Sleep quality, sleep duration and sexual health among older people: Findings from the English Longitudinal Study of Ageing

Association of Abnormal Sleep Duration and Sleep Disturbance with Physical Activity in Older Adults: Between- and within-Person Effects

OBJECTIVES

Sleep is associated with physical activity (PA), yet the nature and directions of this association are less understood. This study aimed to disentangle the long-term temporal sequences between sleep duration/disturbance and PA in older adults, distinguishing between- and within-person effects.

DESIGN

Longitudinal panel study.

SETTING AND PARTICIPANTS

We conducted a longitudinal study using 3 waves of data collected in 2008/09 (T1), 2012/13 (T2), and 2016/17(T3) from adults aged ≥50 years in the English Longitudinal Study of Ageing (N = 10,749 individuals).

MEASURES

Sleep duration, sleep disturbance, and PA were assessed by self-reported questionnaires. We used cross-lagged panel models (CLPMs) to examine between-person effects and random intercept cross-lagged panel models (RI-CLPMs) to examine within-person effects.

RESULTS

Our analyses revealed a reciprocal relationship between abnormal sleep duration and low PA levels at between-person level (abnormal sleep duration to PA: βT1-T2 = -0.053, βT2-T3 = -0.058, all P < .001; PA to abnormal sleep duration: βT1-T2 = -0.040, βT2-T3 = -0.045, all P < .05), with abnormal sleep duration being the driving force in the dynamic association. In addition, there was a unidirectional effect of more severe sleep disturbance on lower levels of PA at both between- and within-person levels (between-person level: βT1-T2 = -0.032, βT2-T3 = -0.028, all P < .001; within-person level: βT1-T2 and T2-T3 = -0.031, all P = .011).

CONCLUSIONS AND IMPLICATIONS

This study adds novel insights into the temporal directionality of sleep and PA among community-dwelling older adults and highlights poor sleep as a potential risk factor for PA. Intervention strategies should aim to improve sleep to promote PA levels and successful aging.

Relationship of insomnia to sexual function and sexual satisfaction: Findings from the sleep and sex survey II

OBJECTIVE

Research suggests that healthy sleep is a key component of sexual function. When evaluating sexual function, however, poor sleep is often overlooked as a contributing factor. This cross-sectional survey expands prior work by exploring relationships among insomnia severity, sexual satisfaction, and sexual function with an updated battery of measures for the Sleep and Sex Survey.

METHOD

The sample (N = 1266) consisted of 618 men, 648 women recruited via Prolific, an online survey platform. The Sleep and Sex Survey II included measures addressing insomnia, fear of sleep, nightmares, sexual function, sexual satisfaction, sexual activity, depression, anxiety, posttraumatic stress, and alcohol use.

RESULTS

Recent sexual activity was correlated with better sleep, lower anxiety, and lower scores on a posttraumatic stress disorder screener. Insomnia severity was negatively correlated with sexual satisfaction (r = 0.22, p < .001) and the presence of insomnia was associated with higher rates of sexual dysfunction in women (53.8% vs. 31.8%; p < .001) and men (22.7% vs. 12.5%; p = .036). In regression analyses, after accounting for depression and anxiety, insomnia had a statistically significant association with sexual function for women (β = 0.12; p < .01) but not men (β = 0.11; p = .60).

CONCLUSION

Findings support a relationship of insomnia to sexual function and satisfaction with some gender differences. Future work may be enhanced by assessing these relationships in a gender diverse population including objective sleep measures and addressing contributing mechanisms. Clinically, findings support the assessment of sleep when evaluating patients for sexual dysfunction.

What Is the Mediating Role of Communication Skills and Sexual Satisfaction between Job and Life Satisfaction of Healthcare Employees?

There are three areas of harmony in human life that are related to each other: "work environment", "love-to be loved-sexual area" and "social environment". Incompatibility and dissatisfaction in one area can also affect other areas. Therefore, the aim of this study is to examine the relationship between job satisfaction, life satisfaction, communication, and sexual satisfaction of healthcare employees. The data collected by questionnaires from 394 employees working in university hospitals in Turkey were analysed using SPSS and AMOS programs. The findings show that there is a positive relationship between the job and life satisfaction of employees of healthcare organizations. Additionally, the findings revealed that communication skills and sexual satisfaction have a mediating role between job satisfaction and life satisfaction of employees in healthcare organizations. Life satisfaction, sexual satisfaction, and relationships are some of the factors that should be considered by healthcare organizations. It would be beneficial to employees and the public if health policy makers implemented programmes to enhance job satisfaction.

The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis

BACKGROUND

The associations between sexual dysfunction (SD) and sleep disorders, sleep quality, and sleep duration remain unclear.

AIM

To assess the relationship between sleep and SD through a literature review and meta-analysis.

METHODS

The PubMed, Scopus, Embase, Ovid MEDLINE, and Cochrane Library databases were systematically searched from inception to November 10, 2022.

OUTCOMES

Pooled relative risks and 95% CIs were used to examine the association of sleep disorders with SD in longitudinal studies. Pooled odds ratios (ORs) and 95% CIs were used to examine the associations between SD and sleep disorders, sleep quality, and sleep duration in cross-sectional studies.

RESULTS

Forty-three articles, including 11 longitudinal studies and 32 cross-sectional studies, were included in the quantitative analysis. The pooled relative risk of SD in patients with sleep disorders was 1.97 in longitudinal studies (95% CI, 1.46-2.67, P < .001; heterogeneity: I2 = 95.0%, P < .001), while the pooled OR of SD in patients with sleep disorders was 2.05 in cross-sectional studies (95% CI, 1.76-2.39, P < .001; heterogeneity: I2 = 91.4%, P < .001). When compared with controls, subjects with poor sleep quality had a 1.49-fold increased risk of SD (OR, 1.49; 95% CI, 1.31-1.71, P < .001; heterogeneity: I2 = 73.4%, P < .001). In addition, short sleep duration was associated with the risk of SD (OR, 1.14; 95% CI, 1.06-1.22, P < .001; heterogeneity: I2 = 0.0%, P = .849).

CLINICAL IMPLICATIONS

The risk of SD is significantly increased in patients with sleep disorders and poor sleep quality, indicating that clinicians should monitor sleep among patients with SD.

STRENGTHS AND LIMITATIONS

This study is the most comprehensive meta-analysis of the association between sleep and SD to date. However, different sleep disorders may have varying associations with sleep duration and sleep quality; thus, we could not identify the independent effects across the studies.

CONCLUSION

Our systematic review and meta-analysis results suggest that sleep disorders, especially obstructive sleep apnea, increase the risk of SD in men and women. Poor sleep quality is significantly associated with SD. Short sleep duration is associated with an increased risk of SD.

Bidirectional longitudinal associations between balance performance and depressive symptoms in older adults: A cross-lagged panel model

BACKGROUND

Evidence on the temporal sequences between balance and depressive symptoms is limited, and no studies have compared the strength of each direction. This study aimed to assess the association between balance performance and depressive symptoms among community-dwelling older adults, and further to explore the driving factors in the dynamic association.

METHODS

Data were obtained from the English Longitudinal Study of Aging (ELSA). Overall, 3971 community-residing adults aged 50 years or older were assessed at 2004/05, 2008/09, and 2012/13. Balance was measured using three progressively more difficult tasks (side-by-side, semi-tandem, and full-tandem). Depressive symptoms were determined with a dichotomous eight-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Cross-lagged panel models were used to test the reciprocal relationships between balance and depressive symptoms.

RESULTS

Our analyses revealed that earlier poorer balance predicted later worse depressive symptoms consistently across waves (β_W2-W4 = -0.058, P < .05, β_W4-W6 = -0.067, P < .001). Conversely, the higher scores of depressive symptoms at wave 4 predicted lower level of balance at wave 6 (β_W4-W6 = -0.038, P = .018). The cross-lagged effects of balance on depressive symptoms were over all stronger than the reverse effects.

CONCLUSIONS

These findings add novel insights into the temporal directionality of balance and depressive symptoms among community-dwelling older adults, and suggest that a predominance of balance disorder effects. Interventional strategy should aim to increase balance ability from earlier stages to promote successful aging.

Factors associated with poor sleep quality in midlife Singaporean women: The Integrated Women's Health program (IWHP)

Objective

To examine factors associated with poor sleep quality in community-dwelling midlife women.

Methods

Healthy women (aged 45-69 years) of Chinese, Malay and Indian ethnicities attending well-women clinics at the National University Hospital, Singapore, completed the Pittsburgh Sleep Quality Index (PSQI). A PQSI score >5 denoted poor sleep quality. The women filled out validated questionnaires covering menopausal and genito-urinary symptoms, and mental health. Physical performance was measured. Bone mineral density and visceral adiposity were assessed by dual energy X-ray absorptiometry. Binary logistic regression analyses assessed independent factors for poor sleep.

Results

Poor sleep quality was reported in 38.2% of women (n = 1094, mean age: 56.4 ± 6.2 years). Indian women had higher sleep disturbance scores than Chinese women (mean ± SD: 1.33 ± 0.58 vs 1.17 ± 0.49). Malays experienced more daytime dysfunction (0.54 ± 0.60 vs 0.33 ± 0.55) and had a higher overall PSQI score (6.00 ± 3.31 vs 5.02 ± 2.97) than the Chinese. A low education level (aOR: 1.76, 95% CI: 1.01-3.05), feelings of irritability (2.67, 1.56-4.60) and vaginal dryness (1.62, 1.03-2.54) were associated with poor sleep quality in the adjusted multivariable model. Women with moderate to severe disability were ∼3 times (2.99, 1.20-7.44) more likely to experience less than ideal sleep quality, while urinary incontinence (1.53, 1.08-2.17) and breast cancer history (2.77, 1.36-5.64) were also associates of poor sleep quality.

Conclusion

Self-reports of education level, irritability, vaginal dryness, disability, urinary incontinence, and breast cancer history were independently related to poor sleep. Ethnic differences suggest the need for targeted interventions among the ethnic groups.

Living Your Best Life: Lifestyle Medicine for All Women

In an era of ever-increasing healthcare expenditures, yet simultaneously worsening outcomes, many of our patients choose between traditional medical care or often unproven alternative therapies. While the recognition of lifestyle change in addressing cardiovascular and metabolic disease grows, there is less understanding of the impact of lifestyle change on issues facing women every day. Millions of women around the globe struggle with infertility, cancer, sexual dysfunction, and dermatologic needs. Yet, research on the benefits of lifestyle change on these conditions is scarce, and gaps exist both in our understanding of evidence-based approaches to address these issues, as well as adequate provider education when evidence exists. The Women’s Health Member Interest Group convened medical experts in these areas that affect women’s lives to provide insights and meaningful education applicable not only for our patients, but also in our own lives.

Pathways linking abdominal obesity to poor memory function: Explore the mediating role of hypertension and depressive symptoms

BACKGROUND

The negative effect of abdominal obesity on cognitive function has been widely reported, especially on memory function, however, it is unclear how the effect is mediated. We aim to investigate the mediating role of hypertension and depressive symptoms.

METHODS

Data were collected from wave 6 (2012-2013) of the English Longitudinal Study of Ageing (ELSA). Abdominal obesity was defined as a waist circumference (WC) ≥88cm for women and ≥102cm for men. Hypertension was determined on the basis of objective blood pressure measurement and previous physician diagnosis. Depressive symptoms were assessed with the 8-item version of the Center for Epidemiologic Studies (CESD) scale. Memory function was measured with the 10-word immediate and delayed recall tests. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.

RESULTS

A total of 7,448 participants aged ≥50 years were included in this study. We found a negative effect of abdominal obesity on memory function (β=-0.047, p=0.031). KHB method identified significant mediating effect of hypertension and depressive symptoms on the relationship between abdominal obesity and memory function, they explained 16.92 and 6.32% of the total effect of abdominal obesity on memory function, respectively.

LIMITATIONS

This study was limited by its cross-sectional design and possibility of residual confounding.

CONCLUSIONS

Hypertension and depressive symptoms might be possible pathways linking abdominal obesity and poor memory function, suggesting that collaborative interventions of abdominal obesity, hypertension and depressive symptoms are beneficial in maintaining memory function.

Dynapenic abdominal obesity and the effect on long-term gait speed and falls in older adults

BACKGROUND

Although both dynapenia and abdominal obesity have negative impact on physical function and health, few prospective studies evaluate the association of dynapenic abdominal obesity (D/AO) with gait speed and falls. Our aim was to examine the combined effect of low muscle strength and abdominal obesity on long-term gait speed and falls in older adults.

METHODS

We used longitudinal data from the English Longitudinal Study of Ageing (ELSA), including 4987 individuals aged 60 years and over. Grip strength and waist circumference were measured at baseline. Gait speed and fall events (falls, recurrent falls, and fall-related injury) were evaluated during a 14-year follow-up. The study population were divided into nondynapenic nonabdominal obesity (ND/NAO), nondynapenic abdominal obesity (ND/AO), dynapenic nonabdominal obesity (D/NAO), and D/AO, according to the sex-specific grip strength (<16 kg for women and <26 kg for men) and waist circumference (>88 cm for women and >102 cm for men). We used generalized estimating equation (GEE) model with gait speed as the outcome and cox proportional hazards models with fall events as the outcome.

RESULTS

GEE model showed that gait speed decreased during the 14-year follow-up in all groups (all P_time < 0.001). Participants with ND/AO, D/NAO, and D/AO at baseline exhibited a worse gait speed than those with ND/NAO (all P_group < 0.001). No significant difference in the rate of gait speed decline between four groups was found (P_group×time = 0.062). Cox regression analysis showed that D/NAO and D/AO highly predicted falls, and the hazard ratio (HR) was 1.181 (95% CI: 1.002, 1.392) for D/NAO and 1.195 (95% CI: 1.006, 1.421) for D/AO. D/AO was the unique condition associated with recurrent falls and fall-related injury, and the HRs were 1.276 (95% CI: 1.018, 1.599) and 1.348 (95% CI: 1.066, 1.704), respectively.

CONCLUSION

Dynapenia abdominal obesity, determined by low grip strength and high waist circumference, exhibits worse gait speed and increases the risk of fall events in older adults. Effort to maintain the mobility should focus on improving muscle strength and reducing excess body fat.

The Health Benefits of Sexual Expression

Objective

Sexual activity is a fundamental human function with short-term and long-term emotional, social, and physical benefits. Yet within healthcare, sexuality has been marginalized and many HCPs are unaware of its beneficial implications for immediate and long-term health.

Methods

To challenge this assumption we combined the data that already had been collected by the authors with an extensive search of articles on the various health benefits of sexual activity. The results of this process are displayed according to short-term, intermediate-term, and long-term benefits with some explanation about potential causal relationships.

Results

For the time being, it cannot yet be proved that "good sex promotes good health" since good health also favors good sex.

Conclusions

Despite lacking such convincing evidence, the article concludes with recommendations for the relevant professions. The balance of research supports that sexuality anyhow deserves greater attention among HCPs and that sexuality research needs better integration within health research.

Hypoactive Sexual Desire Disorder in Women: Physiology, Assessment, Diagnosis, and Treatment

Nearly half of women in the United States report problems with sexual function. Many health care providers do not ask about sexual concerns during routine clinical encounters because of personal discomfort, lack of familiarity with treatment, or the belief that they lack adequate time to address this complex issue. This may be especially true for hypoactive sexual desire disorder (HSDD), the most commonly identified sexual problem among women. HSDD is characterized by a deficiency of sexual thoughts, feelings, or receptiveness to sexual stimulation that has been present for at least 6 months, causes personal distress, and is not due to another medical condition. This is an up-to-date overview of HSDD for clinicians, discussing its physiology, assessment, diagnosis, and treatment strategies. Although a definitive physiology of HSDD is still unknown, multiple hormones and neurotransmitters likely participate in a dual-control model to balance excitation and inhibition of sexual desire. For assessment and diagnosis, validated screening tools are discussed, and the importance of a biopsychosocial assessment is emphasized, with guidance on how this can be implemented in clinical encounters. The 2 recently approved medications for HSDD, flibanserin and bremelanotide, are reviewed as well as off-label treatments. Overall, HSDD represents a common yet likely underrecognized disorder that midwives and other health care providers who care for women across the life span are in a unique position to address.

Associations of Sleep Quality with Gait Speed and Falls in Older Adults: The Mediating Effect of Muscle Strength and the Gender Difference

INTRODUCTION

Although previous studies have reported the significant associations of sleep quality with gait speed and falls, the mechanisms underlying these associations are unclear. We aimed to examine the gender-specific associations of sleep quality with gait speed and falls among older adults and to explore the possible mediating effect of muscle strength on these relationships.

METHODS

Data were taken from wave 6 (2012-2013) of the English Longitudinal Study of Aging (ELSA), including 7,664 participants aged 60 years and older. Sleep quality and falls were assessed by self-report. Gait speed was measured by the "timed walking test" and then adjusted by height. As an indicator of overall muscle strength, grip strength was measured by using the Smedley dynamometer. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were used to examine the mediating effect.

RESULTS

Higher sleep quality was associated with the higher level of gait speed (β = 0.008, p = 0.031 in men; β = 0.008, p = 0.017 in women) and with lower prevalence of falls (OR = 0.878, 95% CI: 0.773, 0.998 in men; OR = 0.874, 95% CI: 0.792, 0.965 in women). Grip strength mediated these associations in men but not in women, and the mediating effects of grip strength can explain 23.74 and 11.01% of the total effect of sleep quality on gait speed and falls, respectively.

CONCLUSION

Our findings help explain the mechanism underlying the associations of sleep quality with gait speed and falls. Effort to maintain the mobility of the older men should focus on improving both sleep quality and muscle strength.

Sleep and Sex: A Review of the Interrelationship of Sleep and Sexuality Disorders in the Female Population, Through the Lens of Sleeping Beauty Syndrome

INTRODUCTION

For many, sleep and sex are crucial for physical, emotional, and mental well-being. Poor sleep quality is linked to a myriad of ailments from coronary artery disease to major depressive disorder. Likewise, a decrease in the frequency of sexual activity is associated with a decrease in self-rated health status. Kleine-Levin syndrome (KLS) is a rare sleep disorder that provides a unique lens to examine the intricate interplay between sleep and sex as it is one of the few sleep disorders defined by concomitant sexual dysfunction.

OBJECTIVES

This study reviews the literature on links between sleep disorders and sexuality with a focus on women's health followed by a case study of unusual patient with KLS with persistent genital arousal disorder.

METHODS

Literature searches were conducted for English language publications, including foreign language publications with English abstracts with ninety-five articles reviewed. The literature review is followed by a case report.

RESULTS

We review the known literature linking sleep and women's sexual health with a focus on insomnia, circadian rhythm sleep disorder, obstructive sleep apnea, restless leg syndrome, sexsomnia, and KLS. We then present a case of KLS-associated persistent genital arousal disorder, which was amenable to treatment with a multimodal approach aimed at symptomatic relief with intravaginal diazepam suppositories, topical clitoral lidocaine, and duloxetine.

CONCLUSION

This case highlights that hypersexuality and persistent arousal cannot effectively be treated in isolation but rather must be contextualized within a patient's broader medical history and diagnoses. Specifically, sleep quality and potential sleep disorders should be assessed for those presenting with sexual health complaints (and vice versa). Zwerling B, Keymeulen S, Krychman ML. Sleep and Sex: A Review of the Interrelationship of Sleep and Sexuality Disorders in the Female Population, Through the Lens of Sleeping Beauty Syndrome. Sex Med Rev 2021;9:221-229.