Relationships between polypharmacy and the sleep cycle among active-duty service members

Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease

BACKGROUND

Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.

AIMS

The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.

METHODS

This cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m² and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).

RESULTS

The mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38-4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B₁₂, and folate (p > 0.05).

CONCLUSIONS

EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.

The association of continuous-use medications and sleep parameters in a sample of working adults

PURPOSE

Although polypharmacy is linked to health outcomes in the elderly, the use of multiple medications is increasing in middle-aged adults. This study analyzed whether or not the increased number of continuous-use medications (C-UM) is associated with objective and subjective sleep parameters in a working population.

METHODS

Cross-sectional study with schoolteachers from public schools in Londrina, Brazil. The participants were classified according to the self-reported number of C-UM. Sleep data were obtained with actigraphy and a concomitant sleep diary for 7 days. The analyses were adjusted for socio-demographic, lifestyle, and morbidity variables.

RESULTS

A total of 17% of the participants were classified as using ≥3C-UM. In fully adjusted analyses, the use of ≥3C-UM was associated with lower actigraphic sleep duration (<6 h) (odds ratio [OR] = 2.51; 95% confidence interval [CI] = 1.01,6.21), higher actigraphic sleep onset latency (SOL) (OR = 2.65; 95%CI = 1.00,7.02), and with a higher number of awakenings during sleep measured by actigraphy (OR = 3.30; 95%CI = 1.32,8.28). The use of ≥3 C-UM was also associated with higher SOL (OR = 3.76; 95%CI = 1.36,10.5) and lower sleep efficiency (OR = 11.6; 95%CI = 2.92,46.1), as measured with the sleep diary. A 1-unit increment in the number of continuous-use medications was associated with higher self-reported SOL and lower subjective sleep efficiency.

CONCLUSION

The continuous use of ≥3 medications is associated with worse objective and subjective parameters of sleep duration and quality in schoolteachers.