Geriatrics: sleep disorders and aging

Ingestion of β-nicotinamide mononucleotide increased blood NAD levels, maintained walking speed, and improved sleep quality in older adults in a double-blind randomized, placebo-controlled study

The study evaluated how ingestion of nicotinamide mononucleotide (NMN) for 12 weeks by older adults affected blood nicotinamide adenine dinucleotide (NAD +) levels and physical function, particularly walking function. Information concerning sleep, and stress was also collected as secondary endpoints. In this randomized, placebo-controlled, double-blind, parallel-group comparison study, 60 participants were randomly allocated into a placebo group or NMN group. Members of the NMN group consumed 250 mg/day NMN for 12 weeks. Motor function tests, blood NAD metabolite analysis, and questionnaires were conducted at the start of the study and 4 and 12 weeks after intake. This trial was registered at umin.ac.jp/ctr as UMIN000047871 on June 22nd, 2022.At primary outcome, at both 4 weeks and 12 weeks, the NMN and placebo groups had no significant differences in a stepping test. At secondary outcomes, after 12 weeks of NMN intake, the NMN group had a significantly shorter 4-m walking time than the placebo group as well as significantly higher blood levels of NAD + and its metabolites. A significant negative correlation was observed between the change in the 4-m walking time and the change in blood NAD + , N1-methyl-2-pridone-5-carboxamide (2-PY), and N1-methyl-4-pridone-3-carboxamide (4-PY) at 12 weeks. The NMN group had improved sleep quality at 12 weeks relative to the placebo group as evidenced by lower scores for "Daytime dysfunction" and "Global PSQI" on the Pittsburgh Sleep Questionnaire. No adverse effects related to test substance consumption were observed. Together, these results indicate that NMN intake could increase blood NAD + levels, maintain walking speed, and improve sleep quality in older adults. Interventions involving NMN aimed at maintaining walking speed could contribute to extended healthy life expectancy.

The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis

Sleep loss is associated with reduced health and quality of life, and increased risk of Alzheimer's disease and related dementias. Up to 66% of persons with Alzheimer's disease and related dementias experience poor sleep, which can predict or accelerate the progression of cognitive decline. Exercise is a widely accessible intervention for poor sleep that can protect against functional and cognitive decline. No previous systematic reviews have investigated the effectiveness of exercise for sleep in older adults with mild cognitive impairment or Alzheimer's disease and related dementias. We systematically reviewed controlled interventional studies of exercise targeting subjectively or objectively (polysomnography/actigraphy) assessed sleep in persons with mild cognitive impairment or Alzheimer's disease and related dementias. We conducted searches in PubMed, Embase, Scopus and Cochrane-Library (n = 6745). Nineteen randomised and one non-randomised controlled interventional trials were included, representing the experiences of 3278 persons with mild cognitive impairment or Alzheimer's disease and related dementias. Ten had low-risk, nine moderate-risk, and one high-risk of bias. Six studies with subjective and eight with objective sleep outcomes were meta-analysed (random-effects model). We found moderate- to high-quality evidence for the beneficial effects of exercise on self-reported and objectively-measured sleep outcomes in persons with mild cognitive impairment or Alzheimer's disease and related dementias. However, no studies examined key potential moderators of these effects, such as sex, napping or medication use. Our results have important implications for clinical practice. Sleep may be one of the most important modifiable risk factors for a range of health conditions, including cognitive decline and the progression of Alzheimer's disease and related dementias. Given our findings, clinicians may consider adding exercise as an effective intervention or adjuvant strategy for improving sleep in older persons with mild cognitive impairment or Alzheimer's disease and related dementias.

Interaction effects between insomnia and depression on risk of out-of-hospital cardiac arrest: Multi-center study

BACKGROUND

Insomnia and depression have been known to be risk factors of several diseases, including coronary heart disease. We hypothesized that insomnia affects the out-of-hospital cardiac arrest (OHCA) incidence, and these effects may vary depending on whether it is accompanied by depression. This study aimed to determine the association between insomnia and OHCA incidence and whether the effect of insomnia is influenced by depression.

METHODS

This prospective multicenter case-control study was performed using Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiology Surveillance (CAPTURES-II) project database for OHCA cases and community-based controls in Korea. The main exposure was history of insomnia. We conducted conditional logistic regression analysis to estimate the effect of insomnia on the risk of OHCA incidence and performed interaction analysis between insomnia and depression. Finally, subgroup analysis was conducted in the patients with insomnia.

RESULTS

Insomnia was not associated with increased OHCA risk (0.95 [0.64-1.40]). In the interaction analysis, insomnia interacted with depression on OHCA incidence in the young population. Insomnia was associated with significantly higher odds of OHCA incidence (3.65 [1.29-10.33]) in patients with depression than in those without depression (0.84 [0.59-1.17]). In the subgroup analysis, depression increased OHCA incidence only in patients who were not taking insomnia medication (3.66 [1.15-11.66]).

CONCLUSION

Insomnia with depression is a risk factor for OHCA in the young population. This trend was maintained only in the population not consuming insomnia medication. Early and active medical intervention for patients with insomnia may contribute to lowering the risk of OHCA.

Linkage of premature and early menopause with psychosocial well-being: a moderated multiple mediation approach

PURPOSE

Menopause occurring before the age of 40 is premature and between 40 and 44 years age is early, since the natural age of menopause lies between 45 and 50. The endocrine changes that come with menopause include an erratic decline in estrogen levels which affects the brain. Thus, leading to changes in cognitive function in the longer term due to the menopausal transition. The study aims to explore the effect of premature and early menopause on cognitive health, and psychosocial well-being. The moderated multiple mediation hypothesis of the study is that the effect of premature or early menopause is mediated by depression and insomnia, while all the pathways are moderated by smoking habits.

DATA AND METHODS

The study utilized Longitudinal Aging Study in India (LASI), 2017-2018, Wave 1 data. The sample of 31,435 women were aged 45 and above and did not undergo hysterectomy. A moderated multiple mediation model was used to understand the association between premature or early menopause (X), insomnia (M1), depression (M2), moderator (W), and cognitive health (Y), while controlling for possible confounders.

RESULTS

Premature menopause was negatively associated with cognition (β:-0.33; SE:0.12; p < 0.05), whereas positively associated with insomnia (β:0.18; SE:0.03; p < 0.001) and depression (β:0.25; SE:0.04; p < 0.001). There is a moderating effect of smoking or tobacco consumption has a significant moderating effect on the pathways among premature menopause, depression, insomnia and cognition. When the same model was carried out for early menopause (40-44 years), the results were not significant.

CONCLUSIONS

The findings emphasize the fact that smoking is associated with premature menopause, depression and insomnia. Women who experienced premature menopause has lower cognitive scores, depressive symptoms and insomnia symptoms, which were higher among those who consumed tobacco. The study, strongly recommends the dissemination of information on the negative effects of tobacco consumption and making more informed choices to maintain a healthy life. More research into various methods and therapy is needed to determine the relationship between the age of early menopause and their psychosocial well-being.

Efficient Deep Learning Based Hybrid Model to Detect Obstructive Sleep Apnea

An increasing number of patients and a lack of awareness about obstructive sleep apnea is a point of concern for the healthcare industry. Polysomnography is recommended by health experts to detect obstructive sleep apnea. The patient is paired up with devices that track patterns and activities during their sleep. Polysomnography, being a complex and expensive process, cannot be adopted by the majority of patients. Therefore, an alternative is required. The researchers devised various machine learning algorithms using single lead signals such as electrocardiogram, oxygen saturation, etc., for the detection of obstructive sleep apnea. These methods have low accuracy, less reliability, and high computation time. Thus, the authors introduced two different paradigms for the detection of obstructive sleep apnea. The first is MobileNet V1, and the other is the convergence of MobileNet V1 with two separate recurrent neural networks, Long-Short Term Memory and Gated Recurrent Unit. They evaluate the efficacy of their proposed method using authentic medical cases from the PhysioNet Apnea-Electrocardiogram database. The model MobileNet V1 achieves an accuracy of 89.5%, a convergence of MobileNet V1 with LSTM achieves an accuracy of 90%, and a convergence of MobileNet V1 with GRU achieves an accuracy of 90.29%. The obtained results prove the supremacy of the proposed approach in comparison to the state-of-the-art methods. To showcase the implementation of devised methods in a real-life scenario, the authors design a wearable device that monitors ECG signals and classifies them into apnea and normal. The device employs a security mechanism to transmit the ECG signals securely over the cloud with the consent of patients.

Instability of non-REM sleep in older women evaluated by sleep-stage transition and envelope analyses

Study objective

Traditionally, age-related deterioration of sleep architecture in older individuals has been evaluated by visual scoring of polysomnographic (PSG) recordings with regard to total sleep time and latencies. In the present study, we additionally compared the non-REM sleep (NREM) stage and delta, theta, alpha, and sigma wave stability between young and older subjects to extract features that may explain age-related changes in sleep.

Methods

Polysomnographic recordings were performed in 11 healthy older (72.6 ± 2.4 years) and 9 healthy young (23.3 ± 1.1 years) females. In addition to total sleep time, the sleep stage, delta power amplitude, and delta, theta, alpha, and sigma wave stability were evaluated by sleep stage transition analysis and a novel computational method based on a coefficient of variation of the envelope (CVE) analysis, respectively.

Results

In older subjects, total sleep time and slow-wave sleep (SWS) time were shorter whereas wake after sleep onset was longer. The number of SWS episodes was similar between age groups, however, sleep stage transition analysis revealed that SWS was less stable in older individuals. NREM sleep stages in descending order of delta power were: SWS, N2, and N1, and delta power during NREM sleep in older subjects was lower than in young subjects. The CVE of the delta-band is an index of delta wave stability and showed significant differences between age groups. When separately analyzed for each NREM stage, different CVE clusters in NREM were clearly observed between young and older subjects. A lower delta CVE and amplitude were also observed in older subjects compared with young subjects in N2 and SWS. Additionally, lower CVE values in the theta, alpha and sigma bands were also characteristic of older participants.

Conclusion

The present study shows a decrease of SWS stability in older subjects together with a decrease in delta wave amplitude. Interestingly, the decrease in SWS stability coincided with an increase in short-term delta, theta, sigma, and alpha power stability revealed by lower CVE. Loss of electroencephalograms (EEG) variability might be a useful marker of brain age.

Association of Sleep Duration and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults

AIM

This study aims to investigate the association of the Cardio-Ankle Vascular Index (CAVI) with self-reported sleep duration and sleep quality in community-dwelling older adults aged ≥ 65 years.

METHODS

The Tarumizu Study was a cohort of community-based health checkups conducted in the Tarumizu City, Japan, in 2018 and 2019. In total, 997 participants aged ≥ 65 years (median age, 74 years) were examined. We obtained the average sleep duration and sleep quality using self-reported questionnaires and classified them into three separate groups according to sleep duration (＜6 h, 6-8 h, and ≥ 8 h) and sleep quality (good, medium, and poor). The arterial stiffness was measured using the CAVI.

RESULTS

As per our findings, the CAVI was significantly higher in the ≥ 8 h sleep group (CAVI=9.6±1.3) than in the ＜6 h (CAVI=9.1±1.1) or 6-8 h (CAVI=9.1±1.2) groups (p＜0.001). After adjustment for age, sex, systolic blood pressure, current smoking status, body mass index, frequency of exercise, educational background, frailty, sleep medication, sleep quality, and nap duration, multivariable regression analysis demonstrated that the CAVI was significantly higher in the ≥ 8 h group than in the 6-8 h group (p=0.016). In contrast, multivariable regression analysis showed that there was no significant association between sleep quality and CAVI.

CONCLUSIONS

A significant association was noted between long sleep duration (≥ 8 h) and elevated CAVI in community-dwelling older adults aged ≥ 65 years. We, therefore, suggest that long sleep duration, not sleep quality, is correlated with arterial stiffness in older adults.

Resetting the circadian clock of Alzheimer’s mice via GLP-1 injection combined with time-restricted feeding

Circadian rhythm disturbances are the most common symptoms during the early onset of AD. Circadian rhythm disorders aggravate the deposition of amyloid plaques in the brains of AD patients. Therefore, improving the circadian rhythm of AD patients might slow down the pathological development of neurodegeneration. Circadian regulation is driven by a master clock in suprachiasmatic nuclei (SCN) and peripheral clock located in peripheral organs. The rhythmic feeding–fasting cycle has been proved to dominant cue to entrain peripheral clocks. We hypothesized that dietary intervention to a certain period of time during the dark phase might entrain the clock and reset the disrupted daily rhythms of AD mice. In this study, exogenous glucagon-like peptide-1 (GLP-1) treatment, time-restricted feeding (TRF), and the combination were used to examine the effect of overall circadian rhythm and neurodegenerative pathogenesis of transgenic AD mice. It was confirmed that GLP-1 administration together with time-restricted feeding improves circadian rhythm of 5 × FAD mice including the physiological rhythm of the activity–rest cycle, feeding–fasting cycle, core body temperature, and hormone secretion. Furthermore, GLP-1 and TRF treatments improved the diurnal metabolic homeostasis, spatial cognition, and learning of 5 × FAD mice. The aberrant expression of clock genes, including Baml1, Clock, and Dbp, was improved in the hypothalamus, and pathological changes in neurodegeneration and neuroinflammation were also observed in AD mice with dual treatment.

Evaluation of the sleep hygiene index and physical activity states of the elderly living in nursing homes

The aim: the sleep quality and physical performance play a vital role in older adults’ well-being to maintain good overall health. Therefore, the parameters that have a role in sleep and physical capacity are crucial to achieve a healthy aging outcome. In this study, we aimed at comparing the quality of sleep and physical activity state of the elderly living in 5 nursing homes. Methods: the 181 elderly individuals living in 5 nursing homes were included in this cross-sectional study. Physical activity, sleep hygiene index and demographics were analysed using SPPS 23.0. Results: overall, 68.5 % of the participants were male, and 31.5 % were female. There was no significant correlation between the sleep hygiene scores and physical activity states (p >0.05). Those who were divorced, those who were on at least one type of medication, those who smoked and those with poor perception of health had statistically significant difference in terms of the Sleep Hygiene Index (p<0.05). Conclusion: other than findings of the presented study that influence sleep and physical activity, the many other factors in different geographical areas or cultures could be a reason that is interrelated with sleep quality and physical performance of older adults. In this study, for primary care and family physicians to boost the sleep quality of the elderly, we recommend improving their health perception, quitting smoking, discontinuing unnecessary medications, and increasing their social interactions

Sleep, Sirtuin 1 and Alzheimer's disease: A review

Sleep plays a major role in brain health, and cognition. Disrupted sleep is a well-described symptom of Alzheimer's disease (AD). However, accumulating evidence suggests suboptimal sleep also increases AD risk. The deacetylase Sirtuin 1 (Sirt 1), encoded by the SIRT1 gene, impacts sleep via its relationship to wake-sleep neurotransmitters and somnogens. Evidence from animal and human studies supports a significant and complex relationship between sleep, Sirt 1/ SIRT1 and AD. Numerous hypotheses attempt to explain the critical impact of Sirt 1/ SIRT1 on wake- and sleep- promoting neurons, their related mechanisms and neurotransmitters. However, there is a paucity of studies assessing the interaction between sleep and Sirt 1/ SIRT1, as a principal component of sleep regulation, on AD pathology. In this review, we explore the potential association between Sirt 1/ SIRT1, sleep, and AD aetiology. Given sleep is a likely modifiable risk factor for AD, and recent studies suggest Sirt 1/ SIRT1 activation can be modulated by lifestyle or dietary approaches, further research in this area is required to explore its potential as a target for AD prevention and treatment.

Abuse/Misuse of Prescription Medications in Older Adults

The world population is aging due to increasing life expectancy. The rate of drug use increases, and inappropriate prescribing is frequently encountered with advancing age. In addition, misuse and abuse of prescription drugs is a serious problem in older adults. It is challenging to detect substance and drug abuse in older patients because it may have fewer consequences in social, legal, and occupational fields. However, there is not enough information about the screening, evaluation, diagnosis, and treatment of abuse. Therefore, the awareness of health care professionals and others involved in older patients' care should be raised about the misuse and abuse of drugs.

Characterizing Sleep Problems in 16p11.2 Deletion and Duplication

Studies of 16p11.2 copy number variants (CNVs) provide an avenue to identify mechanisms of impairment and develop targeted treatments for individuals with neurodevelopmental disorders. 16p11.2 deletion and duplication phenotypes are currently being ascertained; however, sleep disturbances are minimally described. In this study, we examine sleep disturbance in a well-characterized national sample of 16p11.2 CNVs, the Simons Foundation Autism Research Initiative (SFARI) database of youth and adults (n = 692). Factor analyses and multilevel models of derived sleep questionnaires for youth (n = 345) and adults (n = 347) indicate that 16p11.2 carriers show elevated sleep disturbance relative to community controls. Non-carrier family members also show elevated sleep disturbance. However, sleep duration does not differ between carriers and controls. Further studies of sleep in 16p11.2 are needed.

The relationship between sleep and physical activity in nonagenarians and centenarians

OBJECTIVE: Since the relationship between physical activity and sleep quality has been poorly studied in nonagenarians and centenarians, this study sought to relate the sleep quality and physical activity in this age group. METHODS: This is a secondary analysis of the initial assessment of a longitudinal study involving nonagenarians and centenarians in Porto Alegre, Brazil, which included physical activity (yes or no) and sleep quality (altered or normal). The chi-square test, adjusted by logistic regression, was used to investigate the relationship between sleep quality, physical activity, and sociodemographic and clinical characteristics. RESULTS: Among the 233 participants, 26% were physically active and 53% reported altered sleep. Higher frequencies of physical activity and normal sleep occurred in men (36%, p = 0.02 and 54%, p = 0.18), in those living with a caregiver (42%, p = 0.09 and 58, p = 0.51), in those with high school or higher education (33%, p = 0.44 and 58%, p = 0.07), and in those with excellent or good self-perceived health (31%, p = 0.03 and 51%, p = 0.16). Physical activity was lower among those who reported apathy and drowsiness (83%, p = 0.03) and in those who had difficulty falling asleep (66%, p = 0.05). In the adjusted analysis, only education remained significant (p = 0.02, when comparing high school or higher with illiteracy; odds ratio: 3.91 confidence interval 1.18-12.90, p = 0.02). CONCLUSIONS: We observed a low frequency of physical activity and a high prevalence of altered sleep patterns in nonagenarians and centenarians. Factors related greater physical activity were also associated with better sleep quality. High school or higher education was a significant and independent predictor of good sleep quality in nonagenarians and centenarians.

Caudate Volume Mediates the Interaction between Total Sleep Time and Executive Function after Acute Exercise in Healthy Older Adults

Although both exercise and sleep are significant lifestyle factors in cognitive aging, the interaction of these two factors with respect to cognition remains to be determined. Also, little is known regarding the role of the basal ganglia (BG) in cognitive aging despite its involvement in both sleep and executive function. The primary objective of this study was to investigate the interaction between sleep and acute exercise on executive function performance, and secondarily, to assess if BG volume mediates this interaction. Thirty healthy older adults (65.8±7.3 years) completed 30 minutes of seated rest or moderate-intensity cycling exercise on different days. Structural MRI was used to assess the volumes of BG components including caudate, putamen, and globus pallidus shortly after the experimental conditions. Approximately 90 minutes after each condition, the Stroop task was administered to measure executive function. To examine sleep, participants wore a wrist actigraph for 8.0±3.6 days prior to the first experimental session. Results revealed that while longer total sleep time (TST) was associated with shorter Stroop response time (RT), shorter TST was associated with longer RT after exercise, compared to rest, for both congruent (p = 0.029) and incongruent (p = 0.022) trials. Longer TST was correlated with greater caudate volume, and greater caudate volume was associated with exercise-related improvement in Stroop incongruent RT. Ultimately, we found that the association between longer sleep duration and faster processing speed after acute exercise was mediated by greater caudate volume. These findings suggest that TST is an important factor for acute exercise-induced cognitive improvements in older adults, and that our study is a first step in understanding the interactive effects of these important lifestyle factors in cognitive aging that might simultaneously be addressed to promote healthy cognitive aging. Future studies should examine the interactive effects of sleep and chronic exercise on cognitive function, and whether BG volume might also mediate this interaction.

Alzheimer's disease: Neurotransmitters of the sleep-wake cycle

With aging, our sleeping pattern alters. Elderly often wake unrested because their sleep time and sleep efficacy is reduced. In Alzheimer's disease (AD) patients, these alterations are even more pronounced and may further aggravate cognitive decline. Therefore, sleep disturbances greatly impact self-care ability, caregiver exhaustion and institutionalization rate. Reestablishing an effective sleep-wake cycle in these patients still remains an unresolved challenge, partly because sleep physiology is quite complex and multiple neurotransmitter systems contribute to a single process. Gaining a better understanding of sleep physiology will be crucial for further research. Conjointly, animal models, along with a multidisciplinary approach, will be of great value to establish a common ground between AD and sleep disturbances and work towards a potential therapeutic application.

Visibility graph analysis of temporal irreversibility in sleep electroencephalograms

The study of sleep has continued to garner increased attention. However, most studies assume stationarity of sleep electroencephalogram (EEG) signals, whereas they are typically nonlinear and nonstationary. Little work has focused on the time irreversibility of sleep EEG signals. Hence, the aim of this work is to reveal the temporally irreversible structures of rapid-eye-movement (REM) and non-REM sleep using a visibility algorithm, which is robust to nonstationarity and finite-size effect. Results show that the temporal structure of non-REM sleep is more irreversible than that of REM sleep. The degree of irreversibility is highest in slow-wave sleep. Moreover, statistical analysis suggests that aging is the major factor that affects the irreversibility of sleep signals, while gender and body mass index contribute insignificantly. The dominant role of slow oscillations on the irreversible structures of the sleep signals is also indicated.

Habitual Meat Consumption and Changes in Sleep Duration and Quality in Older Adults

Dietary proteins are sources of some amino acid precursors of two neurotransmitters relevant for biological rhythms, serotonin and melatonin, which are involved in sleep and alertness. Meat is the main source of proteins in many countries. Furthermore, meat consumption is of special interest because it provides high-quality protein as well as saturated and trans fatty acids. However, its effect on sleep patterns is unclear. Thereby, the aim was to examine the association of habitual meat consumption with changes in sleep duration and with sleep quality in older adults. We used data from 1,341 participants in the Seniors-ENRICA cohort aged ≥60 years, followed from 2012 through 2015. Habitual meat consumption was assessed at baseline with a validated diet history. Sleep duration and quality were ascertained both in 2012 and 2015. Analyses were performed with logistic regression and adjusted for socio-demographic variables, lifestyle, morbidity, sleep duration and poor sleep indicators at baseline. During follow-up, 9.0% of individuals increased and 7.9% decreased their sleep duration by ≥2 hours/night. Compared with individuals in the lowest tertile of meat consumption (<87 g/d), those in the highest tertile (≥128 g/d) showed increased incidence of a large decrease (≥2 h) in sleep duration (OR: 1.93; 95% CI:1.01-3.72; p-trend:0.04). Higher consumption of meat was also associated with incidence of snoring (OR:2.06; 95% CI:1.17-3.60; p-trend:0.01) and poor general sleep quality (OR:1.71; 95% CI:1.04-2.82; p-trend:0.03). Each 100 g/d increment in meat intake was associated with a 60% higher risk of both large sleep duration changes and poor sleep quality (OR:1.60; 95% CI:1.07-2.40). Results were in the same direction for red and processed meat and for white meat separately, and among individuals with physical impairment. Higher meat consumption (≥128 g/d) was associated with changes in sleep duration and with poor sleep in older adults.

Clock mediates liver senescence by controlling ER stress

Accumulated evidence indicates that circadian genes regulate cell damage and senescence in most mammals. Endoplasmic reticulum (ER) stress and reactive oxygen species (ROS) regulate longevity in many organisms. However, the specific mechanisms of the relationship between the circadian clock and the two stress processes in organisms are poorly understood. Here, we show that Clock-mediated Pdia3 expression is required to sustain reactive oxidative reagents and ER stress. First, ER stress and ROS are strongly activated in the liver tissue of Clock^Δ19 mutant mice, which exhibit a significant aging phenotype. Next, transcription of Pdia3 is mediated by the circadian gene Clock, but this process is affected by the Clock^Δ19 mutant due to the low affinity of the E-box motif in the promoter. Finally, ablation of Pdia3 with siRNA causes ER stress with sustained phosphorylation of PERK and eIF1α, resulting in exaggerated up-regulation of UPR target genes and increased apoptosis as well as ROS. Moreover, the combined effects result in an imbalance of cell homeostasis and ultimately lead to cell damage and senescence. Taken together, this study identified the circadian gene Clock as a regulator of ER stress and senescence, which will provide a reference for the clinical prevention of aging.

Young adults are more vulnerable to chronic sleep deficiency and recurrent circadian disruption than older adults

More than a third of US adults report fewer than 6 hours of sleep a night, making chronic sleep restriction a growing public health concern. Sleep curtailment is associated with an increase in industrial accidents, motor vehicle accidents, medical and other occupational errors. Young adults are more vulnerable to acute sleep deprivation than older adults, but less is known about how young vs. older adults respond to the more commonly experienced chronic sleep restriction. To test the hypothesis that young adults are more vulnerable to chronic sleep loss than older adults, we compared data from young and older adults who underwent three weeks of chronic sleep restriction (equivalent to 5.6 hours/24 hours) combined with recurrent circadian disruption in an experiment that enabled us to separate the influences of the sleep-wake homeostatic process, the circadian timing system, and the chronic sleep deficit. We found that while young and older adults reported similar levels of subjective sleepiness, objective measures of sleepiness revealed that young adults were more vulnerable and had more attentional failures than the older adults. These results have important public health implications, particularly related to prevention of sleep-related motor vehicle crashes in young drivers. Further research is needed to understand the neurobiological basis of these age-related differences.

Gender differences in the relationships between chronic kidney disease, asymmetric dimethylarginine, and sleep quality: The HEIJO-KYO cohort

The association between chronic kidney disease (CKD), serum levels of asymmetric dimethylarginine (ADMA), and sleep quality has not been studied in large populations. In this cross-sectional study of 1115 elderly individuals (mean age, 71.9 years), we measured serum levels of ADMA, and objective and subjective sleep quality using actigraphy and a standardized self-reported questionnaire, respectively. Multivariable analysis adjusted for potential confounders revealed that in females, compared with the non-CKD/low-ADMA group (n=312), sleep efficiency was significantly lower in the CKD/high-ADMA group (n=52) by 3.5% for objective sleep quality [95% confidence interval (CI), 1.1-5.9] and by 4.2% (95% CI, 0.3-8.0) for subjective sleep quality but not in the non-CKD/high-ADMA (n=179) and CKD/low-ADMA (n=36) groups. In males, no significant associations between CKD, ADMA levels, and sleep quality were observed. Wake time after sleep onset was significantly longer by 11.3 min (95% CI, 3.0-19.6) for objective sleep quality and by 25.9 min (95% CI, 4.9-46.9) for subjective sleep quality in the CKD/high-ADMA group than in the non-CKD/low-ADMA group in females but not in males. Mediation analysis revealed a significant effect of serum ADMA levels on the association between renal function and parameters of sleep quality among females. In conclusions, both objective and subjective sleep quality were poorer in elderly females with CKD/high-ADMA than in those with non-CKD/low-ADMA, but not in males. Association between CKD and sleep disturbances might be mediated by ADMA levels.

A nonpharmacological approach to improve sleep quality in older adults

OBJECTIVES

Poor sleep quality is highly prevalent among older adults and is associated with poor quality of life, cognitive and physical decline, depression, and increased mortality. Medication options commonly used are not ideal, and alternative treatment strategies are needed. We evaluate a community-based psychosocial intervention program and its effect on sleep quality in older adults.

METHOD

Elderly participants aged 60 and above were included. Those with Geriatric Depression Scale and Geriatric Anxiety Inventory scores above 5 and 10, respectively, were excluded. The community program included tai chi exercise, art therapy, mindfulness awareness practice, and music reminiscence therapy. Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Geriatric Anxiety Inventory were administered at baseline and at 1 year.

RESULTS

A hundred and eighty-nine subjects (44 men, 145 women; mean age = 69 years, SD = 5.7, range = 60-89) participated. The proportion of participants with good sleep quality had increased from 58.2% to 64.6%. Sleep disturbance was significantly reduced (baseline, 1.04; postintervention, 0.76; mean difference 0.28; P < .01); men experienced greater improvement (P < .001). Improvements were independent of changes in depressive and anxiety symptoms.

CONCLUSION

Participation in this community program led to positive effects on sleep disturbances after a year. Psychosocial interventions have potential as a nondrug intervention approach for sleep problems, and further research is needed to understand its mediating mechanisms.

EEG Transients in the Sigma Range During non-REM Sleep Predict Learning in Dogs

Sleep spindles are phasic bursts of thalamo-cortical activity, visible in the cortex as transient oscillations in the sigma range (usually defined in humans as 12-14 or 9-16 Hz). They have been associated with sleep-dependent memory consolidation and sleep stability in humans and rodents. Occurrence, frequency, amplitude and duration of sleep spindles co-vary with age, sex and psychiatric conditions. Spindle analogue activity in dogs has been qualitatively described, but never quantified and related to function. In the present study we used an adjusted version of a detection method previously validated in children to test whether detections in the dogs show equivalent functional correlates as described in the human literature. We found that the density of EEG transients in the 9-16 Hz range during non-REM sleep relates to memory and is characterized by sexual dimorphism similarly as in humans. The number of transients/minute was larger in the learning condition and for female dogs, and correlated with the increase of performance during recall. It can be concluded that in dogs, automatic detections in the 9-16 Hz range, in particular the slow variant (<13 Hz), are functional analogues of human spindles.

Sleep and Alzheimer's disease: A pivotal role for the suprachiasmatic nucleus

Alzheimer's disease (AD), which accounts for most of the dementia cases, is, aside from cognitive deterioration, often characterized by the presence of non-cognitive symptoms. Society is desperately in need for interventions that alleviate the economic and social burden related to AD. Circadian dysrhythmia, one of these symptoms in particular, immensely decreases the self-care ability of AD patients and is one of the main reasons of caregiver exhaustion. Studies suggest that these circadian disturbances form the root of sleep-wake problems, diagnosed in more than half of AD patients. Sleep abnormalities have generally been considered merely a consequence of AD pathology. Recent evidence suggests that a bidirectional relationship exists between sleep and AD, and that poor sleep might negatively impact amyloid burden, as well as cognition. The suprachiasmatic nucleus (SCN), the main circadian pacemaker, is subjected to several alterations during the course of the disease. Its functional deterioration might fulfill a crucial role in the relation between AD pathophysiology and the development of sleep abnormalities. This review aims to give a concise overview of the anatomy and physiology of the SCN, address how AD pathology precisely impacts the SCN and to what degree these alterations can contribute to the progression of the disease.

Role of Sleep Disturbance in the Trajectory of Alzheimer's Disease

Sleep disturbances such as insomnia, hypersomnia, and circadian rhythm disturbance are common in normal elderly and Alzheimer’s disease (AD) patients. To date, special attention has been paid to sleep disturbance in the clinical course of AD insofar as the interaction of sleep disturbance with the pathogenesis of AD may impact the clinical course and cognitive function of AD patients. This review covers the bidirectional relationship between sleep disturbance and AD pathogenesis; the associations between sleep disturbance and AD-specific neurotransmitters, brain structure, and aspects of sleep disturbance in each phase of AD; and the effects of sleep disturbance on the cognitive functions of patients in each phase of AD. We consider several factors required to exactly interpret the results and suggest a direction for future studies on the role of sleep disturbance in AD.

Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: Meta-analysis and systematic review

The present study pooled the prevalence of sleep disturbances and depression in community-dwelling older adults (mean age≥60years) and quantified the strength of evidence of the relationship between these two problems. From 23 cross-sectional studies and five sets of baseline data, a high pooled prevalence of sleep disturbances (30.5%), depressive symptoms (18.1%) and coexisting disorders (10.6%) were found. In the 23 cohort studies, self-reported sleep disturbances increased the risk of the onset of depression (relative risk [RR]=1.92). Persistent sleep disturbances increased the risk of the development (RR=3.90), recurrence (RR=7.70), and worsening (RR=1.46) of depression in older adults. Little support was found for a predictive role for objective sleep characteristics in the development of depression. Older adults with depression had a higher risk of developing (RR=1.72) and worsening (RR=1.73) symptoms of sleep disturbances. This review emphasizes the importance of timely interventions in incipient sleep disturbances and depression among older adults, preventing the development of more serious comorbidities.

Toward evidence-based prescribing at end of life: A comparative review of temazepam and zolpidem for the treatment of insomnia

A comparative review of temazepam and zolpidem use in managing insomnia in the hospice patient was undertaken to determine whether treatment with temazepam is a more cost-effective approach for this patient population.

A MEDLINE search was conducted to identify pertinent literature, including clinical trials and reviews that involved temazepam or zolpidem. Published data was used as background information and provided in the discussion.

This retrospective analysis, conducted from June 2002 through November 2002, focused on the prescribing patterns of temazepam and zolpidem in our hospice practice setting. We examined the reasons for discontinuation of each agent, along with the frequency of therapeutic change from temazepam to zolpidem. The top 10 ICD-9 codes associated with each treatment modality were investigated to determine any prescribing patterns.

A total of 4,752 participants were prescribed either temazepam or zolpidem during this six-month period. Of the 4,065 patients prescribed temazepam 9.9 percent had the agent discontinued, whereas, 13.0 percent of those taking zolpidem (n = 687) terminated therapy. Reasons for discontinuation included change in dose, incomplete efficacy, change in patient status, adverse drug reaction, cultural/social issues and “other.” Analyses of prescribing patterns and the reasons for termination of each drug therapy were completed and compared with results found in the primary literature.

Due to the limited financial resources available for hospice care, our goal is to provide the most clinically appropriate and cost-effective agents for hospice patients. With the lack of data pertaining to the hospice patient, physicians often are faced with challenges in deciding the most appropriate therapy. They may prefer one agent over another based on current medical opinion rather than sound clinical evidence. After review of the primary literature and the prescribing patterns in our setting, there is currently no evidence in our patient population to support that zolpidem is superior to benzodiazepines for the treatment of insomnia.

Outcomes of nighttime physical restraint removal for severely impaired nursing home residents

There is ample evidence that physical restraint reduction does not lead to increased falls or injuries. This study tests the effect of removing nighttime restraints by comparing two groups: Restrained in bed at pre- but not postintervention (n = 51), or restrained in bed at both pre- and post-intervention (n = 11). No differences in nighttime fall rates between the two groups were detected.

Nighttime physical restraint removal does not lead to increases in falls from bed in older nursing home residents. Although markedly reduced in nursing homes, restraint use remains a common practice among hospitalized older adults. We should continue to focus efforts on developing new, individualized approaches to reduce risk of falling from bed among frail elders.

Measuring the sleep of older people: Tool development and use in the evaluation of therapeutic massage

This paper examines the measurement of sleep in nursing care settings, within the context of a pilot study which aimed to assess the effect of therapeutic back massage by nurses on the quality and pattern of sleep in older people in nursing homes and a community hospital. Sleep is an important factor in effective recovery and rehabilitation from illness and for the quality of life of older people in care settings. Issues are raised concerning the measurement of the sleep of older people for the purposes of evaluation research. New instruments are introduced, some building on existing tools. The value of self-reported and observed sleep data are discussed. Issues of the feasibility and rigour of these instruments are examined and recommendations are made for their further refinement and use.

The association between sleep duration and overweight or obesity in Taiwanese adults: A cross-sectional study

BACKGROUND/OBJECTIVE

The effect of eating habits and sedentary lifestyle on obesity has been extensively examined and supported; however, few studies have examined the association of sleep duration with obesity in Taiwan. To redress this gap, this study investigated the association of sleep duration with overweight and obesity in community-dwelling Taiwanese adults.

METHODS

A cross-sectional study was performed using the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT). A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of the association of sleep duration with overweight and obesity. Nightly sleep duration was divided into three groups: >6 to <9h (normal), ≤6h (short), and ≥9h (long).

RESULTS

A total of 1548 adults aged 20-64 years were examined in this study. The adjusted ORs of obesity for short and long sleep duration relative to a normal sleep duration were 1.31 (95% CI 1.01, 1.76) and 1.64 (95% CI 1.04, 2.61), respectively. No significant association of sleep duration with overweight was observed.

CONCLUSIONS

The present study suggests that both short and long sleep duration are associated with obesity risk.

Geriatric Depression

Depression in the elderly is more common than once thought, especially in nursing home settings, where as many as 25% of residents can exhibit signs and symptoms of depression. Depression in the elderly can have a significant impact on overall health and desired outcome. The depressed elderly patient has been shown to have worsened prognosis of concomitant medical conditions, increased use of health care, decreased recovery time, and more likelihood to experience accelerated physical deterioration. Suicide represents the most serious complication of depression of the older depressed individual. The elderly are at a disproportionate risk for suicide attempts and are more likely to be successful. Diagnosis should be made using Diagnostic and Statistical Manual of Mental Disorders(4th ed.) (DSMIV) criteria, and clinicians should use standardized rating scales such as the Geriatric Depression Scale to assist in monitoring the severity of depressive symptoms and the efficacy of antidepressant treatment. Several treatment options are available to the clinician and include psychotherapy, electroconvulsive therapy, older antidepressants such as the tricyclics, and newer more tolerable therapies such as the serotonin reuptake inhibitors. Drug therapy should be individualized and should take into account the pharmacokinetic and pharmacodynamic changes that are associated with normal aging.

Transcriptome composition of the preoptic area in mid-age and escitalopram treatment in male mice

The decrease in serotonergic neurotransmission during aging can increase the risk of neuropsychiatric diseases such as depression in elderly population and decline the reproductive system. Therefore, it is important to understand the age-associated molecular mechanisms of brain aging. In this study, the effect of aging and chronic escitalopram (antidepressant) treatment to admit mice was investigated by comparing transcriptomes in the preoptic area (POA) which is a key nucleus for reproduction. In the mid-aged brain, the immune system-related genes were increased and hormone response-related genes were decreased. In the escitalopram treated brains, transcription-, granule cell proliferation- and vasoconstriction-related genes were increased and olfactory receptors were decreased. Since homeostasis and neuroprotection-related genes were altered in both of mid-age and escitalopram treatment, these genes could be important for serotonin related physiologies in the POA.

Sleep Quality in Family Caregivers of Individuals With Dementia

Poor sleep quality in family caregivers may impact their health status and cause quality of life to decline. Nurses are conducting an increasing number of studies that use sleep quality or related concepts as a main indicator to assess caregiver’s sleep. Therefore, a clear understanding of sleep quality and how it is different from other relevant sleep domains is essential. This article aimed to analyze the concept of sleep quality using the steps outlined by Walker and Avant. Findings include (a) attributes of sleep quality including subjective perception of sleep, sleep hours, and evaluation of activity after awaking; (b) antecedents of sleep quality including the ability to get naturally into the sleep cycle and status of conscious state; and (c) consequences of sleep quality including bio-psycho-social and global dimensions of health. This article intends to help clinicians and researchers better understand and define sleep quality in dementia caregivers.

The Role of Sleep and Sleep Disorders in the Development, Diagnosis, and Management of Neurocognitive Disorders

It is becoming increasingly apparent that sleep plays an important role in the maintenance, disease prevention, repair, and restoration of both mind and body. The sleep and wake cycles are controlled by the pacemaker activity of the superchiasmic nucleus in the hypothalamus but can be disrupted by diseases of the nervous system causing disordered sleep. A lack of sleep has been associated with an increase in all-cause mortality. Likewise, sleep disturbances and sleep disorders may disrupt neuronal pathways and have an impact on neurological diseases. Sleep deprivation studies in normal subjects demonstrate that a lack of sleep can cause attention and working memory impairment. Moreover, untreated sleep disturbances and sleep disorders such as obstructive sleep apnoe (OSA) can also lead to cognitive impairment. Poor sleep and sleep disorders may present a significant risk factor for the development of dementia. In this review, the underlying mechanisms and the role of sleep and sleep disorders in the development of neurocognitive disorders [dementia and mild cognitive impairment (MCI)] and how the presence of sleep disorders could direct the process of diagnosis and management of neurocognitive disorders will be discussed.

Aging and Circadian Rhythms

Aging is associated with numerous changes, including changes in sleep timing, duration, and quality. The circadian timing system interacts with a sleep-wake homeostatic system to regulate human sleep, including sleep timing and structure. This article reviews key features of the human circadian timing system, age-related changes in the circadian timing system, and how those changes may contribute to the observed alterations in sleep.

Comparisons of Objective Sleep Quality Between Elderly Individuals With and Without Cataract Surgery: A Cross-Sectional Study of the HEIJO-KYO Cohort

Background

Cataract surgery (CS) drastically increases the capacity for light reception to the retina. Several previous studies have suggested the beneficial effect of CS on subjectively measured sleep quality; however, the association between CS and objectively measured sleep quality remains uncertain.

Methods

To evaluate the association between CS and objectively measured sleep quality in home settings, we conducted a cross-sectional study in 1037 elderly individuals (mean age, 71.9 years). We evaluated actigraphically measured sleep quality, urinary 6-sulfatoxymelatonin excretion, and ambulatory light levels, in addition to CS status.

Results

The CS group (n = 174) showed significantly higher sleep efficiency and shorter wake after sleep onset than the no CS group (n = 863), even after adjustment for age, gender, body mass index, current smoking status, alcohol consumption, hypertension, diabetes, sleep medication, bedtime, rising time, daytime physical activity, daytime and nighttime light exposure, and urinary 6-sulfatoxymelatonin excretion (sleep efficiency: 85.8% in the CS group vs 84.4% in the no CS group, P = 0.042; wake after sleep onset: 45.7 min vs 50.6 min, respectively, P = 0.033). In contrast, urinary 6-sulfatoxymelatonin excretion, sleep onset latency, total sleep time, and sleep-mid time did not differ significantly between the CS and no CS groups.

Conclusions

Among a community-dwelling elderly population, CS is significantly associated with objectively measured sleep quality, but urinary levels of melatonin metabolite do not differ between individuals with and without CS. These associations are independent of daily light exposure profiles.

Quantitative association between nocturnal voiding frequency and objective sleep quality in the general elderly population: the HEIJO-KYO cohort

OBJECTIVE

A significant association between nocturia and subjective sleep quality has previously been reported; however, the association between nocturia and objective sleep quality remains unclear. The purpose of this study was to evaluate the quantitative association between nocturnal voiding (NV) frequency and objective sleep quality in a large, general, elderly population.

METHODS

Nocturnal voiding frequency, objective sleep quality, and subjective sleep quality were measured among 1086 community-based elderly individuals using actigraphy and the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

RESULTS

In multivariate analyses adjusted for potential confounding factors (such as age, gender, body mass index, medication use, renal function, bedtime, rising time, daytime physical activity, endogenous melatonin levels, and bedroom light levels), increased NV frequency, ranging from zero, one, two, three or more voids, was significantly associated with poorer objective sleep quality, including lower sleep efficiency (SE) and longer wake after sleep onset (WASO) (mean SE, 86.3, 84.8, 83.6, and 81.2%, respectively; p for trend <0.001; mean WASO: 42.6, 49.0, 53.6, and 66.1 min, respectively; p for trend <0.001), but shorter sleep onset latency (SOL) (mean SOL, 3.0, 3.0, 2.8, and 2.8 log min, respectively; p for trend = 0.018). In addition, an increased NV frequency was significantly associated with poorer subjective sleep quality in a multivariate model (mean PSQI global score, 4.60, 4.86, 5.22, and 5.48, respectively; p for trend 0.012).

CONCLUSION

The present study revealed a quantitative association between NV frequency and objective sleep quality in the general elderly population.

Subjective sleep characteristics associated with anxiety and depression in older adults: a population-based study

OBJECTIVE

Sleep complaints are often associated with anxiety and depression, but the specific complaints related to each syndrome are poorly characterized, especially in older adults. The objective was to identify subjective sleep characteristics specific to anxiety and depression in this population.

METHODS

A random sample of 2393 individuals aged 65 years or older was used. Anxiety and depression were categorized using DSM-V criteria for phobias, panic disorder, generalized anxiety disorder, unspecified anxiety disorder, major depressive episode, and depressive episode with insufficient symptoms. Subjective sleep characteristics were measured using the Pittsburgh Sleep Quality Index. Logistic regression models predicting anxiety or depression were used to determine the independent sleep characteristics associated with each syndrome adjusting for age, sex, education level, cognitive functioning, anxiolytic/sedative/hypnotic use, antidepressants use, subjective health, chronic diseases, cardiovascular conditions, and anxiety or depression (as appropriate).

RESULTS

Nearly all Pittsburgh Sleep Quality Index subscales were significantly associated with anxiety, but these subscales shared variance and only sleep duration in hours, sleep disturbance score, and daytime functioning score were independently related to anxiety. Within these significant subscales, the main specific sleep complaints associated with anxiety were daytime sleepiness and sleep disturbances related to coughing/snoring, feeling cold, and bad dreams. The use of sleeping medication was the only specific sleep characteristic associated with depression.

CONCLUSIONS

These results suggest that in older adults, symptoms of short sleep duration, daytime sleepiness and sleep disturbances are independently related to anxiety while the use of sleep medication is independently associated to depression.

Association between objectively measured sleep quality and physical function among community-dwelling oldest old Japanese: A cross-sectional study

AIM

The present study examined the association between objective measures of sleep quality and performance-based measures of physical function in community-dwelling oldest old Japanese.

METHODS

This cross-sectional study included 207 community-dwelling adults aged 80 years or older (92 men, 115 women; age 83.5 ± 2.6 years [range 80-95 years]). Participants wore an accelerometer (ActiGraph GT3X+) on their non-dominant wrist for 24 h per day over seven consecutive nights. Sleep parameters included total sleep time, sleep efficiency and wake after sleep onset during the night for a week. Performance-based physical function measures were handgrip strength, knee extension strength, and usual and maximum walking speeds. Multivariable linear regression was carried out to determine the associations between weekly sleep parameter averages and physical function measures.

RESULTS

Approximately 24% of participants had a total sleep time of less than 6 h a night, and 13% had greater than 8 h a night. Overall, average daily physical activity was 1771.8 ± 520.6 (counts/min/day). In multiple linear regression, sleep efficiency and wake after sleep onset were significantly associated with maximum walking speed (β = 0.277; 95% confidence interval [CI] 0.103 to 0.351 and β = -0.214; 95% CI -0.339 to -0.082, respectively) and usual walking speed (β = 0.200, 95% CI 0.035 to 0.305 and β = -0.174; 95% CI -0.341 to -0.064, respectively), after adjusting for potential confounding factors including daily physical activity. Both sleep qualities were also independently associated with knee extension strength. However, wake after sleep onset was not associated with handgrip strength.

CONCLUSION

Objectively measured sleep quality was associated with physical function in the oldest old. Further research is required to identify the temporality of associations between sleep and physical function.

Association between light exposure at night and insomnia in the general elderly population: the HEIJO-KYO cohort

Chronic circadian misalignment between the internal and environmental rhythms, which is typically related to night-shift work and clock-gene variants, is associated with disruption of suprachiasmatic nucleus function and increased risk of insomnia. Under controlled laboratory conditions, light at night (LAN) suppresses melatonin secretion, delays the internal biological rhythm, and reduces sleepiness. Therefore, LAN exposure may cause circadian misalignment and insomnia, though it remains unclear in real-life situations whether LAN exposure is associated with insomnia. To evaluate an association between LAN exposure and sleep quality in home settings, we conducted a cross-sectional community-based study in 857 elderly individuals (mean age, 72.2 years). We evaluated bedroom light intensity using a light meter and subjectively and objectively measured sleep quality using the Pittsburgh Sleep Quality Index and an actigraph, respectively, along with urinary 6-sulfatoxymelatonin excretion. Compared with the lowest quartile group of LAN intensity, the highest quartile group revealed a significantly higher odds ratio (OR) for subjective insomnia in a multivariate model adjusted for age, gender, body mass index, daytime physical activity, urinary 6-sulfatoxymelatonin excretion, bedtime, rising time, and day length (adjusted OR, 1.61, 95% confidence interval, 1.05-2.45, p=0.029). In addition, higher OR for subjective insomnia was significantly associated with the increase in quartiles of LAN intensity (ptrend=0.043). Consistently, we observed significant association trends between the increase in quartiles of LAN intensity and poorer actigraphic sleep quality, including decreased sleep efficiency, prolonged sleep-onset latency, increased wake-after-sleep onset, shortened total sleep time, and delayed sleep-mid time in multivariate models adjusted for the covariates mentioned above (all ptrend<0.001). In conclusion, we demonstrated that LAN exposure in home settings is significantly associated with both subjectively and objectively measured sleep quality in a community-based elderly population.

Daytime sleepiness: a risk factor for poor social engagement among the elderly

BACKGROUND

The aim of this study was to investigate the relationship between social engagement and daytime sleepiness among aged residents of a veterans' housing facility in Taiwan.

METHODS

A total of 597 men were enrolled in this cross-sectional study. Each subject was assessed with the Resident Assessment Instrument-Minimum Data Set, Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and Mini-Mental State Examination. Social engagement was measured with the Index of Social Engagement (ISE), and daytime sleepiness was defined according to the relevant Pittsburgh Sleep Quality Index subcomponent. Subjects were divided into two groups according to their ISE levels. A multivariate logistic regression model was used to examine the association between ISE and other variables.

RESULTS

The sample's mean age was 80.8 ± 5.0 years (range: 65-99 years). Mean ISE score was 1.5 ± 1.3 (range 0-5), with 52% of participants reporting poor social engagement (ISE = 0-1). Mean Pittsburgh Sleep Quality Index global score was 5.6 ± 3.6 (range: 0-18), and 31% of participants reported daytime sleepiness. The analysis was adjusted for level of depression, cognitive impairment, dependence in activities of daily life, unsettled relationships, and illiteracy. After adjustment, daytime sleepiness was found to be independently associated with subjects' level of social engagement (odds ratio: 2.5; 95% confidence interval: 1.7-3.8; P < 0.001).

CONCLUSIONS

Daytime sleepiness and poor social engagement are common among aged residents of a veterans' housing facility. Subjects experiencing daytime sleepiness but not poor general sleep quality were at increased risk of poor social engagement. The clinical care of older residents must focus on improving daytime sleepiness to enhance their social engagement.

Association between insomnia symptoms and mortality: a prospective study of U.S. men

BACKGROUND

Insomnia complaints are common in older adults and may be associated with mortality risk. However, evidence regarding this association is mixed. Thus, we prospectively examined whether men with insomnia symptoms had an increased risk of mortality during 6 years of follow-up.

METHODS AND RESULTS

A prospective cohort study of 23,447 US men participating in the Health Professionals Follow-Up Study and free of cancer, reported on insomnia symptoms in 2004, were followed through 2010. Deaths were identified from state vital statistic records, the National Death Index, family reports, and the postal system. We documented 2025 deaths during 6 years of follow-up (2004-2010). The multivariable-adjusted hazard ratios of total mortality were 1.25 (95% confidence interval [CI], 1.04-1.50) for difficulty initiating sleep, 1.09 (95% CI, 0.97-1.24) for difficulty maintaining sleep, 1.04 (95% CI, 0.88-1.22) for early-morning awakenings, and 1.24 (95% CI, 1.05-1.46) for nonrestorative sleep, comparing men with those symptoms most of the time with men without those symptoms, after adjusting for age, lifestyle factors, and presence of common chronic conditions. Men with difficulty initiating sleep and nonrestorative sleep most of the time had a 55% (hazard ratio, 1.55; 95% CI, 1.19-2.04; P-trend=0.01) and 32% (hazard ratio, 1.32; 95% CI, 1.02-1.72; P-trend=0.002) increased risk of cardiovascular disease mortality, respectively, relative to men without those symptoms.

CONCLUSION

Some insomnia symptoms, especially difficulty initiating asleep and nonrestorative sleep, are associated with a modestly higher risk of mortality.

Polysomnographic and subjective sleep markers of mild cognitive impairment

STUDY OBJECTIVES

Growing evidence suggests that sleep disturbances precede by years the clinical onset of Alzheimer disease (AD). The goal of the current study is to determine whether changes in polysomnographic (PSG) sleep patterns accompany subjective sleep complaints in patients with mild cognitive impairment (MCI). We further examine whether meaningful changes in objective sleep physiology are predicted by self-reported sleep measures in MCI patients, and whether incipient neurodegeneration contributes to exacerbate sleep misperception.

DESIGN SETTING AND PARTICIPANTS

Overnight PSG recordings and self-reported sleep measures were obtained from 25 healthy elderly (HE) subjects and 25 patients with MCI at the sleep laboratory.

RESULTS

Both PSG and self-reported sleep measures confirmed that sleep is altered in patients with MCI. Whereas subjective sleep responses predicted fragmentation of slow wave sleep (SWS) in HE individuals, this relationship was not evident in MCI patients. Furthermore, patients with MCI showed significant discrepancies in the estimation of sleep onset latency when compared with HE subjects.

CONCLUSIONS

Sleep is significantly impaired in patients with mild cognitive impairment at both the objective and subjective level, which may be used as a surrogate marker of preclinical Alzheimer disease. Taken together, these findings aid in the development of novel therapeutic strategies devoted to improve sleep in the elderly population at risk of developing Alzheimer disease.