Evaluation of Sleep Disturbances in Older Adults

Sleep Disorders and Aging in Women

Women of advancing age can suffer from an array of sleep disorders. We review the changes in sleep architecture, the impact of hormonal changes on sleep, and the various sleep disorders in women of advancing age. A focused history in this population should include the temporal relation to menopause and comorbid conditions. Treatment options should involve patient preference and review of current medications and comorbid conditions to optimize sleep in this population.

Perioperative Brain Health in the Older Adult: A Patient Safety Imperative

While people 65 years of age and older represent 16% of the population in the United States, they account for >40% of surgical procedures performed each year. Maintaining brain health after anesthesia and surgery is not only important to our patients, but it is also an increasingly important patient safety imperative for the specialty of anesthesiology. Aging is a complex process that diminishes the reserve of every organ system and often results in a patient who is vulnerable to the stress of surgery. The brain is no exception, and many older patients present with preoperative cognitive impairment that is undiagnosed. As we age, a number of changes occur in the human brain, resulting in a patient who is less resilient to perioperative stress, making older adults more susceptible to the phenotypic expression of perioperative neurocognitive disorders. This review summarizes the current scientific and clinical understanding of perioperative neurocognitive disorders and recommends patient-centered, age-focused interventions that can better mitigate risk, prevent harm, and improve outcomes for our patients. Finally, it discusses the emerging topic of sleep and cognitive health and other future frontiers of scientific inquiry that might inform clinical best practices.

Sleep Disorders and Aging in Women

What are the effects of sleep disturbance and changes of sleep on aging women in the short and long term? Most research that has been done in recent years evaluates how sleep disorders and sleep disturbance may change mortality and outcomes of this population. Many confounding factors may be playing a role, including comorbid conditions. This article reviews sleep disorders including insomnia, circadian sleep-wake rhythm disorders, restless legs syndrome, disorders of hypersomnia, and sleep-disordered breathing in women aged 65 and older; prevalence of these disorders; and recommended treatment options.

The Feasibility and Utility of Continuous Sleep Monitoring in Critically Ill Patients Using a Portable Electroencephalography Monitor

BACKGROUND

Sleep disruption in critically ill adults can result in acute decrements in cognitive function, including delirium, but it is underdiagnosed in the setting of the intensive care unit (ICU). Although sleep stages can be assessed by polysomnography (PSG), acquisition and interpretation of PSG is costly, is labor intensive, is difficult to do over an extended period of time with critically ill patients (multiple days of continuous recording), and may interfere with patient care. In this pilot study, we investigated the feasibility and utility of monitoring sleep in the ICU setting using a portable electroencephalography (EEG) monitor, the SedLine brain monitor.

METHODS

We first performed a baseline comparison study of the SedLine brain monitor by comparing its recordings to PSG recorded in a sleep laboratory (n = 3). In a separate patient cohort, we enrolled patients in the ICU who were monitored continuously with the SedLine monitor for sleep disruption (n = 23). In all enrolled patients, we continuously monitored their EEG. The raw EEG was retrieved and sleep stages and arousals were analyzed by a board-certified technologist. Delirium was measured by a trained research nurse using the Confusion Assessment Method developed for the ICU.

RESULTS

For all enrolled patients, we continuously monitored their EEGs and were able to retrieve the raw EEGs for analysis of sleep stages. Overall, the SedLine brain monitor was able to differentiate sleep stages, as well as capture arousals and transitions between sleep stages compared with the PSG performed in the sleep laboratory. The percentage agreement was 67% for the wake stage, 77% for the non-rapid eye movement (REM) stage (N1 = 29%, N2 = 88%, and N3 = 6%), and 89% for the REM stage. The overall agreement was measured with the use of weighted kappa, which was 0.61, 95% confidence interval, 0.58 to 0.64. In the ICU study, the mean recording time for the 23 enrolled patients was 19.10 hours. There were several signs indicative of poor-quality sleep, where sleep was distributed throughout the day, with reduced time spent in REM (1.38% ± 2.74% of total sleep time), and stage N3 (2.17% ± 5.53% of total sleep time) coupled with a high arousal index (34.63 ± 19.04 arousals per hour). The occurrence of ICU delirium was not significantly different between patients with and without sleep disruption.

CONCLUSIONS

Our results suggest the utility of a portable EEG monitor to measure different sleep stages, transitions, and arousals; however, the accuracy in measuring different sleep stages by the SedLine monitor varies compared with PSG. Our results also support previous findings that sleep is fragmented in critically ill patients. Further research is necessary to develop portable EEG monitors that have higher agreement with PSG.

The neuroinflammatory response of postoperative cognitive decline

BACKGROUND

Aseptic surgical trauma provokes a homeostatic neuroinflammatory response to promote healing and protect the organism from further injury. When this response is dysregulated, harmful consequences can follow, including postoperative cognitive decline.

SOURCES OF DATA

We performed a comprehensive search on PubMed related to postoperative cognitive dysfunction (POCD).

AREAS OF AGREEMENT

Although the precise pathogenic mechanisms for POCD remain unclear, certain risk factors are known.

AREAS OF CONTROVERSY

The mechanisms that lead to exaggerated and persistent neuroinflammation and the best way to counteract it are still unknown. AREAS FOR DEVELOPING RESEARCH: It is imperative that we identify the underlying processes that increase the risk of cognitive decline in elderly surgical patients. In this review we explore non-resolution of inflammation as an underlying cause of developing exaggerated and persistent POCD. If interventions can be developed to promote resolution of neuroinflammation, the patient's postoperative recovery will be enhanced and long-term consequences can be prevented.

A critique of the evidence base for non-pharmacological sleep interventions for persons with dementia

Disordered sleep in persons with dementia is a contributing factor for a range of health problems. The evidence base for non-pharmacological interventions has not been evaluated and clearly presented in the literature. This paper provides a structured Critical Literature Review of the evidence for non-pharmacological interventions to reduce disordered sleep in persons with dementia. The systematic search retrieved 29 studies that were evaluated for methodological quality. The quality of evidence ranged from conclusive for light therapy and activity to inconclusive for most other interventions. There is a paucity of conclusive research for non-pharmacological sleep interventions for persons with dementia. Most of the evidence about effective interventions is anecdotal and untested. There is a need for rigorous scientific inquiry, coupled with tacit knowledge to build a strong evidence base on non-pharmacological interventions for disordered sleep for persons with dementia.

The association between habitual sleep duration and sleep quality in older adults according to health status

BACKGROUND

research on the association between habitual sleep duration and quality in older adults is scarce and has shown conflicting results. Moreover, no previous study has assessed the influence of health status on this association.

OBJECTIVES

to examine the association between habitual duration and quality of sleep in older adults, and to test if this association varies with health status, as approximated by self-rated health, quality-of-life and functional limitation.

DESIGN

cross-sectional study with data collected by telephone interview.

SETTING

community-based study.

SUBJECTS

a total of 1,567 community-dwelling individuals aged ≥68 years in Spain.

METHODS

poor sleep quality was ascertained through nighttime complaints (sleeping-pill consumption, difficulty falling asleep, awakening during the night and early awakening), and daytime complaints (feeling unrested in the morning and daytime sleepiness). The analyses were adjusted for the main confounders, and were stratified by health status (self-rated health, health-related quality-of-life and functional limitation).

RESULTS

when compared with those sleeping 7-8 h, those who slept ≤6 h were more likely to report difficulty falling asleep [odds ratio (OR) 3.51; 95% confidence interval (CI) 2.37-5.20], frequent awakening during the night (OR 1.97; 95% CI 1.42-2.75), early awakening in the morning (OR 2.78; 95% CI 2.02-3.82) and feeling unrested in the morning (OR 1.73; 95% CI 1.18-2.54). Moreover, those who slept ≥9 h were more likely to report daytime sleepiness (OR 1.68; 95% CI 1.17-2.42). In stratified analyses, these associations generally did not vary with health status.

CONCLUSIONS

in older adults, short sleep is associated with nighttime sleep complaints and feeling unrested in the morning, while long sleep is associated with daytime sleepiness.

Relação entre problemas do sono, desempenho funcional e ocorrência de quedas em idosos da comunidade

OBJETIVO: Esta revisão objetivou sistematizar estudos que avaliam a relação entre problemas do sono, desempenho funcional e ocorrência de quedas em idosos da comunidade. MÉTODO: Realizou-se revisão bibliográfica entre 21 e 30 de setembro de 2009, no idioma Inglês, com as seguintes palavras-chave: "sleep" AND "falls" AND "functional performance" AND "elderly". Foram utilizadas as bases de dados PubMed, Ageline e Scielo. Foram critérios de inclusão: artigos publicados de janeiro de 2006 a setembro de 2009; artigos completos; estudos transversais, retrospectivos, prospectivos; estudos realizados com idosos da comunidade. RESULTADOS: Foram encontrados 52 estudos, dos quais foram avaliados dez que preencheram os critérios de inclusão. CONCLUSÕES: Os estudos mostraram que os distúrbios do sono podem piorar o desempenho funcional, além de representarem fator de risco independente para quedas em idosos.