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Öberg S, Sandlund C, Westerlind B, Finkel D, Johansson L. The existing state of knowledge about sleep health in community-dwelling older persons - a scoping review. Ann Med 2024; 56:2353377. [PMID: 38767211 PMCID: PMC11107849 DOI: 10.1080/07853890.2024.2353377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVES It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older people. AIM This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons. METHOD We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485. RESULTS The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty. CONCLUSION Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.
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Affiliation(s)
- Sandra Öberg
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Christina Sandlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Björn Westerlind
- Department of Geriatrics, County Hospital Ryhov, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
- School of Health and Welfare, Institute of Gerontology, Jönköping University, Jönköping, Sweden
| | - Deborah Finkel
- School of Health and Welfare, Institute of Gerontology, Jönköping University, Jönköping, Sweden
- Center for Economic and Social Research, University of Southern CA, Los Angeles, CA, USA
| | - Lennarth Johansson
- School of Health and Welfare, Institute of Gerontology, Jönköping University, Jönköping, Sweden
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Furihata R, Endo D, Nagaoka K, Hori A, Ito T, Iwami T, Akahoshi T. Association between a composite measure of sleep health and depressive symptoms in patients with obstructive sleep apnea treated with CPAP therapy: Real-world data. Sleep Med 2024; 120:22-28. [PMID: 38852260 DOI: 10.1016/j.sleep.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/19/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Sleep health is known to be multidimensional, and there is increasing clinical interest in composite sleep health scores that capture the number of adverse sleep characteristics. We investigated whether a composite sleep health score was associated with depressive symptoms in patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). METHODS Participants were OSA patients using CPAP (n = 1768, (92.1 % men, age 52.7 ± 10.7 years) attending sleep clinics in Japan. A cross-sectional survey conducted in 2020 assessed self-reported sleep and depressive symptoms. Sleep health was categorized as "good' or "poor' on five dimensions: satisfaction, daytime sleepiness, mid-sleep time, efficiency, and duration. A composite sleep health score was calculated by summing the "poor' dimensions. Depressive symptoms were assessed using two items from the Patient Health Questionnaire (PHQ-2). Associations between sleep health and depressive symptoms were assessed using multivariable logistic regression analysis. RESULTS Individual sleep health symptoms of poor satisfaction and efficiency were significantly associated with depressed mood; poor satisfaction, daytime sleepiness, and duration were significantly associated with loss of interest; and poor satisfaction, efficiency, and duration were significantly associated with depressive symptoms. Composite sleep health scores were associated with greater odds of depressive symptoms in a graded manner. CONCLUSIONS Individual and composite sleep health scores were associated with depressive symptoms. Measures of multidimensional sleep health may provide a better understanding of the association between poor sleep and depressive symptoms among patients with OSA using CPAP, accounting for CPAP adherence, leading to improved intervention strategies.
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Affiliation(s)
- Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Daisuke Endo
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan
| | - Kenichi Nagaoka
- Yurakucho Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan; Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, School of Medicine, Tokyo, Japan
| | - Ayako Hori
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan
| | - Tatsuya Ito
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Graduate School of Medicine, Kyoto, Japan
| | - Toshiki Akahoshi
- Shinjuku Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan; Yurakucho Sleep and Respiratory Clinic, KEISHINKINENKAI Medical Corporation, Tokyo, Japan; Division of Respiratory Medicine, Department of Internal Medicine, Nihon University, School of Medicine, Tokyo, Japan.
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Drews HJ, Sejling C, Andersen TO, Varga TV, Jensen AK, Rod NH. Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study. Sleep 2024; 47:zsae024. [PMID: 38349329 DOI: 10.1093/sleep/zsae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/16/2023] [Indexed: 03/21/2024] Open
Abstract
STUDY OBJECTIVES Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization. METHODS Four thousand five hundred and twenty individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n = 3221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e. the number of weeks in which at least one service from the patient's general practitioner (GP) was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics. RESULTS Three hundred and nineteen individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95% CI: 1.9, 4.1] fold higher odds of reporting poor health and with an average of 1.4 [95% CI: 0.7, 2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization. CONCLUSIONS Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.
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Affiliation(s)
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
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Turner M, Griffiths M, Laws M, Vial S, Bartlett D, Cruickshank T. The multidimensional sleep health of individuals with multiple sclerosis and Huntington's disease and healthy controls. J Clin Sleep Med 2024; 20:967-972. [PMID: 38305780 PMCID: PMC11145047 DOI: 10.5664/jcsm.11052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVES Sleep issues are common for people with neurodegenerative conditions, yet research has focused on specific aspects of sleep. While important, a more holistic approach to investigating sleep, termed "sleep health," considers sleep's positive and negative aspects. Current studies exploring sleep health have lacked a control group for reference. For the first time, this study investigated the sleep health of people living with multiple sclerosis and Huntington's disease (HD) and compared it with a community sample. METHODS 111 people, including 43 with multiple sclerosis, 19 with HD, and 49 from a community sample, participated in this study. The data, including actigraphy, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale, were collected as part of ongoing research studies. Seven sleep health domains were determined from the collected data, and a composite sleep health score was developed. Analysis of variance and independent t tests were performed to identify population and sex differences. RESULTS The HD group had higher sleep regularity and lower sleep rhythmicity than the multiple sclerosis and community sample groups. The HD group had significantly less sleep duration than the multiple sclerosis group. No significant differences between the groups were observed in the sleep health composite score. Males had significantly higher sleep regularity within the HD group but significantly lower sleepiness scores in the community sample. CONCLUSIONS These findings indicate that people with HD may experience greater variance in their wake times, therefore decreasing the consistency of being awake or asleep 24 hours apart. Understanding the mechanisms for this should be explored in people with HD. CITATION Turner M, Griffiths M, Laws M, Vial S, Bartlett D, Cruickshank T. The multidimensional sleep health of individuals with multiple sclerosis and Huntington's disease and healthy controls. J Clin Sleep Med. 2024;20(6):967-972.
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Affiliation(s)
- Mitchell Turner
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Madeline Griffiths
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Manja Laws
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Shayne Vial
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Danielle Bartlett
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Travis Cruickshank
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
- Perron Institute for Neurological and Translational Sciences, Perth, Western Australia, Australia
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Killingmo RM, Tveter AT, Pripp AH, Tingulstad A, Maas E, Rysstad T, Grotle M. Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study. BMJ Open 2024; 14:e080567. [PMID: 38431296 PMCID: PMC10910429 DOI: 10.1136/bmjopen-2023-080567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss. DESIGN A prospective cohort study with a 1-year follow-up. PARTICIPANTS AND SETTING A total of 549 participants (aged 18-67 years) on sick leave (≥ 4 weeks) due to musculoskeletal disorders in Norway were included. OUTCOME MEASURES AND METHOD The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs. RESULTS Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss. CONCLUSION Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted. TRIAL REGISTRATION NUMBER NCT04196634, 12 December 2019.
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Affiliation(s)
- Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Anne Therese Tveter
- Center for treatment of rheumatic and musculoskeletal diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Alexander Tingulstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Esther Maas
- Department of Health Sciences, Vrije University Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Fank F, Artismo RS, de Santana MG, Esteves AM, Matte DL, Mazo GZ. Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial. Front Psychol 2024; 15:1322545. [PMID: 38425564 PMCID: PMC10902716 DOI: 10.3389/fpsyg.2024.1322545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is a common disorder that affects approximately 1 billion people worldwide. Advanced age is a significant risk factor. Various treatment options have been explored to reduce the severity of OSA symptoms and physical exercise has emerged as a potential alternative therapy. Therefore, this study aims to investigate the effects of a combined exercise program with sleep education on sleep quality and on the severity of OSA in older adults. Methods This is a randomized clinical trial with two parallel groups that will involve individuals of both genders aged between 60 and 79 years who have an apnea-hypopnea index (AHI) of more than 15 events per hour and who have not received or are currently undergoing treatment for OSA. Older adults who have engaged in regular exercise in the last six months and individuals with contraindications to exercise will be excluded. The study will assess outcomes related to OSA, including AHI, oxygen desaturation index, minimum and mean oxyhemoglobin saturation, sleep efficiency, sleep latency, and the type of respiratory events. Additionally, sleep quality-related outcomes, daytime sleepiness, physical activity, physical fitness, aerobic capacity, cognitive status, anthropometric measures, and health-related quality of life will be analyzed. Participants will be randomized to two groups: a combined exercise group (involving both resistance and aerobic training) with sleep education, and a control group that will receive only educational recommendations for managing OSA. The intervention will last 12 weeks and will consist of three sessions per week, totaling 36 exercise sessions. Sample size calculation indicates a minimum number of 36 participants. Discussion If the hypothesis is confirmed, this clinical trial will indicate an effective non-pharmacological intervention for treating OSA in older adults. This intervention could be used as an adjunct to existing approaches designed to improve OSA management. Clinical trail registration Brazil Clinical Trials Registry (ReBEC), identifier RBR-9hk6pgz.
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Affiliation(s)
- Felipe Fank
- Laboratory of Gerontology, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Regiana Santos Artismo
- Teaching, Research and Extension Center in Physiotherapy in the Pre- and Post-Operation of Major Surgeries, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | | | - Andrea Maculano Esteves
- Laboratory of Sleep and Exercise, School of Applied Sciences, State University of Campinas, Campinas, Brazil
| | - Darlan Laurício Matte
- Teaching, Research and Extension Center in Physiotherapy in the Pre- and Post-Operation of Major Surgeries, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Giovana Zarpellon Mazo
- Laboratory of Gerontology, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
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Savin KL, Carlson JA, Patel SR, Jankowska MM, Allison MA, Sotres-Alvarez D, Sallis JF, Talavera GA, Roesch SC, Malcarne VL, Larsen B, Rutledge T, Gallo LC. Social and built neighborhood environments and sleep health: The Hispanic Community Health Study/Study of Latinos Community and Surrounding Areas and Sueño Ancillary Studies. Sleep 2024; 47:zsad260. [PMID: 37788570 PMCID: PMC10851842 DOI: 10.1093/sleep/zsad260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
STUDY OBJECTIVES To test associations between neighborhood social, built, and ambient environment characteristics and multidimensional sleep health in Hispanic/Latino adults. METHODS Data were from San Diego-based Hispanic/Latino adults mostly of Mexican heritage enrolled in the Hispanic Community Health Study/Study of Latinos (N = 342). Home addresses were geocoded to ascertain neighborhood characteristics of greenness, walkability (density of intersections, retail spaces, and residences), socioeconomic deprivation (e.g. lower income, lower education), social disorder (e.g. vacant buildings, crime), traffic density, and air pollution (PM 2.5) in the Study of Latinos Communities and Surrounding Areas Study. Sleep dimensions of regularity, satisfaction, alertness, timing, efficiency, and duration were measured by self-report or actigraphy approximately 2 years later. Multivariable regression models accounting for study design (stratification and clustering) were used to examine associations of neighborhood variables with individual sleep dimensions and a multidimensional sleep health composite score. RESULTS Neighborhood characteristics were not significantly associated with the multidimensional sleep health composite, and there were few significant associations with individual sleep dimensions. Greater levels of air pollution (B = 9.03, 95% CI: 1.16, 16.91) were associated with later sleep midpoint, while greater social disorder (B = -6.90, 95% CI: -13.12, -0.67) was associated with earlier sleep midpoint. Lower walkability was associated with more wake after sleep onset (B = -3.58, 95% CI: -7.07, -0.09). CONCLUSIONS Living in neighborhoods with lower walkability and greater air pollution was associated with worse sleep health, but otherwise findings were largely null. Future research should test these hypotheses in settings with greater variability and investigate mechanisms of these associations.
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Affiliation(s)
- Kimberly L Savin
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jordan A Carlson
- Center for Children’s Health Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, Children’s Mercy Kansas City and University of Missouri Kansas City, Kansas City, MO, USA
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Matthew A Allison
- Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Sallis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Britta Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Thomas Rutledge
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Olatunde K, Patton S. Association Between Insomnia and Healthcare Utilization: A Scoping Review of the Literature. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231164953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Insomnia is a sleep disorder that affects significant portion of the population. It can result in adverse health outcomes and increased healthcare utilization. The purpose of this review was to identify existing research on the association between insomnia and healthcare utilization. A five-stage scoping review process was conducted guided by the Joanna Briggs Institute process. Data sources searched through 2022 were PubMed, HINARI, Google Scholar and Cochrane, with additional studies identified through hand searching. Descriptive and exploratory analyses were conducted from the findings of the selected studies. After reviewing 124 references, 23 studies were selected. A strong and positive association between insomnia and healthcare utilization and healthcare costs was identified. We also found that insomnia was associated with absenteeism from work, lower work performance ratings, disability, difficulties in daily activities, and life dissatisfaction. An unexpected theme that emerged from the included studies is that there is a large population with persistent insomnia who do not seek help that could benefit from improved management. Findings suggest that identifying and managing insomnia could result in a decrease in healthcare utilization and costs. Further research is needed to determine the most effective methods of identifying and managing insomnia.
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Affiliation(s)
- Kolade Olatunde
- Department of Public Policy/Health Policy, University of Arkansas, Fayetteville, AR, USA
| | - Susan Patton
- Department of Nursing, University of Arkansas, Fayetteville, AR, USA
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Mahmood A, Kedia S, Dobalian A, Chang CF, Ahn S. Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States. Health Serv Res 2022; 57:1247-1260. [PMID: 35344596 PMCID: PMC9643080 DOI: 10.1111/1475-6773.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults. DATA SOURCES The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States. STUDY DESIGN This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals. DATA COLLECTION/EXTRACTION METHODS We extracted longitudinal data from 2002 through 2018 waves of the HRS. PRINCIPAL FINDINGS Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms. CONCLUSIONS The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Aram Dobalian
- Division of Health Systems Management and Policy, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Cyril F. Chang
- Fogelman College of Business and EconomicsUniversity of MemphisMemphisTennesseeUSA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
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Makarem N, Castro‐Diehl C, St‐Onge M, Redline S, Shea S, Lloyd‐Jones D, Ning H, Aggarwal B. Redefining Cardiovascular Health to Include Sleep: Prospective Associations With Cardiovascular Disease in the MESA Sleep Study. J Am Heart Assoc 2022; 11:e025252. [PMID: 36259552 PMCID: PMC9673642 DOI: 10.1161/jaha.122.025252] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Although sufficient and healthy sleep is inversely associated with cardiovascular disease (CVD) and its risk factors, the American Heart Association's Life's Simple 7 (LS7), as a measure of cardiovascular health (CVH), did not include sleep. We evaluated an expanded measure of CVH that includes sleep as an eighth metric in relation to CVD risk. Methods and Results The analytic sample consisted of MESA (Multi-Ethnic Study of Atherosclerosis) Sleep Study participants who had complete data on sleep characteristics from overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and the outcome. We computed the LS7 score and 4 iterations of a new CVH score: score 1 included sleep duration, score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea), scores 3 and 4 included sleep characteristics associated with CVD in MESA (score 3: sleep duration and efficiency, daytime sleepiness, and obstructive sleep apnea; score 4: score 3+sleep regularity). Multivariable-adjusted logistic and Cox proportional hazards models evaluated associations of the LS7 and CVH scores 1 to 4 with CVD prevalence and incidence. Among 1920 participants (mean age: 69±9 years; 54% female), there were 95 prevalent CVD events and 93 incident cases (mean follow-up, 4.4 years). Those in the highest versus lowest tertile of the LS7 score and CVH scores 1 to 4 had up to 80% lower odds of prevalent CVD. The LS7 score was not significantly associated with CVD incidence (hazard ratio, 0.62 [95% CI, 0.37-1.04]). Those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratio, 0.57 [95% CI, 0.33-0.97]; and hazard ratio, 0.53 [95% CI, 0.32-0.89]), respectively. Conclusions CVH scores that include sleep health predicted CVD risk in older US adults. The incorporation of sleep as a CVH metric, akin to other health behaviors, may enhance CVD primordial and primary prevention efforts. Findings warrant confirmation in larger cohorts over longer follow-up.
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Affiliation(s)
- Nour Makarem
- Department of Epidemiology, Mailman School of Public HeathColumbia University Irving Medical CenterNew YorkNY
| | - Cecilia Castro‐Diehl
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | | | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Steven Shea
- Department of Epidemiology, Mailman School of Public HeathColumbia University Irving Medical CenterNew YorkNY,Department of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Donald Lloyd‐Jones
- Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Hongyan Ning
- Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Brooke Aggarwal
- Department of MedicineColumbia University Irving Medical CenterNew YorkNY
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11
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Makarem N, Alcantara C, Musick S, Quesada O, Sears DD, Chen Z, Tehranifar P. Multidimensional Sleep Health Is Associated with Cardiovascular Disease Prevalence and Cardiometabolic Health in US Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710749. [PMID: 36078471 PMCID: PMC9518578 DOI: 10.3390/ijerph191710749] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/01/2023]
Abstract
Individual sleep dimensions have been linked to cardiovascular disease (CVD) risk and cardiometabolic health (CMH), but sleep health is multifaceted. We investigated associations of a multidimensional sleep health (MDSH) score, enabling the assessment of sleep health gradients, with CVD and CMH. Participants were 4555 adults aged ≥20 years from the 2017-2018 National Health and Nutrition Examination Survey. A MDSH score, capturing poor, moderate, and ideal sleep was computed from self-reported sleep duration, sleep regularity, difficulty falling asleep, symptoms of sleep disorders, and daytime sleepiness. Survey-weighted multivariable linear and logistic models examined associations of MDSH with CVD and CMH. Ideal and moderate vs. poor MDSH were related to lower odds of hypertension (62% and 41%), obesity (73% and 56%), and central adiposity (68% and 55%), respectively; a statistically significant linear trend was observed across gradients of MDSH (p-trend < 0.001). Ideal vs. moderate/poor MDSH was associated with 32% and 40% lower odds of prevalent CVD and type 2 diabetes, respectively. More favorable MDSH was associated with lower blood pressure, BMI, waist circumference, and fasting glucose. In sex-stratified analyses, ideal vs. moderate/poor MDSH was associated with lower CVD odds and blood pressure in women only. The MDSH framework may be more than just the sum of its parts and could better capture information regarding CVD risk.
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Affiliation(s)
- Nour Makarem
- Department of Epidemiology, Mailman School of Public Heath, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Sydney Musick
- Department of Epidemiology, Mailman School of Public Heath, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH 45219, USA
| | - Dorothy D. Sears
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
- Center for Circadian Biology, University of California San Diego, San Diego, CA 92093, USA
| | - Ziyu Chen
- Department of Epidemiology, Mailman School of Public Heath, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Heath, Columbia University Irving Medical Center, New York, NY 10032, USA
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12
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Schousboe JT, Kats AM, Stone KL, Langsetmo L, Vo TN, Blackwell TL, Buysse DJ, Ancoli-Israel S, Ensrud KE. Self-reported poor sleep on multiple dimensions is associated with higher total health care costs in older men. Sleep 2020; 43:5819391. [PMID: 32280977 DOI: 10.1093/sleep/zsaa073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To estimate the association of self-reported poor sleep in multiple dimensions with health care costs in older men. METHODS Participants were 1,413 men (mean [SD] age 76.5 [5.7] years) enrolled in both the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study and Medicare Fee-for-Service. Poor sleep was characterized at the baseline MrOS Sleep visit on five dimensions (satisfaction, daytime sleepiness, timing, latency, and duration). Health care costs and utilization were ascertained over 3 years of follow-up using Medicare Claims. RESULTS Median (interquartile range [IQR]) annualized total health care costs (2018 US dollars) rose from $3,616 (IQR 1,523-7,875) for those with no impaired sleep dimensions to $4,416 (IQR 1,854-11,343) for men with two impaired sleep dimensions and $5,819 (IQR 1,936-15,569) for those with at least three impaired sleep dimensions. After multivariable adjustment, the ratio of total health care costs (CR) was significantly higher for men with two (1.24, 95% confidence interval [CI] 1.03- to 1.48) and men with at least three impaired sleep dimensions (1.78, 95% CI 1.42 to 2.23) vs. those with no impaired sleep dimensions. After excluding 101 men who died during the 3-year follow-up period, these associations were attenuated and not significant (CR 1.22, 95% CI 0.98 to 1.53 for men ≥3 impaired sleep dimensions vs. none). CONCLUSIONS Self-reported poor sleep on multiple dimensions is associated with higher subsequent total health care costs in older men, but this may be due to higher mortality and increased health care costs toward the end of life among those with poor sleep health.
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Affiliation(s)
- John T Schousboe
- HealthPartners Institute, Bloomington, MN.,Division of Health Policy & Management, University of Minnesota, Minneapolis, MN
| | - Allyson M Kats
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Lisa Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Tien N Vo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
| | - Terri L Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Kristine E Ensrud
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN.,Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN
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13
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Luyster FS, Shi X, Baniak LM, Morris JL, Chasens ER. Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma. Ann Allergy Asthma Immunol 2020; 125:319-324. [PMID: 32389780 DOI: 10.1016/j.anai.2020.04.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. OBJECTIVE To examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. METHODS Cross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. RESULTS Of the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). CONCLUSION Compared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Xiaojun Shi
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lynn M Baniak
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania; Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Jonna L Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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