal elderly and in patients with AD. Our results do not permit drawing any conclusion as to whether changes in urinary aMT6s excretion is correlated with disturbed sleep in patients with AD.

Creation and analysis of a computerized database of interventions to facilitate adult sleep

BACKGROUND

Although sleep problems are a frequent complaint of ill and older adults, there is no ready source of continually updated scientific knowledge about sleep promotion interventions used by nurses.

OBJECTIVES

To create a database of sleep promotion research and to describe the nature and strength of studies about nursing interventions used to promote sleep in adults.

METHODS

Computer, hand, ancestry, and author searches were used to identify nursing and related-discipline studies of sleep promotion in adults. An experimental software program, arcs, was used to store, retrieve, examine, and summarize sleep research findings.

RESULTS

Twelve interventions within the basic scope of nursing practice were identified. All were nonpharmacologic. Interventions were grouped according to their presumed mechanism of action: 1) to relax the sleeper, 2) to manage noise, 3) to re-pattern the sleep-wake schedule, or 4) to inform the sleeper about sleep hygiene.

CONCLUSIONS

The research base underpinning sleep promotion practices in nursing is sparse. The use of relaxation approaches to promote sleep in those with chronic insomnia has the most support. Extensive research involving other interventions and populations is needed. As more studies become available, they can be added to the computer database, thus facilitating dissemination of scientific knowledge to guide nursing practice.

Effects of a daytime nap in the aged

This study evaluated the effects of the daytime nap on performance, mood and physiological measures in aged individuals Participants were six healthy aged persons (M=72.2 years old) who habitually napped in the afternoon three or more times a week. They participated under two conditions with an interval of 1 week. In the nap condition, the subjects went to bed at 13:00 h and slept for 30 min. In the rest condition, they just watched television. In both conditions, electroencephalogram (EEG), blood pressure, mood and performance were measured before and after a nap or rest. The daytime nap improved performance, decreased subjective sleepiness and fatigue, and attenuated EEG alpha band activity. Moreover, following a nap diastolic blood pressure significantly decreased. These findings suggest that a habitual daytime nap helps aged individuals to maintain their daytime physiological, psychological and behavioral arousal at an adequate level.

A follow-up study of actigraphic measures in home-residing Alzheimer's disease patients

This article reports cross-sectional and follow-up data with actigraphic measures of nocturnal sleep and rest/activity in 61 Alzheimer's disease (AD) patients as well as the relation of actigraphic measures to levels of behavioral disturbance across different stages of the disease. Over the course of approximately 1.5 years' follow-up, patients showed significant deterioration of nocturnal sleep parameters, but no significant change in rest/activity circadian rhythm parameters. There were also significant correlations among nocturnal sleep, rest/activity circadian rhythm, and behavioral disturbance measures, but only in relatively early stages of AD. It is argued that study of nocturnal sleep and circadian rhythm in relation to behavioral disturbance in AD requires longitudinal data and analyses that take into account the stage of disease at which patients are assessed.

Sensitivity and reproducibility of the dual-mode actigraph under controlled levels of activity intensity

The purpose of this study was to test the sensitivity and reproducibility of dual-mode actigraphy as an objective measure of functional performance in healthy adults under controlled levels of activity intensity. Twenty subjects wore the instrument on the nondominant wrist while performing standardized tasks selected to represent day-to-day activities at three levels of intensity (five tasks in each level): light (1-2 metabolic equivalents), moderate (3-4 metabolic equivalents), and heavy (4-6 metabolic equivalents). Upon completion of each intensity level, subjects were asked to rate their level of exertion using Borg's 15-point rating of perceived exertion (RPE) scale. Eighteen subjects repeated the protocol within 7 days. Zero-crossing and time-above-threshold modes successfully differentiated between light and moderate and between light and heavy activity. Reproducibility correlation coefficients (rs) across activity levels were .80 and .66 for the two modes, respectively. Results suggest dual-mode actigraphy may be useful for the study of performance variation and structure in healthy and chronically ill individuals.

Sleep patterns in women after coronary artery bypass surgery

Sleep patterns were examined over a 6-month time period after coronary artery bypass graft surgery (CABG) using a wrist-worn actigraph and the Sleep-Rest subscale of the Sickness Impact Profile. The sample included 22 women during the first postoperative week (T1), and 13 of these women during the first posthospitalization week (T2) and the sixth (T3) and twenty-fourth postoperative weeks (T4). Nighttime sleep became less fragmented and, over time, total sleep became more consolidated during nighttime hours, as shown by significant decreases in day, evening, and total sleep and increases in the percentage of total sleep occurring at night during T1. There were also increases in nighttime sleep and percentages of total sleep and the mean sleep interval and decreases in day sleep and evening sleep and nighttime awakenings during T1 through T4. Decreases in the Sleep-Rest subscale indicated perceived improvement in sleep consistent with changes in objective sleep measures over 6 months. These data can be used to help women anticipate changes in sleep patterns over the course of recovery. They suggest the importance of interventions to improve sleep during hospitalization and posthospitalization recovery.