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

Sleep duration and quality are associated with health-related quality of life in adults aged 60 years and older

BACKGROUND

The current study aimed to determine the association between sleep duration and quality with health-related quality of life (HRQoL) among the Iranian older persons.

METHODS

This study was conducted on a representative sample of 3452 Iranian older people (≥ 60 years) who participated in the Iranian Longitudinal Study on Ageing (IRLSA) launched in Neyshabur (Razavi Khorasan province, northeastern Iran). The Persian versions of 12-Item Short Form Survey (SF-12) and Pittsburgh Sleep Quality Index (PSQI) were utilized to measure the level of HRQoL and the level of sleep duration and quality, respectively. Multiple linear regression model was performed to analyze the data and clarify the independent association of sleep duration and quality with HRQoL.

RESULTS

More than half of the study population (52.4%) suffered from poor sleep quality. 57.3% and 3.9% of individuals were short sleepers (< 7 h) and long sleepers (equal or more than 9 h), respectively. The total score of HRQoL was achieved 65.87 ± 20.55. After adjusting the covariates, the results indicated that short sleep duration was negatively associated with HRQoL (P < 0.05), whereas no significant associations were found between long sleep duration and HRQoL (P > 0.05). Interestingly, the results of multiple linear regression model revealed a significant negative association between poor sleep quality and HRQoL (P < 0.001).

CONCLUSION

The current study confirmed that short sleep duration and poor sleep quality were independently associated with lower HRQoL in the older persons. Therefore, interventional courses should be planned to enrich sleep-related healthcare and general HRQoL in the older persons.

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Attachment and sleep quality in adults: A multilevel meta-analysis of actor and partner effect

Within the context of sleep, attachment is hypothesized to play a central role in regulating bedtime affect and arousal. While previous studies have suggested a link between attachment and sleep quality, a meta-analysis specifically examining this association in adults has been lacking. To address this gap, we conducted a series of multilevel meta-analyses of 28 studies on this topic. Our results indicated a correlation between attachment anxiety and an individual's own sleep quality (r = -0.16, p < 0.001), as well as their partner's sleep quality (r = -0.10, p < 0.05). There was also a negative correlation between attachment avoidance and an individual's sleep quality (r = -0.15, p < 0.001) as well as their partner's sleep quality (r = -0.16, p < 0.01). Additionally, the relationships were moderated by several variables, including age, sleep measurement, and gender. Further analysis indicated that attachment anxiety was associated with poorer subjective sleep quality (PSQI) (r = -0.23, p < 0.001), longer sleep latency (r = -0.10, p < 0.05), increased wakefulness after sleep onset (r = -0.09, p < 0.05), and greater daytime sleepiness (r = -0.20, p < 0.01). Attachment avoidance was associated with poorer self-reported sleep quality (PSQI) (r = -0.16, p < 0.001), longer time to fall asleep (r = -0.15, p < 0.05), and increased daytime sleepiness (r = -0.15, p < 0.05). In summary, the findings of the current study supported the association between attachment insecurity and poorer sleep quality in both individuals and their partners. These findings hold important implications for future interventions aimed at improving sleep quality by addressing attachment-related concerns.

Predicting depressive symptoms in middle-aged and elderly adults using sleep data and clinical health markers: A machine learning approach

OBJECTIVES

Comorbid depression is a highly prevalent and debilitating condition in middle-aged and elderly adults, particularly when associated with obesity, diabetes, and sleep disturbances. In this context, there is a growing need to develop efficient screening methods for cases based on clinical health markers for these comorbidities and sleep data. Thus, our objective was to detect depressive symptoms in these subjects, considering general biomarkers of obesity and diabetes and variables related to sleep and physical exercise through a machine learning approach.

METHODS

We used the National Health and Nutrition Examination Survey (NHANES) 2015-2016 data. Eighteen variables on self-reported physical activity, self-reported sleep habits, sleep disturbance indicative, anthropometric measurements, sociodemographic characteristics and plasma biomarkers of obesity and diabetes were selected as predictors. A total of 2907 middle-aged and elderly subjects were eligible for the study. Supervised learning algorithms such as Lasso penalized Logistic Regression (LR), Random Forest (RF) and Extreme Gradient Boosting (XGBoost) were implemented.

RESULTS

XGBoost provided greater accuracy and precision (87%), with a proportion of hits in cases with depressive symptoms above 80%. In addition, daytime sleepiness was the most significant predictor variable for predicting depressive symptoms.

CONCLUSIONS

Sleep and physical activity variables, in addition to obesity and diabetes biomarkers, together assume significant importance to predict, with accuracy and precision of 87%, the occurrence of depressive symptoms in middle-aged and elderly individuals.

Differences between subjective and objective sleep duration according to actual sleep duration and sleep-disordered breathing: the Nagahama Study

STUDY OBJECTIVES

Since subjective sleep duration (SSD) is considered to be longer than objective sleep duration (OSD), results of SSD minus OSD (SSD-OSD) might always be thought to be positive. Some recent reports showed different results, but exact results have not been obtained. The difference between SSD and OSD may change according to OSD. We investigated this difference and its association with sleep-disordered breathing (SDB) or nonrestorative sleep.

METHODS

This cross-sectional study evaluated 6,908 community residents in Nagahama, Japan. SSD was determined by self-administered questionnaire. OSD was measured by wrist actigraphy and sleep diary. SDB was assessed according to the 3% oxygen desaturation index adjusted for OSD.

RESULTS

Worthy of notice was that SSD was shorter than OSD for those with SSD longer than 6.98 hours in all participants, 7.36 hours in males, and 6.80 hours in females. However, SSD was longer than OSD (mean ± SD: 6.49 ± 1.07 vs 6.01 ± 0.96; P < .001) overall, as SSD is considered to be longer than OSD. In patients with SDB, the difference between SSD-OSD was greater when OSD was shorter. The difference also depended on SDB severity. The degree of positivity between OSD and SSD was a significant factor in nonrestorative sleep (odds ratio: 2.691; P < .001).

CONCLUSIONS

When OSD was slightly less than 7 (6.98) hours, participants reported or perceived SSD > OSD. When OSD was > 6.98 hours, participants reported or perceived SSD < OSD. Patients with SDB reported longer SSD than OSD according to severity of SDB. Evaluating SSD, OSD, and their differences may be useful for managing sleep disturbances, including nonrestorative sleep.

CITATION

Takahashi N, Matsumoto T, Nakatsuka Y, et al. Differences between subjective and objective sleep duration according to actual sleep duration and sleep-disordered breathing: the Nagahama Study. J Clin Sleep Med. 2022;18(3):851-859.

A 10-year Trend of Sleeping Patterns, Geographical, and Community Disparities Among Chinese Older Adults

This study examined the trend and geographical/community disparities of sleeping patterns among Chinese older adults. We included older adults from four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; n = 25,672; age ≥65). We used a multivariable logistic regression model to examine sleep quality (not good versus good), and a multinomial logistic regression model to assess daily sleep duration (7–8 hr, <7 hr, >8 hr). Older adults from the Central/South and the West regions were less likely to report good sleep quality (AOR [adjusted odds ratio] = .63, 95% CI: .55, .72 and AOR = .80, 95% CI: .70, .93, respectively) while the Northeastern residents reported better sleep quality (AOR = 1.51, 95% CI: 1.27, 1.79), compared with Northern residents. Older adults from Central/South and West were more likely to obtain less than 7 hr of sleep. Public health interventions are necessary to improve the sleep of Chinese older adults.

The Association Between Alcohol-Related Problems and Sleep Quality and Duration Among College Students: a Multicountry Pooled Analysis

Alcohol consumption and sleep disorders are both prevalent and relevant problems among college students, but the relationship between these conditions is unclear. This study aimed to analyze the association between alcohol-related problems and sleep in first-year college students from Brazil, Chile, and Spain. Cross-sectional analyses were performed with data from three independent studies with first-year college students from each country. The risk of alcohol-related problems (RARP) and sleep quality and duration were self-reported using mixed methods. Pooled odds ratios (p-OR) and 95% confidence intervals (95% CI) of suboptimal sleep quality and of short (< 7 h) and long (> 8 h) sleep duration were estimated according to RARP adjusting for the main confounders. Of the 1830 students included (31.2% Brazilian, 42.2% Chilean, and 26.6% Spanish), 61.6% were female, and the mean age was 20.0 ± 3.6 years. Overall, 25.0% and 9.9% of the students were classified as intermediate and high RARP, respectively. In the combined results for the three countries, intermediate-to-high RARP was associated with a higher likelihood of suboptimal sleep quality (p-OR: 1.24; 95% CI: 1.00 to 1.52; I2 heterogeneity statistics: 43.0%), regardless of sociodemographic and lifestyle covariates and of self-rated health. The frequency of alcohol consumption was not associated with sleep quality or sleep duration. In this multicountry pooled analysis, first-year college students at risk of alcohol-related problems were more likely to report worse sleep quality. The coexistence of alcohol-related problems and sleep disorders could potentiate its adverse health effects among these young adults.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-022-00763-8.

Longitudinal associations between sleep duration and cognitive function in the elderly population in China: A 10-year follow-up study from 2005 to 2014

OBJECTIVE

Sleep duration is increasingly recognized as an important determinant of cognitive function among elderly. However, longitudinal studies on the relationship between sleep duration and cognitive function in Chinese elderly are rare. We sought to investigate the longitudinal association between sleep duration and cognitive function in Chinese elderly during a 10-year follow-up.

METHOD

This longitudinal study analyzed 2148 elderly (the baseline including 43.16% aged 70%-79%, 23.79% aged 80 and over) who had participated in four waves of the Chinese Longitudinal Healthy Longevity Survey during 2005-2014. Cognitive function (including global functioning and cognitive domains) was assessed using the Chinese version of the Mini-Mental State Examination. Sleep duration was assessed via self-reports. Mixed model analysis was used to evaluate the association between sleep duration and cognitive function, adjusting for sociodemographic variables and risk factors for cognitive function.

RESULTS

There is an inverted U-shaped relationship between sleep duration and global cognition and cognitive domains, with the highest cognitive scores observed for sleep durations between 6 and 9 h and the curve shifting from smooth to steeper from 2005 to 2014. The regression model showed that long sleep duration (>9 h) is significantly associated with global cognition and four cognitive domains: orientation, attention and calculation, immediate recall and visual construction. Both long and short sleep durations are significantly associated with delayed recall and not significantly associated with category fluency, language or the ability to follow a three-stage command. The five cognitive domains related to sleep duration are the domains that exhibited a rapid rate of decline.

CONCLUSIONS

Sleep duration can be identified as a modifiable risk factor for cognitive decline, as long or short sleep duration is associated with the five cognitive domains that exhibit cognitive decline. These findings suggest the need for intervention measures to maintain healthy sleep durations among Chinese elderly people.

Prevalence and factors associated with use of sleeping pills among older adults in Brazil

OBJECTIVES

Little is known about sleeping pills consumption among older adults in low- and middle-income countries. This study investigated the prevalence and factors associated with sleeping pills use among Brazilians aged 50 and over.

METHODS

A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9412). Univariate and bivariate analyses were used to describe the sample. Robust Poisson regression was employed to estimate prevalence ratios and predict probabilities.

KEY FINDINGS

Prevalence of sleeping pills use among older Brazilians was estimated at 16.8%, with considerable disparities related to gender (22.3% among women and 10.3% among men), race/skin colour (19.7% among whites and 11.9% among blacks) and geographic region (ranging from 5.9% in the North to 20.5% in the South). The multivariate analysis showed associations between sleeping pills consumption and sociodemographic factors (age, gender, race/skin colour, geographic region and income), health status/behaviour characteristics (poor self-rated health status, number of chronic conditions and alcohol consumption) and variables related to healthcare utilisation (number of visits, usual source of care, care coordination, doctor's awareness of all medication, difficulty in managing own medication and number of medicines).

CONCLUSIONS

Our work found that sleeping pills consumption is disproportionately prevalent among women, is associated with worse health status and increases with more medical office visits and use of additional medicines. Moreover, the large inexplicable variations in care deserve special attention from policy-makers and clinicians.

Health-related quality of life and sleep quality among North Indian type 2 diabetes mellitus patients: evidence from a cross-sectional study

OBJECTIVE

The objective of this study is to measure the relationship between sleep quality and health-related quality of life (HRQOL), in Indian population with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study, included a total of 300 patients with T2DM. All participants were responding to the Pittsburgh Sleep Quality Index (PSQI) and European Quality of Life-5 Dimensions Questionnaire (EQ-5D). A PSQI global score ≥5 was defined as poor sleep quality. EQ-5D visual analogue scale (VAS), determining the overall health status. Logistic regression analysis was used to examine the association between PSQI and EQ-5D. All the study data were analysed using the SPSS software version 20.0. Values of p < 0.05 were considered statistically significant.

RESULTS

The mean age of included participants were 55.29. Majority of the participants (55.3%) were identified as "poor sleepers" and female (31.3%) contributing higher proportion. Poor sleepers had significantly lower the HRQoL (p < 0.001). After adjustment, poor sleep quality was significantly associated with a lower HRQoL; EQ-5D index (OR = 1.080, 95%, CI: 1.015-1.148, p < 0.05), and EQ-5D VAS (OR = 1.092, 95%, CI: 1.021-1.176, p < 0.01). Overall, the EQ-5D index and EQ-5D VAS were found to be an independent predictors of sleep quality.

CONCLUSIONS

Poor sleep quality is prevalent in Indian T2DM population, and it imparts negative impact on several dimensions of EQ-5D that characterising the daily activities performance. Therefore, further real-world studies are needed to determine the causal relationship between T2DM patients and measure of objective sleep and their impact on health.

Sleep Quality and Daytime Functioning in Older European Adults

Abstract. The aim of this article was to review research studies related to the issues of sleep in older adults, examining the relationship between sleep quality and a set of psychological variables of daytime functioning in healthy older adults: quality of life, subjective health, functional ability, cognitive function, and emotional state, in Europe. Combined scoping review search strategies resulted in a total of 84 articles selected for review. We conclude there is a considerable amount of European research on sleep quality and its correlates in older adults’ population. Studying these relationships may be the basis for the targeted planning of psychological interventions aiming at raising the quality of life in older adults. The selected domains of older adults’ everyday functioning were all well represented in the retrieved research studies.

Sleep Quality and Health-Related Quality of Life in Older People With Subjective Cognitive Decline, Mild Cognitive Impairment, and Alzheimer Disease

We aimed to investigate sleep quality and health-related quality of life (HRQOL) in older adults with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer disease (AD). A total of 221 participants were divided into the following five groups: normal controls (NCs), SCD without memory concerns (SCD-0), SCD with memory concerns (SCD-1), MCI, and AD according to their cognitive status. Compared with NC, individuals with SCD-0, SCD-1, MCI, and AD had more sleep problems and reduced HRQOL. Participants with poor sleep quality had an increased risk of cognitive impairment compared with participants with good sleep quality. Within all five subgroups, individuals with poor sleep quality reported more difficulties in HRQOL than individuals with good sleep quality. Future studies employing a longitudinal design, larger samples, and objective evaluation tools are needed.

Sleep Duration and Cognition in a Nationally Representative Sample of U.S. Older Adults

OBJECTIVE

Excessive and insufficient sleep have been associated with cognitive dysfunction in older adults in U.S. and non-U.S.

STUDIES

However, the U.S. studies were not in nationally representative samples. The authors investigated the association between sleep duration and cognitive performance in a nationally representative sample of U.S. older adults.

PARTICIPANTS

The authors studied 1,496 survey participants aged 60 years or older from the National Health and Nutrition Examination Survey 2013-2014 dataset.

MEASUREMENTS

Our primary predictor was weekday (or workday) nighttime sleep duration, categorized as 2-4, 5, 6, 7 (reference), 8, 9, and 10 hours or more. The authors studied five cognitive outcomes: Consortium to Establish a Registry for Alzheimer's Disease Word Learning (CERAD-WL) immediate recall, CERAD-WL delayed recall, Animal Fluency Test (AFT), Digital Symbol Substitution Test (DSST), and subjective cognitive problems (SCP).

RESULTS

After adjusting for age, sex, race, education, depressive symptoms, and sedative-hypnotic use, sleep duration of 10 hours or more was significantly associated with lower scores on CERAD-WL immediate recall, CERAD-WL delayed recall, AFT, and DSST, and greater odds of SCP; sleep duration of 8 hours or more was associated with lower CERAD-WL delayed recall scores: 8, 9, and 10 hours or more. After adjustment, there were no significant associations of shorter sleep duration with cognition.

CONCLUSION

In U.S. adults aged 60 years or older, long nighttime weekday or workday sleep duration is associated with poorer verbal memory, semantic fluency, working memory, and processing speed in addition to greater odds of self-reported cognitive problems. Long sleep duration may be a marker of fragmented sleep or neurodegeneration in U.S. older adults.

Sleep characteristics and self-rated health in older persons

PURPOSE

It remains unclear, how much older persons' sleep problems are due to age-related changes in sleep architecture and pattern, or whether they are a consequence of health problems. This work aimed to examine the association between sleep characteristics and self-rated health, taking into account potential confounders.

METHODS

Data about sleep, including sleep efficiency (ratio of sleep duration to the amount of time spent in bed, considered as good if > 85%), as well as health-rated characteristics were self-reported by community-dwelling persons enrolled in the Lausanne cohort 65+ study (n = 2712, age 66-75 years). Participants' subjective health was categorized as good versus poor. The cross-sectional association between good self-rated health and sleep characteristics was examined in bivariate and multivariate analysis.

RESULTS

The majority of participants (68.4%) rated their health as good. Compared to the participants with poor-rated health, they more often reported a good sleep efficiency (59.5% vs 45.0%, p < 0.001) and less often reported napping (41.6% vs 54.0%, p < 0.001) as well as using sleep medication (12.7% vs 31.8%, p < 0.001). After adjustment for comorbidity, depressive symptoms and cognitive difficulties, a positive association persisted between good sleep efficiency and good self-rated health (adjOR: 1.35, 95% CI 1.10-1.66). Regular napping remained negatively associated to feel healthy (adjOR: 0.65, 95% CI 0.53-0.79).

CONCLUSION

Sleep efficiency is positively associated with subjective health, whereas napping and use of sleep medication are negatively associated to rating own health as good. These associations need to be further investigated in longitudinal analyses to better understand causality.

Cross-sectional comparison of various sleep disturbances among sex- and age-matched HIV-infected versus HIV-uninfected individuals in China

OBJECTIVE/BACKGROUND

This study assessed the prevalence and correlates of various sleep disturbances in HIV-infected patients compared to sex- and age-frequency-matched HIV-uninfected controls in China.

METHODS

This cross-sectional analysis included 1469 HIV-infected cases and 2938 HIV-uninfected controls. Insomnia symptoms, poor sleep quality (Pittsburgh Sleep Quality Index [PSQI] >5) as well as their specific domains, were assessed.

RESULTS

Prevalence of insomnia symptoms, poor sleep quality, and long sleep duration were higher in HIV-infected vs uninfected participants (23.7% vs 19.8%, 24.1% vs 19.9%, and16.1% vs 8.7%, respectively; all p < 0.05), and remained significant after adjusting for age, sex and education. An Age-stratified analysis showed that such differences were significant only at ages 18-29 and 30-44 years for insomnia symptoms and poor sleep quality long sleep duration was significant across all age groups. Among HIV-infected patients, multivariate analysis indicated that older age, depressive symptoms and frailty score were the most consistent variables associated with sleep disorders (ie, insomnia symptoms, poor sleep quality, short and long sleep durations), as well as all associations (if significant) were positive, excluding the negative associations of older age and depressive symptoms with short sleep duration. Regarding HIV-specific factors, only current CD4 cell count ≥500 cells/μL was negatively associated with insomnia symptoms.

CONCLUSIONS

The impact of HIV infection on sleep disturbances may differ across age groups and are more pronounced among young adults. Additionally, the phenomenon of prolonged sleep duration among HIV-infected patients should be noted, and its link to poor physical health warrants further investigation.

Duration and Quality of Sleep and Risk of Physical Function Impairment and Disability in Older Adults: Results from the ENRICA and ELSA Cohorts

Sleep duration and quality have been associated with poor physical function, but both the temporality of the association and the independence of sleep duration and quality are unclear. We examined the prospective association of sleep duration and quality with physical function impairment and disability in older adults. Data were taken from participants in the Seniors-ENRICA (2012-2015, n= 1,773) and in the ELSA cohort (waves 4 and 6, n=4,885) aged ≥60 years. Sleep duration and quality were self-reported. Physical function impairment and disability was obtained either from self-reports (ENRICA and ELSA) or from performance assessment (ENRICA). Logistic regression models were adjusted for potential confounders. After a follow-up of 2.0-2.8 years, no association was found between changes in sleep duration and physical function impairment or disability. However, in both studies, poor general sleep quality was linked to higher risk of impaired agility [OR: 1.93 (95% CI: 1.30-2.86) in Seniors-ENRICA and 1.65 (1.24-2.18) in ELSA study] and mobility [1.46 (0.98-2.17) in Seniors-ENRICA and 1.59 (1.18-2.15) in ELSA study]. Poor general sleep quality was also associated with decreased physical component summary (PCS) [1.39 (1.05-1.83)], disability in instrumental activities of daily living [1.59 (0.97-2.59)] and in basic activities of daily living [1.73 (1.14-2.64)] in Seniors-ENRICA. In addition, compared to those with no sleep complaints, participants with 2 or more sleep complaints had greater risk of impaired agility, impaired mobility, decreased PCS and impaired lower extremity function in both cohorts. Poor sleep quality was associated with higher risk of physical impairment and disability in older adults from Spain and from England.

Sex differences in neurocognitive screening among adults living with HIV in China

HIV-infected (HIV+) women may be more vulnerable to neurocognitive impairment (NCI) due to psychological and physiological factors but previous studies show mixed findings. We investigated the neurocognitive performances in HIV+ versus HIV- women and men. This cross-sectional analysis included 669 HIV+ patients (223 women) and 1338 HIV-uninfected (HIV-) controls (446 women) which were frequency matched on sex, education, and 5-year age categories. NCI was screened using the Mini-mental State Examination. Psychomotor speed was assessed using timed alternating hand sequence test. Prevalence of NCI was higher among women versus men in the HIV+ group (16.1% vs 10.5%) but not the HIV- group (4.3% vs 3.5%). HIV+ women performed worse compared to men on psychomotor speed, orientation, attention, and calculation, whereas HIV- women performed worse compared to men on attention and calculation. Adjusted interaction effects of HIV status × sex (women vs men) were significant on orientation, attention, and calculation, and marginally significant on psychomotor speed (p = 0.053). In multivariable models, among both HIV+ women and men, less years of education and depressive symptoms were associated with NCI. Waist-to-hip ratio above the cut-off was strongly associated with NCI among HIV+ women. HIV+ women perform worse on cognitive measures compared to HIV+ men. The association of central obesity with NCI in HIV+ women should be noted.

Sleep quality mediating the association of personality traits and quality of life among underground workers and surface workers of Chinese coal mine: A multi-group SEM with latent response variable mediation analysis

The aim of this study was to examine whether the association between personality traits and quality of life (QOL) was mediated by sleep quality in coal miners and to explore whether the relationship between surface workers and underground workers was different. The cross-sectional study including 3090 coal mine workers aged 20 to 65 years from Shanxi province of China was conducted. Personality traits, QOL and sleep quality were respectively assessed using Eysenck Personality Questionnaire-Revised Short Scale for Chinese, World Health Organization Quality of Life-BREF, and sleep status questionnaire. The multi-group SEM with latent response variable method was conducted to evaluate the association between personality traits and QOL mediated by sleep quality. The difference of indirect effects between two subgroups was examined by Wald chi-square test. For surface workers, underground workers and overall sample, passive personality traits had a negative impact on QOL through poor sleep quality, whereas the active personality traits acted the opposite. However, the difference of indirect effect between two subgroups was not statistically significant. These results indicated that sleep quality may act as a partial mediator in the relationship between personality traits and QOL, and the relationship may not be affected by working environment.

Sleep, hippocampal volume, and cognition in adults over 90 years old

BACKGROUND

Several lines of research support associations between sleep and cognition in older adults. However, there is a paucity of data regarding sleep and cognition in nonagenarians and centenarians.

AIMS

The current study examined self-reported sleep quantity and sleep quality in relation to hippocampal volume and cognition in adults aged 90 and older.

METHODS

A total of 144 participants of The 90+ Study completed The Medical Outcomes Study sleep questionnaire. Participants reported subjective sleep duration in hours and three sleep quality factors: sleep problems, adequacy, and somnolence. Neuropsychological assessments of memory, global cognition, language, and executive function were completed, on average, 61 days from the questionnaire. Hippocampal volume on 3 T MRI, adjusted for intracranial volume, was obtained in 82 participants. We performed multiple linear regressions, controlling for age, sex, education, sleep medication, and depression, to examine sleep characteristics in relation to hippocampal volume and cognitive performance in all the subjects and then stratified by cognition.

RESULTS

Sleep duration > 8 h was associated with lower scores in tests of global cognition, memory, and executive function compared to sleep duration of 7-8 h when collapsing across cognitive status, but only with memory in cognitively impaired subjects, and not in cognitively normal subjects.

CONCLUSIONS AND DISCUSSION

Long-sleep duration is associated with poorer global cognition, memory, and executive function in the oldest-old, and is only associated with memory in cognitively impaired oldest-old. Additional research is necessary to determine if sleep duration is a risk factor or a result of poor cognition in advanced age.

Exposure to neighborhood green space and sleep: evidence from the Survey of the Health of Wisconsin

INTRODUCTION

Adequate sleep duration and quality are protective against many adverse health outcomes. Many individual-level predictors of poor sleep have been examined, but few studies have examined neighborhood-level influences. Despite known associations between neighborhood green space and sleep influencing factors (eg, physical activity, mental health), few studies have examined green space and sleep's relationship. Furthermore, little work has examined the relationship between the magnitude and type of neighborhood sounds and sleep.

STUDY METHODS

We analyzed data from the Survey of the Health of Wisconsin database (n = 2712) for 2008-2013, a representative sample of Wisconsin residents ages 21-74. Outcomes included weekday and weekend sleep duration and self-rated sleep quality. Primary predictors were the proportion tree canopy (National Land Cover Database) and mean decibel levels of outdoor sound (US National Park Service) at the census block group level. Survey regression analysis was used to examine statistical associations, controlling for individual and neighborhood-level covariates.

RESULTS

Models suggest a significant relationship (P < .05) between weekday sleep duration and green space, and between weekend/day sleep duration and human-made and total neighborhood sound. Increased percent tree canopy in a census block group was associated with lower odds of short weekday sleep (<6 hours) (OR 0.76 [0.58-0.98]). Increased human-made and total mean decibel levels were associated with increased instances of short weekend and weekday sleep (OR 1.05 [1.01-1.08] and 1.03 [1.01-1.06] respectively).

CONCLUSIONS

Neighborhood tree canopy and sound levels may influence sleep duration and are potential targets for neighborhood-level interventions to improve sleep.

Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults

OBJECTIVES

To evaluate cross-sectional and prospective associations between short and long sleep duration and depressive symptoms in older adults (aged >65 years).

METHODS

The data from a subsample of the racially/ethnically diverse Northern Manhattan Study were analyzed. Depressive symptoms were assessed twice with the Center for Epidemiologic Studies Depression Scale (CES-D), approximately 5 years apart. The presence of depressive symptoms was defined as a CES-D score ≥16 or use of antidepressants. Self-reports of short (<6 h), intermediate (6-8 h) and long (≥9 h) sleep were assessed prior to the initial CES-D. Logistic regression was used to evaluate the cross-sectional associations between short and long sleep durations with depressive symptoms, using intermediate sleep as the reference. The prospective association between sleep duration and depression in a sample of participants without depressive symptoms at first CES-D was also analyzed. All models were adjusted for demographic, behavioral, and vascular risk factors.

RESULTS

The initial sample consisted of 1110 participants: 62% women, 69% Hispanic, 17% black, 14% white. Short sleep was reported by 25%, intermediate sleep by 65%, and long sleep by 9%. Depressive symptoms were described in 25% of the initial sample. Short sleep, but not long sleep, was associated with depressive symptoms at baseline (adjusted OR 1.8, 95% CI 1.3-2.6), and at follow-up (adjusted OR 1.9, 95% CI 1.1-3.5; median follow-up = 5.1 years).

CONCLUSION

Short sleep duration had a cross-sectional and prospective association with depressive symptoms in an urban multi-ethnic cohort of older adults.

Association between nighttime sleep duration, midday naps, and glycemic levels in Japanese patients with type 2 diabetes

OBJECTIVES

To clarify the relationship between nighttime sleep duration, midday naps, and glycemic control in Japanese patients diagnosed with type 2 diabetes (n = 355) or impaired glucose tolerance (n = 43).

METHODS

A total of 398 patients completed a self-administered questionnaire on sleep duration/quality and were divided into five groups according to their self-reported nighttime sleep duration: <5 h, 5-6 h, 6-7 h, 7-8 h, and >8 h. Each group was further divided into two subgroups each according to the presence or absence of midday naps. Poor glycemic control was defined as HbA1c ≥ 7.0%.

RESULTS

Short nighttime sleep (<5 h), poor sleep induction, daytime sleepiness, and low sleep satisfaction were associated with high HbA1c levels. HbA1c was higher in the short nighttime sleep/no nap group than in non-nappers with different nighttime sleep duration, whereas the short nighttime sleep/nap group showed similar HbA1c levels to the other nap subgroups. In multivariate logistic regression models, after adjusting for a number of potential confounders, short (<5 h) nighttime sleep without nap was significantly associated with poor glycemic control compared with 6-7 h nighttime sleep without nap (OR [95% CI]: 7.14 [2.20-23.20]). However, taking naps reduced this risk for poor glycemic control in short sleepers. Other risk factors for poor glycemic control were low sleep satisfaction (1.73 [1.10-2.70]) and poor sleep induction (1.69 [1.14-2.50]).

CONCLUSIONS

Poor sleep quality and quantity could aggravate glycemic control in type 2 diabetes. Midday naps could mitigate the deleterious effects of short nighttime sleep on glycemic control.

CLINICAL TRIALS REGISTRATION

UMIN 000017887.

Characterizing Adult Sleep Behavior Over 20 Years-The Population-Based Doetinchem Cohort Study

Study Objectives:

To describe sleep duration patterns of adults over a 20-year period; to compare sociodemographic, lifestyle, and health characteristics across these patterns; and to relate the patterns to sleep quality.

Methods:

The study population consisted of 3695 adults aged 20 to 59 years at baseline. Five measurements of self-reported sleep duration were used to compose seven patterns from 1987 to 2012: persistent short (≤6 hours), moderate (7–8 hours), or long (≥9 hours) sleep duration and several changing patterns (varying and became short, moderate, or long sleepers). Multinomial logistic regression analyses were used to compare characteristics across sleep duration patterns.

Results:

About 56% of the adults had persistent moderate sleep duration over 20 years. This group had a better sleep quality than the other groups. Of the adults who changed in their sleep duration (40%), 43% became a short sleeper. Sleep duration patterns that deviate from persistent moderate sleep duration were associated with physical inactivity during leisure time (odds ratios [ORs] and 95% confidence intervals [95% CIs] varied between 1.26 [1.04–1.53] and 1.58 [1.06–2.37]) and with poor self-rated health (ORs [95% CIs] varied between 1.50 [1.20–1.87] and 2.15 [1.48–3.12]).

Conclusions:

Nearly half of the adults did not have persistent moderate sleep duration over a 20-year period and more than one-sixth became short sleeper. This is reason for concern considering the adverse health status associated with short and long sleep duration. Leisure-time physical activity is a potential important target to prevent unfavorable changes in sleep duration over the life course.

Self-Reported Sleep Quality, Duration, and Health-Related Quality of Life in Older Chinese: Evidence From a Rural Town in Suzhou, China

STUDY OBJECTIVES

To determine the associations of self-reported sleep quality and duration with health-related quality of life (HRQOL) in older Chinese.

METHODS

We analyzed community-based cross-sectional data of 5,539 individuals aged 60 years and older in the Weitang Geriatric Disease Study. Information of sleep quality and duration were self-reported through participants' responses to predefined questions; HRQOL data were collected by using the European Quality of Life-5 Dimensions (EQ-5D). We estimated the associations of sleep quality and duration with the EQ-5D index and visual analog scale (VAS) scores using linear regression models. The associations between sleep quality and duration and EQ-5D-detected health problems were modeled using logistic regression.

RESULTS

In multiple linear models adjusting sociodemographic factors, health conditions, and lifestyle habits, both EQ-5D index and VAS scores declined with deterioration of sleep quality. The coefficients for poor and intermediate sleep quality were -0.053 (95% confidence interval [CI]:-0.065, -0.042) and -0.022 (95% CI: -0.030, -0.013), respectively, in relation to EQ-5D index score. They were -5.2 (95% CI: -6.7, -2.4) and - 3.8 (95% CI: -4.9, -2.7) in modeling the EQ-5D VAS score. HRQOL declined as sleep duration decreased below 7.01 hours or exceeded 8.01 hours, though most of the associations did not reach statistical significance. In multiple logistic models, poor sleep quality was associated with problems of mobility, pain/discomfort, and anxiety/ depression; short sleep duration was associated with mobility problems.

CONCLUSIONS

Poor sleep quality and extreme sleep durations appeared to be negatively associated with HRQOL in older Chinese adults.

Assessment of Sleep Quality and Effects of Relaxation Exercise on Sleep Quality in Patients Hospitalized in Internal Medicine Services in a University Hospital: The Effect of Relaxation Exercises in Patients Hospitalized

This study aims to assess sleep quality and determine the effects of relaxation exercise on sleep quality in patients hospitalized in internal medicine services. In total, 47 patients comprised the control group and did not engage in the exercise intervention--the progressive muscle relaxation exercise, whereas 235 patients were assigned to the intervention group (N = 282). In this study, Description Questionnaire Form and the Pittsburg Sleep Quality Index (PSQI) were used. Most patients (73.8%) had poor sleep quality. The mean pre- and postexercise PSQI scores of the patients in the interventional group were 8.7 ± 4.0 and 6.1 ± 3.3, respectively. The mean pre- and postexercise PSQI scores of the control patients were 6.6 ± 3.5 and 5.6 ± 2.7, respectively. According to this study, the exercises significantly enhanced the quality of sleep. Patients should be encouraged by nurses to perform relaxation exercises.

Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample

OBJECTIVE

Insomnia symptoms have been individually associated with both caffeine consumption and sleep duration abnormalities in prior studies. The goal of this study was to determine whether caffeine consumption was associated with insomnia symptoms from a population perspective and whether this relationship depended on habitual sleep duration.

METHODS

Data were extracted from the 2007-2008 National Health and Nutritional Examination Survey (N = 4730). Caffeine consumption was quantified as mg/d from 2 typical days of use, 7 to 10 d apart. Insomnia symptoms were evaluated using frequencies of difficulty falling asleep (DFA), difficulty staying asleep (DSA), non-restorative sleep (NRS), and daytime sleepiness (DS). Habitual sleep duration was assessed as the hours of sleep obtained on a typical night. Binomial logistic regression analysis evaluated the relationships of individual insomnia and sleepiness symptoms (DFA, DSA, NRS, and DS) with caffeine consumption and sleep duration variables, after adjusting for covariates.

RESULTS

The mean ± SD caffeine consumption was 176.6 ± 201 mg/d. Mean habitual sleep duration was 6.8 ± 1.4 h. Insomnia symptoms were prevalent in 19.1% to 28.4% of the respondents. Although caffeine consumption was associated with all insomnia symptoms in the unadjusted models, the adjusted models demonstrated a trend toward significance with DSA. Sleep duration was inversely associated with the insomnia symptoms in unadjusted and adjusted analysis. Finally, NRS was associated with an interaction between increased caffeine consumption and sleep duration.

CONCLUSION

The association between caffeine use and insomnia symptoms depends on habitual sleep duration at a population level.

Association of chronic insomnia symptoms and recurrent extreme sleep duration over 10 years with well-being in older adults: a cohort study

OBJECTIVES

The extent to which aspects of sleep affect well-being in the long-term remains unclear. This longitudinal study examines the association between chronic insomnia symptoms, recurrent sleep duration and well-being at older ages.

SETTING

A prospective cohort of UK civil servants (the Whitehall II study).

PARTICIPANTS

4491 women and men (25.2% women) with sleep measured 3 times over 10 years and well-being once at age 55-79 years. Insomnia symptoms and sleep duration were assessed through self-reports in 1997-1999, 2003-2004 and 2007-2009.

PRIMARY OUTCOME MEASURES

Indicators of well-being, measured in 2007-2009, were the Control, Autonomy, Self-realisation and Pleasure measure (CASP-19) of overall well-being (range 0-57) and the physical and mental well-being component scores (range 0-100) of the Short Form Health Survey (SF-36).

RESULTS

In maximally adjusted analyses, chronic insomnia symptoms were associated with poorer overall well-being (difference between insomnia at 3 assessments vs none -7.0 (SE=0.4) p<0.001), mental well-being (difference -6.9 (SE=0.4), p<0.001) and physical well-being (difference -2.8 (SE=0.4), p<0.001) independently of the other sleep measures. There was a suggestion of a dose-response pattern in these associations. In addition, recurrent short sleep (difference between ≤ 5 h sleep reported at 3 assessments vs none -1.7 (SE=0.7), p<0.05) and recurrent long sleep (difference between >9 h reported at 2 or 3 assessments vs none -3.5 (SE=0.9), p<0.001) were associated with poorer physical well-being.

CONCLUSIONS

We conclude that in older people, chronic insomnia symptoms are negatively associated with all aspects of well-being, whereas recurrent long and short sleep is only associated with reduced physical well-being.

Influence of Sleep on Quality of Life Among Hospital Nurses

Introduction

Sleep disorders are the cause of morbidity and mortality and can decrease functional capacity and quality of life. Nurses, especially those working irregular or night shifts, are at risk for developing sleep disorders. The present study aims to determine the relationship between sleep quality and health-related quality of life (HRQOL) as well as quantitative and subjective aspects of sleep quality in nurses.

Methods

This cross-sectional study was conducted on 1456 nurses working in 11 hospitals in Shiraz and Tehran (Iran) in 2014. Structured questionnaires (Pittsburg Sleep Quality Index [PSQI] and Medical Outcomes Study Short Form-36 Survey [SF-36]) were used to collect data on participants’ demographic characteristics, sleep quality, and health-related quality of life. Chi-square and independent samples t-test were employed for statistical analysis.

Results

Mean age of participants was 30.81 ± 7.8, and most of them were female (89.04%) and poor sleepers. Long-duration sleepers slept for more than 9.8 h/night, and they obtained higher scores than short-duration sleepers (<4.5 h/night) in all SF-36 domains. The study results showed that increased quality of life was significantly related to health-related quality of life.

Conclusions

This study showed strong evidence that sleep disorders, such as poor quality and short duration of sleep, are negatively associated with HRQOL. Therefore, developing systemic strategies to cope with the problem seems to be necessary.

Ergonomic approach for pillow concept design

Sleep quality is an essential factor to human beings for health. The current paper conducted four studies to provide a suitable pillow for promoting sleep quality. Study 1 investigated the natural positions of 40 subjects during sleep to derive key-points for a pillow design. The results suggested that the supine and lateral positions were alternatively 24 times a night, and the current pillows were too high for the supine position and too low for lateral positions. Study 2 measured body dimensions related to pillow design of 40 subjects to determine pillow sizes. The results suggested that the pillow height were quite different in supine position and lateral position and needed to take into consideration for a pillow design. Study 3 created a pillow design based on the results of above studies. The pillow was a U-form in the front of view in which the pillow height in the middle area was lower for the supine position, and both sides were higher for the lateral positions. Study 4 assessed sleep quality of 6 subjects by using the proposed pillows and the current pillows. The results showed that the newly designed pillow led to significantly higher sleep quality, and the new design received an innovation patent.

The impact of sleep duration on self-rated health

Purpose

To review the association between sleep duration and self-rated health.

Methods

A search for original and review articles focusing on sleep duration and self-rated health was performed in PubMed. The general search strategy was [(“sleep duration” OR “total sleep time” OR “time in bed”) AND “self-rated health”].

Results

We found 22 articles in the English language; 8 articles with no direct association between sleep duration and self-rated health were excluded. Of these articles, 14 were considered potentially relevant and examined in detail, and 9 were excluded for not having self-rated health as the primary outcome. This work was compounded by 5 papers. The extremes of sleep duration (short or long) exhibited an interaction with poor or worse self-rated health.

Conclusion

The sleep duration issue should be considered when inquiring about health conditions, as this factor can lead to adverse results in global health status.

Sleep duration is associated with white matter hyperintensity volume in older adults: the Northern Manhattan Study

Self-reports of long or short sleep durations have indicated an association with cardiovascular morbidity and mortality, but there are limited data evaluating their association with white matter hyperintensity volume (WMHV), a marker of cerebral small vessel disease. We conducted a cross-sectional analysis of self-reported sleep duration to test for a correlation with white matter hyperintensities, measured by quantitative magnetic resonance imaging (MRI), in the Northern Manhattan Study. We used multivariable linear regression models to assess associations between both short (<6 h) and long (≥9 h) sleep durations and log-transformed WMHV, adjusting for demographic, behavioural and vascular risk factors. A total of 1244 participants, mean age 70 ± 9 years, 61% women and 68% Hispanics were analysed with magnetic resonance brain imaging and self-reported sleep duration. Short sleep was reported by 23% (n = 293) and long sleep by 10% (n = 121) of the sample. Long sleep (β = 0.178; P = 0.035), but not short sleep (β = -0.053; P = 0.357), was associated with greater log-WMHV in fully adjusted models. We observed an interaction between sleep duration, diabetes mellitus and log-WMHV (P = 0.07). In fully adjusted models, stratified analysis showed that long sleep duration was associated with greater WMHV only in those with diabetes (β = 0.78; P = 0.0314), but not in those without diabetes (β = 0.022; P = 0.2), whereas short sleep was not associated with white matter hyperintensities in those with or without diabetes. In conclusion, long sleep duration was associated with a greater burden of white matter lesions in this stroke-free urban sample. The association was seen mainly among those with diabetes mellitus.

Sleep quality and the metabolic syndrome: the role of sleep duration and lifestyle

BACKGROUND

This study examined the association between sleep quality and the metabolic syndrome and whether if it is independent of sleep duration and if it can be explained by lifestyles linked to sleep quality.

METHODS

Cross-sectional study conducted from 2008 to 2010 with 10 342 individuals representative of the population aged ≥18 years in Spain. Poor sleep quality was ascertained through self-reported difficulty falling asleep, difficulty maintaining sleep and sleeping pill consumption. Metabolic syndrome was defined according to the recent harmonized definition. Analyses were conducted with logistic regression and adjusted for the main confounders.

RESULTS

Difficulty falling asleep was associated with higher frequency of metabolic syndrome after adjustment for sociodemographic variables, lifestyle and diagnosed morbidity [odds ratio (OR) = 1.25; 95% confidence interval (CI) = 1.06-1.47]. The association was slightly attenuated after further adjusting for sleep duration (OR = 1.23; 95% CI = 1.04-1.46) and held after additional adjustment for energy intake, adherence to a Mediterranean dietary pattern, energy spent in physical activity and time watching TV (OR = 1.20; 95% CI = 1.01-1.42). No associations were found between metabolic syndrome and other sleep quality indicators. Difficulty falling asleep was associated with high blood pressure in the fully adjusted analyses (OR = 1.17; 95% CI = 1.00-1.37) but not with the rest of components of metabolic syndrome.

CONCLUSIONS

Difficulty falling asleep is associated with metabolic syndrome and, in particular, with high blood pressure. This association is independent of sleep duration and is not due to lifestyles related to poor sleep. This finding should be replicated in prospective studies using objective sleep measures; also, the influence of antihypertensive and lipid-lowering drug treatment on this association should be further studied.

Physical and psychosocial factors associated with physical activity in patients with chronic obstructive pulmonary disease

OBJECTIVES

To assess physical activity and sitting time in patients with chronic obstructive pulmonary disease (COPD) and to investigate which physical and psychosocial factors are associated with physical activity and sitting time.

DESIGN

Cross-sectional study.

SETTING

Patients were recruited at outpatient clinics of general hospitals and from general practitioners.

PARTICIPANTS

Patients (N=113) with mild to very severe COPD.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Physical activity and sitting time were measured with a triaxial accelerometer (24h/d).

RESULTS

Mean locomotion time per 24 hours was 6.8% (range, 0.7%-20.4%). Elevated physical activity was independently associated with higher self-efficacy, higher functional exercise capacity, and lower lung hyperinflation. Decreased physical activity was strongest in more severe stages of COPD, in which the patients were mainly limited by physical disease-specific factors (higher lung hyperinflation, worse dyspnea severity, worse leg muscle function, and oxygen use). In less severe patients, physical activity was independently associated with more generic factors (higher self-efficacy and the spring/summer season). Sitting time did not differ between severity stages, and longer sitting time in the total group was independently associated with more positive perception of treatment control, less autonomous motivation to exercise, not using sleep medication, and oxygen use.

CONCLUSIONS

Both physical and psychosocial factors were associated with physical activity in patients with COPD. The factors associated with physical activity differed between disease severity stages, raising the question of whether physical activity enhancement programs should differ as well. Sitting time should be investigated further.

Association between sleep duration and the mini-mental score: the Northern Manhattan study

BACKGROUND

Short and long sleep duration are associated with increased mortality and worse global cognitive function, but is unclear if these relations persist after accounting for the risk of sleep disordered breathing (SDB). The aim of our study is determine the association between short and long sleep duration with worse global cognitive function in a racially/ethnically diverse elderly cohort.

METHODS

We examined sleep hours and global cognitive function cross-sectionally within the population-based Northern Manhattan Study cohort. We conducted nonparametric and logistic regression to examine associations between continuous, short (< 6 h) and long (≥ 9 h) sleep hours with performance on the Mini Mental State Examination (MMSE).

RESULTS

There were 927 stroke-free participants with data on self-reported sleep hours and MMSE scores (mean age 75 ± 9 years, 61% women, 68% Hispanics). The median (interquartile range) MMSE was 28 (10-30). Sleep hours (centered at 7 h) was associated with worse MMSE (β = -0.01; SE [0.004], p = 0.0113) adjusting for demographics, vascular risk factors, medications, and risk for SDB. Reporting long sleep (≥ 9 h) compared to 6 to 8 h of sleep (reference) was significantly and inversely associated with MMSE (adjusted β = -0.06; SE [0.03], p = 0.012), while reporting short sleep was not significantly associated with MMSE performance. Long sleep duration was also associated with low MMSE score when dichotomized (adjusted OR: 2.4, 95% CI: 1.1-5.0).

CONCLUSION

In this cross-sectional analysis among an elderly community cohort, long sleep duration was associated with worse MMSE performance.

Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults

Background

Sleep disturbance is a complex health problem in ageing global populations decreasing quality of life among many older people. Geographic, cultural, and ethnic differences in sleep patterns have been documented within and between Western and Asian populations. The aim of this study was to explore sleep problems among Hong Kong seniors by examining the prevalence of poor sleep quality, the relationship between sleep quality and health-related quality of life, and associated factors of good sleepers in different age groups.

Methods

This cross-sectional study used convenience sampling and gathered data during face-to-face interviews. Older community-dwelling individuals (n = 301) were recruited in community centres in 2010. The Pittsburgh Sleep Quality Index and Medical Outcomes Study Short Form-36 were used to measure sleep quality and health-related quality of life. The Medical Outcomes Study Short Form-36 domain scores were compared between good and bad sleepers and between long and short sleepers using Hotelling’s T-Square test. SF-36 domain scores were placed into a logistic regression model that controlled for significant demographic variables (gender, educational level, perceived health).

Results

Most (77.7%) participants were poor sleepers. Participants who had global Pittsburgh Sleep Quality Index scores <5 and slept ≥5.5 h/night had better health-related quality of life. Vitality, emotional role, physical functioning, and bodily pain domain scores were associated factors of good sleepers in different age groups.

Conclusions

This study found a strong negative association between sleep deprivation (poor quality, short duration) and health-related quality of life. Associated factors for good sleep quality in later life differ among age groups in relation to universal age-related changes, and should be addressed by social policies and health-care programmes.

Race-ethnic differences of sleep symptoms in an elderly multi-ethnic cohort: the Northern Manhattan Study

BACKGROUND

Sleep disorders are associated with stroke and may vary among elderly Hispanics, Blacks and Whites. We evaluated differences in sleep symptoms by race-ethnicity in an elderly population-based urban community sample.

METHODS

Snoring, daytime sleepiness and reported sleep duration were ascertained by standardized interviews as a part of the Northern Manhattan Study, a prospective cohort study of vascular risk factors and stroke risk in a multi-ethnic urban population. Sleep symptoms were compared amongst race-ethnic groups using logistic regression models.

RESULTS

A total of 1,964 stroke-free participants completed sleep questionnaires. The mean age was 75 ± 9 years, with 37% men, with 60% Hispanics, 21% Blacks and 19% Whites. In models adjusted for demographic and vascular risk factors, Hispanics had increased odds of frequent snoring (odds ratio, OR: 3.6, 95% confidence interval, CI: 2.3-5.8) and daytime sleepiness (OR: 2.8, 95% CI: 1.7-4.5) compared to White participants. Hispanics were more likely to report long sleep (≥ 9 h of sleep, OR: 1.8, 95% CI: 1.1-3.1). There was no difference in sleep symptoms between Black and White participants.

CONCLUSION

In this cross-sectional analysis among an elderly community cohort, snoring, sleepiness and long sleep duration were more common in Hispanics. Sleep symptoms may be surrogate markers for an underlying sleep disorder which may be associated with an elevated risk of stroke and may be modified by clinical intervention.