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Huang CJ, Hsu NW, Chen HC. Prevalence, dimensions, and correlates of excessive daytime sleepiness in community-dwelling older adults: the Yilan study, Taiwan. Ann Med 2024; 56:2352028. [PMID: 38803075 PMCID: PMC11136468 DOI: 10.1080/07853890.2024.2352028] [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: 01/15/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Daytime sleepiness is an important health problem. However, the dimensionality of the Epworth Sleepiness Scale (ESS) in older adults remains unclear. This study aimed to determine the prevalence of ESS-defined excessive daytime sleepiness in older adults. Furthermore, the dimensionality of ESS and its respective correlates were also compared. MATERIALS AND METHODS This is a community-based survey in which community-dwelling older adults aged ≥ 65 years participated. Excessive daytime sleepiness was assessed using the ESS and was defined as an ESS score of > 10. Exploratory factor analysis was performed to identify the ESS factors. Multiple logistic regression analysis was used to examine the independent correlates of the ESS-defined and factor-specific correlates of excessive daytime sleepiness. RESULTS In total, 3978 older adults participated in this study. The mean age was 76.6 ± 6.7 years, with 53.8% ≥ 75 years, and 57.1% were female. The prevalence of ESS-defined excessive daytime sleepiness was 16.0%. An exploratory factor analysis revealed two factors in the ESS, which were designated as 'passive' and 'active' according to the soporific levels of ESS items loaded in each factor. Multiple logistic regression showed that male, illiteracy, depression, disability, short sleep duration and no exposure to hypnotics were risk indicators for ESS-defined excessive daytime sleepiness. However, the correlates for passive and active factor-defined excessive daytime sleepiness differ in pattern, especially in variables related to education, exercise, mental health, and sleep. CONCLUSIONS The prevalence of ESS-defined excessive daytime sleepiness is high, and its correlates vary among older adults. This study also suggests a dual ESS structure in community-dwelling older adults.
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Affiliation(s)
- Chiu-Jui Huang
- Department of Medical Education, National Taiwan University Hospital, Taiwan
| | - Nai-Wei Hsu
- Division of Cardiology, Department of Internal Medicine & Community Medicine Center, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Public Health Bureau, Yilan County, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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2
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Kroeger D, Vetrivelan R. To sleep or not to sleep - Effects on memory in normal aging and disease. AGING BRAIN 2023; 3:100068. [PMID: 36911260 PMCID: PMC9997183 DOI: 10.1016/j.nbas.2023.100068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/03/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Sleep behavior undergoes significant changes across the lifespan, and aging is associated with marked alterations in sleep amounts and quality. The primary sleep changes in healthy older adults include a shift in sleep timing, reduced slow-wave sleep, and impaired sleep maintenance. However, neurodegenerative and psychiatric disorders are more common among the elderly, which further worsen their sleep health. Irrespective of the cause, insufficient sleep adversely affects various bodily functions including energy metabolism, mood, and cognition. In this review, we will focus on the cognitive changes associated with inadequate sleep during normal aging and the underlying neural mechanisms.
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Affiliation(s)
- Daniel Kroeger
- Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, United States
| | - Ramalingam Vetrivelan
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
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3
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Gallagher VT, Reilly SE, Williams IC, Mattos M, Manning C. Patterns of sleep disturbances across stages of cognitive decline. Int J Geriatr Psychiatry 2023; 38:e5865. [PMID: 36578203 PMCID: PMC10107468 DOI: 10.1002/gps.5865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate insomnia symptoms and excessive sleep/sluggishness across stages of cognitive decline (cognitively normal [CN], Cognitively Impairment, Not Demented [CIND], dementia) in a large, racially/ethnically diverse sample of older adults (70+) in the US. We also examined whether sleep disturbances at baseline predicted conversion to CIND or dementia at follow-up. METHODS In this secondary analysis of the Aging, Demographics, and Memory Study (ADAMS) supplement of the Health Retirement Study, we analyzed patterns of informant-reported insomnia and excessive sleep symptoms among three groups of older adults (n = 846): CN, CIND, and dementia. RESULTS CIND adults were significantly more likely to have informant-reported insomnia symptoms than those in the CN group (p = 0.013). This was driven by a significant race/ethnicity-by-insomnia interaction with diagnostic status (p = 0.029), such that CIND Black and Hispanic older adults had increased insomnia symptom rates compared to CN, whereas White adults had similar insomnia symptoms across diagnostic status. Across all racial/ethnic groups, the prevalence of excessive sleep symptoms increased stepwise from CN to CIND to dementia (p < 0.001). Overall, insomnia symptoms at baseline predicted conversion from CN to CIND (p < 0.001, OR = 0.288; 95% CI: 0.143-0.580) at 4-year (approximate) follow-up; there was no relationship between baseline insomnia or excessive sleep/sluggishness symptoms and conversion from CIND to dementia. DISCUSSION/CONCLUSION This study provides evidence for the increased risk of insomnia symptoms among Hispanic and Black older adults with CIND, and indicates that insomnia symptoms may be associated with increased risk for development of cognitive impairment.
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Affiliation(s)
| | - Shannon E. Reilly
- Department of NeurologyUniversity of Virginia HealthCharlottesvilleVirginiaUSA
| | | | - Meghan Mattos
- School of NursingUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Carol Manning
- Department of NeurologyUniversity of Virginia HealthCharlottesvilleVirginiaUSA
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4
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Carvalho DZ, St. Louis EK, Przybelski SA, Morgenthaler TI, Machulda MM, Boeve BF, Petersen RC, Jack CR, Graff-Radford J, Vemuri P, Mielke MM. Sleepiness in Cognitively Unimpaired Older Adults Is Associated With CSF Biomarkers of Inflammation and Axonal Integrity. Front Aging Neurosci 2022; 14:930315. [PMID: 35898322 PMCID: PMC9309557 DOI: 10.3389/fnagi.2022.930315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Sleepiness has been associated with cognitive decline and dementia in the elderly. Older adults with excessive daytime sleepiness appear to be more vulnerable to longitudinal amyloid PET accumulation before the onset of the dementia. However, it remains unclear whether sleepiness is similarly associated with other biomarkers of Alzheimer's disease (AD), axonal integrity, and inflammation, which may also contribute to neurodegeneration and cognitive decline. Methods In this cross-sectional analysis, we identified 260 cognitively unimpaired adults (>60 years) from the Mayo Clinic Study of Aging, a population-based cohort from Olmsted County (MN), who underwent CSF quantification of AD biomarkers (Aβ42, p-tau, p-tau/Aβ42) in addition to at least one of the following biomarkers [neurofilament light chain (NfL) interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α (TNF-α)]. We fit linear regression models to assess associations between sleepiness, as measured by the Epworth Sleepiness Scale (ESS), and CSF biomarkers, controlling for age, sex, APOε4 status, body mass index, hypertension, dyslipidemia, and prior diagnosis of obstructive sleep apnea. Results Higher ESS scores were associated with higher CSF IL-6 and NfL, but not with the other CSF biomarkers. For every ESS score point increase, there was a 0.009 ([95% CI 0.001-0.016], p = 0.033) increase in the log of IL-6 and 0.01 ([95% CI 0.002-0.018], p = 0.016) increase in the log of NfL. A sensitivity analysis showed an association between ESS scores and log of p-tau/Aβ42 only in participants with an abnormal ratio (>0.023), highly predictive of amyloid positivity. For every ESS score point increase, there was a 0.006 ([95% CI 0.001-0.012], p = 0.021) increase in the log of CSF p-tau/Aβ42. Conclusion Sleepiness was associated with greater CSF IL-6 and NfL levels, which could contribute to neurodegeneration or alternatively cause sleepiness. Higher NfL levels may result from sleep disruption and/or contribute to sleepiness via disturbed connectivity or damage to wake-promoting centers. Associations between sleepiness and p-tau/Aβ42 in participants with abnormal ratio suggest that amyloid positivity contributes to vulnerability to sleep disturbance, which may further amyloid accumulation in a feed-forward loop process. Prospective studies of these markers are needed to determine cause-effect relationships between these associations.
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Affiliation(s)
- Diego Z. Carvalho
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Erik K. St. Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Scott A. Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Timothy I. Morgenthaler
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mary M. Machulda
- Department of Psychology, Mayo Clinic, Rochester, MN, United States
| | - Bradley F. Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Michelle M. Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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5
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Parveen N, Parganiha A. Consequences and factors associated with OSA: a brief review. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2054558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Noorshama Parveen
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
| | - Arti Parganiha
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur, India
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6
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Liguori C, Maestri M, Spanetta M, Placidi F, Bonanni E, Mercuri NB, Guarnieri B. Sleep-disordered breathing and the risk of Alzheimer's disease. Sleep Med Rev 2020; 55:101375. [PMID: 33022476 DOI: 10.1016/j.smrv.2020.101375] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022]
Abstract
Sleep-disordered breathing is highly prevalent in the elderly population. Obstructive sleep apnea (OSA) represents the most common sleep disorder among the adult and elderly population. Recently, OSA diagnosis has been associated with an increased risk of developing cognitive decline and dementia, including vascular dementia and Alzheimer's disease (AD). Subsequently, there have been studies on AD biomarkers investigating cerebrospinal fluid, blood, neuroimaging, and nuclear medicine biomarkers in patients with OSA. Furthermore, studies have attempted to assess the possible effects of continuous positive airway pressure (CPAP) treatment on the cognitive trajectory and AD biomarkers in patients with OSA. This review summarizes the findings of studies on each AD biomarker (cognitive, biofluid, neuroimaging, and nuclear medicine imaging) in patients with OSA, also accounting for the related effects of CPAP treatment. In addition, the hypothetical model connecting OSA to AD in a bi-directional interplay is analyzed. Finally, the sex-based differences in prevalence and clinical symptoms of OSA between men and women have been investigated in relation to AD risk. Further studies investigating AD biomarkers changes in patients with OSA and the effect of CPAP treatment should be auspicated in future for identifying strategies to prevent the development of AD.
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Affiliation(s)
- Claudio Liguori
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Michelangelo Maestri
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Matteo Spanetta
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Nicola B Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Santa Lucia Foundation, Rome, Italy
| | - Biancamaria Guarnieri
- Center of Sleep Medicine, Department of Neurology, Villa Serena Hospital, Città S. Angelo, Pescara, Italy; Villa Serena Foundation for the Research, Città S. Angelo, Pescara, Italy
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7
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It's complicated: The relationship between sleep and Alzheimer's disease in humans. Neurobiol Dis 2020; 144:105031. [PMID: 32738506 DOI: 10.1016/j.nbd.2020.105031] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by an asymptomatic period of amyloid-β (Aβ) deposition as insoluble extracellular plaque, intracellular tau aggregation, neuronal and synaptic loss, and subsequent cognitive dysfunction and dementia. A growing public health crisis, the worldwide prevalence of AD is expected to rise from 46.8 million individuals affected in 2015 to 131.5 million in 2050. Sleep disturbances have been associated with increased future risk of AD. A bi-directional relationship is hypothesized between sleep and AD with sleep disturbances as either markers for AD pathology and/or a mechanism mediating increased risk of AD. In this review, the evidence in humans supporting this complex relationship between sleep and AD will be discussed as well as the therapeutic potential and challenges of treating sleep disturbances to prevent or delay the onset of AD.
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8
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Shieu M, Morgenstern H, Bragg-Gresham J, Gillespie BW, Shamim-Uzzaman QA, Tuot D, Saydah S, Rolka D, Burrows NR, Powe NR, Saran R. US Trends in Prevalence of Sleep Problems and Associations with Chronic Kidney Disease and Mortality. KIDNEY360 2020; 1:458-468. [PMID: 35368590 PMCID: PMC8809315 DOI: 10.34067/kid.0000862019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/24/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND To better understand the relation between sleep problems and CKD, we examined temporal trends in the prevalence of self-reported sleep problems in adults in the United States and their associations with CKD and all-cause mortality. METHODS Using data from 27,365 adult participants in five biannual National Health and Examination Surveys (2005-2006 through 2013-2014), we studied five self-reported sleep problems-trouble sleeping, sleep disorder, nocturia (urinating ≥2 times/night), inadequate sleep (<7 hours/night), and excessive sleep (>9 hours/night)-plus a composite index. We conducted three types of analysis: temporal trends in the prevalence of each sleep measure by CKD status, using model-based standardization; cross-sectional analysis of associations between four CKD measures and each sleep measure, using logistic regression; and survival analysis of the association between each sleep measure and mortality, using Cox regression. RESULTS The prevalence of trouble sleeping and sleep disorder increased over the five surveys by 4% and 3%, respectively, whereas the other sleep problems remained relatively stable. All sleep problems, except inadequate sleep, were more common during the study period among adults with CKD than without CKD (40% versus 21% for nocturia; 5% versus 2% for excessive sleep; 30% versus 25% for trouble sleeping; 12% versus 8% for sleep disorder). Both eGFR <30 ml/min per 1.73 m2 and albuminuria were positively associated with nocturia and excessive sleep. Excessive sleep and nocturia were also associated with higher mortality (adjusted hazard ratio for >9 versus 7-9 hours/night=1.7; 95% CI, 1.3 to 2.1; and for nocturia=1.2; 95% CI, 1.1 to 1.4). CONCLUSIONS The high prevalence of sleep problems among persons with CKD and their associations with mortality suggest their potential importance to clinical practice. Future work could examine the health effects of identifying and treating sleep problems in patients with CKD.
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Affiliation(s)
- Monica Shieu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Environmental Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Bragg-Gresham
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brenda W. Gillespie
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Q. Afifa Shamim-Uzzaman
- Division of Neurology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Delphine Tuot
- Departments of Medicine, University of California San Francisco, San Francisco, California
| | - Sharon Saydah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Rolka
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Neil R. Powe
- Departments of Medicine, University of California San Francisco, San Francisco, California
| | - Rajiv Saran
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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9
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Grandner MA, Olivier K, Gallagher R, Hale L, Barrett M, Branas C, Killgore WDS, Parthasarathy S, Gehrels JA, Alfonso-Miller P. Quantifying impact of real-world barriers to sleep: The Brief Index of Sleep Control (BRISC). Sleep Health 2020; 6:587-593. [PMID: 32482573 DOI: 10.1016/j.sleh.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Lack of control over sleep may contribute to population-level sleep disturbances, yet relatively little work has explored the degree to which an individual's sense of control over their sleep may represent an important factor. METHODS Data from the Sleep and Healthy Activity Diet Environment and Socialization (SHADES) study, conducted in the Philadelphia area on a population comprising 1,007 individuals aged 22-60 years, was used. The BRief Index of Sleep Control (BRISC) was developed to quantify the degree to which an individual has control over their sleep. Reliability of the BRISC was assessed using Cronbach's alpha. Convergent validity was assessed by examining age-adjusted items and total score relationships to insomnia (ISI), sleepiness (ESS), sleep quality (PSQI), and total sleep time (NHANES). RESULTS After adjustment for covariates, greater control over sleep was associated with a lower PSQI score (B = -2.2, 95% CI [-2.4,-2.0], P < .0001), lower ISI score (B = -3.1, 95% CI [-3.5,-2.7], P < .0001), lower ESS score (B=-1.4, 95% CI [-1.7,-1.1], P < .0001), and more hours of sleep duration (B = 0.5, 95% CI [0.4,0.6], P < .0001). Each BRISC item was separately associated with each sleep outcome (P < .0001), although the items were not collinear with each other (all R<0.7). Thus, the BRISC instrument demonstrated high reliability and good validity. CONCLUSIONS Control over sleep may represent an important factor in sleep health. Control over time to bed, time awake, sleep duration, and sleep quality are all related to sleep outcomes and assessment of these constructs may be useful for future sleep interventions.
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Affiliation(s)
- Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ; UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ.
| | - Kayla Olivier
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Rebecca Gallagher
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Marna Barrett
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Charles Branas
- Department of Epidemiology and Biostatistics, Columbia University, New York, NY
| | | | | | - Jo-Ann Gehrels
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Pamela Alfonso-Miller
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
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10
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Spira AP, An Y, Wu MN, Owusu JT, Simonsick EM, Bilgel M, Ferrucci L, Wong DF, Resnick SM. Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET. Sleep 2019; 41:5088807. [PMID: 30192978 DOI: 10.1093/sleep/zsy152] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/14/2022] Open
Abstract
Study Objectives To determine the association of excessive daytime sleepiness (EDS) and napping with subsequent brain β-amyloid (Aβ) deposition in cognitively normal persons. Methods We studied 124 community-dwelling participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-report measures of EDS and napping at our study baseline and underwent [11C] Pittsburgh compound B positron emission tomography (PiB PET) scans of the brain, an average ±standard deviation of 15.7 ± 3.4 years later (range 6.9 to 24.6). Scans with a cortical distribution volume ratio of >1.06 were considered Aβ-positive. Results Participants were aged 60.1 ± 9.8 years (range 36.2 to 82.7) at study baseline; 24.4% had EDS and 28.5% napped. In unadjusted analyses, compared with participants without EDS, those with EDS had more than 3 times the odds of being Aβ+ at follow-up (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.44, 7.90, p = 0.005), and 2.75 times the odds after adjustment for age, age2, sex, education, and body mass index (OR = 2.75, 95% CI: 1.09, 6.95, p = 0.033). There was a trend-level unadjusted association between napping and Aβ status (OR = 2.01, 95% CI: 0.90, 4.50, p = 0.091) that became nonsignificant after adjustment (OR = 1.86, 95% CI: 0.73, 4.75, p = 0.194). Conclusions EDS is associated with more than 2.5 times the odds of Aβ deposition an average of 15.7 years later. If common EDS causes (e.g., sleep-disordered breathing, insufficient sleep) are associated with temporally distal AD biomarkers, this could have important implications for AD prevention.
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Affiliation(s)
- Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center on Aging and Health, Baltimore, MD
| | - Yang An
- National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Solomon Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Murat Bilgel
- National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Luigi Ferrucci
- National Institute on Aging Intramural Research Program, Baltimore, MD
| | - Dean F Wong
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Solomon Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD
- Russell H Morgan Department of Radiology, Division of Nuclear Medicine and Molecular Imaging/High Resolution Brain PET, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan M Resnick
- National Institute on Aging Intramural Research Program, Baltimore, MD
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11
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Carvalho DZ, St Louis EK, Knopman DS, Boeve BF, Lowe VJ, Roberts RO, Mielke MM, Przybelski SA, Machulda MM, Petersen RC, Jack CR, Vemuri P. Association of Excessive Daytime Sleepiness With Longitudinal β-Amyloid Accumulation in Elderly Persons Without Dementia. JAMA Neurol 2019. [PMID: 29532057 DOI: 10.1001/jamaneurol.2018.0049] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Aging is associated with excessive daytime sleepiness (EDS), which has been linked to cognitive decline in the elderly. However, whether EDS is associated with the pathologic processes of Alzheimer disease remains unclear. Objective To investigate whether EDS at baseline is associated with a longitudinal increase in regional β-amyloid (Aβ) accumulation in a cohort of elderly individuals without dementia. Design, Setting, and Participants This prospective analysis included participants enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study in Olmsted County, Minnesota. Of 2900 participants, 2172 (74.9%) agreed to undergo carbon 11-labeled Pittsburgh compound B positron emission tomography (PiB-PET). We included 283 participants 70 years or older without dementia who completed surveys assessing sleepiness at baseline and had at least 2 consecutive PiB-PET scans from January 1, 2009, through July 31, 2016, after excluding 45 (13.7%) who had a comorbid neurologic disorder. Main Outcomes and Measures Excessive daytime sleepiness was defined as an Epworth Sleepiness Scale score of at least 10. The difference in Aβ levels between the 2 consecutive scans (ΔPiB) in Aβ-susceptible regions (prefrontal, anterior cingulate, posterior cingulate-precuneus, and parietal) was determined. Multiple linear regression models were fit to explore associations between baseline EDS and ΔPiB while adjusting for baseline age, sex, presence of the apolipoprotein E ε4 allele, educational level, baseline PiB uptake, global PiB positivity (standardized uptake value ratio ≥1.4), physical activity, cardiovascular comorbidities (obesity, hypertension, hyperlipidemia, and diabetes), reduced sleep duration, respiratory symptoms during sleep, depression, and interval between scans. Results Of the initial 283 participants, mean (SD) age was 77.1 (4.8) years; 204 (72.1%) were men and 79 (27.9%) were women. Sixty-three participants (22.3%) had EDS. Baseline EDS was significantly associated with increased regional Aβ accumulation in the anterior cingulate (B coefficient = 0.031; 95% CI, 0.001-0.061; P = .04), posterior cingulate-precuneus (B coefficient = 0.038; 95% CI, 0.006-0.069; P = .02), and parietal (B coefficient = 0.033; 95% CI, 0.001-0.065; P = .04) regions. Association of EDS with longitudinal Aβ accumulation was stronger in participants with baseline global PiB positivity in the anterior cingulate (B coefficient = 0.065; 95% CI, 0.010-0.118; P = .02) and cingulate-precuneus (B coefficient = 0.068; 95% CI, 0.009-0.126; P = .02) regions. Conclusions and Relevance Baseline EDS was associated with increased longitudinal Aβ accumulation in elderly persons without dementia, suggesting that those with EDS may be more vulnerable to pathologic changes associated with Alzheimer disease. Further work is needed to elucidate whether EDS is a clinical marker of greater sleep instability, synaptic or network overload, or neurodegeneration of wakefulness-promoting centers. Early identification of patients with EDS and treatment of underlying sleep disorders could reduce Aβ accumulation in this vulnerable group.
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Affiliation(s)
| | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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12
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The estimation of excessive daytime sleepiness in post-stroke patients - a polysomnographic study. Respir Physiol Neurobiol 2019; 267:1-5. [PMID: 31136826 DOI: 10.1016/j.resp.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
Abstract
Excessive daytime sleepiness (EDS) has been reported in stroke patients. EDS in acute stroke was studied repeatedly, but there is a modest amount of data in post-stroke patients. The aim of this study was to assess the frequency of EDS and characterize sleep architecture in patients >3 months after stroke and identify factors which may affect EDS. 66 patients were enrolled, of which 33 had experienced stroke. All underwent a standardized overnight, diagnostic single night polysomnography, including electrocephalogram (EEG) leads, electrooculograms (EOG), chin electromyogram (EMG), and electrocardiogram (ECG). Epworth Sleepiness Scale (ESS) was used to measure subjects' level of daytime sleepiness. We observed similar total ESS score, total sleep time (TST), sleep efficiency, as well as respiratory disturbance index /apnea-hypopnea index (RDI/AHI), oxygen desaturation index (ODI) and mean heart rate in both groups. We observed positive linear correlation between EDS and mean heart rate in the stroke group (r = 0.46, p < 0.05) as well as between EDS and REM duration (r = 0.23, p < 0.05). In the non-stroke group EDS didn't correlate with the heart rate or with the REM duration. In the non-stroke group EDS correlated positively with RDI/AHI and ODI index (r = 0.46; p = <0.05 r = 0.41, p < 0.05 and maximal desaturation (r = 0.55, p < 0.05), this correlation was not observed in post-stroke group. In the both groups we observed negative linear correlation between BMI and saturation (stroke group - mean as well as minimal saturation (r = -0.458, p < 0.05; r = -0.578, p < 0.05), non stroke group - minimal but not mean saturation rate (r = -0.544, p < 0.05). We also noticed in both groups positive correlation between BMI and both AHI and ODI index (stroke group respectively: r = 0.430, p < 0.05; r = 0.451, p < 0.05; non-stroke group - BMI and ODI: r = 0.405, p < 0.05). The positive BMI correlation with RDI/AHI was not significant in the non-stroke group. We noticed that BMI correlates with non-REM sleep N1 (r = 0.760, p < 0.05) in post-stroke group, while it correlates negatively with REM sleep (r = -0.709, p < 0.05). There was no such correlation in the non-stroke group. In summary, in stroke patients subjective daytime sleepiness is associated with heart rate, but not with the severity of OSA. Thus ESS (Epworth Scale Score) may be not as useful as a marker of obstructive sleep apnea (OSA) presence or severity in post stroke patient as in the general population.
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13
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Association of health related quality of life domains with daytime sleepiness among elderly recipients of long-term services and supports. Geriatr Nurs 2019; 40:417-423. [PMID: 30853130 DOI: 10.1016/j.gerinurse.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 01/17/2023]
Abstract
Excessive daytime sleepiness (EDS) is prevalent in older adults; however, data are lacking that examine EDS across living environments. The aims of this secondary data analysis were to identify the prevalence and predictors of EDS among older adults receiving long-term services and supports (LTSS) in assisted living communities (ALCs), nursing homes (NHs), and the community. Participants (n = 470) completed multiple measures including daytime sleepiness. Logistic regression modeling was used to identify EDS predictors. Participants were primarily female and white with a mean age of 81 ± 9 years. The overall prevalence of EDS was 19.4%; the prevalence differed across living environment. Older adults in ALCs and NHs had higher odds of EDS than those living in the community. Also, depressive symptoms and number of bothersome symptoms predicted EDS. Upon admission for LTSS, evaluating older adults, especially those in ALCs and NHs, for depression and bothersome symptoms may reveal modifiable factors of EDS.
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14
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Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Prevalence and risk factors of excessive daytime sleepiness in major depression: A study with 703 individuals referred for polysomnography. J Affect Disord 2019; 243:23-32. [PMID: 30223136 DOI: 10.1016/j.jad.2018.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/30/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND To date, few studies have investigated the prevalence and risk factors of excessive daytime sleepiness (EDS) in major depression. Thus, the aim of the present study was to examine the prevalence and risk factors of EDS in a large sample of individuals with major depression. METHODS Data from 703 individuals with major depression were retrospectively collected from the sleep laboratory research database of Erasme Hospital for analysis. A score of > 10 on the Epworth Sleepiness Scale was used as the cut-off for EDS. Logistic regression analyses were conducted to examine the clinical and demographic risk factors of EDS in major depression. RESULTS The prevalence of EDS in our sample was 50.8%. Multivariate logistic regression analysis revealed that the following were significant risk factors of EDS in major depression: non-use of short to intermediate half-life benzodiazepine receptor agonists, BMI ≥ 25 kg/m², age < 60 years, C-reactive protein > 7 mg/L, Beck Depression Inventory score ≥ 16, atypical depression, apnea-hypopnea index ≥ 15/h, and use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. LIMITATIONS To evaluate EDS, we used the Epworth Sleepiness Scale, which only allows for a subjective measure of daytime sleepiness. CONCLUSION EDS is a common symptom in individuals with major depression. In this subpopulation, interventions are possible for most risk factors of EDS, which justifies improved management of this symptom to avoid its negative consequences.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Paul Linkowski
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
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15
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Benca RM, Teodorescu M. Sleep physiology and disorders in aging and dementia. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:477-493. [PMID: 31753150 DOI: 10.1016/b978-0-12-804766-8.00026-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sleep problems occur commonly in normal and pathologic aging. Older adults typically have more difficulty falling asleep and remaining asleep, report more daytime napping, and have an increased prevalence of primary sleep disorders such as insomnia, parasomnias, sleep apnea, and sleep-related movement disorders. Medical and psychiatric disorders as well as medications used to treat them also contribute to sleep disturbances in aging. Patients with mild cognitive impairment and dementia have more severe sleep problems, and disturbed sleep and sleep disorders contribute to earlier onset and more rapid progression of neurodegenerative disorders. Approaches to diagnosing and treating sleep disorders in the elderly are discussed.
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Affiliation(s)
- Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, United States.
| | - Mihai Teodorescu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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16
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Carleton EL, Barling J. Adult attention deficit hyperactivity disorder symptoms and passive leadership: The mediating role of daytime sleepiness. Stress Health 2018; 34:663-673. [PMID: 30187648 DOI: 10.1002/smi.2833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/11/2022]
Abstract
Passive leadership is attracting empirical interest with the detrimental effects of this type of leadership on a broad array of individual and organizational outcomes becoming apparent. However, just why leaders would engage in this type of nonleadership has received less research attention. We investigate whether and how leaders' attention deficit hyperactivity disorder (ADHD) is associated with passive leadership. Using a framework specifying how the physiology of sleepiness impacts the workplace, we hypothesize that leaders' ADHD is associated with passive leadership indirectly through daytime sleepiness. After controlling for leaders' age, gender, and preclinical symptoms of depression and anxiety, standard ordinary least squares regression procedures were implemented through Hayes' PROCESS models. Multisource data from 98 leader-follower groups (M number of followers per leader = 4.38, SD = 1.78) showed that the effects of leaders' ADHD symptoms on passive leadership were mediated by daytime sleepiness. Conceptual, methodological, and practical implications are discussed.
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Affiliation(s)
- Erica L Carleton
- Edwards School of Business, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julian Barling
- Smith School of Business, Queen's University, Kingston, Ontario, Canada
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17
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Morelhão PK, Pinto RZ, Gobbi C, Tufik S, Andersen ML. Can Sleep Problems Have a Negative Impact on Falls in Older People? J Clin Sleep Med 2018; 14:1821-1822. [PMID: 30353825 DOI: 10.5664/jcsm.7418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/26/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Priscila K Morelhão
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Rafael Z Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Cynthia Gobbi
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica L Andersen
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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18
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Moon C, Melah KE, Rivera-Rivera LA, Bratzke LC. Multimodal brain imaging investigation of self-reported sleep quality and daytime sleepiness in older adults with heart failure. Int J Neurosci 2018; 128:1044-1051. [PMID: 29745279 DOI: 10.1080/00207454.2018.1475374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE OF THE STUDY Individuals with heart failure (HF) have a high frequency of sleep problems. Patients with HF present with structural brain changes different from normal aging including reductions in brain volume, increases in white matter hyperintensity (WMH) and reduced cerebral blood flow. These structural changes in the brain may explain the pathophysiology of sleep and daytime problems. The objective of this study was to determine whether multimodal imaging data are related to self-reported sleep problems and daytime sleepiness in older adults with HF. METHODS Participants in this study underwent magnetic resonance imaging scans on the General Electric 3.0 T Discovery MR750 to acquire WMH, cerebral blood flow and brain volume. Data on 37 stable HF patients (mean age = 68; SD = 5.75) were included. RESULTS In this sample, WMH was associated with daytime sleepiness (p = 0.025). However, gray and white matter volume and cerebral blood flow were not associated with daytime sleepiness, sleep quality or insomnia. CONCLUSION Although further studies are needed to determine the relationship between WMH and sleep and daytime problems, the findings preliminarily support that increases in WMH from ischemic changes could explain increases in daytime sleepiness among people with HF.
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Affiliation(s)
- Chooza Moon
- a College of Nursing, University of Iowa , Iowa City , IA , USA
| | - Kelsey E Melah
- b School of Nursing, University of Wisconsin-Madison , Madison , WI , USA
| | | | - Lisa C Bratzke
- b School of Nursing, University of Wisconsin-Madison , Madison , WI , USA
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19
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Pérez-Carbonell L, Leschziner G. Clinical update on central hypersomnias. J Thorac Dis 2018; 10:S112-S123. [PMID: 29445535 PMCID: PMC5803059 DOI: 10.21037/jtd.2017.10.161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022]
Abstract
The central hypersomnias encompass a range of conditions causing persisting or intermittent excessive daytime sleepiness (EDS). These conditions therefore present not infrequently in general clinical sleep practice, and remain in the differential for patients presenting with sleepiness. Our understanding of the pathophysiology, diagnosis and management of these conditions has progressed significantly over recent years, and in this article we review this group of disorders, focussing in particular on recent changes in classification and diagnosis, pathophysiological advances, and novel treatment options.
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Affiliation(s)
- Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
| | - Guy Leschziner
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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20
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Papadopoulos D, Kikemeni A, Skourti A, Amfilochiou A. The influence of socio-economic status on the severity of obstructive sleep apnea: a cross-sectional observational study. ACTA ACUST UNITED AC 2018; 11:92-98. [PMID: 30083296 PMCID: PMC6056066 DOI: 10.5935/1984-0063.20180018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is limited evidence about the effect of socio-economic status (SES) on the
severity of obstructive sleep apnea (OSA). We aimed to investigate this
relationship in a referral population in Greece, with regards to other
established risk factors. Methods: We used a retrospective
cross-sectional design to assess socio-economic status based on occupational
activity in a sample of 282 OSA patients diagnosed in a public hospital sleep
laboratory during one-year period. Demographic, anthropometric and social
characteristics, as well as the Epworth sleepiness scale (ESS) scores and
apnea-hypopnea indexes (AHI) of subjects in each socio-economic class were
recorded and statistically significant differences were explored in univariate
and multiple regression analysis. Results: 99 (35.1%) of the
subjects were categorized in the upper, 70 (24.8%) in the intermediate and 113
(40.1%) in the working class. Subjects of the intermediate class had
significantly larger neck circumference than those of the upper class
(p=0.022). Neither class differed significantly in terms of
ESS score and intermediate class had a trend for higher AHI than upper class
(p=0.075 in univariate and p=0.082 in
multivariate analysis). Age (p=0.020) and occasional alcohol
consumption (p=0.022) were independent negative and neck
circumference (p<0.001) positive correlates of the variance
in ESS score, while body mass index (p=0.004), neck
circumference (p<0.001), being married
(p=0.014) and current smoker (p=0.025) were
independent positive correlates of the variance in AHI. Discussion:
SES has a minor effect on OSA severity that is only partially accounted for by
other known risk factors. Neck circumference was found to be the most useful
predictor of both subjective daytime sleepiness and severity of respiratory
events during sleep.
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Affiliation(s)
- Dimitrios Papadopoulos
- National School of Public Health, Department of Occupational and Industrial Hygiene - Athens - Attica - Grécia
| | - Anastasia Kikemeni
- National School of Public Health, Department of Occupational and Industrial Hygiene - Athens - Attica - Grécia
| | - Alexandra Skourti
- National School of Public Health, Department of Occupational and Industrial Hygiene - Athens - Attica - Grécia
| | - Anastasia Amfilochiou
- "Sismanoglio" General Hospital of Attica, Respiratory Function & Sleep Study Unit - Marousi - Attica - Grécia
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21
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Prevalence and risk factors of excessive daytime sleepiness in insomnia sufferers: A study with 1311 individuals. J Psychosom Res 2017; 103:63-69. [PMID: 29167048 DOI: 10.1016/j.jpsychores.2017.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Several studies have investigated the prevalence and risk factors of excessive daytime sleepiness in the general population. However, few studies have investigated these in the particular subpopulation of insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of excessive daytime sleepiness in a large sample of insomnia sufferers. METHODS Data from 1311 insomnia sufferers with age≥18years and recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. A score>10 on the Epworth scale was used as the cut-off score for excessive daytime sleepiness. Logistic regression analyses were conducted to examine clinical and demographic risk factors of excessive daytime sleepiness in insomnia sufferers. RESULTS The prevalence of excessive daytime sleepiness in our sample was 45.61%. Multivariate logistic regression analysis revealed that non-use of Z-drugs, non-use of Trazodone alone or in combination, body mass index≥25 & <30kg/m2, body mass index≥30kg/m2, age≥18 & <40years, age≥40 & <65years, Beck depression inventory score≥5 & <16, Beck depression inventory score≥16, apnea-hypopnea index≥15/h, and use of selective serotonin reuptake inhibitors were significant risk factors of excessive daytime sleepiness in the subpopulation of insomnia sufferers. CONCLUSION Excessive daytime sleepiness is a common complaint for individuals with insomnia. In this subpopulation, most of the risk factors for excessive daytime sleepiness are reversible, which justifies better management of this complaint to avoid its negative consequences.
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22
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Abstract
Excessive daytime sleepiness has pathologic causes and numerous adverse consequences; therefore, it requires medical attention in older adults. Excessive sleepiness in older adults is often multifactorial and may signal an underlying sleep disorder, chronic medical condition, undiagnosed mood disorder, or side effects of medications. It is associated with increased risk for cognitive decline and dementia in the elderly. Excessive sleepiness often requires a multi-method assessment in this age group. It is pertinent to take a systematic, step-by-step treatment approach geared toward the underlying cause, and to treat sleepiness directly, when the cause cannot be eliminated to prevent adverse outcomes.
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Affiliation(s)
- Dora Zalai
- Department of Psychology, Ryerson University, 790 Bay Street, Toronto, Ontario M5B 2K8, Canada
| | - Arina Bingeliene
- Department of Neurology, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Colin Shapiro
- Department of Neurology, University Health Network, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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23
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Onen F, Lalanne C, Pak VM, Gooneratne N, Falissard B, Onen SH. A Three-Item Instrument for Measuring Daytime Sleepiness: The Observation and Interview Based Diurnal Sleepiness Inventory (ODSI). J Clin Sleep Med 2016; 12:505-12. [PMID: 26612511 DOI: 10.5664/jcsm.5676] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/02/2015] [Indexed: 01/23/2023]
Abstract
STUDY OBJECTIVES We aimed to develop a new three-item assessment tool for daytime sleepiness in older adults, the Observation and interview-based Diurnal Sleepiness Inventory (ODSI) and determine its validity, internal consistency, test-retest reliability, and optimal cutoff score. METHODS A total of 133 elderly subjects including 73 patients with obstructive sleep apnea (OSA) (mean age, 79 y) and 60 controls (mean age, 80 y) were consecutively enrolled and answered all questionnaires. The ODSI questionnaire was validated using the Epworth Sleepiness Scale considered as a gold standard. Reliability, validity, and cut-points were tested. RESULTS The ODSI has acceptable validity, internal consistency, and test-retest reliability properties. The ODSI has internal consistency and a reliability coefficient (Pearson rho) of 0.70 for its three items, which suggests strong reliability. The estimated sensitivity and specificity were 0.842 with 95% confidence interval [0.624; 0.945] and 0.851 [0.761; 0.911], respectively. The consistency of summated scale scores during test and retest sessions was high (r = 0.970, 95% bootstrap confidence interval [0.898; 0.991]). Receiver operating characteristic analysis suggests that a cut-point of 6 is effective for identifying older adults with excessive levels of daytime sleepiness. CONCLUSIONS The ODSI is a brief, valid, easy-to-administer three-item assessment that can screen for excessive daytime sleepiness among elderly patients with OSA.
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Affiliation(s)
- Fannie Onen
- CHU Bichat Claude Bernard, APHP, Service de Gériatrie, Paris, France.,Université Paris Descartes, INSERM, Paris, France.,Center for Sleep and Circadian Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Victoria M Pak
- Center for Sleep and Circadian Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nalaka Gooneratne
- Center for Sleep and Circadian Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA.,Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Saban-Hakki Onen
- Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA.,Hôpital Eduard Herriot, Centre Gériatrique de Médecine du Sommeil, Lyon, France
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Furihata R, Kaneita Y, Jike M, Ohida T, Uchiyama M. Napping and associated factors: a Japanese nationwide general population survey. Sleep Med 2016; 20:72-9. [DOI: 10.1016/j.sleep.2015.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/01/2015] [Accepted: 12/16/2015] [Indexed: 11/28/2022]
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25
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Gracitelli CPB, Duque-Chica GL, Moura ALDA, Roizenblatt M, Nagy BV, de Melo GR, Borba PD, Teixeira SH, Tufik S, Ventura DF, Paranhos A. Relationship between Daytime Sleepiness and Intrinsically Photosensitive Retinal Ganglion Cells in Glaucomatous Disease. J Ophthalmol 2016; 2016:5317371. [PMID: 26955483 PMCID: PMC4756205 DOI: 10.1155/2016/5317371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/02/2016] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
Patients with glaucoma showed to have higher daytime sleepiness measured by Epworth sleepiness scale. In addition, this symptom was associated with pupillary reflex and polysomnography parameters. These ipRGC functions might be impaired in patients with glaucoma, leading to worse quality of life.
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Affiliation(s)
- Carolina P. B. Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
| | - Gloria Liliana Duque-Chica
- Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Laura de Araújo Moura
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
- Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, SP, Brazil
| | - Marina Roizenblatt
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
| | - Balazs V. Nagy
- Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, SP, Brazil
| | - Geraldine Ragot de Melo
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
| | - Paula Delegrego Borba
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
| | - Sérgio H. Teixeira
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
| | - Sergio Tufik
- Sleep Medicine Division, Psychobiology Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Dora Fix Ventura
- Experimental Psychology Department, Institute of Psychology, University of São Paulo, São Paulo, SP, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821 Vila Clementino, 04023-062 São Paulo, SP, Brazil
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Hayley AC, Williams LJ, Kennedy GA, Holloway KL, Berk M, Brennan-Olsen SL, Pasco JA. Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample. BMC Geriatr 2015; 15:74. [PMID: 26141865 PMCID: PMC4491238 DOI: 10.1186/s12877-015-0068-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/03/2015] [Indexed: 01/11/2023] Open
Abstract
Background Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR = 2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p < .001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR = 2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p = 0.06), however, age explained this relationship (age adjusted OR = 2.20, 95 % CI 1.03-1.10). Conclusions For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.
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Affiliation(s)
- Amie C Hayley
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
| | - Lana J Williams
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia.
| | - Gerard A Kennedy
- School of Psychology, Counselling & Psychotherapy, Cairnmillar Institute, 993 Burke Road, Camberwell, Australia. .,Institute for Breathing and Sleep, Bowen Centre, Austin Health, PO Box 5555, Heidelberg, Melbourne, Australia.
| | - Kara L Holloway
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia.
| | - Michael Berk
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,Department of Psychiatry, The University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, Australia. .,Orygen, the National Centre of Excellence for Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia. .,Florey Institute for Neuroscience and Mental Health, 30 Royal Parade, Parkville, Melbourne, Australia.
| | - Sharon L Brennan-Olsen
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia.
| | - Julie A Pasco
- IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia.
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Grandner MA. Sleep Deprivation: Societal Impact and Long-Term Consequences. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee HJ, Oh KS, Kim T, Lee CS, Jeong J, Youn SY, Yoon IY. Prevalence, Risk Factors, and Impact of Excessive Daytime Sleepiness in an Elderly Korean Population. SLEEP MEDICINE RESEARCH 2014. [DOI: 10.17241/smr.2014.5.2.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lee SD, Kang SH, Ju G, Han JW, Kim TH, Lee CS, Kim T, Kim KW, Yoon IY. The prevalence of and risk factors for sleep-disordered breathing in an elderly Korean population. Respiration 2014; 87:372-8. [PMID: 24714628 DOI: 10.1159/000358442] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are just a few epidemiological studies on sleep-disordered breathing (SDB) in the elderly, and the results are inconsistent. STUDY OBJECTIVES We sought to investigate the prevalence of and risk factors for SDB in a representative elderly population with the use of attended nocturnal polysomnography (NPSG). METHODS Among 6,959 individuals aged ≥ 60 years living in Yongin City, Korea, 696 subjects were selected using random sampling. All the subjects were invited to visit a hospital for NPSG, and SDB was defined as an apnea-hypopnea index ≥ 15. RESULTS Of the 696 participants investigated, 348 participants completed the sleep study and clinical evaluation. SDB was observed in 127 of the 348 participants, and the prevalence of SDB was 36.5% (52.6% in males and 26.3% in females). A body mass index ≥ 25 was associated with SDB in both male and female subjects, particularly in males, whereas snoring was independently associated with SDB in female participants only. In male participants, SDB was a significant risk factor for hypertension (p = 0.025). CONCLUSIONS SDB was found to be common among elderly Koreans, and it was more prevalent and severe in male than in female subjects. Health consequences of SDB in the elderly need to be further explored.
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Affiliation(s)
- Sang Don Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Abete P, Testa G, Della-Morte D, Gargiulo G, Galizia G, de Santis D, Magliocca A, Basile C, Cacciatore F. Treatment for chronic heart failure in the elderly: current practice and problems. Heart Fail Rev 2014; 18:529-51. [PMID: 23124913 DOI: 10.1007/s10741-012-9363-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment for chronic heart failure (CHF) is strongly focused on evidence-based medicine. However, large trials are often far away from the "real world" of geriatric patients and their messages are poorly transferable to the clinical management of CHF elderly patients. Precipitating factors and especially non-cardiac comorbidity may decompensate CHF in the elderly. More importantly, drugs of first choice, such as angiotensin-converting enzyme inhibitors and β-blockers, are still underused and effective drugs on diastolic dysfunction are not available. Poor adherence to therapy, especially for cognitive and depression disorders, worsens the management. Electrical therapy is indicated, but attention to the older age groups with reduced life expectancy has to be paid. Physical exercise, stem cells, gene delivery, and new devices are encouraging, but definitive results are still not available. Palliative care plays a key role to the end-stage of the disease. Follow-up of CHF elderly patient is very important but tele-medicine is the future. Finally, self-care management, caregiver training, and multidimensional team represent the critical point of the treatment for CHF elderly patients.
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Affiliation(s)
- Pasquale Abete
- Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria, Università degli Studi di Napoli Federico II, 80131 Naples, Italy.
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Daytime sleepiness: associations with alcohol use and sleep duration in americans. SLEEP DISORDERS 2014; 2014:959152. [PMID: 24672731 PMCID: PMC3927862 DOI: 10.1155/2014/959152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/29/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022]
Abstract
The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES) 2007-2008 (N = 2919) using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use). A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58–0.95)], a decreased log drinking frequency [0.90 (95% CI, 0.83–0.98)], and lower sleep duration [OR = 0.75 (95% CI, 0.67–0.84)]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (P = 0.004). Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking.
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Endeshaw Y, Rice TB, Schwartz AV, Stone KL, Manini TM, Satterfield S, Cummings S, Harris T, Pahor M. Snoring, daytime sleepiness, and incident cardiovascular disease in the health, aging, and body composition study. Sleep 2013; 36:1737-45. [PMID: 24179308 DOI: 10.5665/sleep.3140] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the association between snoring and incident cardiovascular disease (CVD). DESIGN SETTINGS AND PARTICIPANTS This is a prospective study in which community dwelling older adults were evaluated at baseline, and followed up for an average of 9.9 years. MEASUREMENTS Data on snoring, daytime sleepiness, as well as demographic and clinical characteristics of study participants was collected at baseline, and participants were followed up every six months for an average of 9.9 years. Based on snoring and sleepiness status, 4 groups of participants were created: (1) No Snoring, No Sleepiness; (2) No Snoring, Sleepiness; (3) Snoring, No Sleepiness; (4) Snoring, Sleepiness. Incident CVD was defined as a diagnosis of myocardial infarction, angina pectoris, or congestive heart failure that resulted in overnight hospitalization during the follow-up period. Cox proportional hazard was used to estimate the risk of incident cardiovascular disease during follow-up by baseline snoring and sleepiness status. RESULTS A total of 2,320 participants with a mean age of 73.6 (2.9) years at baseline were included in the analysis. Fifty-two percent were women, and 58% were white. A total of 543 participants developed CVD events during the follow-up period. Participants who reported snoring associated with daytime sleepiness had significantly increased hazard ratio for CVD events (HR = 1.46 [1.03-2.08], P = 0.035) after adjusting for demographic and clinical confounding factors. CONCLUSION The results suggest that self-reported snoring and daytime sleepiness status are associated with an increased risk of future cardiovascular disease among older adults.
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Philip P, Chaufton C, Taillard J, Sagaspe P, Léger D, Raimondi M, Vakulin A, Capelli A. Maintenance of Wakefulness Test scores and driving performance in sleep disorder patients and controls. Int J Psychophysiol 2013; 89:195-202. [PMID: 23727627 DOI: 10.1016/j.ijpsycho.2013.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Sleepiness at the wheel is a risk factor for traffic accidents. Past studies have demonstrated the validity of the Maintenance of Wakefulness Test (MWT) scores as a predictor of driving impairment in untreated patients with obstructive sleep apnea syndrome (OSAS), but there is limited information on the validity of the maintenance of wakefulness test by MWT in predicting driving impairment in patients with hypersomnias of central origin (narcolepsy or idiopathic hypersomnia). The aim of this study was to compare the MWT scores with driving performance in sleep disorder patients and controls. METHODS 19 patients suffering from hypersomnias of central origin (9 narcoleptics and 10 idiopathic hypersomnia), 17 OSAS patients and 14 healthy controls performed a MWT (4×40-minute trials) and a 40-minute driving session on a real car driving simulator. Participants were divided into 4 groups defined by their MWT sleep latency scores. The groups were pathological (sleep latency 0-19 min), intermediate (20-33 min), alert (34-40 min) and control (>34 min). The main driving performance outcome was the number of inappropriate line crossings (ILCs) during the 40 minute drive test. RESULTS Patients with pathological MWT sleep latency scores (0-19 min) displayed statistically significantly more ILC than patients from the intermediate, alert and control groups (F (3, 46)=7.47, p<0.001). INTERPRETATION Pathological sleep latencies on the MWT predicted driving impairment in patients suffering from hypersomnias of central origin as well as in OSAS patients. MWT is an objective measure of daytime sleepiness that appears to be useful in estimating the driving performance in sleepy patients.
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Affiliation(s)
- Pierre Philip
- Univ. de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, F-33000 Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000 Bordeaux, France; CHU Pellegrin, F-33076 Bordeaux, France
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Jaussent I, Empana JP, Ancelin ML, Besset A, Helmer C, Tzourio C, Ritchie K, Bouyer J, Dauvilliers Y. Insomnia, daytime sleepiness and cardio-cerebrovascular diseases in the elderly: a 6-year prospective study. PLoS One 2013; 8:e56048. [PMID: 23457496 PMCID: PMC3573087 DOI: 10.1371/journal.pone.0056048] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/04/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine 1) the associations between history of cardio-cerebrovascular diseases (CVD) and insomnia complaints and excessive daytime sleepiness (EDS), and 2) the relationships between sleep complaints and future CVD in persons over 65. METHODS CVD was assessed at baseline and during two, four, and six-year follow-up in 5494 non-demented subjects. Self-reported insomnia complaints (poor sleep quality, difficulty in initiating sleep, difficulty in maintening sleep, and early morning awakening), EDS and sleep medication use were evaluated at baseline. Logistic regression models and Cox proportional hazard models, with delayed entry and age of participants as the time scale, were adjusted for socio-demographic, lifestyle and clinical variables. RESULTS At baseline, 748 participants had a past-history of CVD. A past-history of CVD was associated with EDS (OR = 1.28 95%CI = [1.05-1.57]) and the number of insomnia complaints (OR = 1.26 95%CI = [1.03-1.55] for 1-2 insomnia complaints; OR = 1.32 95%CI = [1.03-1.71] for ≥3 complaints). In longitudinal analyses, neither the four components of insomnia nor the number of insomnia complaints were significantly associated with first or recurrent CVD events (n = 391 events). EDS was independently associated with future CVD events even after adjusting for prescribed sleep medication and past-history of CVD (HR = 1.35 95%CI = [1.06-1.71]). CONCLUSION Our results suggest that the relationships between sleep complaints and CVD could be complex. Insomnia complaints are more likely a consequence of CVD, whereas EDS appears to be a determinant of CVD independently of past-history of CVD. EDS screening may thus constitute a means of detecting persons at high risk of CVD.
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Affiliation(s)
- Isabelle Jaussent
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, Montpellier, France
| | - Jean-Philippe Empana
- Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France
| | - Marie-Laure Ancelin
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, Montpellier, France
| | - Alain Besset
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, Montpellier, France
| | - Catherine Helmer
- Inserm, U897, Bordeaux, France
- Université Victor Segalen Bordeaux 2, ISPED, Bordeaux, France
| | - Christophe Tzourio
- Inserm, U897, Bordeaux, France
- Université Victor Segalen Bordeaux 2, ISPED, Bordeaux, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, Montpellier, France
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - Jean Bouyer
- Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
- Univ Paris Sud, UMR-S1018, Villejuif, France
| | - Yves Dauvilliers
- Inserm, U1061, Montpellier, France
- Université Montpellier 1, Montpellier, France
- CHU Montpellier, Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac, Montpellier, France
- * E-mail:
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Riegel B, Glaser D, Richards K, Sayers SL, Marzolf A, Weintraub WS, Goldberg LR. Modifiable factors associated with sleep dysfunction in adults with heart failure. Eur J Cardiovasc Nurs 2012; 11:402-9. [PMID: 21353642 PMCID: PMC3106140 DOI: 10.1016/j.ejcnurse.2011.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep dysfunction contributes to poor quality of life in adults with heart failure (HF). The purpose of this study was to identify factors associated with sleep dysfunction that may be modifiable. METHODS Data were collected from 266 subjects enrolled from three sites in the U.S. Sleep dysfunction was measured over the past month with the Pittsburgh sleep quality index, using a score > 10 to indicate sleep dysfunction. Potentially modifiable clinical, behavioral, and psychological factors thought to be associated with sleep dysfunction were analyzed with hierarchical logistic regression analysis. RESULTS When covariates of age, gender, race, data collection site, and New York Heart Association (NYHA) functional class were entered on the first step, only NYHA was a significant correlate of sleep dysfunction. When the clinical, behavioral, and psychological factors were entered, correlates of sleep dysfunction were the number of drugs known to cause daytime somnolence (OR = 2.08), depression (OR = 1.83), worse overall perceived health (OR = 1.64), and better sleep hygiene (OR = 1.40). Although most (54%) subjects had sleep disordered breathing (SDB), SDB was not a significant predictor of sleep dysfunction. DISCUSSION Factors associated with sleep dysfunction in HF include medications with sleepiness as a side-effect, depression, poorer health perceptions, and better sleep hygiene. Sleep dysfunction may motivate HF patients to address sleep hygiene. Eliminating medications with sleepiness as a side-effect, treating depression and perceptions of poor health may improve sleep quality in HF patients.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia 19104–4217, USA.
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Johansson P, Riegel B, Svensson E, Broström A, Alehagen U, Dahlström U, Jaarsma T. The contribution of heart failure to sleep disturbances and depressive symptoms in older adults. J Geriatr Psychiatry Neurol 2012; 25:179-87. [PMID: 23124012 DOI: 10.1177/0891988712458366] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to explore the associations between physical symptoms, sleep disturbances, and depressive symptoms in community-dwelling elderly individuals, comparing persons with and without heart failure (HF). METHODS A total of 613 older adults (mean age 78 years) underwent clinical and echocardiographic examinations. Questionnaires were used to evaluate sleep disturbances and depressive symptoms. A model was developed in those with HF (n = 107) and compared with those without HF (n = 506). RESULTS Cardiopulmonary symptoms (ie, dyspnea and nighttime palpitations) and pain had significant direct associations with sleep disturbances, which indirectly affected depressive symptoms. The model was essentially the same in those with and without HF except that the effect of sleep disturbances on depressive symptoms was stronger in those with HF (β = 0.64 vs β = 0.45, P = .006). CONCLUSION In community-dwelling older adults, regardless of their diagnosis, physical symptoms had a direct effect on sleep disturbances and an indirect effect on depressive symptoms.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden.
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Czeisler CA. Impact of sleepiness and sleep deficiency on public health--utility of biomarkers. J Clin Sleep Med 2012; 7:S6-8. [PMID: 22003334 DOI: 10.5664/jcsm.1340] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sleep disorders and sleep deficiency are important causes of adverse health effects and increased mortality in the United States and worldwide. Sleep deficiency can also result in myriad adverse behavioral consequences, including profound sleepiness, cognitive slowing, automatic behavior, attentional failures and performance degradation, errors, and accidents. It is important to recognize that sleepiness and sleep deficiency are not synonymous.
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Affiliation(s)
- Charles A Czeisler
- Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, USA.
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Riegel B, Ratcliffe SJ, Sayers SL, Potashnik S, Buck HG, Jurkovitz C, Fontana S, Weaver TE, Weintraub WS, Goldberg LR. Determinants of excessive daytime sleepiness and fatigue in adults with heart failure. Clin Nurs Res 2011; 21:271-93. [PMID: 21878581 DOI: 10.1177/1054773811419842] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about excessive daytime sleepiness (EDS) in heart failure (HF). The aim of this cross-sectional descriptive study was to describe the prevalence of EDS and factors associated with it in HF. A secondary purpose was to explore the correlates of fatigue. We enrolled a consecutive sample of 280 adults with a confirmed diagnosis of chronic HF from three outpatient settings in the northeastern United States. Patients with major depressive illness were excluded. Clinical, sociodemographic, behavioral, and perceptual factors were explored as possible correlates of EDS. Using an Epworth Sleepiness Scale score > 10, the prevalence of EDS was 23.6%. Significant determinants of EDS were worse sleep quality (p = .048), worse functional class (p = .004), not taking a diuretic (p = .005), and lack of physical activity (p = .04). Only sleep quality was associated with fatigue (p < .001). Sleep-disordered breathing was not significantly associated with EDS or with fatigue. These factors may be amenable to intervention.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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Enderlin CA, Coleman EA, Cole C, Richards KC, Kennedy RL, Goodwin JA, Hutchins LF, Mack K. Subjective Sleep Quality, Objective Sleep Characteristics, Insomnia Symptom Severity, and Daytime Sleepiness in Women Aged 50 and Older With Nonmetastatic Breast Cancer. Oncol Nurs Forum 2011; 38:E314-25. [DOI: 10.1188/11.onf.e314-e325] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gooneratne NS, Richards KC, Joffe M, Lam RW, Pack F, Staley B, Dinges DF, Pack AI. Sleep disordered breathing with excessive daytime sleepiness is a risk factor for mortality in older adults. Sleep 2011; 34:435-42. [PMID: 21461321 DOI: 10.1093/sleep/34.4.435] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness (EDS) is associated with increased mortality in older adults, yet sleep disordered breathing (SDB), a common cause of sleepiness, has not been shown to increase mortality in older adults. This study examined the relationship between daytime sleepiness, SDB, self-report sleep parameters, and mortality in older adults. DESIGN Longitudinal cohort study. SETTING Clinical and Translational Research Center, at-home testing. PARTICIPANTS 289 study participants (age >65, no dementia or depression at the time of enrollment) classified as having EDS (n=146) or not (n=143). MEASUREMENTS AND RESULTS Study participants underwent in-lab polysomnography and multiple sleep latency testing at cohort inception. Survival analysis was conducted, with an average follow-up of 13.8 years. Excessive daytime sleepiness was associated with an unadjusted mortality hazard ratio of 1.5 (95% CI 1.1-2.0). The unadjusted mortality hazard ratio for study participants with both EDS and SDB (apnea-hypopnea index ≥20 events/h) was 2.7, 95% CI: 1.8-4.2. These findings persisted with an adjusted mortality hazard ratio of 2.3, 95% CI: 1.5-3.6 in the final model that included other covariates associated with increased mortality (sleep duration >8.5 h, self-reported angina, male gender, African American race, and age). CONCLUSION The presence of SDB is an important risk factor for mortality from excessive daytime sleepiness in older adults. In the presence of SDB at an AHI ≥20 events/h, EDS was associated with an increased all-cause mortality risk in older adults, even when adjusting for other significant risk factors, such as prolonged sleep duration. In older patients who had SDB without EDS, or EDS without SDB, there was no increased all-cause mortality rate.
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Affiliation(s)
- Nalaka S Gooneratne
- Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Sforza E, Roche F, Thomas-Anterion C, Kerleroux J, Beauchet O, Celle S, Maudoux D, Pichot V, Laurent B, Barthélémy JC. Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study. Sleep 2010; 33:515-21. [PMID: 20394321 DOI: 10.1093/sleep/33.4.515] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep related breathing disorders (SRBD) are risk factors for cognitive dysfunction in middle-aged subjects, but this association has not been observed in the elderly. We assess the impact of SRBD on cognitive performance in a large cohort of healthy elderly subjects. DESIGN Cross-sectional study examining the association between subjective memory test, neuropsychological battery testing and SRBD in the elderly. SETTING Community-based sample in home and research clinical settings. PARTICIPANTS 827 subjects, 58.5% women, aged 68 y at study entry, participated in the study. All were free of previously diagnosed SRBD, coronary heart disease, and neurological disorders, including stroke and dementia. Clinical interview, neurological assessment, polygraphy, and extensive cognitive testing were conducted for all participants. INTERVENTION N/A. MEASUREMENT AND RESULTS SRBD (apnea-hypopnea index [AHI] > 15 events/h) was diagnosed in 445 (53%) subjects, 167 (37%) of them with AHI > 30. Minimal daytime sleepiness was found in the group; 9.2% of the population had an Epworth Sleepiness Scale score > 10. No significant association was found between AHI, nocturnal hypoxemia, and cognitive scores. Comparison of mild vs severe cases showed a trend toward lower cognitive scores with AHI > 30, affecting delayed recall and Stroop test. CONCLUSIONS The impact of undiagnosed SRBD on cognitive function appeared quite limited in a generally older healthy population, and only slightly affected severe cases. The implication of undiagnosed SRBD on the cognitive impairment in elderly subjects remains hypothetical and needs to be prospectively studied.
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Affiliation(s)
- Emilia Sforza
- Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, Faculté de Médecine J. Lisfranc, UJM et PRES Université de Lyon, Saint-Etienne, France
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Riegel B, Weaver TE. Poor sleep and impaired self-care: towards a comprehensive model linking sleep, cognition, and heart failure outcomes. Eur J Cardiovasc Nurs 2009; 8:337-44. [PMID: 19679510 PMCID: PMC2788056 DOI: 10.1016/j.ejcnurse.2009.06.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 01/28/2009] [Accepted: 06/13/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Persons with heart failure (HF) have significantly lower sleep quantity and quality than persons without HF. The purpose of this article is to propose a conceptual model describing how poor sleep may contribute to inadequate self-care and untoward outcomes in persons with HF. AIMS Our overarching hypothesis is that sleep affects self-care and outcomes through its effects on cognition. Building on the work of others, we outline a conceptual model that illustrates that even transient sleep disruption prevents sleep-related restorative processes and contributes to cognitive dysfunction-especially in the 25-50% of HF patients with existing cognitive impairment. Poor sleep may be sufficient to impair cognition to a level that interferes with higher order functions involved in effective HF self-care practices. Through these mechanisms, inadequate sleep may contribute to poor outcomes such as low health-related quality of life and greater risk of unplanned hospitalization. CONCLUSION The proposed model (1) bridges physical, neuropsychological and behavioral phenomena, (2) suggests a mechanism by which poor sleep affects daytime behavior, and (3) is empirically testable. Exploring factors that interfere with sleep may improve self-care and outcomes in persons with HF.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-6020, USA.
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Problems associated with short sleep: bridging the gap between laboratory and epidemiological studies. Sleep Med Rev 2009; 14:239-47. [PMID: 19896872 DOI: 10.1016/j.smrv.2009.08.001] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 08/21/2009] [Accepted: 09/01/2009] [Indexed: 11/24/2022]
Abstract
Existing data from laboratory studies suggest a number of negative consequences of acute reductions in sleep time. Also, epidemiological data suggest links between shorter self-reported sleep duration and negative health outcomes. These bodies of work are growing, revealing several key points of convergence and opportunities for future exploration. In addition, they begin to highlight possible problems experienced by "short sleepers," who sleep approximately 6h or less per night. While it is likely that this group is heterogeneous, comprised both of individuals with less need for sleep and those not sleeping enough, the laboratory and epidemiological findings point towards directions that can be more fully explored in verified short sleepers. This paper discusses problems associated with the terminology used to describe "short sleep," summarizes laboratory studies exploring neurobehavioral performance, metabolism and obesity, and psychological health and epidemiological studies exploring mortality risk, obesity and metabolism, cardiovascular disease, and general health/psychosocial stress, describes studies of verified short sleepers and explores areas of convergence, laying out possible future directions.
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Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, Gurvitz MZ, Havranek EP, Lee CS, Lindenfeld J, Peterson PN, Pressler SJ, Schocken DD, Whellan DJ. State of the Science. Circulation 2009; 120:1141-63. [DOI: 10.1161/circulationaha.109.192628] [Citation(s) in RCA: 638] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Prevalence of excessive daytime sleepiness and associated factors in the adult population of Korea. Sleep Med 2009; 10:182-8. [DOI: 10.1016/j.sleep.2008.03.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 03/24/2008] [Accepted: 03/31/2008] [Indexed: 11/20/2022]
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Chasens ER, Umlauf MG, Weaver TE. Sleepiness, physical activity, and functional outcomes in veterans with type 2 diabetes. Appl Nurs Res 2009; 22:176-82. [PMID: 19616165 DOI: 10.1016/j.apnr.2007.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 12/06/2007] [Accepted: 12/08/2007] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to explore the association between daytime sleepiness on physical activity and functional outcomes in veterans with type 2 diabetes. Physical activity was based on mean self-reported minutes walked per week; the American Diabetes Association's recommendation of 150 minutes activity per week was used to dichotomize participants as sedentary or active. The Epworth Sleepiness Scale measured sleepiness. Sleepy participants had significantly lower scores on the Functional Outcomes of Sleep Questionnaire. Sleepiness was predictive of being sedentary (p = .01) after controlling for age and body mass index. The conclusion is that daytime sleepiness may impede physical activity among veterans with diabetes, confounding self-management.
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Affiliation(s)
- Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Abstract
Nominal group technique was used with persons with type 2 diabetes to identify and rank the severity of problems associated with being sleepy. Participants were adults who were subjectively sleepy according to the Epworth Sleepiness Scale. Daytime sleepiness was associated with a general decrease in motivation to engage in activities that are important to the management of diabetes. Because decreased motivation may have a negative influence on psychological well-being, it is important that health care providers assess not only for how well their patients' diabetes is being controlled, but also for sleep disturbances and the patients' general state of psychological well-being.
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Affiliation(s)
- Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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