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McPhillips MV, Petrovsky DV, Lorenz R, Lee J, George T, Smyth A, Bubu OM, Brewster GS. Treatment Modalities for Insomnia in Adults Aged 55 and Older: A Systematic Review of Literature from 2018 to 2023. CURRENT SLEEP MEDICINE REPORTS 2024; 10:232-256. [PMID: 39156226 PMCID: PMC11328977 DOI: 10.1007/s40675-024-00285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 08/20/2024]
Abstract
Purpose of Review Insomnia is the most common sleep disorder experienced by older adults. There is a wide range of pharmacological and non-pharmacological treatment options in existing literature. The purpose of this systematic review was to synthesize randomized controlled trials of insomnia treatment modalities for adults aged 55 and older over the last 5 years. We searched four databases, and after screening, there were 34 full-text manuscripts that met the inclusion/exclusion criteria. Recent Findings We found non-pharmacological interventions, including exercise and behavioral/psychoeducational therapies, remain effective and favorable. Complementary and alternative therapies ranged across studies and warrant further testing in larger, more diverse samples. Dual orexin receptor antagonist medications were tested in a few studies with positive benefits for sleep and minimal side effects. Finally, measures of insomnia/sleep disturbance outcomes varied among the studies, with the Pittsburgh Sleep Quality Index being used most frequently. Summary Non-pharmacological interventions for insomnia in older adults are effective, and some newer medications may be safer, with less side effects, at managing insomnia in this population.
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Affiliation(s)
| | - Darina V. Petrovsky
- Health Care Policy, and Aging Research, School of Nursing, Institute for Health, Rutgers University, New Brunswick, USA
| | | | - Jiwon Lee
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Tessy George
- Georgia Baptist College of Nursing, Mercer University, Macon, USA
| | - Aisling Smyth
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, USA
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Australia
| | - Omonigho Michael Bubu
- Departments of Psychiatry, NYU Grossman School of Medicine, Population Health & Neurology, New York, NY, USA
| | - Glenna S. Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 256, Atlanta, GA 30322, USA
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Aversa V, Hawa R, Lee EK, Mak MSB. C-L Case Conference: Insomnia Disorder. J Acad Consult Liaison Psychiatry 2024; 65:293-301. [PMID: 38016579 DOI: 10.1016/j.jaclp.2023.11.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023]
Abstract
We present the case of a 67-year-old male with a history of major depressive disorder, panic disorder, treatment refractory hypertension, dyslipidemia, benign prostatic hypertrophy, and environmental allergies who was initially brought to medical attention following an unwitnessed fall. He subsequently developed symptoms of insomnia disorder. Experts in consultation-liaison psychiatry and sleep medicine provide guidance for this clinical scenario based on their experience and a review of current literature, exploring the epidemiology of insomnia disorder and comorbidities in relation to this case. Furthermore, we offer a review of current treatment for insomnia disorder, including non-pharmacologic methods such as cognitive behavioral therapy for insomnia and pharmacotherapy.
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Affiliation(s)
- Vanessa Aversa
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto Western Hospital, Toronto, ON, Canada
| | - Elliott K Lee
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Michael S B Mak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada.
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Seaver C, Bowers C, Beidel D, Holt L, Ramakrishnan S. A game-based learning approach to sleep hygiene education: a pilot investigation. Front Digit Health 2024; 6:1334840. [PMID: 38680214 PMCID: PMC11045930 DOI: 10.3389/fdgth.2024.1334840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Sleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems. Methods 35 participants played the SHE games for 30 days. Differences in pre- and post-state anxiety and sleep quality measures were examined. Results Participants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated. Discussion This pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE.
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Affiliation(s)
- Christine Seaver
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Clint Bowers
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Deborah Beidel
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Lisa Holt
- BlueHalo, Rockville, MD, United States
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Distler KR, Lindsey MJ, Mims MH, Taylor MA, Hollingsworth JC. Primary Care Clinic Approaches to Facilitating Patient Health Behavior Change in Alabama. Cureus 2024; 16:e55973. [PMID: 38601414 PMCID: PMC11006427 DOI: 10.7759/cureus.55973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Background Non-communicable chronic diseases (NCCDs), such as cardiovascular disease, diabetes, and cancer, are the leading cause of death and disability and the leading driver of healthcare costs in the U.S. It is estimated that 80% of chronic diseases and premature deaths are attributable to modifiable lifestyle factors related to smoking and alcohol intake, poor eating patterns, and physical inactivity. Inadequate sleep also plays a significant role. Among other directives, primary care providers (PCPs) have the opportunity to contribute to preventing and treating NCCD in their patients. Comprehensive, evidence-based behavioral counseling interventions are recommended to PCPs as a first-line approach to improving outcomes. However, presumably due to a lack of PCP time, training or resources, most patients report not receiving such services. Currently, the extent to which PCPs in Alabama offer or refer patients to health behavior change (HBC) services is unknown. Objectives This study aims to assess the following: (1) Alabama PCPs' current approaches in facilitating patient HBC in the domains of eating patterns, physical activity, sleep, and stress and (2) the likelihood of the Alabama PCPs referring patients to virtual HBC programs, once developed by an osteopathic medical school in the state. Methods Data were collected from clinic personnel who were knowledgeable regarding the clinic's approach to facilitating patient HBC via scripted telephone interviews and online surveys sent via email. The clinic list utilized for the study was derived from a list of VCOM-Auburn clinical preceptors. Primary care and specialty clinics were included. Data were analyzed descriptively to determine the number of clinics that (1) provide, recommend, or refer programs, services, or resources to patients to facilitate HBC related to eating patterns, physical activity, sleep, and stress management and (2) are likely to refer patients to free virtual HBC programs, once developed by an osteopathic medical school in the state. Results Of the 198 clinics that were contacted, 75 were excluded, 46 were "no response," 53 agreed to participate, and 50 completed the survey. Of the 50 clinics that completed the survey, 33 indicated offering resources or referrals for diet, 29 stated they offered resources or referral services for physical activity, 33 indicated offering resources or referrals for sleep, and 28 indicated offering or recommending resources for stress management to patients. Most of the clinics (29/50) felt that their patients would benefit most from a program that facilitates improvement in eating patterns, and 41/50 clinics said that they are either "somewhat" or "extremely" likely to refer patients to a free VCOM-Auburn HBC program, once available. Conclusions Findings indicate that a significant percentage of PCP clinics are not offering HBC resources to patients and that most PCP clinics would consider referring patients to free VCOM-Auburn HBC programs, once available. Phone data were significantly different from email data. The primary limitations were a low response rate and potential response bias.
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Affiliation(s)
- Kyle R Distler
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Marla Jo Lindsey
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Mary Hinson Mims
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Mary Ann Taylor
- Psychiatry and Neuro-behavioral Sciences, Center for Institutional, Faculty, and Student Success, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
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Sheffler JL, Burchard V, Pickett S. Adverse Childhood Experiences and Poor Sleep Quality in Older Adults: The Influence of Emotion Regulation. J Gerontol A Biol Sci Med Sci 2023; 78:1919-1924. [PMID: 36694358 DOI: 10.1093/gerona/glad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with sleep impairment across the life span, but little is known about modifiable factors that may ameliorate this relationship, such as adaptive emotion regulation (ER) skills. METHODS Data were obtained from an online questionnaire completed by a community sample of older adults (N = 278). The questionnaire included the Pittsburgh Sleep Quality Index, an Adverse Childhood Experiences questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), and measures of health conditions, and other sample demographics. Moderation analyses were used to examine the interaction between ACEs and 5 adaptive ER skills of CERQ on sleep quality in older adults, while accounting for the effects of age, sex, income, body mass index, and health. RESULTS ACEs were significantly associated with worse sleep quality in older adults, and this effect was moderated by positive reappraisal and refocusing on planning (all ps < .05). For individuals reporting greater use of these ER skills, ACEs had no effect on sleep quality, whereas for individuals reporting less frequent use of these ER skills, ACEs were associated with substantially worse sleep quality. This relationship remained significant after accounting for age, sex, income, body mass index, and health conditions in the model. CONCLUSIONS The effects of ACEs on sleep quality persist into older age; however, greater use of ER skills that focus on positively reframing negative events and identifying strategies for coping protect against sleep impairment in individuals with higher ACEs.
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Affiliation(s)
- Julia L Sheffler
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Valeria Burchard
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Scott Pickett
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA
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Brewster GS, Pierpaoli Parker C, Epps F, Bonds Johnson K, Yeager KA. Sleep Profiles of Caregivers for Persons Living with Dementia: A Qualitative Study. West J Nurs Res 2023; 45:688-695. [PMID: 37161397 DOI: 10.1177/01939459231175242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sleep disturbance is prevalent among caregivers of people living with dementia. However, gaps exist about caregivers' sleep patterns before and during their caregiving trajectory. This exploratory secondary analysis using a qualitative descriptive approach aimed to (1) identify and describe current caregivers' patterns of change in sleep before and during caregiving, and (2) understand caregivers' perceptions of their current sleep compared to their pre-caregiving sleep. We conducted semi-structured interviews with 19 caregivers taking part in a larger randomized controlled trial. Participants were female (n = 11), white (n = 13) and on average 63 years of age. Interview questions focused on caregivers' sleep patterns. The interviews were audio-recorded using a videoconferencing platform and ranged from 20 to 45 minutes. We conducted thematic analysis of the interview transcripts. Three distinct caregiver-sleep profiles emerged from the qualitative data: changed and dissatisfied, changed and satisfied, and unchanged and dissatisfied. Caregivers whose sleep was categorized as changed reported a difference when comparing their current sleep pattern to their pre-caregiving sleep pattern. This was usually a change from good to poor sleep. Caregivers whose sleep was unchanged had poor sleep pre-caregiving and continued to have poor sleep during caregiving. Caregivers also reported being satisfied or dissatisfied with their current sleep pattern, defined in terms of distress and impairment. These three subtypes highlight the heterogeneity of caregivers' sleep experiences and debut a useful clinical framework with which to identify, categorize, and target caregivers at risk for sleep disturbance, many who may be ready to engage in behaviors to improve their sleep. Knowing caregivers' sleep profiles will enable health care providers and researchers to determine caregivers' needs and readiness for interventions then work collaboratively with them to improve their sleep problems.
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Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Christina Pierpaoli Parker
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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McPhillips MV, Li J, Petrovsky DV, Gooneratne NS, Aryal S, Hodgson NA. A randomized controlled trial to test a behavioral sleep intervention to improve insomnia symptoms in older adults with mild cognitive impairment: Multicomponent Behavioral Sleep Intervention (MBSI) protocol. Contemp Clin Trials 2023; 127:107137. [PMID: 36858255 PMCID: PMC10068807 DOI: 10.1016/j.cct.2023.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Insomnia symptoms in older adults with mild cognitive impairment represent a significant public health burden in terms of impaired quality of life, risks from untreated insomnia, and adverse effects from pharmaceutical insomnia treatment. To address current limitations in the most effective non-pharmacological treatments for insomnia in older adults with mild cognitive impairment, we are conducting a randomized pilot study to test a brief (4- week), tablet-based, personalized, multicomponent behavioral sleep intervention (MBSI) for insomnia, compared to a sleep education control, in a sample of older adults with mild cognitive impairment. METHODS Participants will be randomized in a 1:1 ratio to intervention or control group. Both groups will complete three virtual study data collection visits: baseline, 4-week post-intervention, and 12-week post-intervention follow-up. Key components of the 4-week intervention include sleep hygiene education, stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (4-week) and sustained efficacy (12-week) of MBSI compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which the intervention affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. RESULTS (N/A). DISCUSSION The findings of the proposed project will inform future, larger scale clinical trials and may provide a novel and innovative way for older adults with mild cognitive impairment to achieve better sleep and health-related quality of life outcomes.
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Affiliation(s)
| | - Junxin Li
- School of Nursing, John Hopkins University, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, USA
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Benca RM, Bertisch SM, Ahuja A, Mandelbaum R, Krystal AD. Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care. J Clin Med 2023; 12:jcm12072498. [PMID: 37048582 PMCID: PMC10094753 DOI: 10.3390/jcm12072498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
While both patients and physicians consider sleep to be important, sleep health may not receive appropriate consideration during patient visits with health care professionals (HCPs). We completed the first large-scale survey of people with trouble sleeping (PWTS) and physicians who treat insomnia to understand their perspectives and potential discrepancies between them. The Harris Poll conducted online surveys of adult PWTS and HCPs (primary care physicians [PCPs] and psychiatrists) in the United States from September to October 2021. Respondents included 1001 PWTS, 300 PCPs, and 152 psychiatrists. Most HCPs agreed that sleep is critical to good health, yet very few reported routinely conducting full sleep histories on their patients. Approximately 30% of PWTS reported that their PCP never asks about sleep; zero HCPs in this survey reported “never” inquiring. Few HCPs reported being “very satisfied” with current treatment options; 50% of PCPs reported their patients being satisfied. Two-thirds of PWTS did not believe current treatment options adequately improved their sleep. This survey provides evidence that both PWTS and physicians agreed on the importance of sleep, but that treatment is often perceived as ineffective. This survey identifies a need for HCPs to address insomnia management and treatment gaps.
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Ireland PA, Topp M, Wensley C. Attitudinal Factors Influencing Quality Nurse-Led Mental Health Interventions in Primary Care Settings: An Integrative Literature Review. J Psychosoc Nurs Ment Health Serv 2022:1-8. [DOI: 10.3928/02793695-20221122-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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McPhillips MV, Li J, Petrovsky DV, Brewster GS, Ward EJ, Hodgson N, Gooneratne NS. Assisted Relaxation Therapy for Insomnia in Older Adults With Mild Cognitive Impairment: A Pilot Study. Int J Aging Hum Dev 2022; 97:65-80. [PMID: 36259123 PMCID: PMC10110766 DOI: 10.1177/00914150221132163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Insomnia symptoms are prevalent in older adults with mild cognitive impairment (MCI) and can pose treatment challenges. We tested the feasibility, acceptability, and preliminary efficacy of assisted relaxation therapy (ART) to improve insomnia symptoms in community-dwelling older adults with MCI. In this pilot RCT, 25 participants were assigned to intervention or control groups for 2 weeks. The final sample (n = 20) consisted of all Black, primarily female (70%) older adults (mean age 69.10; SD = 7.45) with mean Montreal Cognitive Assessment scores of 21.10 (SD = 2.49). Recruitment was timely; attrition was low (80%). Participants were able to use ART (average use 7.00; SD = 5.07 days). Participants in the ART group improved on Insomnia Severity Index (ISI) (- 7.10; 95% CI [-11.63, -2.55]; p = .004) compared to baseline. There were clinically meaningful mean change scores on ISI for the intervention group compared to the control (- 7.10 vs. - 4.33). Results provide justification for testing ART in a fully powered clinical trial.
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Affiliation(s)
- Miranda V McPhillips
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Junxin Li
- School of Nursing, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Darina V Petrovsky
- Institute for Health, Health Care Policy, and Aging Research, School of Nursing, 242612Rutgers University, New Brunswick, NJ, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, 1371Emory University, Atlanta, GA, USA
| | - E John Ward
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Hodgson
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Nalaka S Gooneratne
- Center for Sleep and Circadian Neurobiology, 6572University of Pennsylvania, Philadelphia, PA, USA.,Division of Geriatric Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
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Huang J, Li M, McPhillips MV, Lukkahatai N, Li J. Association of Sleep and Physical Activity Among Older Adults and the Moderation of Chronotype. Int J Aging Hum Dev 2022; 97:35-51. [PMID: 36217729 DOI: 10.1177/00914150221128974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to examine the associations of both subjectively and objectively measured sleep with physical activity among older adults and to explore the possible moderating role of chronotype in these associations. We included baseline data of 116 community-dwelling older adults without dementia from three prior studies. Pittsburgh Sleep Quality Index and Actigraphy were used as subjective and objective sleep measures, respectively. Physical activity was assessed by the Physical Activity Scale for the Elderly. The Morningness-Eveningness Questionnaire was used to measure chronotype, which was further dichotomized into morning type and non-morning type. Multiple linear regressions were performed to examine the associations, controlling for demographic and health characteristics. We found that better subjective sleep quality, shorter actigraphy sleep duration, and higher actigraphy sleep efficiency were uniquely associated with greater physical activity. Being a morning type might alleviate the adverse association between poor subjective sleep quality and physical activity among older adults.
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Affiliation(s)
- Jing Huang
- School of Nursing, 1466John Hopkins University, Baltimore, MD, USA
| | - Mengchi Li
- School of Nursing, 1466John Hopkins University, Baltimore, MD, USA
| | | | - Nada Lukkahatai
- School of Nursing, 1466John Hopkins University, Baltimore, MD, USA
| | - Junxin Li
- School of Nursing, 1466John Hopkins University, Baltimore, MD, USA
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