Poor sleep quality is independently associated with physical disability in older adults

Longitudinal analysis of anxiety and sleep disorders in the Korean population with disabilities, from 2006 to 2017: Incidence, prevalence, and association with disability type and severity

BACKGROUND

Individuals with disabilities often face a higher risk of concurrent psychological problems, yet comprehensive assessments of the anxiety and sleep disorders in this population remain limited. This study examined longitudinal trends in the incidence and prevalence of anxiety and sleep disorders among people with disabilities and explored their associations with disability type and severity.

METHODS

Utilizing claim data from the National Health Insurance database and the National Disability Registry, which cover the entire Korean population, we estimated the age-standardized incidence and prevalence of anxiety and sleep disorders between 2006 and 2017. Logistic regression was used to analyze the associations between disability type and severity and these disorders.

RESULTS

The unadjusted incidence and prevalence of anxiety and sleep disorders were consistently higher among individuals with disabilities during the study period. A significant gap in the prevalence of these disorders persisted between individuals with and without disabilities in both sexes, even after accounting for socioeconomic status and comorbidities. However, the incidence showed mixed results, with some categories of disabilities showing lower likelihood of developing the conditions compared to individuals without disabilities.

CONCLUSIONS

Actions should also be taken to identify undiagnosed cases of anxiety and sleep disorders among individuals with disabilities. Moreover, individuals with disabilities who are diagnosed with these disorders should be more actively managed to avert the progression to the chronic stage.

Comparing Sleep Quality, Duration, and Efficiency Among Low-Income Community-Dwelling Older Adults With and Without Physical Disabilities

PURPOSE

Physical disabilities may exacerbate the natural decline in sleep quality that occurs with aging. In the current study, we assessed sleep quality and medicinal sleep aid use among 87 community-dwelling older adults with (n = 24) and without (n = 63) physical disabilities.

METHOD

Sleep quality, duration, and efficiency were assessed subjectively with the Pittsburgh Sleep Quality Index. Sleep duration and efficiency were objectively measured with actigraphy. Participants self-reported medicinal sleep aid use.

RESULTS

Significant group differences were observed in sleep duration measured objectively (p = 0.01) and subjectively (p = 0.04). No other group differences were observed for sleep factors (p > 0.05) or medicinal sleep aid use (p = 0.41).

CONCLUSION

Findings show that physical disability may be a factor in sleep duration; however, physical disability was not found to be associated with worsened sleep perception or greater reliance on medicinal sleep aids. Future research should consider longer objective actigraphy assessment windows and explore potential subgroup differences in sex and race/ethnicity. [Journal of Gerontological Nursing, 50(7), 12-18.].

An Exploratory Analysis of Preclinical and Clinical Factors Associated With Sleep Disturbance Assessed via the Neuro-QoL After Hemorrhagic Stroke

Background and Purpose

Sleep disturbance after hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) can impact rehabilitation, recovery, and quality of life. We sought to explore preclinical and clinical factors associated with sleep disturbance after hemorrhagic stroke assessed via the Quality of Life in Neurological Disorders (Neuro-QoL) short form sleep disturbance inventory.

Methods

We telephonically completed the Neuro-QoL short form sleep disturbance inventory 3-months and 12-months after hemorrhagic stroke for patients >18-years-old hospitalized between January 2015 and February 2021. We examined the relationship between sleep disturbance (T-score >50) and social and neuropsychiatric history, systemic and neurological illness severity, medical complications, and temporality.

Results

The inventory was completed for 70 patients at 3-months and 39 patients at 12-months; 18 (26%) had sleep disturbance at 3-months and 11 (28%) had sleep disturbance at 12-months. There was moderate agreement (κ = .414) between sleep disturbance at 3-months and 12-months. Sleep disturbance at 3-months was related to unemployment/retirement prior to admission (P = .043), lower Glasgow Coma Scale score on admission (P = .021), higher NIHSS score on admission (P = .041) and infection while hospitalized (P = .036). On multivariate analysis, sleep disturbance at 3-months was related to unemployment/retirement prior to admission (OR 3.58 (95% CI 1.03-12.37), P = .044). Sleep disturbance at 12-months was related to premorbid mRS score (P = .046).

Conclusion

This exploratory analysis did not demonstrate a sustained relationship between any preclinical or clinical factors and sleep disturbance after hemorrhagic stroke. Larger studies that include comparison to patients with ischemic stroke and healthy individuals and utilize additional techniques to evaluate sleep disturbance are needed.

The bidirectional relationship between sleep problems and chronic musculoskeletal pain: a systematic review with meta-analysis

ABSTRACT

Chronic musculoskeletal pain and sleep problems/disorders exhibit a recognized bidirectional relationship; yet, systematic investigations of this claim, particularly in a prospective context, are lacking. This systematic review with meta-analysis aimed to synthesize the literature on the prospective associations between sleep problems/disorders and chronic musculoskeletal pain. A comprehensive search across 6 databases identified prospective longitudinal cohort studies in adults examining the relationship between sleep problems/disorders and chronic musculoskeletal pain. Random-effects meta-analyses, using the Hartung-Knapp adjustment for 95% confidence intervals (CIs), were conducted, and all results were presented as odds ratios (ORs). Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Including 16 articles from 11 study populations (116,746 participants), meta-analyses indicated that sleep problems at baseline may heighten the risk of chronic musculoskeletal pain in both short term (OR 1.64, 95% CI 1.01-2.65) and long term (OR 1.39, 95% CI 1.21-1.59). The evidence for different sleep problem categories was very uncertain. Chronic musculoskeletal pain at baseline may increase the risk of short-term sleep problems (OR 1.56, 95% CI 1.02-2.38), but long-term evidence was very uncertain. The impact of only local or only widespread pain on short-term sleep problems was very uncertain, whereas widespread pain may elevate the risk of long-term sleep problems (OR 2.0, 95% CI 1.81-2.21). In conclusion, this systematic review with meta-analysis suggests that sleep problems are associated with an increased risk of chronic musculoskeletal pain, but the bidirectional nature of this relationship requires further investigation.

Association between sleep problems and functional disability in community-dwelling older adults

BACKGROUND

Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults.

METHODS

This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest.

RESULTS

Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems.

CONCLUSIONS

Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS)

BACKGROUND

Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults.

METHODS

Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes.

RESULTS

In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance.

CONCLUSIONS

Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.

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.

The Association between Caffeine Consumption from Coffee and Tea and Sleep Health in Male and Female Older Adults: A Cross-Sectional Study

Poor sleep health is common in older adults and is associated with negative health outcomes. However, the relationship between caffeine consumption and sleep health at an older age is poorly understood. This study investigated the association between caffeine consumption and sleep health in community-dwelling older males and females in The Netherlands. Cross-sectional analyses were performed using data from 1256 participants aged 61-101 years from the Longitudinal Ageing Study Amsterdam. Self-reported questions assessed sleep disturbances (including sleep latency, continuity, and early awakening), sleep duration, and perceived sleep quality. Caffeine consumption was determined with questions about frequency, quantity, and type of coffee and tea consumption. Logistic and linear regression models were used, controlling for potential confounders, and interaction by sex and age was tested. Caffeine consumption showed significant interactions with sex (p < 0.005) in association with sleep health outcomes. Older females who abstained from caffeine consumption reported more sleep disturbances (β = 0.64 [95%CI 0.13; 1.15]) and had greater odds of short sleep duration (<7 h/day) (OR = 2.26 [95% CI 1.22; 4.20]) compared to those who consumed caffeine. No associations were observed for long sleep duration (>8 h/day) and perceived sleep quality. No associations were observed in older males. Caffeine abstinence was associated with more sleep disturbances and short sleep duration in older females, but not in males. The observed association in older females may reflect reverse causation, suggesting that females may have different motivations for discontinuing caffeine consumption than males.

The relationship between sleep status and activity of daily living: based on China Hainan centenarians cohort study

OBJECTIVE

This study, based on the China Hainan Centenarians Cohort Study (CHCCS), aims to comprehensively describe the characteristic of daytime, night and total sleep duration, sleep quality and different sleep mode of Hainan centenarians and their associations with activity of daily living (ADL) functions.

METHOD

The baseline data of CHCCS was used. ADL function was evaluated the Bathel index, sleep quality was evaluated by Pittsburgh sleep quality index (PSQI), sleep status including daytime, night and total sleep duration as well as sleep quality and sleep mode. Multivariate logistic regression model was used to explore the association between sleep status and ADL disability and ADL moderate & severe disability.

RESULTS

A total of 994 centenarians were included in this study with the age range 100-116 years old. Compared with the centenarians who sleep 6-9 h at night and < 2 h in the daytime, the adjusted OR between sleep > 9 h at night and sleep ≥ 2 h in the daytime and ADL disability was 2.93 (95% CI: 1.02-8.44), and adjusted OR of ADL moderate & severe disability was 2.75 (95% CI: 1.56-4.83). Compared with centenarians who sleep for 7-9 h and have good sleep quality, centenarians who sleep for > 9 h and have poor sleep quality have an increased risk of ADL moderate & severe disability (OR = 3.72, 95% CI: 1.54-9.00).

CONCLUSION

Relation between sleep duration and ADL disability was more significant compared with sleep quality in Hainan centenarians. Poor sleep quality can aggravate the relationship between sleep duration and ADL moderate & severe disability.

The impact of social support, physical and psychological performance on sleep outcomes in Iranian older adults: a case-control study

BACKGROUND

Sleep quality is one of the most important factors to improve the quality of life in older adults and physical and mental health plays an essential role in better sleep quality. This study aimed to determine the impact of social support, and physical and psychological performance on sleep outcomes in Iranian older adults.

METHODS

In this case-control study, 400 elder people, who were exposed to sleep problems, and 400 people without sleep problems were randomly selected during 2016-2017 in Amirkola, Iran. Subjects in the case and control groups were matched in terms of gender and age. The demographic characteristics, Duke Social Support Questionnaire (DSSI), Physical Activity Scale for the Elderly (PASE), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Mini-Mental State Examination (MMSE), and Pittsburgh Sleep Quality Questionnaire (PSQI) questionnaires were used to collect data. T-test, Chi-square, Pearson Correlation coefficient, and multiple Logistic regression were used for data analysis.

RESULTS

The mean score of DSSI and its domains including social interaction (DSSI.Int) and social satisfaction (DSSI.Sat) were 28.15 ± 3.55, 9.31 ± 1.23, and 18.84 ± 2.88 in the case group and 28.87 ± 3.20, 9.48 ± 1.10, and 19.83 ± 2.44 in the control group, respectively. In this study, the mean scores of MMSE, PASE, ADL, and IADL were 25.36 ± 3.95, 101.71 ± 56.99, 13/97 ± 0.37, 20.59 ± 2/79; respectively. There was a significant inverse correlation between poor sleep quality with DSSI score (rho = -0.165, P < 0.0001), DSSI.Int (rho = -0.113, P < 0.001), DSSI.Sat (rho = -0.160, P < 0.0001), PASE (rho=-0.160, P < 0.0001), and IADL (rho = -0.112, P < 0.001) score. Therefore, more social support and physical activity improved the quality of sleep. There was a significant negative relationship between DSSI, and its domains with sleep quality in terms of gender. DSSI (rho = 0.25, P < 0.0001), DSSI.Int (P < 0.0001, rho=-0.18), and DSSI.Sat (P < 0.0001, rho=-0.22) was significant in men but not in women. The results of the adjusted logistic regression revealed a significant association between sleep quality problems and DSSI (p < 0.045, OR = 1.40), the use of hypnotic drugs (p < 0.0001, OR = 7.56), and occupation (p <0.03, OR= 12.66).

CONCLUSIONS

The results of the present study suggest that low social support and all its domains, PASE, IADL, and using hypnotic drugs may play a role in the development of sleep problems. It can be used as an effective, safe, and low-cost strategy for promoting sleep quality in older adults.

The Quality of Life of Seniors with Eye Diseases during COVID-19

Purpose

To assess health-related quality of life (HRQoL), vision-related quality of life (VRQoL), depression and anxiety symptoms, and social support and community integration of seniors with eye diseases and to identify important predictor variables of the outcomes.

Methods

A cross-sectional survey was performed in seniors with eye diseases (n = 90). Demographic characteristics and questionnaire scores were summarized. Linear regression analysis with backward stepwise selection was used to predict the value of the outcomes of eye disease.

Results

Preference-based HRQoL of the study patients with eye diseases during the pandemic was likely good with a mean utility value of 0.88. VRQoL and sleep quality appeared to be good as well. Depression and anxiety symptoms appeared to be low, while community integration and social support were moderate. Furthermore, the presence of retinal disease, number of nonocular comorbidities, and education appeared to have significant negative effects on social support and community integration. The presence of retinal disease and the number of nonocular comorbidities both appeared to negatively impact VRQoL. The use of a mobility aid appeared to negatively affect depressive symptoms and sleep quality.

Conclusions

Overall quality of life and wellness among seniors with eye diseases appeared to be good during the COVID-19 pandemic. However, the presence of retinal disease and the number of nonocular comorbidities both appeared to negatively impact VRQoL and social support and community integration. Education appeared to impact social support and community integration negatively. The use of a mobility aid appeared to negatively affect depressive symptoms and sleep quality.

The Relationship between Handgrip Strength, Timed Up-and-Go, and Mild Cognitive Impairment in Older People during COVID-19 Pandemic Restrictions

The COVID-19 lockdown restrictions affected physical performance and cognitive function in older people as they were confined to their homes. There is an association between physical and cognitive functions. Mild Cognitive Impairment (MCI) is a condition that risks progressing to dementia. This study aimed to identify the relationship between handgrip strength (HGS), Timed Up-and-Go (TUG), and MCI in older people during the COVID-19 pandemic restrictions. The cross-sectional study recruited 464 eligible participants for an interview and anthropometric measurement. The Montreal Cognitive Assessment-Basic (MoCA-B), HGS, and TUG were measured in addition to demographic and health characteristics. A total of 398 participants (85.8%) were found to have MCI when screened with the MoCA-B. Their mean age was 71.09 ± 5.81 years. Forward multiple regression analysis demonstrated that HGS (β = 0.032, p < 0.001), education level (β = 2.801, p < 0.001), TUG (β = -0.022, p = 0.013), Thai Geriatric Depression Score, TGDS (β = -0.248, p = 0.011), and age (β = -1.677, p = 0.019) were associated with MCI. A decrease in HGS and an increased TUG might allow for the early detection of MCI and promote physical training in order to reduce the risk of MCI. Further studies can investigate multidomain indicators for MCI, for example, fine motor skills and pinch strength as components of the motor abilities.

Association Between COVID-19 and Activities of Daily Living in Older Adults

Older adults gradually decrease their independence with activities of daily living (ADL) due to aging. The coronavirus disease-19 (COVID-19), the recent pandemic, can accelerate the decline in functions, such as ADL. This study aimed to examine whether there is an association between positive COVID-19 results and decreased independence with ADL in older adults. Data for a total of 3,118 older adults were extracted from the 2020 National Health and Aging Trends Study-COVID-19. A total of 71 (2.29%) participants presented with positive COVID-19 tests. There was a significant association between a positive COVID-19 result and decreased independence with ADL (relative risk [RR] = 1.47, 95% confidence interval [CI] = [1.11, 1.96], p = .0079). The study findings revealed that COVID-19 survivors had a high risk of decreased independence with ADL. These findings indicate that COVID-19 survivors have residual functional deficits and would need comprehensive health care services.

Risk factors of poor sleep quality in older adults: an analysis based on comprehensive geriatric assessment

OBJECTIVES

Sleep quality is associated with many diseases and conditions that affect individuals' health in various ways. We aimed to investigate the association between sleep quality and common geriatric conditions in older adults.

METHODS

The study included 237 older adults admitted to the geriatric outpatient clinic of a university hospital. All patients underwent comprehensive geriatric assessment (CGA). The Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life (EQ-5D), Pittsburgh Sleep Quality Index (PSQI), Katz Index of Independence in Activities of Daily Living (ADL) and Lawton and Brody Instrumental Activities of Daily Living (IADL) questionnaires, Tinetti Balance and Gait Assessment (TBGA), and Mini Nutritional Assessment (MNA) were performed on the participants.

RESULTS

Participants had a mean age of 72.2 ± 6.3 years, and 146 (61.6%) of them had poor sleep quality. Of the participants, 61.2% were female. In the poor sleep quality group, GDS and BAI scores were higher while ADL, IADL, MNA, and EQ-5D index scores were lower. PSQI score had a negative correlation with ADL (r = -.207, p = .01), EQ-5D index (r = -.372, p = .00), MNA (r = -.277, p = .00), and TBGA (r = -.263, p = .41) scores and a positive correlation with GDS (r = .426, p = .00) and BAI (r = .450, p = .00) scores according to the results of correlation analysis. Multivariate logistic regression analysis showed that the presence of diabetes mellitus (DM) and higher GDS and BAI scores were independent variables for poor sleep quality [(p = .48, OR = 1.92; p = .20, OR = 1.11; and p <.01, OR = 1.11, respectively)].

CONCLUSIONS

We found that DM and depressive and anxiety symptoms were the risks of poor sleep quality. In addition, participants with poor sleep quality had a worse quality-of-life and nutritional status. Improving sleep quality may be helpful in the management of geriatric syndromes and that sleep quality assessment should be part of CGA.

Attitudes and knowledge of nurses working at night and sleep promotion in nursing home residents: multicenter cross-sectional survey

BACKGROUND

Sleep disturbances are common in nursing home residents and challenging for their nurses. Knowledge about sleep and sleep promoting factors is essential to provide adequate sleep management, where nurses play a key role. Therefore, nurses' knowledge and attitudes towards sleep and sleep promoting interventions is important as enabling or inhibiting factor for successful sleep management.

METHODS

A multicenter cross-sectional study was conducted among nurses working wholly or partially at night in nursing homes in Germany. Data were collected between February and April 2021 via online or paper and pencil questionnaires, comprising 56 items. Nursing homes were recruited through existing cooperation with the study centers as well as via nursing home registers.

RESULTS

Finally, 138 nursing homes participated and 271 nurses completed the survey. Nurses agreed that sleep disturbances are an important topic with important impact on resident' health. Although, the assessment of sleep was seen as nurses' responsibility, only 40 nurses (14.7%) stated that residents' sleep was always documented. Only 21.7% reported the availability of policy documents providing guidance regarding the management of sleep disturbances. The vast majority (93.2%) reported never having received training about sleep and management of sleep disturbances after their basic nursing training.

CONCLUSIONS

Our results indicate that nurses working at night can play an important role in residents' sleep promotion. The findings indicate nurses' educational needs regarding sleep and sleep promotion. Nursing homes should implement institutional guidelines in order to promote residents' sleep based on adequate evidence-based non-pharmacological interventions.

Deferral of elective surgeries during the COVID-19 pandemic and its impact on Palestinian patients: a cross-sectional study

BACKGROUND

During the Covid-19 epidemic, the increased number of people seeking medical attention worsened hospital shortages. This shortage required reallocating the workforce, personal protective equipment (PPE), medical equipment, medical disposables, and hospital wards. This reallocation delayed a number of elective surgeries. This study explored the financial, physical, and psychological implications of deferring elective surgeries on Palestinians in three West Bank hospitals during the pandemic.

METHODS

This cross-sectional study included 398 patients from tertiary hospitals in Palestine whose elective surgical procedures were deferred due to the COVID-19 pandemic. Between 8/8/2021 and 6/9/2021, data were collected on patients who had elective surgery deferral at three government hospitals in the West Bank of the Palestinian territories. There were five parts to the study tool; personal information, access to the health system, physical affection, financial effect, and psychological effect. Statistical analysis included a univariate, bivariate and multivariate.

RESULTS

The healthcare system's response to the COVID-19 epidemic directly affected patients whose surgeries were deferred. The healthcare system's response was the cause of the delay in 91.5% of the cases. Orthopedic and neurological surgeries account for 48.3% of deferred surgery. Other than delayed surgeries, 30.2% of patients were unable to get additional health care services. Physically, 55.5% of patients were impacted, 45% were anxious, and 29.6% were depressed.

CONCLUSIONS

Patients who had procedures deferred as a result of the healthcare system's response to the COVID-19 epidemic were impacted physically, financially, and psychologically. There should bea better crisis management strategyto ensure that certain hospitals are able to operate regularly despite the situation.

Improving sleep using mentored behavioral and environmental restructuring (SLUMBER): A randomized stepped-wedge design trial to evaluate a comprehensive sleep intervention in skilled nursing facilities

INTRODUCTION

Poor sleep is ubiquitous in skilled nursing facilities (SNFs) and is associated with a myriad of negative symptoms. Non-pharmacological interventions can improve sleep, yet sustainability has not been demonstrated. The Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER) trial will test whether a staff mentoring approach to address resident sleep issues positively impacts sleep quality and whether improved sleep benefits mood, cognitive performance, and activity engagement for residents living in SNFs.

INTERVENTION

This is a four-year hybrid type I effectiveness/implementation randomized stepped-wedge trial using a comprehensive sleep improvement program conducted in three urban SNFs.

METHODS

We will provide SNF staff with sleep promotion strategies over a four-month intervention. Staff will have access to in-person workshops, webinars, weekly sleep pearls via text messaging, environmental data, and expert program mentors. We will consent residents for data collection (at baseline, end of intervention, and three- and six-months post-intervention) including resident observations, questionnaires, and wrist actigraphy (to objectively measure sleep). We will also use selected Minimum Data Set 3.0 (MDS) measures.

CONCLUSION

SLUMBER uses a unique strategy to iteratively improve sleep interventions through SNF staff buy-in, expert mentoring, and technological supports within a quality improvement framework. As a stepped-wedge trial, the initial SNF units provide opportunities for program improvement in subsequent units, accounting for variation across resident populations at different sites. Protocol limitations include strategies which may require substantial customization for greater spread. A comprehensive staff training program that addresses both sleep quality and related symptoms has the opportunity for considerable dissemination.

TRIAL REGISTRATION

USGOV Clinical Trials ID: NCT03327324.

Cardiometabolic Diseases and Quality-of-Life Outcomes in Adults With HIV in the Deep South: A Cross-sectional Study

ABSTRACT

The role of cardiometabolic diseases (CMDs) on physical health-related quality of life (P-HRQoL) and quality of sleep was examined among 261 PLWH ≥40 years, recruited from a university-affiliated HIV clinic in the Deep U.S. South. Using a cross-sectional study design, participants completed the Medical Outcomes Study HIV Health Survey (MOS-HIV; P-HRQoL) and Pittsburgh Sleep Quality Index. The overall prevalence of self-reporting ≥1 CMD was 64.4%. P-HRQoL scores were lower in PLWH with ≥1 CMD compared with those with no CMDs (45.53 ± 11.54 vs. 49.67 ± 10.77, p <.01). Poor sleep quality was higher among participants with ≥1 CMD compared with those with no CMDs (9.28 ± 4.42 vs. 7.26 ± 4.17, p <.01). Each additional CMD resulted in a 1.83-point decrease in P-HRQoL and 0.74-point increase in poor sleep quality scores. Interventions that focus on targeting these quality-of-life domains in PLWH with CMDs are needed.

Activities of Daily Living and Depression in Chinese Elderly of Nursing Homes: A Mediation Analysis

Purpose

This study aimed to explore the role of sleep quality as a mediator in the activities of daily living (ADLs) and depression.

Patients and Methods

Participants (N=645; age≥60) were included in six nursing homes in Weifang, Shandong Province, using convenience sampling. Participants completed questionnaires to assess sleep quality, ADLs, and depression. Depression condition was assessed by the Patient Health Questionnaire (PHQ-9), ADLs was assessed by the Barthel Index (BI), and sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Mediation analysis was carried out by SPSS PROCESS.

Results

ADLs (r=0.449, P<0.01) and sleep quality (r=0.450, P<0.01) were found to be positively associated with depression among the elderly. Sleep quality plays a significant mediating role in the influence of ADLs on depression in the elderly in nursing homes (Bootstrap 95% CI [0.076, 0.139]), The pathway from ADLs to sleep quality to depression yielded a medium effect size of 20.23%.

Conclusion

ADLs help to explain how sleep quality partly mediates depression among the elderly in nursing homes. It is therefore recommended that timely detection and efficient interventions should focus on promoting physical function and improving sleep quality among the elderly in nursing homes.

Sleep Quality and Disability for Custodial Grandparents Caregivers in the Southern United States

Sleep quality amongst caregivers with disability may have been compounded by the COVID-19 pandemic. We evaluated differences in sleep quality amongst custodial grandparents from a southern state that were identified through state-based Kinship Care support groups coordinators and online. Participants ( N = 102) completed the Pittsburgh Sleep Quality Index and self-reported disability statuses. Gamma tests showed a strong negative relationship between disability and sleep duration indicating fewer hours of sleep, higher use of sleep medication and greater sleep disturbances. Disability is not significantly related to sleep latency, sleep efficiency, and daytime dysfunction. T-tests showed no strength of relationship between disability and overall sleep quality. During the first year of the COVID-19 pandemic, custodial grandparents with disability had greater issues with their sleep quality than those without disability. Sleep, as it pertains to its overall preponderant role in maintaining good health, should be examined amongst custodial grandparent caregivers and those with disability.

Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A national observational study

Background

Poor sleep status as a common concern is a risk factor for many health problems among older people. China with an aging society lacks relevant nationwide data on the sleep status among older people. Therefore, the purpose of this study was to investigate trends and disparities in sleep quality and duration among older adults, and exploring influencing factors of poor sleep in China between 2008 and 2018.

Method

We used the four-waves data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Sleep quality and average sleep hours per day was investigated by using questionnaires in the CLHLS. We categorized sleep duration as three groups including ≤5 h (short duration), 5-9 h (normal duration), or ≥9 h (long duration) per day. Multivariate logistic regression models were used to examine trends and risk factors of poor sleep quality, short sleep duration, and long sleep duration.

Results

The prevalence of poor sleep quality significantly increased from 34.87% in 2008 to 47.67% in 2018 (p < 0.05). Short sleep duration significantly increased from 5.29 to 8.37%, whereas long sleep duration decreased from 28.77 to 19.27%. Multivariate analysis showed that female sex, poor economic status, a greater number of chronic diseases, underweight, poor self-reported quality of life, and poor self-reported health were associated with poor sleep quality and short sleep duration (p < 0.05).

Conclusion

Our findings revealed that older adults had increased prevalence of poor sleep quality and short sleep duration from 2008 to 2018. More attention should be paid to the increased sleep problems among older adults and early interventions should be made to improve sleep quality and guarantee enough sleep time.

Factors associated with poor sleep quality in midlife Singaporean women: The Integrated Women's Health program (IWHP)

Objective

To examine factors associated with poor sleep quality in community-dwelling midlife women.

Methods

Healthy women (aged 45-69 years) of Chinese, Malay and Indian ethnicities attending well-women clinics at the National University Hospital, Singapore, completed the Pittsburgh Sleep Quality Index (PSQI). A PQSI score >5 denoted poor sleep quality. The women filled out validated questionnaires covering menopausal and genito-urinary symptoms, and mental health. Physical performance was measured. Bone mineral density and visceral adiposity were assessed by dual energy X-ray absorptiometry. Binary logistic regression analyses assessed independent factors for poor sleep.

Results

Poor sleep quality was reported in 38.2% of women (n = 1094, mean age: 56.4 ± 6.2 years). Indian women had higher sleep disturbance scores than Chinese women (mean ± SD: 1.33 ± 0.58 vs 1.17 ± 0.49). Malays experienced more daytime dysfunction (0.54 ± 0.60 vs 0.33 ± 0.55) and had a higher overall PSQI score (6.00 ± 3.31 vs 5.02 ± 2.97) than the Chinese. A low education level (aOR: 1.76, 95% CI: 1.01-3.05), feelings of irritability (2.67, 1.56-4.60) and vaginal dryness (1.62, 1.03-2.54) were associated with poor sleep quality in the adjusted multivariable model. Women with moderate to severe disability were ∼3 times (2.99, 1.20-7.44) more likely to experience less than ideal sleep quality, while urinary incontinence (1.53, 1.08-2.17) and breast cancer history (2.77, 1.36-5.64) were also associates of poor sleep quality.

Conclusion

Self-reports of education level, irritability, vaginal dryness, disability, urinary incontinence, and breast cancer history were independently related to poor sleep. Ethnic differences suggest the need for targeted interventions among the ethnic groups.

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.

Effectiveness of melatonin treatment for sleep disturbance in orthopaedic trauma patients: A prospective, randomized control trial

OBJECTIVES

Explore sleep disturbance in postoperative orthopedic trauma patients and determine the impact of melatonin supplementation on postoperative sleep, pain, and quality of life.

MATERIALS AND METHODS

In this prospective, randomized controlled trial at a Level I trauma center, 84 adult orthopedic trauma patients with operative fracture management were randomized 2-weeks postoperatively to either the melatonin or placebo group. Patients randomized to the melatonin group (42 subjects, mean age 41.8 ± 15.5 years) received 5 mg melatonin supplements. Patients in the placebo group (42 subjects, mean age 41.3 ± 14.0 years) received identical glucose tablets. Both groups were instructed to take the tablets 30 minutes before bed for 4 weeks and received sleep hygiene education and access to the Cognitive Behavioral Therapy for Insomnia (CBT-I) Coach app.

MAIN OUTCOME MEASURES

Our primary outcome was sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were pain measured by the Visual Analog Scale (VAS), quality of life measured by the 36-Item Short Form Survey (SF-36), and opioid use.

RESULTS

Patients in both groups had significant sleep disturbance (PSQI ≥ 5) at 2-weeks (83%) and 6-weeks (67%) postoperatively. PSQI improved by 3.3 points (p<0.001) at follow-up, but there was no significant difference between groups (melatonin PSQI = 5.6, placebo PSQI = 6.1, P = 0.615). Compared to placebo, melatonin did not affect VAS, SF-36, or opioid use significantly.

CONCLUSION

Sleep disturbance is prevalent in orthopedic trauma patients. Melatonin treatment did not significantly improve subjective sleep quality, pain, quality of life or opioid use.

LEVEL OF EVIDENCE

Therapeutic Level I.

Cross-Sectional and Longitudinal Associations between Subjective Sleep Difficulties and Self-Perceptions of Aging

BACKGROUND

Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function).

PARTICIPANTS/METHODS

We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties.

RESULTS

Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant.

CONCLUSIONS

Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.

Prevalence and risk factors of sleep disturbance in adults with underlying health conditions during the ongoing COVID-19 pandemic

To determine the prevalence of sleep disturbance during the coronavirus disease 2019 (COVID-19) pandemic among US adults who are more vulnerable to complications because of age and co-morbid conditions, and to identify associated sociodemographic and psychosocial factors. Cross-sectional survey linked to 3 active clinical trials and 2 cohort studies, conducted between 11/30/2020 and 3/3/2021. Five academic internal medicine practices and 2 federally qualified health centers. A total of 715 adults ages 23 to 91 years living with one or more chronic conditions. A fifth (20%) of participants reported poor sleep. Black adults were twice as likely to report poor sleep compared to Whites. Self-reported poor physical function (51%), stress (42%), depression (28%), and anxiety (36%) were also common and all significantly associated with poor sleep. Age ≥70 years and having been vaccinated for COVID-19 were protective against poor sleep. Sex, education, income, alcohol use, and employment status were not significantly associated with sleep quality. In this diverse sample of adults with chronic conditions, by race, ethnicity, and socioeconomic status, disparities in sleep health amid the ongoing pandemic were apparent. Worse physical function and mental health were associated with poor sleep and should be considered targets for health system interventions to prevent the many subsequent consequences of disturbed sleep on health outcomes. Measurements: self-reported sleep quality, physical function, stress, depression, and anxiety.

Promoting sleep in low-income older adults with disabilities: Comparing CAPABLE with a social engagement control

Sleep plays a vital role in older adults' health. The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) trial, conducted in Maryland between 2012 and 2016, is a 5-month biobehavioral environmental intervention study to reduce functional disabilities in 300 low-income older adults. Individual and environmental factors impacting sleep were addressed in CAPABLE. This secondary data analysis was to test the preliminary effect of CAPABLE on actigraph-measured sleep, compared with a social engagement control in 73 CAPABLE participants with pretest-posttest actigraph data. Participants in this analysis were aged 75.8±7.5 years; 86.3% of them were females and 84.9% were Black/African Americans. Both CAPABLE intervention and social engagement control improved sleep efficiency and reduced sleep onset latency. The effect of CAPABLE on sleep was comparable to social engagement. These findings underline the importance of promoting physical function and maintaining social activity for sleep in low-income older adults with disabilities.

Sleep Deficiency in the Elderly

With aging, there are normative changes to sleep physiology and circadian rhythmicity that may predispose older adults to sleep deficiency, whereas many health-related and psychosocial/behavioral factors may precipitate sleep deficiency. In this article, we describe age-related changes to sleep and describe how the health-related and psychosocial/behavioral factors typical of aging may converge in older adults to increase the risk for sleep deficiency. Next, we review the consequences of sleep deficiency in older adults, focusing specifically on important age-related outcomes, including mortality, cognition, depression, and physical function. Finally, we review treatments for sleep deficiency, highlighting safe and effective nonpharmacologic interventions.

Maternal sleep deprivation induces gut microbial dysbiosis and neuroinflammation in offspring rats

Maternal sleep deprivation (MSD) is a global public health problem that affects the physical and mental development of pregnant women and their newborns. The latest research suggests that sleep deprivation (SD) disrupts the gut microbiota, leading to neuroinflammation and psychological disturbances. However, it is unclear whether MSD affects the establishment of gut microbiota and neuroinflammation in the newborns. In the present study, MSD was performed on pregnant Sprague-Dawley rats in the third trimester of pregnancy (gestational days 15-21), after which intestinal contents and brain tissues were collected from offspring at different postnatal days (P1, P7, P14, and P56). Based on microbial profiling, microbial diversity and richness increased in pregnant rats subjected to MSD, as reflected by the significant increase in the phylum Firmicutes. In addition, microbial dysbiosis marked by abundant Firmicutes bacteria was observed in the MSD offspring. Furthermore, quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) showed that the expression levels of proinflammatory cytokines interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) were significantly higher in the MSD offspring at adulthood (P56) than in the control group. Through Spearman correlation analysis, IL-1β and TNF-α were also shown to be positively correlated with Ruminococcus_1 and Ruminococcaceae_UCG-005 at P56, which may determine the microbiota-host interactions in MSD-related neuroinflammation. Collectively, these results indicate that MSD changes maternal gut microbiota and affects the establishment of neonatal gut microbiota, leading to neuroinflammation in MSD offspring. Therefore, understanding the role of gut microbiota during physiological development may provide potential interventions for cognitive dysfunction in MSD-impacted offspring.

Changes in objectively measured lifestyle factors during the COVID-19 pandemic in community-dwelling older adults

Background

In this manuscript, we investigate whether objectively measured lifestyle factors, including walking steps, sedentary time, amount of unforced physical activity, level of slight and energetic physical activity, conversation time, and sleep parameters, were altered before and during the COVID-19 pandemic among community-dwelling older adults.

Methods

Data were obtained from a prospective cohort study conducted from 2015 to 2019 and a subsequent dementia prevention study undertaken in September 2020. Community-dwelling adults aged ≥ 65 years wore wearable sensors before and during the pandemic.

Results

A total of 56 adults were enrolled in this study. The mean age was 74.2 ± 3.9 years, and 58.9% (n = 33) of the participants were female. Moderate and vigorous physical activity time significantly decreased, and sedentary time significantly increased during the pandemic.

Conclusions

This is the first study to demonstrate differences in objectively assessed lifestyle factors before and during the COVID-19 pandemic among community-dwelling older adults. The findings show that the pandemic has adversely affected physical activity among older adults living on their own in Japan.

Volunteer participation differentially moderates the association between insomnia and poor subjective well-being in community-dwelling older adults: the Yilan study, Taiwan

Objectives

We aimed to elucidate the moderating effect of volunteer participation on the association between insomnia and subjective well-being.

Methods

This was a community-based, cross-sectional study that targeted community-dwelling older adults aged ≥ 65 years in Yilan city, Taiwan. Whether individuals had volunteered in the past month was asked. Insomnia was measured using the Athens Insomnia Scale-5. Subjective well-being was evaluated using self-rated health, self-rated happiness, the physical component summary (PCS), and the mental component summary (MCS) of Short-form 12. Interaction terms between volunteer participation and insomnia were examined to test the moderating effect of volunteer participation on subjective well-being.

Results

In total, 3,875 participants were included in the study. After controlling for confounders, older adults with insomnia were more likely to have poor subjective well-being, except with respect to PCS. By contrast, volunteering was associated with a low risk of association between self-rated health and happiness. The interaction terms for volunteering with self-rated happiness (p = 0.03) and the MCS (p = 0.02) were significant. The association between insomnia and poor self-rated happiness among volunteers (odds ratio [OR] = 3.91, 95% confidence interval [CI] = 1.85–8.28) was significantly stronger than that in non-volunteers (OR = 1.48, 95% CI = 1.18–1.86). However, insomnia was linked with poor MCS in non-volunteers (OR = 1.53, 95% CI = 1.21–1.94), but not in volunteers (OR = 0.64, 95% CI = 0.27–1.50).

Discussion

Volunteer participation moderated the association between insomnia and subjective well-being; specifically, volunteering strengthened the association between insomnia and poor self-rated happiness but mitigated the relationship between insomnia and poor MCS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03004-8.

Stress Susceptibility Moderates the Relationship Between Eveningness Preference and Poor Sleep Quality in Non-Acute Mood Disorder Patients and Healthy Controls

OBJECTIVE

This study aimed to investigate the relationship between eveningness preference and poor sleep quality and eventually examine the moderation effect of stress susceptibility.

METHODS

Individuals with non-acute major depressive disorder or bipolar affective disorder and healthy participants were recruited. The Composite Scale of Morningness (CSM) and the Pittsburgh Sleep Quality Index (PSQI) were used to evaluate chronotype and sleep quality, respectively. Eysenck Personality Questionnaire, Tridimensional Personality Questionnaire, Perceived Stress Scale, and Beck Anxiety Inventory were used to formulate stress susceptibility and as indicator variables for empirical clustering by latent class analysis (LCA). Linear regression models were used to examine the relationship between chronotype preference and sleep quality. The interaction terms of CSM and stress susceptibility were examined for the moderation effect.

RESULTS

A total of 887 individuals were enrolled in this study, with 68.2% female and 44.1% healthy participants. Three subgroups were derived from LCA and designated as low stresssusceptibility (40.2%), moderate stress susceptibility (40.9%), and high stress susceptibility (18.8%) groups. After controlling for covariates, the CSM scores inversely correlated with PSQI scores [b (se)=-0.02 (0.01), p=0.01], suggesting that individuals with eveningness preferences tend to have poor sleep quality. Moreover, stress susceptibility moderated the relationship between CSM and PSQI scores (p for interaction term = 0.04). Specifically, the inverse association between CSM and PSQI was more robust in the high stress susceptibility group than that in the low stress susceptibility group.

CONCLUSION

Eveningness preference was associated with poor sleep quality, and this relationship was moderated by stress susceptibility.

Precision Medicine and Physical Therapy: A Healthy Living Medicine Approach for the Next Century

There is a reciprocal relationship between common health conditions encountered in physical therapist practice, disability, and healthy living factors, such as physical inactivity, blood pressure, sleep quality, diet, and obesity. This relationship is apparent across all practice settings. Physical therapists are well positioned in the health care system to mitigate chronic disease by routinely screening and addressing healthy living factors to improve overall health and lower the risk for chronic disease (healthy living medicine). However, there are several challenges to the successful implementation of this framework in physical therapist practice. This Perspective will elucidate this relationship between healthy living behaviors and physical therapist practice, review the current state of practice regarding screening and intervention of 5 key healthy living behaviors, and outline future steps the profession can take toward implementing precision medicine using a healthy living medicine approach.

Effects of Xbox Kinect exercise training on sleep quality, anxiety and functional capacity in older adults

The aim of this study was to examine the effects of an Xbox Kinect exercise program on sleep quality, anxiety and functional capacity in older adults. Twenty-nine older adults were randomized into two treatment groups: XBOX (n = 15) or CONTROL (n = 14). The XBOX group performed exercise with an Xbox Kinect for 60 min, three times per week for 6 weeks. The CONTROL group did not exercise. Improvements in sleep quality (p = 0.04), anxiety (p = 0.007), aerobic endurance (p = 0.003), agility/balance (p = 0.02), and lower limb strength (p = 0.05) were observed in the XBOX group compared with the CONTROL. Xbox Kinect exercise program improved sleep quality, reduced anxiety, and increased the functional capacity of older adults. These results support the value of exercise in the Xbox Kinect for sleep quality and anxiety in older adults. (Clinical Trials Registration NCT04692272).

Relevance of Sleep Disturbances to Orthopaedic Surgery: A Current Concepts Narrative and Practical Review

➤

Sleep disturbances can increase the risk of falls and motor vehicle accidents and may reduce bone density.

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Poor sleep can lead to worse outcomes after fracture, such as chronic pain and delayed recovery.

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Orthopaedic surgeons can play an important role in the screening of sleep disorders among their patients.

Sleep duration and progression to sarcopenia in Japanese community-dwelling older adults: a 4 year longitudinal study

BACKGROUND

Identifying factors that contribute to the development of sarcopenia in older adults is a public health priority. Although several studies have examined the association between sleep duration and sarcopenia, additional evidence is needed to reveal the causality of this association, especially from a longitudinal study. The purpose of the present study was to examine whether sleep duration was associated with the progression to sarcopenia and its subcomponents among community-dwelling older adults in Japan.

METHODS

A total of 3918 older community-dwelling people (mean age: 73.2 ± 6.0 years, 51.8% female) included in the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analysed. Sleep duration was assessed using a self-reported questionnaire. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of progression of sarcopenia at Wave 2 (4 years later), according to the three categories of sleep duration [short: ≤6.0 h, medium: 6.1-8.9 h (control), & long: ≥9.0 h)] at Wave 1.

RESULTS

The numbers in each group in the second wave among the total sample were as follows: short 403 (10.3%), medium 2877 (73.4%), and long 638 (16.3%). Significant associations with the progression of sarcopenia were found in the long sleep duration group compared with the medium one, even after adjustment for other covariates (OR 1.66, 95% CI: 1.02-2.69, P = 0.040). Long sleep duration was significantly associated with slow gait (OR: 1.55, 95% CI: 1.17-2.06, P = 0.002) and low grip strength (OR: 1.34, 95% CI: 1.00-1.78, P = 0.047) but was not associated with low muscle mass (OR: 1.33, 95% CI: 0.74-2.38, P = 0.343).

CONCLUSIONS

This study revealed that long sleep duration was associated with an increased risk of progression to sarcopenia among older adults.

The Relationship Between Diet and Sleep in Older Adults: a Narrative Review

PURPOSE OF REVIEW

Older adults more frequently experience reduced sleep quality and quantity compared to younger adults. Diet is one modifiable lifestyle factor that may influence sleep outcomes in older adults. The purpose of this review is to synthesise the current literature investigating the impact of diet, including foods and nutrients, on the sleep quality and quantity of older adults.

RECENT FINDINGS

Overall, the observational and intervention studies suggest that following a Mediterranean diet, and the consumption of certain food items (e.g. milk), and nutrients (e.g. vitamin D and vitamin E) may influence (improve or reduce) sleep quality and quantity. This review describes the potential efficacy for dietary factors to improve sleep outcomes in older adults. However, given the heterogeneity of included studies in this review (i.e. aims, methodologies, and outcomes assessed), it is difficult to consolidate the available evidence to make specific recommendations. More targeted research exploring the relationship between diet and sleep in older adults is needed to strengthen the current evidence base.

Evaluation of sleep disorder in orthopedic trauma patients: a retrospective analysis of 1129 cases

Background

In the trauma center wards, it is not unusual for patients to have sleep disorders, especially patients with an acute injury. Meanwhile, there is substantial evidence that sleep disorder is a predictor of depression and is an important feature of posttraumatic stress disorder.

Methods

All orthopedic trauma patients confined in a trauma ward in West China Hospital of Sichuan University between April 2018 and July 2019 were included in this retrospective study. Patients with mental impairment or craniocerebral injuries were excluded from the study. Basic demographic data and the Injury Severity Score (ISS) classification based on medical records were collected. The Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality, the visual analog scale (VAS) was used to evaluate physical pain, and the Barthel Index (BI) was used to evaluate activities of daily living (ADL). Univariate linear regression analysis and multivariate linear regression analysis were used to identify independently related factors.

Results

The average PSQI score was 6.3 (± 4.0). A total of 581 (51.4%) patients had a PSQI score > 5, indicating the presence of sleep disorders. The PSQI score was > 10 in 174 (15.4%) patients. Univariate statistical analysis showed that age, sex, education, ADL, and ISS classification were associated with increased PSQI scores. Marital status and pain were not associated with increased PSQI scores. When we used multivariate analysis to control for confounding variables, sex, ADL, and ISS classification remained independently associated with PSQI (P = 0.002, < 0.000, and 0.002, respectively).

Conclusions

In our study, sleep disorders were common (51.4% with PSQI > 5) and serious (15.4% with PSQI > 10) in patients with traumatic orthopedic injury. The following factors were closely associated with sleep disorders: sex, ADL, and ISS classification. Moreover, age and educational attainment have an independent impact on sleep quality. Unexpectedly, the VAS score for pain was not independently associated with the seriousness of sleep quality, which may be related to preemptive and multimodal analgesia. Further studies are required to clarify this ambiguity.

Lifestyle Factors, Cognitive Functioning, and Functional Capacity in Older Adults

Research suggests that clinical management of cognitive impairment can occur through interventions targeting lifestyle factors, such as physical exercise and sleep quality. The present study examined the associations among lifestyle factors (exercise and sleep quality), cognition, and functional capacity in older adults (ages 56-94) who completed an outpatient neuropsychological evaluation (N = 356). Exercise habits and sleep quality were accessed using a self-report questionnaire and a clinical interview. Cognitive functioning was assessed using the Dementia Rating Scale-2 (DRS-2). Functional capacity was measured by the Texas Functional Living Scale (TFLS). Results indicated that physical exercise and sleep quality were positively associated with better cognitive functioning and functional capacity. Further research is needed to elucidate the relationship between lifestyle factors, cognition, and functional capacity in older adults.

Factors associated with seeking medical care for low back pain in a twin adult sample

BACKGROUND

Previous studies have only investigated how symptom presentation and socio-demographic factors influence care-seeking for low back pain (LBP). However, the influence of health and lifestyle factors remains unclear, and the potential confounding effects of aggregated familial factors (including genetics and the early shared environment) has not been considered extensively.

METHODS

A cross-sectional analysis was performed on 1605 twins enrolled in the Murcia Twin Registry (Spain). The outcome was seeking medical care for LBP and various self-reported demographic, health and lifestyle factors were considered predictors. All variables except sleep quality and diabetes were collected in 2013, which were cross-referenced from 2009 to 2010. A multivariate logistic regression model was performed on the total sample, followed by a co-twin case-control analysis.

RESULTS

The only significant factor found to increase the odds of seeking medical care for LBP without being affected by familial factors was poor sleep quality (total sample OR = 1.58, 95%CI 1.24-2.01; case-control OR = 1.75, 95%CI 1.14-2.69). The factors that were associated with reduced odds of seeking medical care for LBP and not confounded by familial factors were male sex (case-control OR = 0.55, 95%CI 0.33-0.93), alcohol intake (case-control OR = 0.90, 95%CI 0.82-0.99) and a history of diabetes (case-control OR = 0.50, 95%CI 0.25-0.97). No other factors significantly influenced medical care-seeking for LBP.

CONCLUSIONS

People reporting poor sleep quality are more likely to seek medical care for LBP in the long term, with this relationship being independent from aggregated familial factors. Conversely, males, people reporting higher alcohol intake, and people with a history of diabetes are less likely to seek medical care for LBP.

SIGNIFICANCE

This is the first study investigating the factors that influence seeking medical care for LBP, while adjusting for the influence of familial factors using a co-twin control design. Poor sleep quality is associated with seeking medical care for LBP in the long term and does not appear to be confounded by familial factors. Early screening for indicators of poor sleep quality and appropriate referral to interventions for improving sleep quality or reducing pain in sleep may improve LBP management.

The Development of a Rapid Classification Scale for Sleep Quality in Community-Dwelling Older Adults - The Yilan Study, Taiwan

OBJECTIVE

Poor sleep quality is prevailing, deleterious, but heterogeneous in older adults. This study aimed to develop a simplified instrument to screen and classify poor sleep quality in community-dwelling older adults, by which stepped care with needs-based interventions could be implemented.

METHODS

Cohorts of adults aged 65 years and older were used to develop the Rapid Classification Scale for Sleep Quality (RCSSQ). Poor sleep quality was defined with the Pittsburgh Sleep Quality Index (PSQI). Established subgroups of poor sleep quality in the development dataset (n = 2622) were used as the criterion standard. Two independent validation datasets (n = 964 and 193, respectively) were used to examine the external validity. Questions in the PSQI were examined by the stepwise multinomial logistic regressions to determine the optimal numbers of items in the RCSSQ. On the premise of item parsimony and instrument validity, the optimal combination of reduced items was determined.

RESULTS

In the development dataset, the 4-item RCSSQ (RCSSQ-4) was the optimal predictive model. In terms of internal validity, the accuracy rates to identify PSQI-defined poor sleep quality and its subgroups in the developmental dataset by the RCSSQ-4 were 89.0% and 79.9%, respectively. Meanwhile, the RCSSQ-4 also had good external validity in the validation datasets to detect PSQI-defined poor sleep quality (accuracy rates: 89.1-90.7%). Furthermore, the profiles of PSQI component scores and comorbid conditions for the predicted subgroups in the validation dataset were comparable with the criterion standard.

CONCLUSION

The RCSSQ-4 is a valid instrument for screening and subgrouping poor sleep quality in community-dwelling older adults. The RCSSQ-4 may help guide tailored interventions under the context of stepped care in the community.

Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies

BACKGROUND

Sleep disturbance affects around 60% of people living with dementia and can negatively affect their quality of life and that of their carers. Hypnotic Z-drugs (zolpidem, zopiclone and zaleplon) are commonly used to treat insomnia, but their safety and efficacy have not been evaluated for people living with dementia.

OBJECTIVES

To estimate the benefits and harms of Z-drugs in people living with dementia with sleep disturbance.

DESIGN

A series of observational cohort studies using existing data from (1) primary care linked to hospital admission data and (2) clinical cohort studies of people living with dementia.

DATA SOURCES

Primary care study - Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. Clinical cohort studies - the Resource Use and Disease Course in Dementia - Nursing Homes (REDIC) study, National Alzheimer's Coordinating Centre (NACC) clinical data set and the Improving Well-being and Health for People with Dementia (WHELD) in nursing homes randomised controlled trial.

SETTING

Primary care study - 371 primary care practices in England. Clinical cohort studies - 47 nursing homes in Norway, 34 Alzheimer's disease centres in the USA and 69 care homes in England.

PARTICIPANTS

Primary care study - NHS England primary care patients diagnosed with dementia and aged > 55 years, with sleep disturbance or prescribed Z-drugs or low-dose tricyclic antidepressants, followed over 2 years. Clinical cohort studies - people living with dementia consenting to participate, followed over 3 years, 12 years and 9 months, for REDIC, NACC and WHELD, respectively.

INTERVENTIONS

The primary exposure was prescription or use of Z-drugs. Secondary exposures included prescription or use of benzodiazepines, low-dose tricyclic antidepressants and antipsychotics.

MAIN OUTCOME MEASURES

Falls, fractures, infection, stroke, venous thromboembolism, mortality, cognitive function and quality of life. There were insufficient data to investigate sleep disturbance.

RESULTS

The primary care study and combined clinical cohort studies included 6809 and 18,659 people living with dementia, with 3089 and 914 taking Z-drugs, respectively. New Z-drug use was associated with a greater risk of fractures (hazard ratio 1.40, 95% confidence interval 1.01 to 1.94), with risk increasing with greater cumulative dose (p = 0.002). The hazard ratio for Z-drug use and hip fracture was 1.59 (95% confidence interval 1.00 to 2.53) and for mortality was 1.34 (95% confidence interval 1.10 to 1.64). No excess risks of falls, infections, stroke or venous thromboembolism were detected. Z-drug use also did not have an impact on cognition, neuropsychiatric symptoms, disability or quality of life.

LIMITATIONS

Primary care study - possible residual confounding because of difficulties in identifying patients with sleep disturbance and by dementia severity. Clinical cohort studies - the small numbers of people living with dementia taking Z-drugs and outcomes not necessarily being measured before Z-drug initiation restricted analyses.

CONCLUSIONS

We observed a dose-dependent increase in fracture risk, but no other harms, with Z-drug use in dementia. However, multiple outcomes were examined, increasing the risk of false-positive findings. The mortality association was unlikely to be causal. Further research is needed to confirm the increased fracture risk. Decisions to prescribe Z-drugs may need to consider the risk of fractures, balanced against the impact of improved sleep for people living with dementia and that of their carers. Our findings suggest that when Z-drugs are prescribed, falls prevention strategies may be needed, and that the prescription should be regularly reviewed.

FUTURE WORK

More research is needed on safe and effective management strategies for sleep disturbance in people living with dementia.

STUDY REGISTRATION

This study is registered as European Union electronic Register of Post-Authorisation Studies (EU PAS) 18006.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 1. See the NIHR Journals Library website for further project information.

Sleeping time is associated with functional limitations in a national sample of older Americans

BACKGROUND

Engaging in healthy behaviors may help to preserve function during aging; however, it is not well understood how sleeping time is associated with functional capacity in older adults.

AIMS

We sought to determine the association of sleeping time on functional limitation in a national sample of older Americans.

METHODS

The analytical sample included 6020 adults aged at least 65 years who participated in the 2007-2016 waves of the National Health and Nutrition Examination Survey. Respondents indicated their hours of sleep/weeknight and were categorized as < 5, 5-6.5, 7-8, 8.5-9, and > 9 h of sleep/weeknight. Ability to complete 19 functional tasks including basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical activities were also self-reported. A covariate-adjusted logistic model analyzed the associations between each sleeping time category and functional limitation.

RESULTS

Relative to those reporting 7-8 h of sleep/weeknight, older Americans reporting < 5, 5-6.5, 8.5-9, and > 9 h of sleep/weeknight had 1.66 [95% confidence interval (CI): 1.05, 2.62], 1.25 (CI: 1.02, 1.52), 1.59 (CI: 1.19, 2.12), and 2.99 (CI: 1.96, 4.56) greater odds for functional limitation, respectively.

DISCUSSION

Sleep should be recognized as a health factor that may reflect functional capacity in older adults. Healthcare providers should discuss the importance of optimal sleep with their older patients and older adults should practice healthy sleeping behaviors for preserving function.

CONCLUSIONS

Not meeting optimal sleep recommendations is associated with functional limitations in older Americans.

Weight management for adults with mobility related disabilities: Rationale and design for an 18-month randomized trial

Adults with mobility related disabilities (MRDs) represent an underserved group with a high prevalence of overweight/obesity and limited options for weight management. We previously demonstrated clinically meaningful 12-month weight loss in adults with MRDs (-6.2%, 36% ≥5% of baseline weight) using an enhanced Stop Light Diet (eSLD) delivered using at home face-to-face behavioral sessions and optional physical activity. However, the costs/logistics associated with intervention delivery by individual home visits limits the potential for scaling and implementation of this approach. Thus, we will conduct a two-arm randomized trial in 128 overweight/obese adults with MRDs to compare weight loss (6 mos.) and maintenance (12 mos.) between interventions utilizing the eSLD, behavioral counseling, and increased physical activity delivered to individual participants in their homes or delivered to groups of participants in their homes remotely via video conferencing. The primary aim will compare weight loss between interventions arms across 6 months. Secondarily, we will compare weight loss (0-18 mos.), the proportion of participants who achieve clinically meaningful weight loss (≥5%) from 0 to 6 and 0 to18 months, and changes in quality of life from 0 to 6 and 0 to 18 months between interventions arms. We will also conduct cost, cost-effectiveness and contingent valuation comparisons and explore the influence of behavioral session attendance, compliance with the recommendations for diet and physical activity, self-monitoring of diet and physical activity, barriers to physical activity, sleep quality, and medications on weight change across 6 and 18 months. NCT REGISTRATION: NCT04046471.

Daytime and Nighttime Sleep Characteristics and Pain Among Adults With Stable Heart Failure

BACKGROUND

Pain and sleep disturbance are common among patients with heart failure (HF) and are associated with symptom burden, disability, and poor quality of life. Little is known about the associations between specific sleep characteristics and pain in people with HF.

OBJECTIVE

The aim of this study was to describe the relationships between nocturnal sleep characteristics, use of sleep medication, and daytime sleep characteristics and pain among people with HF.

METHODS

We conducted a cross-sectional study of stable participants with HF. We administered the SF36 Bodily Pain Scale, Pittsburgh Sleep Quality Index, and Sleep Habits Questionnaire and obtained 3 days of wrist actigraphy and 1 night of home unattended polysomnography. We conducted bivariate analyses and generalized linear models.

RESULTS

The sample included 173 participants (mean [SD] age, 60 [16.1] years; 65.3% [n = 113] male). Insomnia symptoms (P = .0010), sleep duration (P = .0010), poor sleep quality (P = .0153), use of sleep medications (P = .0170), napping (P = .0029), and daytime sleepiness (P = .0094) were associated with increased pain. Patients with the longest sleep duration, who also had insomnia, had more pain (P = .0004), fatigue (P = .0028), daytime sleepiness (P = .0136), and poorer sleep quality (P < .0001) and took more sleep medications (P = .0029) than did those without insomnia.

CONCLUSIONS

Pain is associated with self-reported poor sleep quality, napping, daytime sleepiness, and use of sleep medication. The relationship between pain and sleep characteristics differs based on the presence of insomnia and sleep duration. Studies are needed to evaluate the causal relationships between sleep and pain and test interventions for these cooccurring symptoms.

Cardiometabolic disease, depressive symptoms, and sleep disorders in middle-aged adults with functional disabilities: NHANES 2007-2014

Purpose: This study examined whether depressive symptoms and sleep disorders modified the association between functional disabilities and cardiometabolic disease profiles in middle-aged adults (40-64 years).Methods: Participants came from the 2007-2014 NHANES. Information regarding cardiometabolic diseases, demographics, depressive symptoms, and sleep disorders were obtained. Logistic regression analyses were performed with group as the exposure and cardiometabolic diseases as the response.Results: Adults with moderate (n = 550) and severe (n = 556) functional disabilities had a higher prevalence of cardiometabolic diseases, depressive symptoms, and sleep disorders compared to adults without functional disabilities (n = 3765; p < 0.05). After adjusting for demographics, the odds of cardiovascular disease and diabetes were higher in adults with severe functional disabilities (OR: 1.47 and 1.76, p < 0.05), but not in adults with moderate functional disabilities (OR: 1.21 and 1.22, p > 0.05). With further adjustment for depressive symptoms and sleep disorders, the odds of cardiovascular disease (OR: 1.47) and diabetes (OR: 1.76) remained increased (p < 0.05) in adults with severe functional disabilities.Conclusions: By middle-age, adults with functional disabilities have an elevated prevalence of cardiometabolic diseases, depressive symptoms, and sleep disorders compared to adults without functional disabilities. The elevated cardiometabolic disease profiles are present in adults with severe functional disabilities even after adjusting depressive symptoms and sleep disorders.IMPLICATIONS FOR REHABILITATIONIn the elderly population, cardiometabolic diseases, depression, and sleep disorders are prevalent conditions and are often co-morbid.In a nationally representative sample of middle-aged adults, study findings found that those with severe functional disabilities had an elevated cardiometabolic disease prevalence compared to adults without functional disabilities, even after accounting for the higher prevalence of depressive symptoms and sleep disorders.Earlier screening for cardiometabolic diseases, depression, and sleep disorders in adults with functional disabilities, or those who are at risk for developing functional disabilities, are warranted.Interventions pertaining to physical, pharmacological, or care coordination focused on improving cardiometabolic disease profiles among adults with functional disabilities are needed.

Sleep disturbance as a moderator of the association between physical activity and later pain onset among American adults aged 50 and over: evidence from the Health and Retirement Study

OBJECTIVE

To examine whether sleep disturbance modifies the association between physical activity and incident pain.

DESIGN

Prospective population-based study.

SETTING

Health and Retirement Study.

PARTICIPANTS

American adults aged ≥50 years who reported no troublesome pain in 2014 were re-assessed for pain in 2016. Of 9828 eligible baseline respondents, 8036 (82%) had complete follow-up data for adjusted analyses (weighted analysis population N=42 407 222).

EXPOSURES

Physical activity was assessed via interview with questions about time spent in moderate and vigorous physical activity. Sleep disturbance, assessed using a modified form of the Jenkins Sleep Scale, was examined as a potential moderator.

MAIN OUTCOME MEASURE

Troublesome pain.

RESULTS

In weighted analyses, 37.9% of the 2014 baseline pain-free sample participated in moderate or vigorous physical activity once a week or less, with an overall mean Physical Activity Index Score of 9.0 (SE=0.12). 18.6% went on to report troublesome pain in 2016. Each one-point higher on the Physical Activity Index Score was associated with a reduced odds ratio (OR) of incident pain for those who endorsed sleep disturbance never/rarely (OR=0.97, 95% CI 0.94 to 0.99), but not for those who endorsed sleep disturbance sometimes (OR=0.99, 95% CI 0.97 to 1.01) or most of the time (OR=1.01, 95% CI 0.99 to 1.03). The analysis of possible interaction demonstrated that frequency of sleep disturbance moderated the physical activity and incident pain association (Wald test: p=0.02).

CONCLUSIONS

The beneficial association of physical activity on reduced likelihood of later pain was only observed in persons who endorsed low levels of sleep disturbance.

Subgrouping Poor Sleep Quality in Community-Dwelling Older Adults with Latent Class Analysis - The Yilan Study, Taiwan

The manifestation of older adults with poor sleep quality is heterogeneous. Using data-driven classifying methods, the study aims to subgroup community-dwelling older adults with poor sleep quality. Adults aged 65 and older participated in the Yilan study. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index. Latent class analysis with the 7 subscores of the Pittsburgh Sleep Quality Index as the indicators was used to generate empirical subgroups. Differences in comorbidity patterns between subgroups were compared. A total of 2622 individuals, of which 1011 (38.6%) had Pittsburgh Sleep Quality Index -defined poor sleep quality, participated. Three groups for poor sleep quality were specified in the latent class analysis: High Insomnia (n = 191, 7.3%), Mild Insomnia (n = 574, 21.9%), and High Hypnotics (n = 246, 9.4%). The High Insomnia and Mild Insomnia groups shared similar profiles but different severities in the 7 domains of the Pittsburgh Sleep Quality Index. In contrast, the High Hypnotics group had the lowest Pittsburgh Sleep Quality Index total scores and insomnia severity but had similar mental and physical comorbid patterns as the High Insomnia group. This finding suggests that poor sleep quality in community-dwelling older adults had various feature-based subgroups. It also implicates the development of group-centered interventions.