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Fernandes M, Antonucci M, Capecci F, Mercuri NB, Della-Morte D, Liguori C. Prevalence of sleep disorders in geriatrics: an exploratory study using sleep questionnaires. Geriatr Nurs 2024; 60:107-113. [PMID: 39236368 DOI: 10.1016/j.gerinurse.2024.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 07/31/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of sleep problems in older subjects, considering sex and age differences. METHODS Subjects admitted to a geriatrics clinic underwent a medical visit and completed a battery of questionnaires assessing sleep quality, insomnia, sleep apnea risk, excessive daytime sleepiness (EDS), restless legs syndrome (RLS), chronotype, depression and global cognition. RESULTS Fifty-eight subjects (58.6 % women, mean age 77.36±6.07) were included. The most predominant sleep-related complaint was poor sleep quality (36.2 %), followed by sleep apnea risk (34.5 %), insomnia symptoms (25.9 %), EDS (15.5 %) and RLS (12.1 %). Older women reported more insomnia, poorer sleep quality and depressive symptoms than males. Patients aged ≥ 75 years old had more comorbidities and higher sleep apnea risk compared to those under 75 years old. CONCLUSIONS Sleep problems are frequent in older adults, requiring their screening and treatment for possibly improving well-being and reduce the burden of neuropsychiatric and medical comorbidities.
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Affiliation(s)
- Mariana Fernandes
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Matteo Antonucci
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Francesca Capecci
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome "Tor Vergata", 00133 Rome, Italy
| | - David Della-Morte
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome "Tor Vergata", 00133 Rome, Italy.
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Canever JB, Zurman G, Vogel F, Sutil DV, Diz JBM, Danielewicz AL, Moreira BDS, Cimarosti HI, de Avelar NCP. Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis. Sleep Med 2024; 119:118-134. [PMID: 38669835 DOI: 10.1016/j.sleep.2024.03.040] [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: 01/30/2024] [Revised: 03/09/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil; Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Gabriela Zurman
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Felipe Vogel
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daiana Vieira Sutil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Ana Lúcia Danielewicz
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Iturvides Cimarosti
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Han AH, Burroughs CR, Falgoust EP, Hasoon J, Hunt G, Kakazu J, Lee T, Kaye AM, Kaye AD, Ganti L. Suvorexant, a Novel Dual Orexin Receptor Antagonist, for the Management of Insomnia. Health Psychol Res 2023; 10:67898. [PMID: 36726477 PMCID: PMC9886170 DOI: 10.52965/001c.67898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose of Review The present investigation is a comprehensive review regarding the use of Suvorexant for insomnia treatment. It covers the background, pathophysiology, and significance of addressing insomnia, the pharmaceutical details of Suvorexant, and its safety, efficacy, and implications in treating insomnia. We further discuss Suvorexant's role in targeting insomnia with other comorbidities. Recent Findings Insomnia refers to poor quality and/or quantity of sleep. While there are many existing treatments such as benzodiazepines, melatonin agonists, TCAs, and atypical antipsychotics used to target various receptors involved in normal induction and maintenance of sleep, Suvorexant is an antagonist that specifically targets orexin receptors. Recent clinical studies suggest that Suvorexant is both clinically safe and effective. Quantity and quality of sleep are measured in various ways, yet the consensus points towards Suvorexant's effectiveness in improving sleep time, onset, latency, and quality compared to placebo. In addition to helping improve isolated insomnia, Suvorexant helps improve sleep in patients that have other comorbidities such as obstructive sleep apnea, Alzheimer's disease, dementia, acute stroke, and delirium. While Suvorexant is safe, there are still adverse effects associated with the drug that needs to be considered. The most common adverse effects include dizziness, somnolence, headaches, and cognitive impairment. Summary Insomnia is a major public health concern that affects many people worldwide and has been linked to many adverse health outcomes. While there are existing treatments that target different receptors and pathways of normal sleep induction and maintenance, Suvorexant is a novel drug that targets dual orexin receptors. Its safety and efficacy, mechanism of action, pharmacokinetic parameters, and relative lack of rebound and withdrawal effects render suvorexant a reliable choice for the treatment of insomnia.
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Affiliation(s)
- Andrew H. Han
- Georgetown University School of Medicine, Washington, DC
| | | | - Evan P. Falgoust
- AnesthesiologyLouisiana State University Shreveport, Shreveport, LA
| | - Jamal Hasoon
- AnesthesiologyCritical Care, and Pain Medicine, , Beth Israel Deaconess Medical Center, Boston, MA
| | - Grace Hunt
- AnesthesiologyLouisiana State University Shreveport, Shreveport, LA
| | - Juyeon Kakazu
- Georgetown University School of Medicine, Washington, DC
| | - Tim Lee
- NeurologyHCA Florida Osceola Hospital, & University of Central Florida College of Medicine, Orlando, FL
| | - Adam M. Kaye
- Pharmacy PracticeThomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
| | - Alan D. Kaye
- AnesthesiologyLouisiana State University Shreveport, Shreveport, LA
| | - Latha Ganti
- NeurologyHCA Florida Osceola Hospital, & University of Central Florida College of Medicine, Orlando, FL
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Associations between objectively measured sleep parameters and cognition in healthy older adults: A meta-analysis. Sleep Med Rev 2023; 67:101734. [PMID: 36577339 DOI: 10.1016/j.smrv.2022.101734] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Multiple studies have examined associations between sleep and cognition in older adults, but a majority of these depend on self-reports on sleep and utilize cognitive tests that assess overall cognitive function. The current meta-analysis involved 72 independent studies and sought to quantify associations between objectively measured sleep parameters and cognitive performance in healthy older adults. Both sleep macrostructure (e.g., sleep duration, continuity, and stages) and microstructure (e.g., slow wave activity and spindle activity) were evaluated. For macrostructure, lower restlessness at night was associated with better memory performance (r = 0.43, p = 0.02), while lower sleep onset latency was associated with better executive functioning (r = 0.28, p = 0.03). Greater relative amount of N2 and REM sleep, but not N3, positively correlated with cognitive performance. The association between microstructure and cognition in older adults was marginally significant. This relationship was moderated by age (z = 0.07, p < 0.01), education (z = 0.26, p = 0.03), and percentage of female participants (z = 0.01, p < 0.01). The current meta-analysis emphasizes the importance of considering objective sleep measures to understand the relationship between sleep and cognition in healthy older adults. These results also form a base from which researchers using wearable sleep technology and measuring behavior through computerized testing tools can evaluate their findings.
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Hernández B, Scarlett S, Moriarty F, Romero-Ortuno R, Kenny RA, Reilly R. Investigation of the role of sleep and physical activity for chronic disease prevalence and incidence in older Irish adults. BMC Public Health 2022; 22:1711. [PMID: 36085044 PMCID: PMC9463855 DOI: 10.1186/s12889-022-14108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic diseases are the leading cause of death worldwide. Many of these diseases have modifiable risk factors, including physical activity and sleep, and may be preventable. This study investigated independent associations of physical activity and sleep with eight common chronic illnesses. Methods Data were from waves 1, 3 and 5 of The Irish Longitudinal Study on Ageing (n = 5,680). Inverse probability weighted general estimating equations were used to examine longitudinal lifetime prevalence and cumulative incidence of self-reported conditions. Results Sleep problems were significantly associated with increased odds of incident and prevalent arthritis and angina. Additionally sleep problems were associated with higher odds of lifetime prevalence of hypertension and diabetes. Physical activity was negatively associated incident osteoporosis and respiratory diseases and negatively associated with lifetime prevalence of hypertension, high cholesterol and diabetes. Conclusions Worse sleep quality and lower physical activity were associated with higher odds of chronic diseases. Interventions to improve sleep and physical activity may improve health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14108-6.
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Effects of an internet-delivered insomnia intervention for older adults: A secondary analysis on symptoms of depression and anxiety. J Behav Med 2022; 45:728-738. [PMID: 35932397 PMCID: PMC9362578 DOI: 10.1007/s10865-022-00353-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
Objective To test whether an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program for older adults attenuates symptoms of depression and anxiety. Methods Adults aged ≥ 55 with insomnia were randomized to SHUTi-OASIS (Sleep Healthy Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness; N = 207) or Patient Education (PE; N = 104). Depression and anxiety were assessed (HADS-D and HADS-A, respectively) at baseline, post-assessment, and 6- and 12-month follow-ups. Results Multilevel modeling of HADS-D showed a condition by time interaction (F[3,779] = 3.23, p = .02): SHUTi-OASIS participants reported lower symptoms than PE at post-assessment. There was no such interaction effect for HADS-A (F[3,779] = 2.12, p = .10). Generalized linear modeling showed no moderation of effects by baseline symptom severity. Conclusions Participants randomized to Internet-delivered CBT-I showed stable depression and anxiety across time, while control participants’ depressive symptoms briefly increased. CBT-I may help prevent development or worsening of psychological distress among older adults with insomnia. TRIAL REGISTRATION [Registered at ClinicalTrials.gov; identifier removed for anonymity]
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Langenberg SCN, Kocevska D, Luik AI. The multidimensionality of sleep in population‐based samples: a narrative review. J Sleep Res 2022; 31:e13608. [PMID: 35429087 PMCID: PMC9339471 DOI: 10.1111/jsr.13608] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022]
Abstract
The identification of optimal sleep duration recommendations for the general population has long been an important goal on the public health agenda, as both short and long sleep duration have been linked to unfavourable health outcomes. Yet, sleep is more than duration alone and can be described across multiple domains, such as timing, regularity, satisfaction, alertness, and efficiency. We reviewed observational population‐based studies that examined differences in age, sex, and origin across multiple dimensions of sleep. Reviewed literature suggests an increasing prevalence of insomnia symptoms, shorter and less deep sleep in old age. Overall, women report poorer sleep quality than men despite objective measures revealing shorter and more fragmented sleep in men. Minorities generally have poorer quantity and quality of sleep, but multi‐ethnic studies have reported mixed results regarding the subjective experience of sleep. In sum, effects of age, sex and origin differ across sleep dimensions, thereby suggesting that the multidimensionality of sleep and how these different aspects interact should be studied across individuals. Studies should include both self‐reported measures and objective assessments in diverse population‐based samples, as both aspects are important to understand sleep health in the general population. Data‐driven descriptions could provide researchers and clinicians with insights into how well individuals are sleeping and offer concrete targets for promotion of sleep health across the population.
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Affiliation(s)
| | - Desana Kocevska
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
- Department of Sleep and Cognition Netherlands Institute for Neuroscience Amsterdam the Netherlands
| | - Annemarie I. Luik
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology Erasmus MC University Medical Center Rotterdam the Netherlands
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Amiri S, Behnezhad S. Smoking and risk of sleep-related issues: a systematic review and meta-analysis of prospective studies. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:775-786. [PMID: 32185746 PMCID: PMC7501367 DOI: 10.17269/s41997-020-00308-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Smoking has many deleterious consequences on health, one of which can be sleep-related issues. Therefore, a meta-analysis was performed with the aim of pooling results from studies on the relationship between smoking and sleep-related issues. METHODS The present study follows PRISMA guidelines. Databases were searched by both researchers to find the articles. The review was done up to December 2018. In order to analyze the results of the screened articles, statistical indexes were converted to logarithms and the studies were combined with each other. Finally, several analyses were conducted with respect to various subgroups. In the subgroup analysis, the pool index of the studies was determined and the degree of heterogeneity in each subgroup was presented. Meta-regression was also used. RESULTS Smoking is associated with a risk of developing sleep-related issues. Risk ratio (1.47; 1.20-1.79) for smokers was higher than for non-smokers. Egger's test and Begg's test indicated publication bias. CONCLUSIONS Smoking is associated with sleep-related issues. Informing smokers about the effects of smoking on sleep issues can be effective in reducing and preventing its consequences.
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Affiliation(s)
- Sohrab Amiri
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Garbarino S, Lanteri P, Prada V, Falkenstein M, Sannita WG. Circadian Rhythms, Sleep, and Aging. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Abstract. Circadian mechanisms and the sleep-wakefulness rhythms guarantee survival, adaptation, efficient action in everyday life or in emergencies and well-being. Disordered circadian processes at central and/or cellular levels, sleep disorders, and unhealthy wakefulness/sleep rhythms can impair the physiological circadian organization and result in subjective, professional, or behavioral changes ranging from functional inadequacy to higher risks at work or on the road to medical relevance. Circadian rhythms and the sleep organization change ontogenetically; major changes result from normal aging and from the multiple diseases that are often associated. There are circular functional interactions involving sleep/sleep disorders, the autonomic and immune systems, and the functional changes in the circadian system due to aging that deserve attention but have been overlooked thus far.
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Polyclinic Hospital San Martino IRCCS, Genova, Italy
| | - Paola Lanteri
- Department of Diagnostics and Applied Technology, Neurophysiopathology Center, Fondazione IRCCS, Istituto Neurologico C. Besta, Milano, Italy
| | - Valeria Prada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Polyclinic Hospital San Martino IRCCS, Genova, Italy
| | | | - Walter G. Sannita
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genova, Polyclinic Hospital San Martino IRCCS, Genova, Italy
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Hu Z, Zhu X, Kaminga AC, Zhu T, Nie Y, Xu H. Association between poor sleep quality and depression symptoms among the elderly in nursing homes in Hunan province, China: a cross-sectional study. BMJ Open 2020; 10:e036401. [PMID: 32665347 PMCID: PMC7359068 DOI: 10.1136/bmjopen-2019-036401] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To examine the association between the prevalence of poor sleep quality and depression symptoms among the elderly in the nursing homes of Hunan province in China. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional study investigating 817 elderly people from 24 nursing homes in China's Hunan province. MAIN OUTCOME MEASURES Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) such that poor sleep quality was defined as PSQI Score >5. In addition, depression symptoms were assessed using the Geriatric Depression Scale (GDS). Linear regression models and binary logistic regression models were used to analyse the relationship between the prevalence of poor sleep quality and depression symptoms. RESULTS The mean PSQI Score was 8.5±4.9, and the prevalence of poor sleep quality was 67.3%. Additionally, the mean GDS Score was 9.8±7.5, and the prevalence of depression symptoms was 36.0%. Elderly people with poor sleep quality had increased GDS Score (mean difference=2.54, 95% CI 1.66 to 3.42) and increased risk of depression symptoms (OR=3.19, 95% CI 2.04 to 4.98) after controlling for demographics, chronic disease history, lifestyle behaviours, social support, activities of daily living and negative life events. CONCLUSIONS The prevalence of poor sleep quality was relatively high, and this was associated with increased depression symptoms. Therefore, poor sleep quality could be speculated as a marker of current depression symptoms in the elderly.
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Affiliation(s)
- Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health,Central South University, Changsha, Hunan, China
| | - Xidi Zhu
- Department of Social Medicine and Health Management, Xiangya School of Public Health,Central South University, Changsha, Hunan, China
| | - Atipatsa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Tingting Zhu
- Department of Scientific Research Management, Shanghai Health Development Research Center, Shanghai, China
| | - Yu Nie
- Educational Administration Office, The Second Xiangya Hospital, Changsha, Hunan, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health,Central South University, Changsha, Hunan, China
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Zhu X, Hu Z, Nie Y, Zhu T, Chiwanda Kaminga A, Yu Y, Xu H. The prevalence of poor sleep quality and associated risk factors among Chinese elderly adults in nursing homes: A cross-sectional study. PLoS One 2020; 15:e0232834. [PMID: 32413064 PMCID: PMC7228093 DOI: 10.1371/journal.pone.0232834] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Sleep problems have become the most common complaints among the elderly. There are a few studies that explored the prevalence of poor sleep quality and its associated factors among the elderly in nursing homes. Therefore, this study aimed to examine the prevalence of poor sleep quality and its associated factors among the Chinese elderly in nursing homes. Methods A total of 817 elderly residents, from 24 nursing homes, were included in this cross-sectional study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and poor sleep quality was defined as PSQI >5. Multiple binary logistic regression was used to estimate the strength of the association between risk factors and poor sleep quality in terms of adjusted odds ratios (AORs) and their 95% confidence intervals (CIs), and interactions of risk factors for poor sleep quality were also examined. Results The prevalence of poor sleep quality was 67.3% (95% CI: 64.0, 70.5%) among the Chinese elderly in nursing homes. Multiple binary logistic regression results showed that participants with the following characteristics had an increased risk of poor sleep quality after adjustments for other confounders: being 70–79 years old (AOR: 1.78, 95% CI: 1.08, 2.92) or 80 years old and above (AOR: 2.67, 95% CI: 1.68, 4.24); having one to two kinds of chronic diseases (AOR: 2.05, 95% CI: 1.39, 3.01) or three or more kinds of chronic diseases (AOR: 2.35, 95% CI: 1.39, 4.00); depression symptoms (AOR: 1.08, 95% CI: 1.04, 1.11), anxiety symptoms (AOR: 1.11, 95% CI: 1.05, 1.18), and social support(AOR: 0.97, 95% CI: 0.95, 0.99). Additive interactions were detected between age and anxiety symptoms (AOR: 8.34, 95% CI: 4.43, 15.69); between chronic disease and anxiety symptoms (AOR: 8.61, 95% CI; 4.28, 17.31); and between social support and anxiety symptoms (AOR: 6.43, 95% CI: 3.22, 12.86). Conclusions The prevalence of poor sleep quality among the elderly in nursing homes is relatively high. Besides, anxiety symptoms has additive interactions with age, chronic disease and social support for poor sleep quality. These findings have significant implications for interventions that aim to improve sleep quality among elderly residents in nursing homes.
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Affiliation(s)
- Xidi Zhu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yu Nie
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tingting Zhu
- Department of Scientific Research Management, Shanghai Health Development Research Center, Shanghai, China
| | - Atipatsa Chiwanda Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yunhan Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- * E-mail:
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12
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D'Rozario AL, Chapman JL, Phillips CL, Palmer JR, Hoyos CM, Mowszowski L, Duffy SL, Marshall NS, Benca R, Mander B, Grunstein RR, Naismith SL. Objective measurement of sleep in mild cognitive impairment: A systematic review and meta-analysis. Sleep Med Rev 2020; 52:101308. [PMID: 32302775 DOI: 10.1016/j.smrv.2020.101308] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/23/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
Older adults with mild cognitive impairment (MCI) are at-risk of developing dementia, particularly Alzheimer's disease. While some research suggests that alterations in sleep architecture may mediate cognitive decline, the nature and magnitude of changes to sleep macro- (sleep stages) and micro-architecture (electroencephalography (EEG) oscillations) in MCI is not yet clear. This study aimed to systematically review and meta-analyse case-control studies objectively measuring sleep in MCI. A systematic search was conducted using PubMed, Scopus, Web of Science, Embase and Psycinfo databases and after review, a total of 10 studies met inclusion criteria. Of these, all reported sleep macro-architecture and four reported micro-architecture outcomes. A combined total of 430 participants (209 with and 221 without MCI) underwent objective sleep assessments in the included full text articles. Findings show that compared to healthy controls, those with MCI have pronounced changes in sleep macro-architecture with greater wake after sleep onset, reduced total sleep time, lower sleep efficiency, longer sleep onset latency, longer rapid eye movement sleep (REM) latency, reduced REM sleep, greater N1 sleep, and worse severity of hypoxemia. Pooling of sleep micro-architecture EEG measures was not possible due to limited studies, however reduced spindles in non-REM sleep and greater EEG slowing in REM sleep were reported.
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Affiliation(s)
- Angela L D'Rozario
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.
| | - Julia L Chapman
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Craig L Phillips
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jake R Palmer
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Loren Mowszowski
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Bryce Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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13
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Kume Y, Kodama A, Maekawa H. Preliminary report; Comparison of the circadian rest-activity rhythm of elderly Japanese community-dwellers according to sarcopenia status. Chronobiol Int 2020; 37:1099-1105. [PMID: 32164426 DOI: 10.1080/07420528.2020.1740725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated in a preliminarily study the circadian rest-activity rhythm of elderly Japanese community-dwellers according to sarcopenia status based upon the 2019 updated classification criteria of the Asian Working Group for Sarcopenia. A total of 30 participants were recruited from a single rehabilitation center in northern Japan between July and November 2019. The rest-activity rhythm of those with and without sarcopenia was assessed for 7 consecutive 24 h spans by wrist actigraphy in free-living condition and gait performance in the clinic. As group phenomena, the circadian activity rhythm of the sarcopenia cohort (N = 11) was of significantly lower amplitude and more fragmented than the non-sarcopenia cohort (N = 19). The nonparametric circadian rest activity (RAR) parameters of intra-daily variability (IV), relative amplitude (RA), most active 10-h span (M10), and the least active 5-h span (L5), but not interdaily stability (IS), of the sarcopenia group, were all significantly worse than those of the non-sarcopenia group. Gait performance for the sarcopenia group correlated strongly with the fragmentation and altered amplitude of the RAR. These preliminary findings motivated future longitudinal investigation both to improve the detection of sarcopenia in community dwelling elderly and to inform novel preventive or rehabilitative strategies.
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Affiliation(s)
- Yu Kume
- Graduate School of Medicine, Course of Health Sciences, Department of Occupational Therapy, Akita University , Akita, Japan
| | - Ayuto Kodama
- Katagami, Katagami Community-Rehabilitation Station , Japan
| | - Hiroki Maekawa
- Graduate School of Medicine, Master Course in Health Sciences, Akita University , Akita, Japan
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14
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Nutakor JA, Dai B, Gavu AK, Antwi OA. Relationship between chronic diseases and sleep duration among older adults in Ghana. Qual Life Res 2020; 29:2101-2110. [PMID: 32100183 DOI: 10.1007/s11136-020-02450-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Aging increases the prevalence of health problems that are often chronic, resulting in more sleep problems for people with poor health or chronic conditions. Relatively fewer studies have been conducted on the relationship between sleep duration and chronic conditions in Sub-Saharan Africa compared to Western or Asian populations. This study uses a nationally representative sample of older adults in Ghana to examine the association between sleep duration and chronic conditions. METHOD Data were gathered from the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 in Ghana (n = 3617). Data on duration of sleep and chronic conditions were derived from self-reported data and validated symptom reporting. Multinomial logistic regression was conducted to examine the association between sleep duration and chronic conditions. RESULTS Women had a significantly longer period of sleep than men. Older people (> 60 years) were more likely than people under 60 years old to sleep for longer periods. The prevalence of stroke, depression, and chronic lung disease among long sleepers was high compared with short and medium sleepers. Our study found that respondents with stroke, arthritis, depression, chronic lung disease, asthma, and hypertension were likely to sleep for a long time. CONCLUSION This study showed a significant association between long hours of sleep and chronic conditions. To health professionals, paying particular attention to this association among older adults is medically important.
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Affiliation(s)
- Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China.
| | | | - Osei-Asibey Antwi
- Kwame Nkrumah University of Science and Technology, PMB, Kumasi, Ghana
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15
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Laudisio A, Giovannini S, Finamore P, Navarini L, Margiotta DPE, Vannetti F, Macchi C, Coraci D, Imbimbo I, Molino-Lova R, Loreti C, Antonelli Incalzi R, Zuccalà G, Padua L. Metabolic syndrome is associated with better quality of sleep in the oldest old: results from the "Mugello Study". Diabetol Metab Syndr 2020; 12:46. [PMID: 32742311 PMCID: PMC7386243 DOI: 10.1186/s13098-020-00554-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Reduced sleep quality is common in advanced age. Poor sleep quality is associated with adverse outcomes, chiefly cardiovascular, in young and middle-aged subjects, possibly because of its association with metabolic syndrome (MetS). However, the correlates of sleep quality in oldest populations are unknown. We evaluated the association of sleep quality with MetS in a cohort of subjects aged 90+. METHODS AND RESULTS We analysed data of 343 subjects aged 90+ living in the Mugello area (Tuscany, Italy). Quality of sleep was assessed using the Pittsburgh Sleep Quality Assessment Index (PSQI). Good quality of sleep was defined by a PSQI score < 5. MetS was diagnosed according to the National Cholesterol Education Program's ATP-III criteria; 83 (24%) participants reported good quality of sleep. MetS was diagnosed in 110 (24%) participants. In linear and logistic models, MetS was inversely associated with PSQI score ((B = - 1.04; 95% CI - 2.06 to - .03; P = .044), with increased probability of good sleep quality (OR = 2.52; 95% CI 1.26-5.02; P = .009), and with a PSQI below the median (OR = 2.11; 95% CI 1.11-3.40, P = .022), after adjusting. None of the single components of MetS were associated with PSQI (all P values > .050). However, an increasing number of MetS components was associated with increasing probability of good quality of sleep (P for trend = .002), and of PSQI below the median (P for trend = .007). Generalized Additive Model analysis documented no smoothing function suggestive of nonlinear association between PSQI and MetS. CONCLUSION Our results confirm a high prevalence of poor sleep quality in oldest age; however, in these subjects, MetS seems to be associated with better sleep quality. Additional larger, dedicated studies are required to confirm our results, and, if so, to identify the subsystems involved and the potential therapeutic implications of such an association.
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Affiliation(s)
- Alice Laudisio
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Panaiotis Finamore
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | | | - Daniele Coraci
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Claudia Loreti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giuseppe Zuccalà
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Efficacy and safety of non-benzodiazepine and non-Z-drug hypnotic medication for insomnia in older people: a systematic literature review. Eur J Clin Pharmacol 2019; 76:363-381. [DOI: 10.1007/s00228-019-02812-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022]
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17
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Abstract
Insomnia poses significant challenges to public health. It is a common condition associated with marked impairment in function and quality of life, psychiatric and physical morbidity, and accidents. As such, it is important that effective treatment is provided in clinical practice. To this end, this paper reviews critical aspects of the assessment of insomnia and the available treatment options. These options include both non-medication treatments, most notably cognitive behavioral therapy for insomnia, and a variety of pharmacologic therapies such as benzodiazepines, "z-drugs", melatonin receptor agonists, selective histamine H1 antagonists, orexin antagonists, antidepressants, antipsychotics, anticonvulsants, and non-selective antihistamines. A review of the available research indicates that rigorous double-blind, randomized, controlled trials are lacking for some of the most commonly administered insomnia therapies. However, there are an array of interventions which have been demonstrated to have therapeutic effects in insomnia in trials with the above features, and whose risk/benefit profiles have been well characterized. These interventions can form the basis for systematic, evidence-based treatment of insomnia in clinical practice. We review this evidence base and highlight areas where more studies are needed, with the aim of providing a resource for improving the clinical management of the many patients with insomnia.
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Affiliation(s)
- Andrew D. Krystal
- Department of PsychiatryUniversity of California San Francisco School of MedicineSan FranciscoCAUSA,Department of NeurologyUniversity of California San Francisco School of MedicineSan FranciscoCAUSA
| | - Aric A. Prather
- Department of PsychiatryUniversity of California San Francisco School of MedicineSan FranciscoCAUSA
| | - Liza H. Ashbrook
- Department of NeurologyUniversity of California San Francisco School of MedicineSan FranciscoCAUSA
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18
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Cybulski M, Cybulski L, Krajewska-Kulak E, Orzechowska M, Cwalina U, Kowalczuk K. Sleep disorders among educationally active elderly people in Bialystok, Poland: a cross-sectional study. BMC Geriatr 2019; 19:225. [PMID: 31426755 PMCID: PMC6701151 DOI: 10.1186/s12877-019-1248-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sleep disorders in an ageing society constitute a significant public health problem. It is estimated that approximately 50% of people aged 55 years and older have trouble sleeping, including initiating and maintaining sleep. The aim of this study was to determine the prevalence of sleep disorders in a group of educationally active elderly people living in Bialystok, Poland. METHODS The study included a total of 182 people - residents of Bialystok - aged 60 or older; 146 women (80.22%) and 36 men (19.78%). The study used three standardized psychometric scales: The Athens Insomnia Scale (AIS), The Epworth Sleepiness Scale (ESS) and The Insomnia Severity Index (ISI). RESULTS More than half of the respondents scored 6 or more points on the AIS, which is considered a value that indicates a high probability of insomnia symptom occurrence. A similar percentage of respondents obtained a point value on the ISI indicating the presence of insomnia. The vast majority of respondents scored below 11 points on the ESS, which means no symptoms of excessive sleepiness. There was a significant correlation between the results of the above scales in the examined group in total and also by sex. CONCLUSIONS Sleep disorders, particularly insomnia, constitute a significant social and health problem in the group of educationally active elderly people living in Bialystok. In light of the obtained study results, it is recommended to conduct and improve existing health education programs aimed at the elderly regarding sleep disorders to improve the quality of their sleep, and thus quality of life, and raise the awareness of the elderly about the importance of sleep in everyday life. There is a need for further research in the field of sleep disorders in the elderly to determine the prevalence of these disorders on a national scale.
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Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie str., 15-096, Bialystok, Poland.
| | - Lukasz Cybulski
- National security student, Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, 14 Zolnierska str., 10-561, Olsztyn, Poland
| | - Elzbieta Krajewska-Kulak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie str., 15-096, Bialystok, Poland
| | - Magda Orzechowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie str., 15-096, Bialystok, Poland
| | - Urszula Cwalina
- Department of Statistics and Medical Informatics, Faculty of Health Sciences, Medical University of Bialystok, 37 Szpitalna str., 15-295, Bialystok, Poland
| | - Krystyna Kowalczuk
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie str., 15-096, Bialystok, Poland
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Choi H, Jeong J, Kim H, Shin C, Yoon IY. Implication of Fast Activities of Spectral Analysis in Subjective Sleep Complaints of Elderly Women. J Geriatr Psychiatry Neurol 2019; 32:24-30. [PMID: 30477382 DOI: 10.1177/0891988718813711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In elderly patients, women have better qualities of sleep than men in objective parameters; however, women subjectively complain more about sleep disturbances than men. We performed visual scoring and spectral analysis of sleep electroencephalograms to explain these gender differences in the degree of arousal, the most representative marker in insomnia. METHODS A total of 354 participants (≥60 years old) were recruited from a Korean community underwent nocturnal polysomnography (NPSG). A Fast Fourier transform was used for the spectral analysis of the NPSG data. Relative power was calculated as absolute power of each band divided by total absolute power. Difference in total sleep time (D_TST) is obtained by subtracting the total sleep time reported in Pittsburgh Sleep Quality Index (PSQI) from the TST measured by the NPSG. RESULTS A total of 75 participants (women, 51) were finally analyzed. Women had higher PSQI, longer sleep latencies, sleep inefficiencies, and daytime dysfunctions compared to men. The percentage of stage 1 sleep was higher in men versus in women, whereas percentage of stage 3 sleep was higher in women than in men ( P = .001; P = .001). Women had higher relative alpha and beta powers than men during nonrapid eye movement (NREM) sleep ( P = .017; P = .015). During NREM sleep, beta power was negatively correlated with D_TST ( R = -0.250, P = .033), and relative alpha power in stage 3 sleep was positively correlated with sleep latency in PSQI ( R = 0.267, P = .022). CONCLUSION Spectral analysis showed that women had more disturbed sleep than men. The result from the spectral analysis may explain hyperarousal in elderly women.
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Affiliation(s)
- Hayun Choi
- 1 Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Jahyun Jeong
- 2 Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Heejun Kim
- 2 Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chuljin Shin
- 3 Department of Neuropsychiatry, Chungbuk National University School of Medicine, Cheongju, Chungbuk, Republic of Korea
| | - In-Young Yoon
- 2 Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,4 Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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20
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Amorim L, Magalhães R, Coelho A, Moreira PS, Portugal-Nunes C, Castanho TC, Marques P, Sousa N, Santos NC. Poor Sleep Quality Associates With Decreased Functional and Structural Brain Connectivity in Normative Aging: A MRI Multimodal Approach. Front Aging Neurosci 2018; 10:375. [PMID: 30524267 PMCID: PMC6257343 DOI: 10.3389/fnagi.2018.00375] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022] Open
Abstract
Sleep is a ubiquitous phenomenon, essential to the organism homeostasis. Notwithstanding, there has been an increasing concern with its disruption, not only within the context of pathological conditions, such as neurologic and psychiatric diseases, but also in health. In fact, sleep complaints are becoming particularly common, especially in middle-aged and older adults, which may suggest an underlying susceptibility to sleep quality loss and/or its consequences. Thus, a whole-brain modeling approach to study the shifts in the system can cast broader light on sleep quality mechanisms and its associated morbidities. Following this line, we sought to determine the association between the standard self-reported measure of sleep quality, the Pittsburgh Sleep Quality Index (PSQI) and brain correlates in a normative aging cohort. To this purpose, 86 participants (age range 52–87 years) provided information regarding sociodemographic parameters, subjective sleep quality and associated psychological variables. A multimodal magnetic resonance imaging (MRI) approach was used, with whole-brain functional and structural connectomes being derived from resting-state functional connectivity (FC) and probabilistic white matter tractography (structural connectivity, SC). Brain regional volumes and white matter properties associations were also explored. Results show that poor sleep quality was associated with a decrease in FC and SC of distinct networks, overlapping in right superior temporal pole, left middle temporal and left inferior occipital regions. Age displayed important associations with volumetric changes in the cerebellum cortex and white matter, thalamus, hippocampus, right putamen, left supramarginal and left lingual regions. Overall, results suggest that not only the PSQI global score may act as a proxy of changes in FC/SC in middle-aged and older individuals, but also that the age-related regional volumetric changes may be associated to an adjustment of brain connectivity. These findings may also represent a step further in the comprehension of the role of sleep disturbance in disease, since the networks found share regions that have been shown to be affected in pathologies, such as depression and Alzheimer's disease.
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Affiliation(s)
- Liliana Amorim
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Ricardo Magalhães
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Ana Coelho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Carlos Portugal-Nunes
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Paulo Marques
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
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21
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Abad VC, Guilleminault C. Insomnia in Elderly Patients: Recommendations for Pharmacological Management. Drugs Aging 2018; 35:791-817. [PMID: 30058034 DOI: 10.1007/s40266-018-0569-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic insomnia affects 57% of the elderly in the United States, with impairment of quality of life, function, and health. Chronic insomnia burdens society with billions of dollars in direct and indirect costs of care. The main modalities in the treatment of insomnia in the elderly are psychological/behavioral therapies, pharmacological treatment, or a combination of both. Various specialty societies view psychological/behavioral therapies as the initial treatment intervention. Pharmacotherapy plays an adjunctive role when insomnia symptoms persist or when patients are unable to pursue cognitive behavioral therapies. Current drugs for insomnia fall into different classes: orexin agonists, histamine receptor antagonists, non-benzodiazepine gamma aminobutyric acid receptor agonists, and benzodiazepines. This review focuses on Food and Drug Administration (FDA)-approved drugs for insomnia, including suvorexant, low-dose doxepin, Z-drugs (eszopiclone, zolpidem, zaleplon), benzodiazepines (triazolam, temazepam), and ramelteon. We review the indications, dosing, efficacy, benefits, and harms of these drugs in the elderly, and discuss data on drugs that are commonly used off-label to treat insomnia, and those that are in clinical development. The choice of a hypnotic agent in the elderly is symptom-based. Ramelteon or short-acting Z-drugs can treat sleep-onset insomnia. Suvorexant or low-dose doxepin can improve sleep maintenance. Eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance. Low-dose zolpidem sublingual tablets or zaleplon can alleviate middle-of-the-night awakenings. Benzodiazepines should not be used routinely. Trazodone, a commonly used off-label drug for insomnia, improves sleep quality and sleep continuity but carries significant risks. Tiagabine, sometimes used off-label for insomnia, is not effective and should not be utilized. Non-FDA-approved hypnotic agents that are commonly used include melatonin, diphenhydramine, tryptophan, and valerian, despite limited data on benefits and harms. Melatonin slightly improves sleep onset and sleep duration, but product quality and efficacy may vary. Tryptophan decreases sleep onset in adults, but data in the elderly are not available. Valerian is relatively safe but has equivocal benefits on sleep quality. Phase II studies of dual orexin receptor antagonists (almorexant, lemborexant, and filorexant) have shown some improvement in sleep maintenance and sleep continuity. Piromelatine may improve sleep maintenance. Histamine receptor inverse agonists (APD-125, eplivanserin, and LY2624803) improve slow-wave sleep but, for various reasons, the drug companies withdrew their products.
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Affiliation(s)
- Vivien C Abad
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Outpatient Medical Center, Stanford University, 450 Broadway St. Pavilion C 2nd Floor MC 5704, Redwood City, CA, 94063, USA
| | - Christian Guilleminault
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Outpatient Medical Center, Stanford University, 450 Broadway St. Pavilion C 2nd Floor MC 5704, Redwood City, CA, 94063, USA.
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22
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Bliwise DL, Howard LE, Moreira DM, Andriole GL, Hopp ML, Freedland SJ. Nocturia and associated mortality: observational data from the REDUCE trial. Prostate Cancer Prostatic Dis 2018; 22:77-83. [DOI: 10.1038/s41391-018-0090-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
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23
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Gender-specific Correlations of Insomnia and Attitudes toward Treatment among Community-dwelling Elderly in Northern Taiwan. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Khou CS, Rendzia B, Watts A. Evaluation of waist-worn actigraphy monitors for the assessment of sleep in older adults with and without Alzheimer's disease. J Rehabil Assist Technol Eng 2018; 5:2055668318777989. [PMID: 31191943 PMCID: PMC6453051 DOI: 10.1177/2055668318777989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/18/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Evaluate differences in sleep characteristics between older adults with and without mild Alzheimer's disease using waist-worn actigraphy monitors. Methods Actigraph GT3X+ monitors and self-reported sleep and activity logs were used for one week and compared between older adults (N = 85) with (n = 35) and without Alzheimer's disease (n = 51). Results Participants with Alzheimer's disease had greater total sleep time and spent more time in bed than nonimpaired older adults. Estimates for sleep efficiency and total sleep time for the total sample were elevated compared to previous studies of wrist-worn devices in similar populations, while estimates of sleep onset latency and wake after sleep onset for the total sample were lower. Conclusions Actigraphy-based sleep studies in older adults with Alzheimer's disease should consider discrepancies between objective and subjective estimates of sleep and monitor placement to maximize the ability to measure both activity and sleep.
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Affiliation(s)
| | - Brady Rendzia
- Department of Psychology, University of Kansas, Lawrence, USA
| | - Amber Watts
- Department of Psychology, University of Kansas, Lawrence, USA
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25
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Press Y, Punchik B, Freud T. The association between subjectively impaired sleep and symptoms of depression and anxiety in a frail elderly population. Aging Clin Exp Res 2018; 30:755-765. [PMID: 29022191 DOI: 10.1007/s40520-017-0837-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most previous studies showed an association between sleep impairment in the elderly and symptoms of depression and anxiety. Majority of these studies were conducted in "strong", community-dwelling elderly. AIM To assess the association between subjective sleep impairment and its affective disturbances among frail elderly patients. METHODS The retrospective study included patients 65 years old and above. Data included socio-demographic characteristics, the mini-mental state examination, the short anxiety screening test, the 15-item Geriatric Depression Scale, and the Patient Health Questionnaire. The patients were asked about sleep complaints. RESULTS The study population consisted of 496 patients. The mean age was 83.7 ± 6.2 years, and only 7 (1.4%) did not report any sleep disturbance. After adjustment, depression symptoms were associated only with decreased overall sleep satisfaction (OR 2.62, 95% CI 1.18-5.81), while anxiety symptoms were associated with decreased overall sleep satisfaction (OR 3.17, 96% CI 1.71-5.88), difficulty falling asleep (OR 3.58, 95% CI 1.96-6.52), waking up during the night (OR 3.16, 95% CI 1.63-6.1), morning weakness (OR 2.68, 95% CI 1.44-5.0) and daytime drowsiness (OR 2.39, 95% CI 1.21-4.69). DISCUSSION Sleep impairment is very prevalent among frail elderly and associated much more with anxiety than with depression. CONCLUSION The findings of the present study provide further evidence for the importance in taking a detailed history of sleep habits during the course of the geriatric assessment in frail elderly patients.
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Affiliation(s)
- Yan Press
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Comprehensive Geriatric Assessment Unit, Clalit Health Services, Yasski Clinic, 24 King David Street, Beer-Sheva, Israel.
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Boris Punchik
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Comprehensive Geriatric Assessment Unit, Clalit Health Services, Yasski Clinic, 24 King David Street, Beer-Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics 2018; 18:155-165. [PMID: 29878472 DOI: 10.1111/psyg.12319] [Citation(s) in RCA: 251] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/27/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022]
Abstract
In contrast to newborns, who spend 16-20 h in sleep each day, adults need only about sleep daily. However, many elderly may struggle to obtain those 8 h in one block. In addition to changes in sleep duration, sleep patterns change as age progresses. Like the physical changes that occur during old age, an alteration in sleep pattern is also a part of the normal ageing process. As people age, they tend to have a harder time falling asleep and more trouble staying asleep. Older people spend more time in the lighter stages of sleep than in deep sleep. As the circadian mechanism in older people becomes less efficient, their sleep schedule is shifted forward. Even when they manage to obtain 7 or 8 h sleep, they wake up early, as they have gone to sleep quite early. The prevalence of sleep disorders is higher among older adults. Loud snoring, which is more common in the elderly, can be a symptom of obstructive sleep apnoea, which puts a person at risk for cardiovascular diseases, headaches, memory loss, and depression. Restless legs syndrome and periodic limb movement disorder that disrupt sleep are more prevalent in older persons. Other common medical problems of old age such as hypertension diabetes mellitus, renal failure, respiratory diseases such as asthma, immune disorders, gastroesophageal reflux disease, physical disability, dementia, pain, depression, and anxiety are all associated with sleep disturbances.
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Affiliation(s)
- Kamalesh K Gulia
- Division of Sleep Research, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Velayudhan Mohan Kumar
- Division of Sleep Research, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Hughes JM, Song Y, Fung CH, Dzierzewski JM, Mitchell MN, Jouldjian S, Josephson KR, Alessi CA, Martin JL. Measuring Sleep in Vulnerable Older Adults: A Comparison of Subjective and Objective Sleep Measures. Clin Gerontol 2018; 41:145-157. [PMID: 29283797 PMCID: PMC5809246 DOI: 10.1080/07317115.2017.1408734] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study compared subjective (questionnaire) and objective (actigraphy) sleep assessments, and examined agreement between these methods, in vulnerable older adults participating in a Veterans Administration Adult Day Health Care (ADHC) program. METHODS 59 ADHC participants (95% male, mean age = 78 years) completed sleep questionnaires and 72 continuous hours of wrist actigraphy. Linear regression was used to examine agreement between methods and explore discrepancies in subjective/objective measures. RESULTS Disturbed sleep was common, yet there was no agreement between subjective and objective sleep assessment methods. Compared with objective measures, one-half of participants reported worse sleep efficiency (SE) on questionnaires while one-quarter over-estimated SE. Participants reporting worse pain had a greater discrepancy between subjective and objective SE. CONCLUSIONS Vulnerable older adults demonstrated unique patterns of reporting sleep quality when comparing subjective and objective methods. Additional research is needed to better understand how vulnerable older adults evaluate sleep problems. CLINICAL IMPLICATIONS Objective and subjective sleep measures may represent unique and equally important constructs in this population. Clinicians should consider utilizing both objective and subjective sleep measures to identify individuals who may benefit from behavioral sleep treatments, and future research is needed to develop and validate appropriate sleep assessments for vulnerable older adults.
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Affiliation(s)
- Jaime M Hughes
- a Center for Health Services Research in Primary Care , Durham VA Medical Center , Durham , North Carolina , USA
| | - Yeonsu Song
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Constance H Fung
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Joseph M Dzierzewski
- d Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Michael N Mitchell
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Stella Jouldjian
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Karen R Josephson
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Cathy A Alessi
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Jennifer L Martin
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
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Nogueira BOCL, Li L, Meng LR, Ungvari GS, Forester BP, Chiu HFK, Kuok KCF, Tran L, Liu ZM, Xiang YT. Prevalence of Sleep Disturbances and Their Associations With Demographic and Clinical Characteristics and Quality of Life in Older Adults in Macao. Perspect Psychiatr Care 2018; 54:46-53. [PMID: 27966223 DOI: 10.1111/ppc.12199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/01/2016] [Accepted: 10/26/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine the prevalence of sleep disturbances (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], and early morning awakening [EMA]), their socio-demographic and clinical correlates, and quality of life (QOL) in older adults in Macao. DESIGN AND METHODS Four hundred fifty-one subjects were interviewed using standardized instruments. FINDINGS The prevalence of at least one type of sleep disturbance was 38.1%; the figures of DIS, DMS, and EMA were 18.6, 31.3, and 23.9%, respectively. Female sex and depressive symptoms were independently associated with more frequent sleep disturbances. Sleep disturbances were independently associated with lower physical QOL. PRACTICE IMPLICATIONS Sleep disturbances are common in older adults in Macao. Appropriate strategies should be implemented to prevent and treat sleep disturbances and concerted attempts should be made to improve access to treatment.
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Affiliation(s)
- Bernice O C Lam Nogueira
- Associate Professor, School of Health Sciences, Macao Polytechnic Institute.,Macao Sino-Portuguese Nurses Association, Macao SAR, China
| | - Lu Li
- PhD Student, Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Li-Rong Meng
- Professor, School of Health Sciences, Macao Polytechnic Institute, Macao SAR, China
| | - Gabor S Ungvari
- Professor, University of Notre Dame Australia/Marian Centre.,School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Brent P Forester
- Assistant Professor, Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA.,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Helen F K Chiu
- Professor, Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kenny C F Kuok
- Lecturer, School of Health Sciences, Macao Polytechnic Institute, Macao SAR, China
| | - Linda Tran
- Vice-President, Macao Sino-Portuguese Nurses Association, Macao SAR, China
| | - Zhao-Min Liu
- Professor, School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Nioi A, Roe J, Gow A, McNair D, Aspinall P. Seasonal Differences in Light Exposure and the Associations With Health and Well-Being in Older Adults: An Exploratory Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 10:64-79. [PMID: 29056090 PMCID: PMC5656103 DOI: 10.1177/1937586717697650] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This article reports summer verses winter seasonal variations across a suite of blue light, illuminance levels and health and well-being indicators. BACKGROUND The quality of lighting in care homes has been assessed previously, yet seasonal comparisons and the associations with sleep quality are limited. This exploratory study investigates light exposure in two seasons to determine the changes over time and the associations with health and well-being. METHODS In a repeated measures design, 16 older people (aged 72-99 years) living in a care home had their personal light exposure and sleep/wake patterns monitored for 4 days. Cognitive ability, mental well-being, daytime physical activity, and visual function were assessed. Mean light levels at preset times across the day, duration in light exposure over 1,000 lux, and sleep parameters were computed. Statistical investigations included correlations exploring associations and paired means tests to detect the changes between seasons. RESULTS The mean morning illuminance level in summer was 466 lux and 65 lux in winter. Duration in bright light over 1,000 lux was 46 min in summer and 3 min in winter. Light measures were significantly higher in summer. There was no statistical difference in sleep quality parameters between seasons, but there were significant difference in daytime physical activity level (i.e., this was higher in summer). CONCLUSION The findings indicate low level of light exposures experienced in both seasons, with exposure levels being particularly low in winter. This provides new insights into the limited amount of light older people receive independent of season and the possible impacts on sleep and daytime physical activity level.
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Affiliation(s)
- Amanda Nioi
- Department of Human Health, School of Engineering and Physical Science, Heriot-Watt University, Edinburgh, UK
- School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh, UK
| | - Jenny Roe
- Center for Design and Health, School of Architecture, University of Virginia, Charlottesville, VA, USA
- Stockholm Environment Institute, University of York, York, UK
| | - Alan Gow
- School of Management and Languages, Heriot-Watt University, Edinburgh, UK
- Centre for Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - David McNair
- Dementia Centre, Hammond Care, Sydney, Australia
| | - Peter Aspinall
- School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Edinburgh, UK
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Tufan A, Ilhan B, Bahat G, Karan MA. An under-diagnosed geriatric syndrome: sleep disorders among older adults. Afr Health Sci 2017; 17:436-444. [PMID: 29062339 PMCID: PMC5637029 DOI: 10.4314/ahs.v17i2.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. METHODS Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. RESULTS The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered 'yes' to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. CONCLUSION We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.
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Affiliation(s)
- Asli Tufan
- Marmara University Hospital, Department of Internal Medicine, Division of Geriatrics, Pendik, Istanbul, 34662, Turkey
| | - Birkan Ilhan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
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Malinowska KB, Ikezoe T, Ichihashi N, Arai H, Murase K, Chin K, Kawaguchi T, Tabara Y, Nakayama T, Matsuda F, Tsuboyama T. Self-reported quality of sleep is associated with physical strength among community-dwelling young-old adults. Geriatr Gerontol Int 2017; 17:1808-1813. [PMID: 28060455 DOI: 10.1111/ggi.12965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/27/2016] [Accepted: 10/12/2016] [Indexed: 12/01/2022]
Abstract
AIM The present study examined the association between self-reported quality of sleep (QOS) and physical function in community-dwelling young-old adults. METHODS This cross-sectional study included 737 community-dwelling older adults aged 60 years and older (498 women, 239 men); age 68.3 ± 5.2 years (range 60-79 years). Participants completed a self-administered questionnaire, which included the Pittsburgh Sleep Quality Index, as well as information regarding sociodemographic characteristics, physical activity, smoking and alcohol consumption. The χ2 -test was used to compare categorical variables stratified by QOS, and the unpaired t-test was used for continuous variables for men and women separately. Furthermore, logistic regression analyses were carried out to verify the association between QOS and physical function measures. RESULTS The unpaired t-test showed a significant difference ((P < 0.05) in the Timed Up and Go test and physical strength outcomes, which included: handgrip, quadriceps setting, knee extension and hip flexion strength between the good QOS and poor QOS groups among the men. However, the t-test results for physical function outcomes did not show a significant difference among the women. In the logistic regression model, after adjusting for age, sex and potential confounding factors, handgrip strength remained significantly associated with QOS (OR 0.96, 95% CI 0.92-1.00). CONCLUSION QOS was associated with physical function in young-old adults; those with good QOS were especially more likely to possess stronger grip strengths; however, further research is required to identify the temporal relationship. Geriatr Gerontol Int 2017; 17: 1808-1813.
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Affiliation(s)
- Katarzyna B Malinowska
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tome Ikezoe
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kimihiko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University of Public Health, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Tsuboyama
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Wong SH, Ng BY. Review of sleep studies of patients with chronic insomnia at a sleep disorder unit. Singapore Med J 2016; 56:317-23. [PMID: 26106238 DOI: 10.11622/smedj.2015089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic insomnia is associated with many physical and psychiatric illnesses, and its underlying aetiology needs to be identified in order to achieve safe and effective treatment. Obstructive sleep apnoea (OSA) and periodic limb movement disorder (PLMD) are common primary sleep disorders that can lead to chronic insomnia. Patients with these conditions are evaluated using polysomnography (PSG). METHODS The PSG records of 106 patients with chronic insomnia who presented to a multidisciplinary sleep clinic in Singapore over a five-year period were reviewed. To examine the utility of PSG in the evaluation of chronic insomnia, the clinical diagnoses of the patients before and after the sleep studies were compared. RESULTS Among the 106 patients, 69 (65.4%) were suspected to have primary sleep disorders based on clinical history and examination alone. Following PSG evaluation, 42.5% and 4.7% of the study population were diagnosed with OSA and PLMD, respectively. OSA was found in 35.9% of the 39 patients who had underlying psychiatric conditions. CONCLUSION This study illustrates that many patients with chronic insomnia have underlying primary sleep disorders. It also highlights the danger of attributing chronic insomnia in psychiatric patients to their illness, without giving due consideration to other possible aetiologies. Clinicians should maintain a high index of suspicion for the presence of other aetiologies, and make timely and targeted referrals for sleep studies where appropriate.
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Affiliation(s)
- Sheau-Hwa Wong
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Beng-Yeong Ng
- Department of Psychiatry, Singapore General Hospital, Singapore
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Kim KW, Kang SH, Yoon IY, Lee SD, Ju G, Han JW, Kim TH, Lee CS, Kim T. Prevalence and clinical characteristics of insomnia and its subtypes in the Korean elderly. Arch Gerontol Geriatr 2016; 68:68-75. [PMID: 27665575 DOI: 10.1016/j.archger.2016.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Insomnia is known to be associated with psychiatric disorders, other sleep disorders and medical conditions, but the prevalence of insomnia diagnosis has never been estimated according to its subtypes. We studied the prevalence and clinical characteristics of insomnia diagnosis and its subtypes in the Korean elderly population. METHODS Among 1423 sampled elderly individuals aged 60 years or older, 881 subjects participated in this study. The Athens Insomnia Scale was applied to detect insomnia symptoms, and insomnia diagnosis was finally evaluated using the international classification of sleep disorders, 2nd edition. To define insomnia subtypes, the DSM-IV-based interview, detailed history on sleep disorders and semi-structured interview for medical conditions were performed. Subsyndromal depression was defined when depressive symptoms did not meet the criteria for depressive disorders. RESULTS The prevalence of insomnia disorder was 32.8% in all subjects, with the prevalence being significantly higher in women than in men (37.9% vs. 25.2%; p<0.001). The prevalence of insomnia subtypes was as follows; psychophysiological insomnia (PI), 20.5%; insomnia due to mental disorder 7.2%; insomnia due to general medical conditions 2.9%; insomnia in other sleep disorders 2.2%, and insomnia due to substance use 0.2%. Among subjects with PI, subsyndromal depression was diagnosed in 53.7%. CONCLUSIONS Nearly one third of Korean elderly individuals suffer from insomnia and insomnia patients showed diverse comorbid conditions, especially depressive symptoms. By establishing insomnia subtypes, we can plan to treat comorbid conditions as well as insomnia itself.
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Affiliation(s)
- Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Suk-Hoon Kang
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, South Korea; Department of Psychiatry, Center for Sleep Medicine, Seoul, South Korea
| | - In-Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sang Don Lee
- Department of Psychiatry, Korean Armed Forces Capital Hospital, Gyeonggi-do, South Korea
| | - Gawon Ju
- Department of Neuropsychiatry, Chungbuk National University Hospital, Cheongju, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Tae Hui Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Chung Suk Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Tae Kim
- Department of Psychiatry, Kyung Hee University Hospital at Gangdong, Seoul,Seoul, South Korea
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Kiełbasa G, Stolarz-Skrzypek K, Pawlik A, Łątka M, Drożdż T, Olszewska M, Franczyk A, Czarnecka D. Assessment of sleep disorders among patients with hypertension and coexisting metabolic syndrome. Adv Med Sci 2016; 61:261-268. [PMID: 27124215 DOI: 10.1016/j.advms.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/06/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The coexistence of hypertension, abdominal obesity, and carbohydrate and lipid metabolism disturbances favors the acceleration of other disease entities - also apart from cardiovascular system disorders. This study was planned to estimate the relationship between the presence of metabolic syndrome and sleep disorders among a group of hypertensive patients. PATIENTS/METHODS The study was conducted on unselected group of 261 patients from the Outpatient Hypertension Clinic. The standardized questionnaire was used to collect the data on medical history, prescribed drugs and lifestyle. Sleep disorders were diagnosed based on the Athens Insomnia Scale and STOP-Bang Questionnaire. According to the study protocol, anthropometric parameters (weight, height, waist and neck circumferences), blood pressure, serum lipids and fasting glucose laboratory measurements were performed. Metabolic syndrome was defined according to IDF criteria. RESULTS Sleep disorders were recognized in 183 participants of the study - significantly more frequently (P=0.03) among patients with diagnosed metabolic syndrome (120; 75%) in comparison with participants without this disturbance (63; 62.38%). Male gender, poor financial situation, tingling sensations before falling asleep and combination therapy of hypertension significantly increased the risk of sleep disorder occurrence in the group of patients with metabolic syndrome. Night food intake, aging, hypertension combination therapy and poor socioeconomic status were the factors increasing the risk of sleep problems among participants without metabolic syndrome. CONCLUSIONS Sleep disorders often coexist with metabolic syndrome in hypertensive patients. A number of factors increase the probability of occurrence of sleep disorders, but most of them are modifiable.
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Endeshaw YW, Yoo W. Association Between Social and Physical Activities and Insomnia Symptoms Among Community-Dwelling Older Adults. J Aging Health 2016; 28:1073-89. [PMID: 26690253 PMCID: PMC4914473 DOI: 10.1177/0898264315618921] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the association between organized social activity, walking exercise, and insomnia symptoms. MATERIAL AND METHOD Data for analysis are derived from the National Health Aging Trends Study (NHATS). At baseline, demographic characteristics, socioeconomic status, health-related behaviors, sleep-related problems, and health status were assessed using questionnaires. RESULTS Data for 7,162 community-dwelling older adults were available for analysis. Difficulty falling asleep, trouble staying asleep, and both insomnia symptoms were reported by 12%, 5%, and 11% of the participants, respectively. The proportion of participants who reported engaging in organized social activity, walking exercise, and both activities were 11%, 35%, and 26%, respectively. Participants who reported engaging in organized social activity and/or walking exercise were significantly less likely to report insomnia symptoms. CONCLUSION These results have important implications for future studies that plan to implement nonpharmacological interventions for management of insomnia among older adults.
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Affiliation(s)
| | - Wonsuk Yoo
- Georgia Regents University, Augusta, USA
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Sun YJ, Yuan JM, Yang ZM. Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:217. [PMID: 27411310 PMCID: PMC4944240 DOI: 10.1186/s12906-016-1179-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary insomnia is a widespread and refractory disease. Moxibustion therapy for insomnia shows some advantages compared with conventional therapies. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effectiveness and safety of moxibustion therapy for insomnia. METHODS We conducted a comprehensive literature review of the CENTRAL, PubMed, EMBASE, Web of science, CNKI, VIP, and Wanfang Data databases from their inception to July 2015 for RCTs that compared moxibustion with western medications, oral Chinese medicine, or other methods of traditional Chinese medicine (TCM) in patients with primary insomnia. The primary outcome measure was effective rate and secondary outcome measure was adverse events. Data collection and analysis included risk of bias evaluation, meta-analysis, sensitivity analysis, publication bias and adverse events analysis according to corresponding criteria. RESULTS The study included 22 RCTs (1,971 patients). The quality of the studies was low. The overall meta-analysis demonstrated that moxibustion was more effective for insomnia than western medications, oral Chinese medicine and other TCM therapies (RR = 1.17, 95 % CI 1.12 to 1.23, P < 0.00001). Subgroup analyses demonstrated that moxibustion was more effective for insomnia than western medications (RR = 1.16, 95 % CI 1.09 to 1.24, P < 0.00001), oral Chinese medicine (RR = 1.11, 95 % CI 1.04 to 1.18, P = 0.002), and other TCM therapies (RR = 1.22, 95 % CI 1.15 to 1.30, P < 0.00001). There were no serious adverse effects associated with moxibustion therapy for insomnia, and the rate of adverse events was low. CONCLUSION It is difficult to get the conclusion regarding the effectiveness and safety of moxibustion for primary insomnia due to insufficient evidence, such as the high risk of bias in the included studies, small sample sizes, and few reports on adverse effects. Moxibustion should be considered as a novel therapeutic option for insomnia, and more rigorous clinical trials of moxibustion therapy for insomnia are needed to assess its effects.
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Affiliation(s)
- Yu-Jiao Sun
- />Guangzhou University of Chinese Medicine, No.12, Jichang Road, Bai Yun District, Guangzhou, Guangdong 510405 China
| | - Jia-Min Yuan
- />Guangdong Hospital of Traditional Chinese Medicine, No.111, Dade Road, Yue Xiu District, Guangzhou, Guangdong 510120 China
| | - Zhi-Min Yang
- />Guangdong Hospital of Traditional Chinese Medicine, No.111, Dade Road, Yue Xiu District, Guangzhou, Guangdong 510120 China
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Abstract
Humans spend approximately one-third of their lives asleep. Whether due to evolutionary or ontogenetic factors, sleep and psychiatric disorders change with age. Although much of sleep remains an enigma, sleep research is experiencing an exponential increase in its understanding of the causes, correlates, and consequences of sleep disturbances. Although the relationship between age-related sleep and psychiatric conditions is a common clinical observation, empirical investigations remain scarce. Thus, treating patients with symptoms of sleep disorders in the context of psychiatric conditions remains a challenge. This article reviews the state-of-the-science of sleep disorders in the context of psychiatric conditions in late-life.
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Lima CA, Soares WJDS, Bilton TL, Dias RC, Ferrioll E, Perracini MR. Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:607-17. [DOI: 10.1590/1980-5497201500030007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/30/2014] [Indexed: 01/14/2023] Open
Abstract
Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.
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Wu WW, Kwong E, Lan XY, Jiang XY. The Effect of a Meditative Movement Intervention on Quality of Sleep in the Elderly: A Systematic Review and Meta-Analysis. J Altern Complement Med 2015; 21:509-19. [PMID: 26120865 DOI: 10.1089/acm.2014.0251] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/OBJECTIVES Sleep disorders are one of the most common difficulties facing older people. Meditative movement interventions (MMIs), a new category of exercise integrating physical activity and meditation (e.g., t'ai chi, yoga, and qigong), may benefit older people with sleep problems. This systematic review synthesized the evidence on the effect of MMIs on older people's quality of sleep. METHODS PubMed, EMBASE, CINAHL, PsycINFO, Scopus, the Cochrane Library, the China Science and Technology Journal Database (CSTJ) and the China National Knowledge Infrastructure (CNKI) were searched-from 1950 to March 2014-for randomized controlled trials. Articles were screened and selected by two researchers. Data were extracted from the included studies using specified forms. The same researchers independently evaluated the quality of each article. A meta-analysis was conducted to examine the pooled effect of MMI on sleep quality compared with the control groups. RESULTS Fourteen of 1049 studies were included, involving 1225 participants. Interventions included t'ai chi, yoga, qigong, and multicomponent MMI and lasted 12-24 weeks. Ten studies had a low risk of bias. The interventions resulted in significantly better sleep quality scores than either active therapy or usual care/wait-list controls (standardized mean difference, -0.70;95% confidence interval, -0.96 to -0.43). Subgroup analyses revealed that the effect of MMI on sleep quality was not influenced by the type or duration of the intervention. However, pooled results of studies with intervention frequency of fewer than 3 times per week did not show a positive effect on sleep quality. Lower-quality studies had larger effect sizes than high-quality studies. No adverse events were reported. CONCLUSION The current review demonstrated that MMI had a moderate effect on improving the quality of sleep for older people with sleep complaints. However, the evidence is inconclusive because of the varying study quality and MMI modalities. This study highlights the need for higher-quality randomized, controlled trials and more sufficient fidelity of intervention implementation to confirm the results. It also highlights the need for comparing the effectiveness of MMI on different subgroups of the elderly population.
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Affiliation(s)
- Wei-Wei Wu
- 1 School of Nursing, Fujian Medical University , Fuzhou, Fujian, China .,2 School of Nursing, The Hong Kong Polytechnic University , Hong Kong, China
| | - Enid Kwong
- 2 School of Nursing, The Hong Kong Polytechnic University , Hong Kong, China
| | - Xiu-Yan Lan
- 1 School of Nursing, Fujian Medical University , Fuzhou, Fujian, China
| | - Xiao-Ying Jiang
- 1 School of Nursing, Fujian Medical University , Fuzhou, Fujian, China
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Affiliation(s)
- Michael C Woodward
- Aged & Residential Care Services; Heidelberg Repatriation Hospital; Heidelberg Victoria
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Malinowska KB, Okura M, Ogita M, Yamamoto M, Nakai T, Numata T, Tsuboyama T, Arai H. Effect of self-reported quality of sleep on mobility in older adults. Geriatr Gerontol Int 2015; 16:266-71. [DOI: 10.1111/ggi.12468] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Katarzyna B Malinowska
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Mika Okura
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Mihoko Ogita
- Department of Health Science; Kyoto Koka Women's University; Kyoto Japan
| | | | | | | | - Tadao Tsuboyama
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Hidenori Arai
- Department of Human Health Sciences; Kyoto University Graduate School of Medicine; Kyoto Japan
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Almoznino G, Zini A, Sharav Y, Shahar A, Zlutzky H, Haviv Y, Lvovsky A, Aframian DJ. Sleep quality in patients with dental anxiety. J Psychiatr Res 2015; 61:214-22. [PMID: 25529787 DOI: 10.1016/j.jpsychires.2014.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/26/2014] [Accepted: 11/28/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. OBJECTIVES To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. METHODS 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. RESULTS 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. CONCLUSIONS DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.
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Affiliation(s)
- Galit Almoznino
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Avraham Zini
- Department of Community Dentistry, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yair Sharav
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Adi Shahar
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; In partial fulfillment of DMD Degree, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Hulio Zlutzky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Yaron Haviv
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Alex Lvovsky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
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Abstract
We explored the relationship between sleep disturbances and mild cognitive impairment (MCI) in community-dwelling seniors. Recent evidence suggests that sleep habits are differentially compromised in different subtypes of MCI, but the relationship between sleep disruption and MCI remains poorly understood. We gathered daily objective measures of sleep disturbance from 45 seniors, including 16 with MCI (mean age, 86.9±4.3 y), over a 6-month period. We also collected self-report measures of sleep disturbance. Although there were no differences between groups in any of our self-report measures, we found that amnestic MCI (aMCI) volunteers had less disturbed sleep than both nonamnestic MCI (naMCI) and cognitively intact volunteers, as measured objectively by movement in bed at night (F2,1078=4.30, P=0.05), wake after sleep onset (F2,1078=41.6, P<0.001), and number of times up at night (F2,1078=26.7, P<0.001). The groups did not differ in total sleep time. In addition, the aMCI group had less day-to-day variability in these measures than the intact and naMCI volunteers. In general, the naMCI volunteers showed a level of disturbed sleep that was intermediate to that of aMCI and intact volunteers. These differences in sleep disruption between aMCI and naMCI may be related to differences in the pathology underlying these MCI subtypes.
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Scullin MK, Bliwise DL. Sleep, cognition, and normal aging: integrating a half century of multidisciplinary research. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 10:97-137. [PMID: 25620997 PMCID: PMC4302758 DOI: 10.1177/1745691614556680] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep is implicated in cognitive functioning in young adults. With increasing age, there are substantial changes to sleep quantity and quality, including changes to slow-wave sleep, spindle density, and sleep continuity/fragmentation. A provocative question for the field of cognitive aging is whether such changes in sleep physiology affect cognition (e.g., memory consolidation). We review nearly a half century of research across seven diverse correlational and experimental domains that historically have had little crosstalk. Broadly speaking, sleep and cognitive functions are often related in advancing age, though the prevalence of null effects in healthy older adults (including correlations in the unexpected, negative direction) indicates that age may be an effect modifier of these associations. We interpret the literature as suggesting that maintaining good sleep quality, at least in young adulthood and middle age, promotes better cognitive functioning and serves to protect against age-related cognitive declines.
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Affiliation(s)
- Michael K Scullin
- Department of Psychology and Neuroscience, Baylor University Department of Neurology, Emory University School of Medicine
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Chang KJ, Son SJ, Lee Y, Back JH, Lee KS, Lee SJ, Chung YK, Lim KY, Noh JS, Kim HC, Koh SH, Roh HW, Park MA, Kim JJ, Hong CH. Perceived sleep quality is associated with depression in a Korean elderly population. Arch Gerontol Geriatr 2014; 59:468-73. [PMID: 24852666 DOI: 10.1016/j.archger.2014.04.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/01/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Gao Y, Guan W, Xu G, Lin Z, Tang Y, Lin Z, Li H, Gao Y, Luo Q, Zhong N, Chen R. Sleep disturbances and health-related quality of life in adults with steady-state bronchiectasis. PLoS One 2014; 9:e102970. [PMID: 25036723 PMCID: PMC4103887 DOI: 10.1371/journal.pone.0102970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/24/2014] [Indexed: 12/03/2022] Open
Abstract
Background Sleep disturbances are common in patients with chronic lung diseases, but little is known about the prevalence in patients with bronchiectasis. A cross sectional study was conducted to investigate the prevalence and determinants associated with sleep disturbances, and the correlation between sleep disturbances and quality of life (QoL) in adults with steady-state bronchiectasis. Methods One hundred and forty-four bronchiectasis patients and eighty healthy subjects were enrolled. Sleep disturbances, daytime sleepiness, and QoL were measured by utilizing the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and St. George Respiratory Questionnaire (SGRQ), respectively. Demographic, clinical indices, radiology, spirometry, bacteriology, anxiety and depression were also assessed. Results Adults with steady-state bronchiectasis had a higher prevalence of sleep disturbances (PSQI>5) (57% vs. 29%, P<0.001), but not daytime sleepiness (ESS≥10) (32% vs. 30%, P = 0.76), compared with healthy subjects. In the multivariate model, determinants associated with sleep disturbances in bronchiectasis patients included depression (OR, 10.09; 95% CI, 3.46–29.37; P<0.001), nocturnal cough (OR, 1.89; 95% CI, 1.13–3.18; P = 0.016), aging (OR, 1.04; 95% CI, 1.01–1.07; P = 0.009) and increased 24-hour sputum volume (OR, 2.01; 95% CI, 1.22–3.33; P = 0.006). Patients with sleep disturbances had more significantly impaired QoL affecting all domains than those without. Only 6.2% of patients reported using a sleep medication at least weekly. Conclusions In adults with steady-state bronchiectasis, sleep disturbances are more common than in healthy subjects and are related to poorer QoL. Determinants associated with sleep disturbances include depression, aging, nighttime cough and increased sputum volume. Assessment and intervention of sleep disturbances are warranted and may improve QoL.
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Affiliation(s)
- Yonghua Gao
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weijie Guan
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Gang Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiya Lin
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan Tang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huimin Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yang Gao
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qun Luo
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- * E-mail:
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Dai J, Chiu HFK, Xiang YT, Chan SSM, Yu X, Hou ZJ, Ungvari GS, Caine ED. The prevalence of insomnia and its socio-demographic and clinical correlates in older adults in rural China: a pilot study. Aging Ment Health 2014; 17:761-5. [PMID: 23547946 DOI: 10.1080/13607863.2013.781117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To investigate the prevalence of insomnia (DIS: difficulty initiating sleep; DMS: difficulty maintaining sleep; and EMA: early morning awakening), its socio-demographic and clinical correlates, and the treatment patterns in older adults in rural China. METHOD A sample of 263 subjects was recruited in Mianyang and interviewed using standardized instruments. Basic socio-demographic and clinical data were collected. RESULTS The expected mean total sleep time (TST) of the whole sample was 6.8 ± 2.2 hours, and the actual mean TST was 6.3 ± 2.1 hours. The 1-year prevalence of at least one type of insomnia was 7.6%; the rates of DIS, DMS, and EMA were 5.7%, 7.2%, and 6.8%, respectively. On multivariate analyses, female sex and psychiatric disorders were independently associated with more frequent insomnia. CONCLUSION Insomnia is not uncommon in older adults in rural China, and the low percentage of subjects treated suggests that improved access to treatment might be indicated.
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Affiliation(s)
- Jing Dai
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
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Figueiro MG, Plitnick B, Rea MS. Pulsing blue light through closed eyelids: effects on acute melatonin suppression and phase shifting of dim light melatonin onset. Nat Sci Sleep 2014; 6:149-56. [PMID: 25506253 PMCID: PMC4259558 DOI: 10.2147/nss.s73856] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Circadian rhythm disturbances parallel the increased prevalence of sleep disorders in older adults. Light therapies that specifically target regulation of the circadian system in principle could be used to treat sleep disorders in this population. Current recommendations for light treatment require the patients to sit in front of a bright light box for at least 1 hour daily, perhaps limiting their willingness to comply. Light applied through closed eyelids during sleep might not only be efficacious for changing circadian phase but also lead to better compliance because patients would receive light treatment while sleeping. Reported here are the results of two studies investigating the impact of a train of 480 nm (blue) light pulses presented to the retina through closed eyelids on melatonin suppression (laboratory study) and on delaying circadian phase (field study). Both studies employed a sleep mask that provided narrowband blue light pulses of 2-second duration every 30 seconds from arrays of light-emitting diodes. The results of the laboratory study demonstrated that the blue light pulses significantly suppressed melatonin by an amount similar to that previously shown in the same protocol at half the frequency (ie, one 2-second pulse every minute for 1 hour). The results of the field study demonstrated that blue light pulses given early in the sleep episode significantly delayed circadian phase in older adults; these results are the first to demonstrate the efficacy and practicality of light treatment by a sleep mask aimed at adjusting circadian phase in a home setting.
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Affiliation(s)
- Mariana G Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Mark S Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, USA
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