Association Between Sleep and Physical Function in Older Veterans in an Adult Day Healthcare Program

Relationship of psychotropic medication use with physical function among postmenopausal women

To examine cross-sectional and longitudinal relationships of psychotropic medications with physical function after menopause. Analyses involved 4557 Women's Health Initiative Long Life Study (WHI-LLS) participants (mean age at WHI enrollment (1993-1998): 62.8 years). Antidepressant, anxiolytic, and sedative/hypnotic medications were evaluated at WHI enrollment and 3-year follow-up visits. Performance-based physical function [Short Physical Performance Battery (SPPB)] was assessed at the 2012-2013 WHI-LLS visit. Self-reported physical function [RAND-36] was examined at WHI enrollment and the last available follow-up visit-an average of 22 [±2.8] (range: 12-27) years post-enrollment. Multivariable regression models controlled for socio-demographic, lifestyle, and health characteristics. Anxiolytics were not related to physical function. At WHI enrollment, antidepressant use was cross-sectionally related to worse self-reported physical function defined as a continuous (β = -6.27, 95% confidence interval [CI]: -8.48, -4.07) or as a categorical (< 78 vs. ≥ 78) (odds ratio [OR] = 2.10, 95% CI: 1.48, 2.98) outcome. Antidepressant use at WHI enrollment was also associated with worse performance-based physical function (SPPB) [< 10 vs. ≥ 10] (OR = 1.53, 95% CI: 1.05, 2.21) at the 2012-2013 WHI-LLS visit. Compared to non-users, those using sedative/hypnotics at WHI enrollment but not at the 3-year follow-up visit reported a faster decline in physical function between WHI enrollment and follow-up visits. Among postmenopausal women, antidepressant use was cross-sectionally related to worse self-reported physical function, and with worse performance-based physical function after > 20 years of follow-up. Complex relationships found for hypnotic/sedatives were unexpected and necessitate further investigation.

Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life

This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults' ADL and depression as integral components of promoting older adults' HRQOL.

Sleep Quality among Homeless-Experienced Older Adults: Exploratory Results from the HOPE HOME Study

BACKGROUND

Sleep is essential to health and affected by environmental and clinical factors. There is limited longitudinal research examining sleep quality in homeless older adults.

OBJECTIVE

To examine the factors associated with poor sleep quality in a cohort of older adults in Oakland, California recruited while homeless using venue-based sampling and followed regardless of housing status.

DESIGN

Longitudinal cohort study.

PARTICIPANTS

244 homeless-experienced adults aged ≥ 50 from the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) cohort.

MAIN MEASURES

We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI). We captured variables via biannual questionnaires and clinical assessments.

KEY RESULTS

Our sample was predominantly men (71.3%), Black (82.8%), and had a median age of 58.0 years old (IQR 54.0, 61.0). Two-thirds of participants (67.2%) reported poor sleep during one or more study visits; sleep duration was the worst rated subdomain. In a multivariable model, having moderate-to-severe depressive symptoms (AOR 2.03, 95% CI 1.40-2.95), trouble remembering (AOR 1.56, 95% CI 1.11-2.19), fair or poor physical health (AOR 1.49, 95% CI 1.07-2.08), two or more chronic health conditions (AOR 1.76, 95% CI 1.18-2.62), any ADL impairment (AOR 1.85, 95% CI 1.36-2.52), and being lonely (AOR 1.55, 95% CI 1.13-2.12) were associated with increased odds of poor sleep quality. Having at least one confidant was associated with decreased odds of poor sleep (AOR 0.56, 95% CI 0.37-0.85). Current housing status was not significantly associated with poor sleep quality.

CONCLUSIONS

Homeless-experienced older adults have a high prevalence of poor sleep. We found that participants' physical and mental health was related to poor sleep quality. Poor sleep continued when participants re-entered housing. Access to physical and mental healthcare, caregiving support, and programs that promote community may improve homeless-experienced older adults sleep quality, and therefore, their overall health.

Exosomes: Promising Delivery Tools for Overcoming Blood-Brain Barrier and Glioblastoma Therapy

Gliomas make up virtually 80% of all lethal primary brain tumors and are categorized based on their cell of origin. Glioblastoma is an astrocytic tumor that has an inferior prognosis despite the ongoing advances in treatment modalities. One of the main reasons for this shortcoming is the presence of the blood-brain barrier and blood-brain tumor barrier. Novel invasive and non-invasive drug delivery strategies for glioblastoma have been developed to overcome both the intact blood-brain barrier and leverage the disrupted nature of the blood-brain tumor barrier to target cancer cells after resection-the first treatment stage of glioblastoma. Exosomes are among non-invasive drug delivery methods and have emerged as a natural drug delivery vehicle with high biological barrier penetrability. There are various exosome isolation methods from different origins, and the intended use of the exosomes and starting materials defines the choice of isolation technique. In the present review, we have given an overview of the structure of the blood-brain barrier and its disruption in glioblastoma. This review provided a comprehensive insight into novel passive and active drug delivery techniques to overcome the blood-brain barrier, emphasizing exosomes as an excellent emerging drug, gene, and effective molecule delivery vehicle used in glioblastoma therapy.

The Mediating Role of Depression in Association Between Total Sleep Time and Instrumental Activities of Daily Living in China

Objectives: This study aims to investigate the mediating role of depression and the moderating effect of gender in the relationship between total sleep time (TST) and instrumental activities of daily living (IADL) in middle-aged and elderly people (aged 45 or above). Methods: The data used in this study is from the China Health and Retirement Longitudinal Study (CHARLS), including a total of 10,460 respondents. Associations between TST, IADL, depression, and gender were analyzed using logistic regression and Karlson, Holm, and Breen (KHB) methods. Results: Short (OR = 1.42, 95% CI = 1.28-1.58 of ≤6 h) and long TST (OR = 1.16, 95% CI = 1.02-1.32 of 8-9 h; OR = 1.35, 95% CI = 1.19-1.54 of >9 h) were both associated with IADL. The mediation effect analyses observed that depression explained 64.80% of the total effect of short TST (≤6 h) and IADL, but was insignificant in long TST (8-9 h and >9 h). Meanwhile, gender has moderating effects on the mediation effect model. Conclusion: The study suggests that health interventions that focused on the dimensions of TST and depression are crucial for preventing functional disability while accounting for gender differences.

Effects of chair-based resistance band exercise on physical functioning, sleep quality, and depression of older adults in long-term care facilities: Systematic review and meta-analysis

Objective

Chair-based resistance band exercise (CRBE) is a simple and safe physical activity for persons with limited mobility. This study aimed to review and analyze CRBE effects on physical functioning, sleep quality, and depression among older adults in long-term care facilities (LTCF).

Method

A systematic search guided by the PRISMA 2020 approach was performed on specific databases: AgeLine, CINAHL, PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The randomized controlled trial studies that trialed CRBE for older adults in LTCF, peer-reviewed articles published in the English language from inception to March 2022 were retrieved. Methodological quality was established using the Physiotherapy Evidence Database scale. The random and fixed effects model were used to generate the pooled effect size.

Results

Nine studies met the eligibility criteria and were synthesized. The results revealed that CRBE significantly promoted the activity of daily living (six studies; SMD = 0.30, P = 0.001), lung capacity (three studies; MD = 40.35, P < 0.001), handgrip strength (five studies; MD = 2.17, P < 0.001), upper limb muscle endurance (five studies; MD = 2.23, P = 0.012), lower limb muscle endurance (four studies; MD = 1.32, P < 0.001), upper body flexibility (four studies; MD = 3.06, P = 0.022), lower body flexibility (four studies; MD = 5.34, P < 0.001), dynamic balance (three studies; MD = -0.35, P = 0.011), sleep quality (two studies; MD = -1.71, P < 0.001), and reduced depression (two studies; SMD = -0.33, P = 0.035).

Conclusion

The evidence suggests that CRBE improved physical functioning parameters, and sleep quality, and lowers depression among older adults in LTCF. This study could be used to persuade long-term care facilities to allow people with limited mobility to engage in physical activity.

Relationships of Low Cognitive Performance and Sleep Disorder With Functional Disabilities Among Older Adults

Objectives

This study examined the relationships of low cognitive performance and sleep disorder with functional disabilities among older adults. Methods: NHANES 2011–2014 data on 3179 individuals [Mage=69.71] were analyzed. Functional domains included: activities of daily living (ADL), instrumental ADL (IADL) and leisure and social activities (LSA). Animal Fluency Test and the Digit Symbol Substitution Test assessed cognitive performance. Participants self-reported having physician-diagnosed sleep disorder. Results: Participants with both low cognitive performance and sleep disorder had 4- to 10-times greater odds for ADL, IADL, and LSA difficulties compared to the participants with no low cognitive performance/sleep disorder. Participants with only low cognitive performance and those with only sleep disorder were two to three times more likely to experience these difficulties. Discussion: Low cognitive performance and sleep disorder together or independently were associated with functional disabilities. Participants with both low cognitive performance and sleep disorder had higher odds of functional disabilities.

Nursing staff's experiences of how weighted blankets influence resident's in nursing homes expressions of health

Purpose

The most common treatment for resident’s health problems is pharmacological. Little research has been done on how an intervention with a non-pharmacological method, such as a weighted blanket, Through the nursing staff view, we can learn how weighted blankets influence resident’s health in nursing homes. The aim of this study was to explore nursing staff’s experiences of how an intervention with weighted blankets influenced resident’s expressions of health.

Methods

The study had a descriptive qualitative design with semi-structured interviews with 20 nursing staff working in nursing homes, and an inductive content analysis was applied.

Results

The nursing staff expressed that the weighted blanket positively influenced resident’s health in the areas of sleep, physical activity, and psychological behaviour. The weighted blanket made them fall asleep faster, sleep was uninterrupted andthey felt more rested in the morning. The nursing staff observed an increased level of activity as the resident became more energetic . The nursing staff also experienced reduced negative psychological behaviours like anxiety and worrying.

Conclusion

This study indicated that the weighted blanket changed the health expression of resident in several crucial areas. Deep pressure treatment indicates an alternative health-improved treatment for resident in nursing homes.

Association of Longitudinal Sleep and Next-day Indoor Mobility Measured via Passive Sensors among Community-dwelling Older Adults

Previous studies have shown there is a relationship between sleep and mobility in older adults by collecting and analysing self-reported data from surveys and questionnaires, or by using objective measures from polysomnography or actigraphy. However, these methods have limitations for long-term monitoring, especially for community-dwelling adults. In this paper, we investigate the association between sleep and indoor mobility using longitudinal data collected over a period of about 12 months for older adults (65 years or older) living at home in Australia. The data was collected objectively and continuously using non-invasive and passive sensors. First, we explored whether sleep and indoor mobility are different across gender and age groups (70s, 80s, and 90s). Second, we investigate the association of sleep and next-day indoor mobility through a stepwise multivariate regression. We found that males and females have significant differences in mobility, time in bed, total time in sleep, number and duration of awakenings and sleep efficiency. Additionally, mobility and all sleep measures significantly vary across the three age groups, except for sleep onset latency between 80s and 90s. Our findings show that sleep efficiency and total sleep time are the key sleep measures affecting next-day mobility, while sleep onset latency has the least effect.Clinical relevance - Our study contributes to a better understanding of the sleep patterns of older adults and how they affect their physical functioning.

Objectively measured sleep and physical function: Associations in low-income older adults with disabilities

OBJECTIVE

Late-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations.

DESIGN

We determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities.

PARTICIPANTS

One hundred thirty-six older adults (mean age 76.0 years, 83.8% women, 82.4% Black).

MEASUREMENTS

Primary predictors were actigraphic total sleep time (TST), wake after sleep onset (WASO), and subjective sleep complaints. Outcomes were objective physical performance (Short Physical Performance Battery (SPPB)) and participant-reported difficulties in basic and instrumental activities of daily living (ADLs and IADLs).

RESULTS

In regression models adjusted for potential confounders, both longer TST and greater WASO were associated with lower SPPB scores and increased IADL difficulty. Participants with a mean TST in the longest (>7.5 hours) vs. intermediate (6.3-7.5 hours) tertile had 27% higher odds of additional IADL difficulty (incident rate ratio = 1.27, 95% confidence interval [CI] 1.03, 1.58). Each additional 10 minutes of WASO was associated with 0.13 point lower SPPB scores (B = -0.13, 95% CI -0.25, -0.01) and increased IADL difficulty (B = 0.02, 95% CI 0.0003, 0.04). Sex moderated the associations of WASO with IADL and ADL difficulties: associations were stronger for males. Subjective sleep complaints were not statistically significantly associated with function.

CONCLUSIONS

Among disabled, low-income, mostly Black older adults, objective measures of long sleep and greater WASO are associated with poorer physical function. Effect sizes for the associations were modest; however, findings may have important implications given the significant consequences of decreased function on quality of life and caregiving demands.

Insomnia and Daily Function in Older Adults With Asthma

The current study examined the prevalence of insomnia and its relationship with daily function in older adults with asthma. Data on 278 older adults with asthma (aged ≥60 years) from the 2005-2008 National Health and Nutrition Examination Survey were analyzed. Insomnia was present in 40% of the study sample and was associated with a greater number of activities of daily living (ADL) and instrumental ADL (IADL) limitations. In multivariate analyses accounting for covariates including depressive symptoms, insomnia was not associated with having at least two ADL/IADL limitations. However, those with co-occurring insomnia and depressive symptoms were more likely to have at least two ADL/IADL limitations compared to those with either condition singly. Insomnia in the presence of depressive symptoms may impede one's ability to perform ADL/IADL. Current findings suggest that assessment and treatment of insomnia and depression in older adults with asthma may be important for maintaining active, independent living. [Journal of Gerontological Nursing, 46(11), 28-36.].

Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults

STUDY OBJECTIVES

To determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults.

METHODS

We used data from Waves 2 (W2) and 3 (W3) (2010-2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase.

RESULTS

After controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02-2.84) and mortality (OR = 2.12, 95% CI: 1.09-4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02-1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17-0.97) were associated with mortality.

CONCLUSIONS

Among community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.

Association between sleep quality and physical functioning in adults with down syndrome: A brief report

BACKGROUND

Sleep quality is associated with physical functioning in adults, but this has not been examined in those with Down syndrome (DS). High body mass index (BMI) and accelerated aging, both common in adults with DS, may alter the relationship between sleep quality and physical functioning in this population.

OBJECTIVE

To examine sleep quality indicators and its association with physical functioning in adults with DS, and whether associations are altered by BMI and age.

METHODS

Participants were 15 adults with DS (8 women; age 29 ± 14 years). We evaluated sleep quality over seven days with wrist-worn accelerometers and physical functioning with the timed-up-and-go (TUG) and 6-min walk (6 MW) tests. We examined the associations between sleep quality and physical functioning variables using Spearman's rho.

RESULTS

Sleep quality indicators were: total sleep time 407 ± 54 min; latency 26.8 ± 21 min; efficiency 73.9 ± 12 %; wake after sleep onset 122.8 ± 65.2 min; number of awakenings 21.0 ± 6.2; and average length of awakenings 6.1 ± 3 min. Total sleep time and average length of awakenings were significantly associated with 6 MW distances (rho = 0.58 and -0.69; p < 0.05, respectively). After controlling for age and BMI, 6 MW distance was significantly associated with total sleep time, latency, efficiency, and average length of awakenings (rho = 0.56, -0.73, 0.60, and -0.87; p < 0.05, respectively). TUG was significantly associated with total time in bed (rho = 0.71); p < 0.05).

CONCLUSIONS

Sleep quality indicators are associated with walking performance in adults with DS. Age and BMI strengthen the relationship between sleep quality and physical functioning.

Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial

BACKGROUND

Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown.

PURPOSE

We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults.

METHOD

Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed with the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcomes included sleep diary variables, actigraphy-measured sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient Health Questionnaire-9, and health-related quality of life. Analyses compared slope of change in DBAS subscales from baseline to posttreatment between CBTI and control, and assessed the relationship between DBAS change and the slope of change in outcomes from baseline to 6 months.

RESULTS

Compared to controls, the CBTI group demonstrated stronger associations between improvement in DBAS-Consequences and subsequent improvement in PSQI, ISI, ESS, and FFS. The CBTI group also demonstrated stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvements in DBAS-Medication and PSQI; and improvements in DBAS-Sleep Expectations and wake after sleep onset (sleep diary) and FFS (all p < .05).

CONCLUSIONS

Significant reduction in dysfunctional sleep-related beliefs following CBTI in older adults predicted improvement in several outcomes of sleep and daytime functioning. This suggests the importance of addressing sleep-related beliefs for sustained improvement with CBTI in older veterans.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00781963.

Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program

Background

Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.

Methods

This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.

Discussion

This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.

Trial registration

NCT04533815, ClinicalTrials.gov, August 20, 2020. 

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02189-8.

Associations of Self-Reported Sleep Quality with Demographic and Other Characteristics in Older Korean Immigrants

Poor sleep is common among older adults, affecting a wide range of health outcomes. However, little is known about sleep issues among older Korean immigrants, the fastest growing Asian American subgroup in the United States. We aimed to explore multiple factors associated with sleep among this group. We analyzed cross-sectional survey data from 43 older immigrants living in two large Korean communities in Southern California. Perceived sleep quality was significantly associated with gender, living arrangement, employment status, mental health, and sleep-related beliefs (all p-values < 0.05). Living with someone and being employed for wages were significantly uniquely associated with better sleep quality, accounting for demographic and health-related factors (R² = 51.8%, adjusted R² = 38.7%, p = 0.002). These findings suggest a potential role of sociocultural factors on sleep. Further studies are needed to confirm these findings and to inform a sleep intervention program tailored to the characteristics of older Korean immigrants.

The mediating role of cognition in the relationship between sleep duration and instrumental activities of daily living disability among middle-aged and older Chinese

OBJECTIVE

To explore the effect of sleep duration at baseline on the incident IADL disability among middle-aged and older Chinese, and test whether cognition mediates this causality.

METHODS

Data were collected from wave 1 (2011-2012) to wave 3 (2015-2016) of the China Health and Retirement Longitudinal Study (CHARLS). Sleep duration was self-reported at baseline. Cognitive function, including episodic memory and mental intactness were measured via a questionnaire. IADL was assessed at baseline and follow-up. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were conducted to examine the mediating effect.

RESULTS

A total of 10,328 participants free of IADL disability at baseline were included in this study. Over 4 years of follow-up, 17.1% of participants developed IADL disability. Compared to 7-8 h sleep duration, both short sleep (OR=1.460; 95% CI: 1.261-1.690 for sleeping ≤5 h; OR= 1.189; 95% CI: 1.011-1.400 for sleeping 5-7 h) and long sleep (OR=1.703; 95% CI: 1.269-2.286 for sleeping >9 h) were linked with incident IADL disability. KHB method identified significant mediating effect of cognition on the relationship between extreme sleep durations (≤5 h or >9 h) and IADL disability and the proportional mediation through cognition was 21.32% and 21.06% for sleeping ≤5 h and >9 h, respectively.

CONCLUSION

Both short (sleeping ≤5 h) and long sleep duration (sleeping >9 h) predicted incident IADL disability. Cognition partially mediated the effect of extreme sleep durations on IADL disability.

Sedentary Time, Physical Activity, Fitness, and Physical Function in Older Adults: What Best Predicts Sleep Quality?

The aim of this study was to identify the best predictor of sleep quality (SQ) among physical behavior or capacity-related variables, namely physical activity, sedentary time, fitness, and physical function (activities of daily living) of independent elders using a representative sample of Portuguese aged 65 years and older (N = 437). SQ and activities of daily living were evaluated by a questionnaire, sedentary time, and physical activity through accelerometry, and physical fitness by means of the Senior Fitness Test. The logistic regression analysis revealed that activities of daily living measured by the Composite Physical Function was the only explanatory variable discriminating between poor SQ and good SQ. Receiver operating characteristic analysis showed that the best trade-off between sensitivity and specificity to discriminate older adults with poor SQ and good SQ was 20 points in the Composite Physical Function (sensitivity = 57.9%; specificity = 60.9%; area under the curve = 0.600, 95% confidence interval [0.536, 0.665], p = .003). Better physical function seems to be associated with better SQ in independent elders.

Nursing Home Eligible, Community-Dwelling Older Adults' Perceptions and Beliefs About Sleep: A Mixed-Methods Study

Sleep disturbances are highly prevalent in older adults; little is known about sleep in those who remain living in the community despite qualifying for nursing home placement. We conducted a concurrent, nested, mixed-methods study to describe sleep characteristics and sleep disturbances in this population. Our final sample (n = 40) was Black (100%), female (85%) older adults with a mean (±SD) age of 72 ± 9.5 years. Of these, 35 had objectively measured short or long sleep duration, and 30 had subjectively reported poor sleep quality. Our evidence suggests that sleep disturbances are common in this group, and these older adults had adjusted their expectations and adapted to their sleep disturbances. Given that at-risk older adults may not perceive their sleep disturbances as problematic, clinicians must proactively assess sleep and educate about the importance of sleep. These results reveal modifiable factors with potential to improve health outcomes in this vulnerable population.

Delivering Cognitive Behavioral Therapy for Insomnia in Military Personnel and Veterans

Insomnia is commonly reported by military populations, especially those with comorbid mental and physical health conditions. Co-occurring conditions result in an altered presentation of insomnia symptoms, and complicate provision of cognitive-behavioral therapy for insomnia (CBT-I), requiring supplementary assessment or modifications to traditional techniques. CBT-I has consistently demonstrated positive outcomes for active-duty service members and veterans, even in the context of significant comorbidities such as post-traumatic stress disorder, depression, sleep apnea, and chronic pain. Despite its promise, studies of CBT-I in some populations, including women and individuals with substance use disorders, remain relatively understudied in active-duty and veteran populations.

Adult Gross Motor Learning and Sleep: Is There a Mutual Benefit?

Posttraining consolidation, also known as offline learning, refers to neuroplastic processes and systemic reorganization by which newly acquired skills are converted from an initially transient state into a more permanent state. An extensive amount of research on cognitive and fine motor tasks has shown that sleep is able to enhance these processes, resulting in more stable declarative and procedural memory traces. On the other hand, limited evidence exists concerning the relationship between sleep and learning of gross motor skills. We are particularly interested in this relationship with the learning of gross motor skills in adulthood, such as in the case of sports, performing arts, devised experimental tasks, and rehabilitation practice. Thus, the present review focuses on sleep and gross motor learning (GML) in adults. The literature on the impact of sleep on GML, the consequences of sleep deprivation, and the influence of GML on sleep architecture were evaluated for this review. While sleep has proven to be beneficial for most gross motor tasks, sleep deprivation in turn has not always resulted in performance decay. Furthermore, correlations between motor performance and sleep parameters have been found. These results are of potential importance for integrating sleep in physiotherapeutic interventions, especially for patients with impaired gross motor functions.

Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment

INTRODUCTION

The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of actigraphy.

METHODS

The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of actigraphy, sleep logs, and/or polysomnography. Statistical analyses were performed to determine the clinical significance of using actigraphy as an objective measure of sleep and circadian parameters. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations.

RESULTS

The literature search resulted in 81 studies that met inclusion criteria; all 81 studies provided data suitable for statistical analyses. These data demonstrate that actigraphy provides consistent objective data that is often unique from patient-reported sleep logs for some sleep parameters in adult and pediatric patients with suspected or diagnosed insomnia, circadian rhythm sleep-wake disorders, sleep-disordered breathing, central disorders of hypersomnolence, and adults with insufficient sleep syndrome. These data also demonstrate that actigraphy is not a reliable measure of periodic limb movements in adult and pediatric patients. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.

A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial

Study Objective

To test the effectiveness of a 4-week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4-week information-only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double-blind, randomized, clinical trial.

Methods

Forty-two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in-person sleep and health assessments at baseline, post-treatment and 4-months follow-up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post-treatment and 4-months follow-up, with baseline values as covariates.

Results

SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post-treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4-month follow-up (all p's < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4-month follow-up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post-treatment or 4-month follow-up.

Conclusions

A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.

Associations of sleep disturbance with physical function and cognition in older adults with cancer

PURPOSE

Although sleep disturbances are common in older adults, studies evaluating the prevalence of sleep disturbance and its influence on functional outcomes in older adults with cancer are few. In this study, we examined the prevalence of sleep disturbance and its association with physical function and cognition in older adults with cancer.

METHODS

This is a cross-sectional study of patients who were referred and evaluated in the Specialized Oncology Care & Research in the Elderly (SOCARE) clinics at the Universities of Rochester and Chicago from May 2011 to October 2015. All patients underwent a geriatric assessment (GA) as part of their routine evaluation. Our final study cohort included patients who completed a sleep assessment and consented to the study. We collected demographics (age, sex, race, marital status, and education level) and clinical characteristics (depression, comorbidity, cancer type, and stage) from the GA and medical chart reviews. Presence of sleep disturbance was self-reported (yes/no). Physical function was assessed using Instrumental Activities of Daily Living (IADLs), physical activity (PA) survey, falls in the preceding 6 months, and Short Physical Performance Battery (SPPB). Cognition was screened using the Blessed Orientation-Memory-Concentration Test (impairment >4) or Montreal Cognitive Assessment (impairment <26). Bivariate and multivariable analyses were used to examine the associations between sleep disturbance with functional outcomes and cognition.

RESULTS

We included 389 older patients. The prevalence of sleep disturbance was 40%. Sixty-eight percent had ≥1 IADL impairment, 76% had PA limitation, 37% had ≥1 fall, 70% had impairment on SPPB, and 47% screened positive for cognitive impairment. On bivariate analyses, sleep disturbance was associated with IADL impairment (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.23-3.13, P = 0.005), and PA limitation (OR 2.43, 95% CI 1.38-4.28, P = 0.002). The associations remained significant on multivariable analyses. Sleep disturbance was not significantly associated with falls, impairment on SPPB, and performance on the cognitive screen.

CONCLUSION

Sleep disturbance was associated with IADL impairment and PA limitation. It is important for oncologists to inquire about sleep problems, and these patients should also be screened for functional impairment if sleep disturbance was present.

Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health, and Functioning

The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its eighth Bedside-to-Bench research conference, entitled "Sleep, Circadian Rhythms, and Aging: New Avenues for Improving Brain Health, Physical Health and Functioning," October 4 to 6, 2015, in Bethesda, Maryland. Part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm (SCR) disturbance, and voiding dysfunction-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these three geriatric syndromes. The conference provided a forum for discussing current sleep, circadian rhythm, and aging research; identifying gaps in knowledge; and developing a research agenda to inform future investigative efforts. The conference also promoted networking among developing researchers, leaders in the field of SCR and aging, and National Institutes of Health program personnel.

Association between nighttime sleep and successful aging among older Chinese people

OBJECTIVE

This study aims to assess the association between sleep and successful aging among Chinese ≥60 years of age.

METHODS

Data were collected from the baseline survey of the China Health and Retirement Longitudinal Study. Two self-reported questions about sleep quality and duration were examined. Successful aging was defined following Rowe and Kahn's multidimensional model. To assess the adjusted association between sleep and successful aging, multivariable logistic regression was applied.

RESULTS

The average number of self-reported hours of sleep was 6.2 ± 2.0 among older Chinese people. Successful aging was related to sleep duration, with the proportion of those adults considered to be aging successfully falling into the following sleep duration categories (<6 h - 7.8%; 6 h - 16.3%; 7 h - 19.1%; 8 h - 14.7%; and ≥9 h - 12.8%). The plots between sleep duration and successful aging were an inverse U-shape. Participants who slept less than 6 h per day had lower odds ratios of successful aging [odds ratio (OR) = 0.52, 95% confidence interval (CI) 0.40-0.67] relative to those who slept for 7 h per day. Compared with those who reported poor sleep less than once a week, older people who reported poor sleep five to seven days a week showed a lower ratio of successful aging (OR = 0.29, 95% CI 0.21-0.39).

CONCLUSION

Older age, shorter or longer sleep, and poor sleep were related to lower odds of, rates of successful aging. Most older Chinese adults experience insufficient sleep and poor sleep quality, which could be an important influential factor in successful aging.

Caffeine intake has no effect on sleep quality in community dwellers living in a rural Ecuadorian village (The Atahualpa Project)

More information is needed to better understand the effect of caffeine on sleep quality at the community level. In a population-based, cross-sectional study design, we aimed to assess the effect of caffeine intake on sleep quality by the use of a multivariate exposure-effect model, adjusted for relevant confounders. All Atahualpa residents aged ≥40 years were identified during a door-to-door survey and interviewed with the Pittsburgh Sleep Quality Index (PSQI) and a structured instrument designed to estimate the daily amount of caffeine intake. An exposure-effect model was built using augmented inverse probability weighting taking into account variables that were associated with exposure (using a probit model) and variables that were associated with outcome (in a linear model). Out of 779 eligible individuals, 716 (92%) were included. Consumption of <100 mg/day of caffeine was recorded in 320 (45%) participants, from 100 to 200 mg/day in 299 (42%), and >200 mg/day in 97 (13%). Mean score in the PSQI was 4.5±2.2 points, with 203 (28%) individuals classified as poor sleepers (≥6 points). The exposure-effect model, adjusted for variables associated with the exposure (symptoms of depression, total cholesterol blood levels and smoking) and the outcome (age, symptoms of depression, physical activity and fasting glucose levels), revealed no effect of caffeine intake in sleep quality (average exposure effect: 0.027, 95% C.I.: -0.284 to 0.338, p=0.866). This population-based study shows that caffeine intake has no effect on sleep quality in community-dwelling adults living in a rural village of Ecuador.