Sleep quality and sleep problems in Mexican Americans aged 75 and older

Moderating role of functional/ mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India

Hypertension has become a global health concern and is recognized as an important modifiable risk factor for cardiovascular diseases (CVDs). There are very limited studies in India and worldwide focused on sleep problems, activities of daily living (ADL), instrumental ADL (IADL) and mobility limitations, and their discrete and combined effects on hypertension. Therefore, this study examined whether sleep problems are associated with hypertension, and whether the association is more pronounced among middle-aged and older adults with functional/mobility limitations. This study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-18, with a total sample of 59,951 adults aged 45 years and above. Log-binomial regression, and interaction terms were used to assess the relationship between sleep problems and hypertension, and the moderating effect of functional/mobility limitations. Respondents with sleep problems had a 29 % higher prevalence of hypertension [PR (prevalence ratio): 1.29; CI (confidence interval): 1.20-1.39]. Those with ADL and IADL limitations had 20 % [PR: 1.20; CI: 1.09-1.32] and 9 % [PR: 1.09; CI: 1.00-1.18] greater prevalence of hypertension. Interaction analysis revealed that individuals with ADL, IADL, and mobility limitations had 58 %, 52 %, and 45 % higher prevalence of hypertension, respectively, and was especially pronounced among women. Our findings highlight that improved sleep can reduce the prevalence of hypertension in middle-aged and older adults. Individuals with functional/mobility limitations may need additional care and support from their family members or the community, which could lower the prevalence of elevated blood pressure due to their sleep problems.

The impact of insomnia symptoms on obesity among Mexicans aged 50 and older

OBJECTIVE

To examine the association between insomnia and obesity in Mexican adults aged 50 and older.

MATERIALS AND METHODS

We used data from the Mexican Health and Aging Study (2015-2018). Self-reported insomnia was measured using the modified insomnia severity index with scores ranging from zero to six. Obesity was categorized using body mass index (BMI ≥ 30 kg/m2). We used generalized estimating equations to assess the association between insomnia and obesity over three years.

RESULTS

Insomnia was associated with obesity (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.01,1.11), among those with no obesity at baseline. Among those with obesity, insomnia was not associated with changes in BMI. Lastly, obesity was not associated with changes in insomnia symptoms.

CONCLUSION

This work highlights the association between insomnia and obesity among older Mexican adults and demonstrates the importance of further studies on the effects of insomnia within this population.

Physical and mental health quality of life among underserved African American and Latino older adults

OBJECTIVES

There is an increasing amount of research on Health-Related Quality of Life (HRQoL) among older adults in the U.S. However, under-resourced and underserved African American and Latino older adults remain underrepresented in research and interventional studies, resulting in limited data on their quality of life and health promotion practices. This study examined the association between HRQoL and several layers of independent variables, including health conditions, level of pain, sleep disorders, and lifestyle factors, among African American and Latino older adults.

DESIGN

Nine hundred and five African Americans and Latinos aged 55 years and older from an underserved urban community participated in this face-to-face structured study. Multiple linear regression was performed.

RESULTS

This study documented that HRQoL among African American and Latino participants was substantially lower compared with their White counterparts reported by other studies. Adjusting for other relevant variables, this study documented an association between: (1) physical HRQoL and financial strain, perceived health, the severity of pain, number of major chronic conditions, smoking, and binge drinking; and (2) mental HRQoL and financial strain, perceived health status, the severity of pain, and sleep disorders.

CONCLUSION

Significantly lower levels of HRQoL among underserved African American and Latino older adults, compared with their White counterparts, point to another important racial/ethnic disparity in the U.S. geriatric population. The devastating consequences of financial strain, excessive chronic conditions, undiagnosed and untreated pain, and sleep disorders are all experienced by underserved African American and Latino older adults, and these factors directly contribute to a lower quality of life among this segment of our population. Longitudinal multi-faceted, multi-disciplinary, culturally sensitive, both clinic- and community-based participatory interventions are needed to address these factors, particularly pain and sleep disorders, in order to enhance the quality of life among these underserved communities.

Sleep state of the elderly population in Korea: Nationwide cross-sectional population-based study

Objective

Interest in sleep disorders among the elderly, especially those in Korea, has increased. We aimed to describe the overall sleep status of the elderly population in Korea using survey data and to determine the risk factors concerning different aspects of sleep status.

Methods

We conducted a cross-sectional survey on 271 respondents aged 65-86 years old. We performed multistage clustered random sampling according to the population and socioeconomic distribution of all Korean territories. The survey questionnaire was used to perform a structural assessment of sociodemographic characteristics; medical comorbidities; psychiatric comorbidities; and sleep status, including sleep duration, sleep quality, presence of insomnia, excessive daytime sleepiness, sleep apnea, and restless legs syndrome.

Results

Approximately 12.5, 22.%, and 51.3% of the elderly population had poor sleep quality, excessive daytime sleepiness, and insomnia, respectively. Hypertension, dyslipidemia, insomnia, anxiety, and depression predicted poor sleep quality. Female sex, insomnia, and sleep apnea predicted excessive daytime sleepiness. Poor sleep quality and depression predicted insomnia.

Conclusion

A substantial proportion of the elderly Korean population have sleep problems, including poor sleep quality, excessive daytime sleepiness, and insomnia. Sleep status is influenced by various factors, including age, sex, and metabolic and psychiatric comorbidities.

The Association between Hypertension and Insomnia: A Bidirectional Meta-Analysis of Prospective Cohort Studies

Background

Studies on bidirectional associations between hypertension and insomnia are inconclusive. The purpose of this meta-analysis was to systematically review and summarize the current evidence from epidemiological studies that evaluated this relationship.

Materials and Methods

PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP databases were searched for studies published up to May 2021. Prospective cohort studies that reported the relationship between hypertension and insomnia in adults were included. Data were extracted or provided by the authors according to the prevalence rate, incidence rate, unadjusted or adjusted odds ratio (OR), and 95% confidence interval (CI). Heterogeneity was assessed by I2 statistics. ORs were pooled by using random-effects models.

Results

A total of 23 prospective studies were identified. Twenty cohort studies recorded OR-adjusted value with the outcome for hypertension (OR = 1.11, 95% CI: 1.07-1.16; I2 = 83.9%), and three cohort studies reported OR-adjusted value with the outcome for insomnia (OR = 1.20, 95%CI: 1.08-1.32; I2 = 35.1%). Subgroup analysis showed that early morning awakening and composite insomnia were significantly associated with hypertension.

Conclusions

The result indicates a possible bidirectional association between hypertension and insomnia. Early identification and prevention of insomnia in hypertension patients are needed, and vice versa.

Relationship Between Diabetes-Related Complications and Sleep Complaints in Older Mexican Americans

INTRODUCTION/OBJECTIVE

The prevalence of Type 2 Diabetes Mellitus is increasing in the older American population, especially Mexican Americans. Sleep disorders are common in older adults with T2DM. This study examined the relationship between T2DM-related complications and sleep complaints in older Mexican Americans over 9 years of follow-up.

METHODS

Study included 310 participants aged 77 years or older with self-reported diabetes from the Hispanic Established Population for the Epidemiological Study of the Elderly (2007/08-2016).

RESULTS

Of the 310 participants, the mean age was 82.04 years. The cohort had significantly more females (69.03%) than males (30.97%). A substantial number of participants had trouble falling asleep (16.13%), waking up several times (36.45%), trouble staying asleep (15.16%), and feeling tired and worn out after waking up (12.90%). The percent of diabetes complications were 70.2% for circulation problems, 58.2% for eye disorders, 15.9% for kidney disease, and 4.4% for amputation. Participants who experienced sleep complaints for 15 or more days in a month were more likely to experience diabetic complications.

DISCUSSION

This study demonstrated a significant relationship between T2DM macro- and micro-vascular complications and increased risk of sleep disorders in older Mexican Americans.

The prevalence of poor sleep quality and associated risk factors among Chinese elderly adults in nursing homes: A cross-sectional study

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.

Associations between objectively assessed physical fitness levels and sleep quality in community-dwelling elderly people in South China

PURPOSE

The aim of this study was to explore associations between objectively assessed physical fitness levels and sleep quality in community-dwelling elderly people in South China.

METHODS

One thousand one hundred thirty-six (504 males and 632 females) community-dwelling adults aged ≥ 50 years old in Dongguan City, South China, were included in the cross-sectional study. All the participants were asked to complete all prepared multi-instrument questionnaire, including the Pittsburgh Sleep Quality Index (Chinese version), for the assessment of the sleep quality and information regarding socio-demographic characteristics, lifestyle, and physical health data. Physical fitness was measured by grip strength, one-leg standing test (OLST) with eyes open, back scratch test, and the forced vital capacity (FVC).

RESULTS

The percentage of poor sleep quality among elderly people (≥ 50 years old) was up to 18.2%. Lower FVC was associated with the poorer sleep quality (adjusted OR = 0.74 per SD increase; P = 0.009), and participants with lower performance in back scratch test were more likely to suffer poor sleep quality (adjusted OR = 1.17 per SD increase; P = 0.035). The independent contribution of physical fitness tests results on the risk of poor sleep quality was 22.1%.

CONCLUSIONS

Our results indicated that sleep quality was strongly associated with physical fitness among community-dwelling elderly people; the lower of the physical fitness predicted poorer sleep quality.

The association between subjectively impaired sleep and symptoms of depression and anxiety in a frail elderly population

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.

The Association between Sleep Duration and 25-Hydroxyvitamin D Concentration with Obesity in an Elderly Korean Population: A Cross-Sectional Study

Studies have recently reported an association between sleep duration and obesity in some individuals. Vitamin D deficiency is common in elderly populations and is also associated with obesity. In this study, the combined interaction effect of vitamin D levels and sleep duration on obesity-related variables was analyzed in 3757 individuals from an elderly Korean population using the Korean National Health and Nutrition Examination Survey. Significant differences were observed in the interaction effect of the vitamin D levels and sleep duration on obesity-related variables, including BMI (p = 0.004) and the risk of obesity (p < 0.001). Using vitamin D sufficient status and proper sleep duration as a reference, subjects with sufficient vitamin D did not differ in their risk of obesity regardless of their sleep duration. However, the risk of obesity tended to increase with short sleep duration rather than proper sleep duration among subjects who were vitamin D insufficient odds ratio (OR) (95% CI) = 1.293 (1.10–1.657) for proper sleep duration vs. 1.374 (1.066–1.770) for short sleep duration). Only the participants in the vitamin D deficient population who consumed less protein showed an increasing trend in the risk of obesity according to the sleep duration (OR (95% CI) = 1.645 (1.155–2.344) for proper sleep duration and 1.668 (1.156–2.406) for short sleep duration).

Determinants of racial/ethnic disparities in disordered sleep and obesity

Racial/ethnic minorities experience a disproportionate risk of both suboptimal sleep and obesity, and the relationship between sleep and obesity may differ by race/ethnicity for modifiable and non-modifiable reasons. Because many people of color have historically lived and continue to largely live in disadvantaged, obesogenic physical and social environments, these greater adverse exposures likely negatively affect sleep, resulting in physiological dysregulation. Physiological dysregulation may, in turn, lead to increased obesity risk and subsequent health consequences, which are likely more influential than potential genetic differences in race, a social construct. The purpose of this article is to describe potential environmental, genetic, and epigenetic determinants of racial/ethnic differences in the sleep-obesity relationship and to review current epidemiological findings regarding either racial/ethnic minority specific estimates of the association or disparities in the relationship. Using the socioecological framework as a conceptual model, I describe sleep and obesity as socially patterned and embedded in modifiable physical and social contexts with common causes that are influenced by upstream social conditions. I also provide examples of sleep and obesity-related studies that correspond with the downstream, intermediate, and upstream factors that likely contribute to commonly observed racial/ethnic disparities in the sleep-obesity relationship. The review concludes with broad recommendations for (1) advancing research methodology for epidemiological studies of disparities in the link between sleep and obesity, (2) future research topics, as well as (3) several broad policies and structures needed to address racial/ethnic disparities in sleep health and obesity.

Determinants of Change in Objectively Assessed Sleep Duration Among Older Men

We examined potential risk factors for changes in objectively assessed sleep duration within a large sample of community-dwelling older men. Participants (n = 1,055; mean baseline age = 74.6 (standard deviation (SD), 4.7) years) had repeated ActiGraph assessments (ActiGraph LLC, Pensacola, Florida) taken at the baseline (2003-2005) and follow-up (2009-2012) waves of the Outcomes of Sleep Disorders in Older Men Study (an ancillary study to the Osteoporotic Fractures in Men (MrOS) Study conducted in 6 US communities). Among men with a baseline nighttime sleep duration of 5-8 hours, we assessed the odds of becoming a short-duration (<5 hours) or long-duration (>8 hours) sleeper at follow-up. The odds of becoming a short-duration sleeper were higher among men with peripheral vascular disease (adjusted odds ratio (aOR) = 6.54, 95% confidence interval (CI): 2.30, 18.55) and ≥1 impairment in Instrumental Activities of Daily Living (IADL) (aOR = 2.57, 95% CI: 0.97, 6.78). The odds of becoming a long-duration sleeper were higher among those with greater baseline age (per SD increment, aOR = 1.49, 95% CI: 1.12, 2.00), depression symptoms (aOR = 3.13, 95% CI: 1.05, 9.36), and worse global cognitive performance (per SD increment of Modified Mini-Mental State Examination score, aOR = 0.74, 95% CI: 0.58, 0.94). Peripheral vascular disease and IADL impairment, but not chronological age, may be involved in the etiology of short sleep duration in older men. The risk factors for long-duration sleep suggest that deteriorating brain health predicts elongated sleep duration in older men.

Risk factors for sleep disturbances in older adults: Evidence from prospective studies

No systematic review of epidemiological evidence has examined risk factors for sleep disturbances among older adults. We searched the PubMed database combining search terms targeting the following domains 1) prospective, 2) sleep, and 3) aging, and identified 21 relevant population-based studies with prospective sleep outcome data. Only two studies utilized objective measures of sleep disturbance, while six used the Pittsburgh sleep quality index (PSQI) and thirteen used insomnia symptoms or other sleep complaints as the outcome measure. Female gender, depressed mood, and physical illness were most consistently identified as risks for future sleep disturbances. Less robust evidence implicated the following as potentially relevant predictors: lower physical activity levels, African-American race, lower economic status, previous manual occupation, widowhood, marital quality, loneliness and perceived stress, preclinical dementia, long-term benzodiazepine and sedative use, low testosterone levels, and inflammatory markers. Chronological age was not identified as a consistent, independent predictor of future sleep disturbances. In conclusion, prospective studies have identified female gender, depressed mood, and physical illness as general risk factors for future sleep disturbances in later life, although specific physiological pathways have not yet been established. Research is needed to determine the precise mechanisms through which these factors influence sleep over time.

Sleep, cognition, and normal aging: integrating a half century of multidisciplinary research

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.

The link between sleep disturbance and depression among Mexican Americans: a Project FRONTIER study

OBJECTIVE

To examine the link between disturbed sleep and depression scores in Mexican Americans and non-Hispanic Whites.

METHODS

Data were analyzed for 566 participants (45% Mexican Americans) who were part of a rural healthcare study, Project FRONTIER. Mean age was 55.5 years for Mexican Americans (70% female) and 65.6 years for non-Hispanic Whites (69% female). Self-reported sleep disturbance was entered as the predictor, GDS-30 total and factor scores as the outcome variables, and age, sex, education, BMI, and medical diagnoses (hyperlipidemia, diabetes mellitus, and hypertension) entered as covariates.

RESULTS

Mexican Americans reported higher rates of sleep disturbances (25%) than non-Hispanic whites (17%). Sleep disturbances were significantly associated with GDS-30 total scores and the factors Dysphoria and Cognitive Impairment in both Mexican Americans and non-Hispanic whites.

CONCLUSIONS

In this study, Mexican Americans reported higher rates of sleep disturbances than non-Hispanic whites. Disturbed sleep was positively associated with depression and the factor scores for Dysphoria and Cognitive Impairment in both groups. Given the paucity of research on sleep disorders in Mexican Americans, identifying what sleep disorders are present and the impact treating these sleep disorders have on depression warrant further investigation.

Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors

Maintaining weight is important for better prognosis of breast cancer survivors. The associations between weight and cancer-related symptoms are not known. We examined associations among weight, weight change, inflammation, cancer-related symptoms, and health-related quality of life (HRQOL) in a cohort of stage 0-IIIA breast cancer survivors. Participants were recruited on average 6 months (2–12 months) after diagnosis. Height, weight, and C-reactive protein (CRP) were assessed at approximately 30 months post-diagnosis; cancer-related symptoms (chest wall and arm symptoms, vasomotor symptoms, urinary incontinence, vaginal symptoms, cognition/mood problems, sleep, sexual interest/function), and HRQOL (SF-36) were assessed at approximately 40 months post-diagnosis. Weight was measured at baseline in a subset. Data on 661 participants were evaluable for body mass index (BMI); 483 were evaluable for weight change. We assessed associations between BMI (<25.0, 25.0–29.9, ≥30.0 kg/m2), post-diagnosis weight change (lost ≥5 %, weight change <5 %, gained ≥5 %), and CRP (tertile) with cancer-related symptoms and HRQOL using analysis of covariance. Higher symptoms scores indicate more frequent or severe symptoms. Higher HRQOL scores indicate better HRQOL. Compared with those with BMI <25 kg/m2, women with BMI ≥30 kg/m2 had the following scores: increased for arm symptoms (+25.0 %), urinary incontinence (+40.0 %), tendency to nap (+18.9 %), and poorer physical functioning (−15.6 %, all p < 0.05). Obese women had lower scores in trouble falling asleep (−9.9 %; p < 0.05). Compared with weight change <5 %, participants with ≥5 % weight gain had lower scores in physical functioning (−7.2 %), role-physical (−15.5 %) and vitality (−11.2 %), and those with weight loss ≥5 % had lower chest wall (−33.0 %) and arm symptom scores (−35.5 %, all p < 0.05). Increasing CRP tertile was associated with worse scores for chest wall symptoms, urinary incontinence, physical functioning, role-physical, vitality and physical component summary scores (all P trend < 0.05). Future studies should examine whether interventions to maintain a healthy weight and reduce inflammation could alleviate cancer-related symptoms and improve HRQOL.