Sleep in the Aging Population

Respiratory function and sleep parameters in adults following recovery from acute COVID-19

The impact of COVID-19 on lung function and sleep in otherwise healthy individuals has been subject to a limited number of studies. The aim of this study was to investigate the effect of COVID-19 on pulmonary function and sleep in adults. Participants, 50-85 years old, who had recovered from COVID-19 (COVID-19 group: n = 48) and those without history of COVID-19 (control group: n = 28) underwent pulmonary function assessment (Forced Vital Capacity, FVC, and Slow Vital Capacity, SVC) using spirometry. Sleep and circadian variables were measured objectively with wrist-worn actigraphy for seven days. Subjective sleep of participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). There were no significant differences in age (60 ± 6 vs 62 ± 6 years), BMI (26.30 ± 4.25 vs 26.48 ± 3.60 kg/m2), or pulmonary function (FVC, 4.02 ± 1.04 vs 3.80 ± 0.98 L, p = 0.36; and SVC, 3.82 ± 1.09 vs 3.89 ± 0.92 L, p = 0.76) between COVID-19 and control groups. The COVID-19 group had significantly reduced sleep efficiency (0.87 ± 0.04 vs 0.91 ± 0.04, p < 0.01), increased sleep disturbance (awakenings, 1.70 ± 1.02 vs 1.15 ± 1.15, p < 0.01; and wakefulness after sleep onset, 35:05 ± 25:37 vs 20:02 ± 12:48 min, p = 0.01) and PSQI score (5.19 ± 2.88 vs 3.93 ± 2.89, p = 0.01), compared to the control group. Individuals with history of COVID-19 demonstrate reduced sleep quality compared to a non-COVID-19 control group.

Sleep disorders among Tunisian night-shift workers: a cross-sectional study

PURPOSE

Night shift work is common today and disrupts circadian rhythms, leading to health concerns. This study examines the impact of night shifts on sleep quality among Tunisian workers, determines the prevalence of sleep disorders, and identifies factors associated with poor sleep quality.

METHODOLOGY

This cross-sectional study employed an online questionnaire to assess sleep disorders among night workers aged 18 and older. Key measures included sleep quality, daytime alertness, mood, and subjective well-being, assessed with validated Arabic versions of the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and WHO-Five Well-Being Index (WHO-5).

RESULTS

A study of 503 Tunisian night shift workers aged 25 to 64 revealed significant sleep disturbances. Poor sleep quality (PSQI score > 5) was found in 59.4%, while 13.7% reported insomnia (ISI score > 15). Severe insomnia, excessive daytime sleepiness, severe depression, and poor well-being were present in 2%, 32.6%, 4%, and 58.3%, respectively. Factors linked to poor sleep quality included BMI, active smoking, fatty meals, hypnotic use, nasal obstruction, sinusitis, gastrointestinal disorders, and well-being scores.

CONCLUSION

The findings of this study highlight the significant impact of night shift work on sleep quality and overall well-being among Tunisian workers. To mitigate these effects, practical interventions are essential, including promoting shift work schedules, improving workplace wellness programs, encouraging healthier lifestyle choices, and providing access to mental health support. Future research should investigate the relationship between shift work, sleep, and mental health while finding ways to mitigate these effects.

Towards proactively improving sleep: machine learning and wearable device data forecast sleep efficiency 4-8 hours before sleep onset

Wearable devices with sleep tracking functionalities can prompt behavioral changes to promote sleep, but proactively preventing poor sleep when it is likely to occur remains a challenge due to a lack of prediction models that can forecast sleep parameters prior to sleep onset. We developed models that forecast low sleep efficiency 4 and 8 hours prior to sleep onset using gradient boosting (CatBoost) and deep learning (Convolutional Neural Network Long Short-Term Memory, CNN-LSTM) algorithms trained exclusively on accelerometer data from 80,811 adults in the UK Biobank. Associations of various sleep and activity parameters with sleep efficiency were further examined. During repeated cross-validation, both CatBoost and CNN-LSTM exhibited excellent predictive performance (median AUCs > 0.90, median AUPRCs > 0.79). U-shaped relationships were observed between total activity within 4 and 8 hours of sleep onset and low sleep efficiency. Functional data analyses revealed higher activity 6 to 8 hours prior to sleep onset had negligible associations with sleep efficiency. Higher activity 4 to 6 hours prior had moderate beneficial associations, while higher activity within 4 hours had detrimental associations. Additional analyses showed that increased variability in sleep duration, efficiency, onset timing, and offset timing over the preceding four days was associated with lower sleep efficiency. Our study represents a first step towards wearable-based machine learning systems that proactively prevent poor sleep by demonstrating that sleep efficiency can be accurately forecasted prior to bedtime and by identifying pre-bed activity targets for subsequent intervention.

Effects of acute exercise or short-term exercise interventions on metabolic markers during experimentally-induced sleep loss in humans: A systematic literature review

BACKGROUND

Exercise has positive impacts on metabolic health, whereas sleep loss has potentially negative impacts. This systematic literature review investigates whether acute and short-term exercise interventions can mitigate negative effects of experimentally-induced sleep loss on metabolic markers in humans.

METHODS

A systematic search (PubMed, Web of Science, Scopus, Embase, SPORTDiscus, and Cochrane) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted up to June 2024 for studies that compared glucose and insulin concentrations, insulin sensitivity, skeletal muscle gene expression, and other molecular markers following an acute or short-term (<14 days) exercise intervention during experimentally-induced sleep loss in adult humans. Articles were considered for inclusion and assessed for eligibility using the PICOS (Population, Intervention, Comparison, Outcomes, and Study design) framework, and critically appraised with the Cochrane Risk of Bias 2.0 tool.

RESULTS

Of the identified records, 4026 records were screened, with 12 studies meeting all the inclusion criteria and including 177 participants. Sleep intervention varied from a single night of total sleep deprivation to 5 consecutive nights of 4-h sleep opportunity (e.g., early or late sleep restriction), while exercise intervention varied in terms of model (walking/running, cycling, and resistance exercise), volume (e.g., minute to hour), and intensity (e.g., maximum efforts to low-intensity exercise). Most studies indicated a negative effect of insufficient sleep on glucose and insulin concentration as well as mitochondrial adaptations, whereas exercise had a positive impact, mitigating the negative effects on the aforementioned parameters.

CONCLUSION

Exercise is likely to be effective as a therapeutic intervention for mitigating the negative effects of sleep loss on metabolic markers, at least in short-term intervention studies.

Factors affecting dysbiosis of the gut microbiota in the elderly and the progress of interventions in traditional Chinese and Western medicine

As the population ages, intestinal health in the elderly has become a key area of concern, with gut microbiota dysbiosis emerging as a significant issue. This review summarizes the factors influencing dysbiosis and interventions from both traditional Chinese medicine (TCM) and Western medicine, offering a reference for future research. A comprehensive search of global databases up to March 2024 identified 617 original studies on gut microbiota dysbiosis in individuals aged 65 and older. After applying strict PRISMA guidelines, 20 articles met the inclusion criteria. Key findings are summarized in four areas: 1) the definition and mechanisms of dysbiosis, 2) evaluation tools for gut microbiota imbalance, 3) factors contributing to dysbiosis in the elderly, and 4) pharmacological treatments. Both TCM and Western medicine offer unique advantages in managing gut microbiota dysbiosis, and the choice of intervention should be tailored to the individual's condition. Future research should focus on optimizing integrated TCM and Western medicine approaches to improve outcomes for elderly patients with gut microbiota dysbiosis.

Characteristics of objectively-measured naturalistic light exposure patterns in U.S. adults: A cross-sectional analysis of two cohorts

Light is an environmental feature important for human physiology. Investigation of how light affects population health requires exposure assessment and personal biomonitoring efforts. Here, we derived measures of amount, duration, regularity, and timing from objective personal light (lux) measurement in >4000 participants across two United States (US)-based cohort studies, the Multi-Ethnic Study of Atherosclerosis (MESA) and the Hispanic Community Health Study / Study of Latinos (HCHS/SOL), encompassing eight geographic regions. Objective light and actigraphy data were collected over a week using wrist-worn devices (Actiwatch Spectrum). Cohort-stratified light exposure metrics were analyzed in relation to sex, season, time-of-day, location, and demographic and sleep health characteristics using Spearman correlation and linear and logistic regressions (separately by cohort) adjusted for age, sex (where applicable), and exam site. Light exposure showed sex-specific patterns and had seasonal, diurnal, geographic, and demographic and sleep health-related correlates. Results between independent cohorts were strongly consistent, supporting the utility and feasibility of light biomonitoring. These findings provide a fundamental first characterization of light exposure patterns in a large US sample and will inform future work to incorporate light as a biologically relevant exposure in environmental public health and key component of the human exposome.

Cyclical Links Between Daily Partner Interactions and Sleep Quality in Older Adult Couples: The Mediating Role of Perceived Partner Responsiveness and Negative Affect

Researchers have found significant associations between romantic relationship experiences and sleep quality. However, most existing studies are cross-sectional, few have focused on the aging population, and few have considered mechanisms underlying such associations. To address these gaps, 238 older adult couples completed 7-day daily diaries, reporting on their daily relationship, emotional, and sleep experiences. Multilevel structural equation modeling revealed that husbands' higher negative partner interactions and lower positive partner interactions were indirectly associated with their own and their wives' decreased sleep quality that night via lower perceived partner responsiveness and increased negative affect. Moreover, decreased sleep quality was associated with participants' and their partners' increased negative partner interactions and participants' decreased positive partner interactions the next day, with no significant gender differences. This research provides a foundation for future research on cyclical associations between romantic relationship experiences and sleep quality, with implications for relationship-based interventions to improve sleep quality.

Sleep disturbances in elderly patients with distal radius fractures: a prospective observational study

PURPOSE

No previous studies have reported the presence of sleep disturbances or their association with baseline factors in elderly patients with distal radius fracture (DRF). This study aimed to describe the proportion of patients with sleep disturbances and analyze their association with baseline factors in patients older than 60 years with conservatively treated DRFs.

METHODS

This prospective observational study included 220 patients with extra-articular DRFs who completed the Pittsburgh Sleep Quality Index at two time points: two weeks after cast removal and at the one year follow-up. Sociodemographic, anthropometric, clinical, radiological, and patient-reported outcome measures were analyzed as baseline predictors, with measurements performed two weeks after cast removal.

RESULTS

At two weeks after cast removal, 166 (75.5%) patients had sleep disturbances. Sleep disturbances were associated with the affected dominant hand (β = 1.6; p = 0.04), high-energy injury (β = 3.8; p < 0.001), extra-articular comminuted metaphyseal DRFs (β = 2.3; p < 0.001), higher Tampa Scale of Kinesiophobia scores (β = 2.4; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.4; p < 0.001), higher Pain Anxiety Symptoms Scale-20 scores (β = 2.1; p < 0.001), and higher visual analogue scale scores (β = 4.1; p < 0.001). At the one year follow-up, 85 (38.6%) patients had sleep disturbances, which were associated with higher Tampa Scale of Kinesiophobia scores (β = 2.6; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.5; p < 0.001), and higher Pain Anxiety Symptoms Scale-20 scores (β = 1.8; p = 0.02).

CONCLUSIONS

A high proportion of elderly patients with DRF experienced sleep disturbances. Expanding our understanding of the interplay between sleep disturbances and baseline risk factors may lead to improved care and clinical outcomes for these patients. Future studies should incorporate the clinical management of sleep disturbances in patients with DRFs.

The prevalence and risk factors of sleep disturbances in community-dwelling older adults: a systematic review and meta-analysis

PURPOSE

Sleep disturbance is one of the most prevalent health issues among community-dwelling older adults. This systematic review aims to assess the prevalence of sleep disturbances among these adults living in the community and identify associated risk factors.

METHODS

A comprehensive literature search was performed using PubMed, Web of Science, Embase, and the Cochrane Library databases. We screened studies focusing on the prevalence of sleep disturbances in community-dwelling older adults (≥ 60 years). A random-effects model was used to calculate the pooled prevalence of sleep disturbances. Sensitivity and subgroup analyses were conducted to investigate sources of heterogeneity, and funnel plots were used to assess publication bias.

RESULTS

Our systematic review included 41 articles, encompassing a total sample of 71,607 participants from 13 countries. The pooled prevalence of sleep disturbances, measured by PSQI, was found to be 45% (95% CI: 40-50%). Notably, the prevalence of sleep disturbances was significantly higher among individuals aged 70 years and older (48%) compared to those aged 60 years and older (41%). Common risk factors for sleep disturbances included depression, advanced age, females, chronic diseases (hypertension, coronary heart disease, chronic obstructive pulmonary disease) and poor external support (poor social support and poor family relationships).

CONCLUSION

The findings highlight the necessity for comprehensive assessments and management strategies targeting this population with depression, advanced age, females, hypertension, coronary heart disease, chronic obstructive pulmonary disease, and poor external support while also underscoring the significance of healthcare planners and policymakers in enhancing sleep quality for older adults.

Association of reported sleep disturbances with objectively assessed mild cognitive impairment among adults in the United States

Background

Sleep is a multifaceted phenomenon influenced by both duration and quality. Various sleep disturbances have been associated with mild cognitive impairment, but the role of specific disturbances in mild cognitive impairment pathophysiology remains unclear. This study investigated the associations between distinct sleep disturbances and mild cognitive impairment in adults aged 50 and older using nationally representative data.

Methods

Longitudinal data from the Health and Retirement Study were analyzed to explore the association between mild cognitive impairment and three types of sleep disturbances: trouble falling asleep, trouble waking up, and waking up too early. Logistic regression models estimated unadjusted (Model 1) and adjusted associations accounting for sex, race/ethnicity, age, social determinants of health (Model 2), general health (Model 3), depression (Model 4), and pain and physical activity (Model 5).

Results

The study cohort included 8877 participants aged ⩾50 years in 2018 (baseline) who were followed up in 2020. Overall, 15.4% reported trouble falling asleep, 23.2% reported trouble waking up, and 12.8% reported waking up too early and being unable to fall back asleep most of the time. Among older adults, approximately 13.1% reported experiencing mild cognitive impairment; The prevalence of mild cognitive impairment was even higher in those who experienced sleep disturbances. The unadjusted odds ratio (uOR) for experiencing trouble falling asleep most of the time was 1.69 (95% CI: 1.42-2.03), for trouble waking up most of the time was 1.31 (95% CI: 1.10-1.57), and for waking up early most of the time was 1.88 (95% CI: 1.51-2.35). However, these positive associations attenuated depending on the covariate adjustment.

Conclusions

Nearly one in seven adults had mild cognitive impairment. The relationship between sleep disturbances and mild cognitive impairment has been challenging to delineate. Our findings demonstrate a positive association between sleep disturbances and mild cognitive impairment, although these associations were sensitive to covariate adjustments. These findings suggest multifaceted pathways for reducing the risk of mild cognitive impairment.

Automated remote sleep monitoring needs uncertainty quantification

Wearable electroencephalography devices emerge as a cost-effective and ergonomic alternative to gold-standard polysomnography, paving the way for better health monitoring and sleep disorder screening. Machine learning allows to automate sleep stage classification, but trust and reliability issues have hampered its adoption in clinical applications. Estimating uncertainty is a crucial factor in enhancing reliability by identifying regions of heightened and diminished confidence. In this study, we used an uncertainty-centred machine learning pipeline, U-PASS, to automate sleep staging in a challenging real-world dataset of single-channel electroencephalography and accelerometry collected with a wearable device from an elderly population. We were able to effectively limit the uncertainty of our machine learning model and to reliably inform clinical experts of which predictions were uncertain to improve the machine learning model's reliability. This increased the five-stage sleep-scoring accuracy of a state-of-the-art machine learning model from 63.9% to 71.2% on our dataset. Remarkably, the machine learning approach outperformed the human expert in interpreting these wearable data. Manual review by sleep specialists, without specific training for sleep staging on wearable electroencephalography, proved ineffective. The clinical utility of this automated remote monitoring system was also demonstrated, establishing a strong correlation between the predicted sleep parameters and the reference polysomnography parameters, and reproducing known correlations with the apnea-hypopnea index. In essence, this work presents a promising avenue to revolutionize remote patient care through the power of machine learning by the use of an automated data-processing pipeline enhanced with uncertainty estimation.

Adverse childhood experiences, sleep quality/duration and later-life lower extremity function among older adults in China: evidence from CHARLS

OBJECTIVE

This study aimed to explore the relationship between adverse childhood experiences (ACEs), sleep, and lower extremity function in older adults using a nationally representative cohort.

METHODS

This study included 4,439 participants aged 60 years or older (mean age: 67.2 ± 5.7 years) from the China Health and Retirement Longitudinal Study (CHARLS) 2015 national survey and the 2014 Life History Survey. ACEs, sleep duration, and sleep quality were assessed through self-report, and lower extremity function was measured using the Short physical performance battery (SPPB). The relationships between ACEs, sleep, and lower extremity function were analyzed using multivariate linear regression model and restricted cubic splines.

RESULTS

After adjusting for covariates, older adults with four or more ACEs exhibited worse lower extremity function compared to those with no ACEs (β: -0.175). 6-8 h of sleep was associated with improved lower extremity function (β: 0.119), while good sleep quality was also associated with higher lower extremity function scores (β: 0.177). Age-related differences revealed that the association between four or more ACEs and reduced lower extremity function (β: -0.431) was significant only in individuals aged 70 years and older. In the 60-69 years age group, the sleep duration of 6-8 h was significantly related to better lower extremity function (β: 0.150), however, in those aged 70 years and older, more than 8 h of sleep was associated with poorer function (β: -0.378). Furthermore, good sleep quality was associated with better lower extremity function in individuals aged 70 years and older (β: 0.246).

CONCLUSION

ACEs, particularly household mental illness and parental disability, are associated with poorer lower extremity function in older adults. Normal sleep duration and good sleep quality are linked to better lower extremity function and may mitigate the negative effects of ACEs. However, these associations vary by age.

Sleep quality and cognitive functioning among Chinese older adults living in the US: a mixed-effects model analysis

BACKGROUND

Racial and ethnic disparities in sleep quality and cognitive health are increasingly recognized, yet little is understood about their associations among Chinese older adults living in the United States. This study aims to examine the relationships between sleep health and cognitive functioning in this population, utilizing data from the Population Study of Chinese Elderly in Chicago (PINE).

METHODS

This observational study utilized a two-wave panel design as part of the PINE, including 2,228 participants aged 65 years or older who self-identified as Chinese. Participants completed interviews at two time points. Cognitive functioning was assessed using a battery of tests, including the Chinese Mini-Mental State Examination (C_MMSE), the immediate and delayed recall of the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Sleep quality was assessed using items from the Pittsburgh Sleep Quality Index (PSQI), covering four aspects: subjective sleep quality, sleep latency, sleep efficiency, and sleep duration. Insomnia was assessed using four items from the Women's Health Initiative Insomnia Rating Scale. Mixed-effects regression models were used to assess the effects of sleep parameters on baseline cognitive functioning and cognitive change over time.

RESULTS

Participants had an average age of 77.42 years (± 7.57) at baseline, with about 39% reporting fairly bad or very bad sleep quality. Poorer overall sleep quality (B = -0.01, SE = 0.01, p < .01), and more insomnia symptoms (B = -0.01, SE = 0.00, p < .001) were associated with lower baseline global cognition. However, these associations diminished over time (sleep quality: B = 0.01, SE = 0.00, p < .05; insomnia: B = 0.00, SE = 0.00, p < .05). Among sleep quality subdomains, all except sleep efficiency had significantly negative relationships with baseline global cognition. The associations between sleep parameters and the four cognitive domains were less consistent.

CONCLUSIONS

The findings highlight cross-sectional negative relationships between self-reported sleep parameters and cognition, showing distinct associations between various aspects of sleep quality and cognitive domains. Targeted interventions to improve sleep quality may have the potential to enhance cognitive health outcomes.

Older Adult Misuse of Over-the-Counter Medications: Effectiveness of a Novel Pharmacy-Based Intervention to Improve Patient Safety

OBJECTIVES

Older adults' (ages ≥65) inappropriate over-the-counter medications (OTC) use is prevalent, comprising Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Given that pharmacies sell many OTCs, structurally redesigning pharmacy aisles for improving patient safety (Senior Safe) was conceived to mitigate older adult OTC misuse, using Stop Signs and Behind-the-Counter Signs for high-risk OTCs. This study determined whether Senior Safe reduced high-risk OTCs misuse, while secondarily evaluating misuse changes for all OTCs.

METHODS

A randomized controlled trial design matched and randomly allocated 20 health system community pharmacies to control or intervention groups. All 288 study participants completed an OTC choice task in which they chose a hypothetical symptom scenario (pain, sleep, cough/cold/allergy), selected an OTC, and described how they would use it at symptom onset and if symptoms persisted or worsened. Reported OTC use was evaluated for each misuse type. Intervention and control sites were compared for each misuse type using multivariate modeling.

RESULTS

For high-risk OTCs, Drug-Age and Drug-Drug misuse were more likely in control sites (OR = 2.752, P = 0.004; OR = 6.199, P = 0.003, respectively), whereas Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. For all OTCs, only Drug-Age misuse was more likely for control sites (OR = 5.120, P = 0.001). Adults aged 85+ years had the greatest likelihood of all misuse types.

CONCLUSIONS

Results demonstrated that older adults frequently reported multiple misuse types, highlighting safety concerns. Senior Safe reduced high-risk OTC misuse, especially for older adults younger than 85 years. Cumulatively, these findings provide insights into practice recommendations supported through regulatory guidance.

Insomnia during the COVID-19 pandemic: prevalence and correlates in a multi-ethnic population Singapore

BACKGROUND

Globally, the Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on mental health. Sudden lifestyle changes, threatening information received through various sources, fear of infection and other stressors led to sleep disturbances such as insomnia. The current study aimed to assess the prevalence of insomnia and its associated risk factors during the first wave of COVID-19 pandemic among Singapore residents.

METHODS

A cross-sectional study conducted online and in person, from May 2020 to June 2021, recruited Singapore citizens and permanent residents, aged 21 years and above, fluent in English, Chinese or Malay language. Respondents answered an interviewer-administered questionnaire, including Insomnia Severity Index (ISI), Generalised Anxiety Disorder-7 (GAD-7), Physical Health Questionnaire (PHQ-9), stress scale of the Depression, Anxiety and Stress Scales (DASS), chronic conditions checklist and COVID-19 related stressors (exposure to COVID-19, current and future perceived risk of infection). Chi-squared test followed by stepwise logistic regression analysis were conducted to determine factors associated with insomnia.

RESULTS

The study recruited 1129 respondents. Prevalence of insomnia was noted to be 7.4% in the sample. Insomnia was significantly associated with psychological distress- depression (p < 0.001) and anxiety (p < 0.001), financial loss as a source of stress (p < 0.012), ever been diagnosed with asthma (p < 0.001) and backache (p < 0.002).

CONCLUSION

Insomnia was prevalent and associated with higher level of psychological distress among Singapore residents. These findings can be utilised to design effective targeted interventions like cognitive behavioural therapy, therapist assisted relaxation and meditation programs to improve sleep and reduce psychological distress. Interventions like these can be delivered via smartphone applications enabling easy access, delivery, and utilization by the vulnerable groups. Overall, these strategies would not only help people maintain better mental health and sleep quality during a pandemic but also build resilience, enhancing society's ability to cope with future crises.

Socioeconomic status and sleep duration among a representative, cross-sectional sample of US adults

BACKGROUND

Sleep is a crucial determinant of physical and mental health outcomes, and insufficient sleep is highly prevalent among United States adults. Although some risk factors of poor sleep have been extensively studied, including substance use, age, health behaviors, and others, the associations between socioeconomic status (SES) and sleep remain inconclusive. There is limited evidence on SES and sleep duration among the US adult population. This study analyzed the relationships between three SES indicators (poverty, education, and food security), and sleep duration.

METHODS

We used responses from the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES). Respondents younger than 25 years old were excluded. Sleep duration was classified using self-reported sleep time and stratified by work vs. non-workdays. SES was operationalized using three indicators: poverty-income ratio, educational attainment, and food security status. We imputed missing data for socioeconomic status and outcome variables using multiple imputation. Weighted Poisson regression models with robust standard errors were used to calculate the crude and adjusted prevalence ratios for insufficient sleep duration (< 7 h of self-reported sleep) on workdays and non-workdays separately by each of the three SES indicators.

RESULTS

We included a total of 8,457 individuals. In the adjusted model, participants with lower income, educational status, and food security had significantly higher prevalence of insufficient sleep duration on both workdays and non-workdays. For example, low-income individuals (poverty-income ratio < 1) had 1.22 (95% CI 1.04-1.44) and 2.08 (95% CI 1.61-2.67) higher prevalence of insufficient sleep as compared to high income individuals on workday and non-workdays, respectively. In general, we found larger differences by level of SES indicator for the non-workday than for the workday outcome. There were no major differences in gender-stratified analysis. We also found that lower SES was associated with higher prevalence of excessive sleep (≥ 9 h).

CONCLUSION

Socioeconomic status indicators are significantly associated with sleep duration in the US adult population. Lower SES correlates with increased prevalence of insufficient sleep duration, which has implications for the overall wellbeing of US adults with lower SES. Targeted interventions and further research are needed to reduce this disparity.

Linking Gut Microbiota, Oral Microbiota, and Serum Metabolites in Insomnia Disorder: A Preliminary Study

Purpose

Despite recent findings suggesting an altered gut microbiota in those suffering from insomnia disorder (ID), research into the gut microbiota, oral microbiota, serum metabolites, and their interactions in patients with ID is sparse.

Patients and Methods

We collected a total of 114 fecal samples, 133 oral cavity samples and 20 serum samples to characterize the gut microbiota, oral microbiota and serum metabolites in a cohort of 76 ID patients (IDs) and 59 well-matched healthy controls (HCs). We assessed the microbiota as potentially biomarkers for ID for ID by 16S rDNA sequencing and elucidated the interactions involving gut microbiota, oral microbiota and serum metabolites in ID in conjunction with untargeted metabolomics.

Results

Gut and oral microbiota of IDs were dysbiotic. Gut and oral microbial biomarkers could be used to differentiate IDs from HCs. Eleven significantly altered serum metabolites, including adenosine, phenol, and phenol sulfate, differed significantly between groups. In multi-omics analyses, adenosine showed a positive correlation with genus_Lachnospira (p=0.029) and total sleep time (p=0.016). Additionally, phenol and phenol sulphate had a negative correlation with genus_Coprococcus (p=0.0059; p=0.0059) and a positive correlation with Pittsburgh Sleep Quality Index (p=0.006; p=0.006) and Insomnia Severity Index (p=0.021; p=0.021).

Conclusion

Microbiota and serum metabolite changes in IDs are strongly correlated with clinical parameters, implying mechanistic links between altered bacteria, serum metabolites and ID. This study offers novel perspective into the interaction among gut microbiota, oral microbiota, and serum metabolites for ID.

Mental illness and sleep disorders among women with gynecological problems

This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.

Sleep characteristics and hearing loss in middle-aged and older adults: The National Health and Nutrition Examination Survey 2015-2018✰

Background

Population-based evidence linking sleep characteristics with hearing is limited and how the associations change with age remains unknown. We aim to investigate cross-sectional associations between sleep characteristics and hearing by age in a nationally representative sample of U.S. adults.

Methods

We included 3,100 participants aged 40 years and older from the National Health and Nutrition Examination Survey 2015-18. Audiometric hearing thresholds at 0.5, 1, 2 and 4 kilohertz were averaged to calculate better-ear pure-tone average (PTA). Sleep questions were self-reported, including sleep duration on weekdays or workdays, snoring, snorting or stopping breathing, trouble sleeping, and daytime sleepiness. Multivariable-adjusted linear regression with an interaction term between sleep characteristic (categorical) and age (continuous in years) was used. Primary models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors in secondary models.

Results

There was no association of reported sleep duration with PTA at age 50; however, compared to those reporting 7-8 h of sleep, there was a borderline-significant association at age 60 (<7 h: 1.72 dB, 95 % confidence interval [CI], -0.21, 3.66; >8 h: 1.25 dB, 95 % CI, -0.01, 2.51), and a significant association at age 70 (<7 h: 2.52 dB, 95 % CI, -0.27, 5.31; >8 h: 2.67 dB, 95 % CI, 0.56, 4.79). No consistent associations for other sleep characteristics were found.

Conclusions

Long sleep duration is associated with worse hearing among middle-aged and older adults and the association differs by age. Longitudinal evidence is needed to establish temporality and examine changes in hearing associated with sleep characteristics.

Sleep Deficiency in the Elderly

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

Association of sleep quality with physical and psychological health indicators in overweight and obese rural Indians

Objective

To measure the association of sleep quality with physical (i.e., grip strength, functional mobility, balance) and psychological (depression, anxiety) health indicators in an overweight/obese population.

Methods

Baseline data of 2337 participants (1382 overweight/obese and 955 normal weight) from an aging cohort in rural southern India (CBR-SANSCOG) was analyzed retrospectively. Assessment tools included the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, dynamometry for Hand Grip Strength (HGS), Timed Up-and-Go (TUG) for functional mobility, Chair Stand Test (CST) for lower limb strength, Geriatric Depression scale (GDS-30) for depressive symptoms and Generalized Anxiety Disorder scale (GAD-7) for anxiety symptoms. Linear regression models, adjusted for known confounders, were used to examine the association of sleep quality with the health parameters in overweight/obese and normal-weight groups.

Results

In the fully adjusted model, higher global PSQI score was associated with higher TUG time (β = 0.06, 95 % CI: 0.004,0.12), higher scores on GDS (β = 1.08, 95 % CI: 0.96,1.20) and GAD (β = 0.71, 95 % CI: 0.62,0.79), and lower scores on CST (β = -0.12, 95 % CI: -0.19,-0.06) in overweight/obese individuals. The sleep disturbance sub-component of PSQI was associated with most of the physical (TUG, CST) and psychological (GDS and GAD) health indicators. Sleep duration and use of sleep medication showed no significant association with any of the health indicators.

Conclusion

The concurrent presence of poor sleep quality and overweight/obesity could worsen physical and psychological health in middle-aged and older adults. We highlight the importance of early detection and timely management of sleep problems in this population to reduce physical and psychological morbidities.

Cross-sectional and prospective associations between sleep health and multimorbidity in middle to older-aged adults: Results from the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVE

Middle-aged to older adults often exhibit the co-existence of poor sleep health and multimorbidity. We examined cross-sectional and prospective associations of pooled index of sleep health with prevalent and incident multimorbidity in the framework of an ongoing cohort study in Canada.

METHODS

Data were from approximately 24,000 individuals from the Canadian Longitudinal Study on Aging (CLSA), an ongoing national study of community-dwelling adults aged 45-85 years at baseline. Multimorbidity was defined as two or more chronic conditions out of five major condition categories. Sleep variables included sleep duration, quality, initiation, maintenance, and excessive daytime sleepiness, which were combined into an index using pooled approaches. Weighted logistic regression models were computed for each index with additional age- and sex-stratified analyses.

RESULTS

Higher sleep index scores, indicating poorer sleep health, were observed in females and younger age groups (ages 45-54 and 55-64). In cross-sectional analysis, the fully adjusted model showed that a 1-unit increase in pooled scores was significantly associated with 1.48 higher odds (95 % CI = 1.38, 1.58; p < 0.001) of prevalent multimorbidity at baseline. Similarly, the prospective analysis indicated significant changes in incident multimorbidity with pooled index scores in the fully adjusted model (OR = 1.33; 95 % CI = 1.20, 1.48; p < 0.001).

CONCLUSION

The pooled sleep index introduced in this study may offer a novel, concise, and comprehensive approach to assessing sleep health among middle-aged and older adults. Those in these age groups experiencing poorer sleep health are at a greater risk of prevalent multimorbidity, as well as of developing multimorbidity over time.

Effects of caffeine on accelerometer measured sleep and physical activity among older adults under free-living conditions

BACKGROUND

Adequate sleep and physical activity promote longevity among older adults. Caffeine supplementation could be used to increase activity levels, but its effects have not been examined in real-world settings where potential trade-offs regarding sleep quality are also considered. This study sought to examine associations between caffeine intake and accelerometer-derived sleep and activity among older adults under free-living conditions.

METHODS

Cross-sectional data were gathered from older adults aged 65 + in the 2011-14 National Health and Nutrition Examination Surveys (NHANES). Sleep parameters were derived from accelerometer data using a data-driven machine learning approach. Caffeine consumption was categorized based on weight (in mg/kg: 0, > 0 to 1, > 1 to 2, > 2 to 3, > 3) and absolute consumption (in mg: 0, > 0 to 100, > 100 to 200, > 200 to 300, > 300). Multivariable survey weighted regression models were used to examine associations between caffeine with average total daytime activity, highly active minutes, sleep duration, and sleep efficiency. Covariate adjustments included demographics, body mass index, smoking, alcohol, sleep disorders, sleep parameters (for activity outcomes), and daytime activity (for sleep outcomes).

RESULTS

N = 1,629 NHANES participants were included. Caffeine consumption was highest in the morning. In adjusted models, older adults who consumed > 3 mg/kg were 16.5% more active during the day (95% CI: 9.0, 24.4) and were highly active for 42.8 additional minutes (95% CI: 20.3, 65.4) compared to non-consumers. Similar results were observed for absolute consumption (mg), and significant but lower magnitude effects were observed for lower levels of consumption. Caffeine showed no association with sleep efficiency, while low levels of consumption (≤ 1 mg/kg, ≤ 200 mg) were associated with longer sleep duration.

CONCLUSIONS

Under free-living dietary, sleep, and activity patterns, this study found older adults who consumed caffeine were more active than non-consumers. Overall consumption was not associated with sleep efficiency but was associated with longer sleep duration at ≤ 1 mg/kg and ≤ 200 mg. Future causal studies should determine the effectiveness of caffeine for promoting higher activity in older adult populations.

Risk Factors for Chronic Lower Back Pain among Older Workers: A Prospective Cohort Study

OBJECTIVE

The purpose of this study was to identify the risk factors for the development of chronic lower back pain in older workers.

METHODS

This was a prospective cohort study using an Internet survey of workers aged 60-75 years, with a baseline survey conducted in September 2022 and a follow-up survey in October 2023. A total of 2257 participants who did not have chronic lower back pain in the baseline survey were included in the analysis, and the risk factors for chronic lower back pain were examined by logistic regression analysis.

RESULTS

The median age of the analyzed participants was 63.0 years, and the incidence of chronic lower back pain was 9.0%. Logistic regression analysis revealed that poor sleep habits (adjusted odds ratio [aOR]: 1.66, 95% confidence interval [CI]: 1.21-2.26), poor eating habits (aOR: 1.44, 95% CI: 1.03-2.01), no physical activity (aOR: 1.45, 95% CI: 1.00-2.09), and high stress (aOR: 1.62, 95% CI: 1.13-2.32) were significantly associated with the occurrence of chronic lower back pain.

CONCLUSION

A comprehensive multidisciplinary collaboration program incorporating the assessment and management of lifestyle habits and mental health issues should be developed and implemented to prevent chronic lower back pain in older workers.

Sleep disorders in younger and middle-older age adults with newly diagnosed type 2 diabetes mellitus: A retrospective cohort study in >1million individuals

AIMS

To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes.

METHODS

This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961).

RESULTS

The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults.

CONCLUSIONS

The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.

The interplay between insomnia symptoms and Alzheimer's disease across three main brain networks

STUDY OBJECTIVES

Insomnia symptoms are prevalent along the trajectory of Alzheimer's disease (AD), but the neurobiological underpinning of their interaction is poorly understood. Here, we assessed structural and functional brain measures within and between the default mode network (DMN), salience network, and central executive network (CEN).

METHODS

We selected 320 participants from the ADNI database and divided them by their diagnosis: cognitively normal (CN), Mild Cognitive Impairment (MCI), and AD, with and without self-reported insomnia symptoms. We measured the gray matter volume (GMV), structural covariance (SC), degrees centrality (DC), and functional connectivity (FC), testing the effect and interaction of insomnia symptoms and diagnosis on each index. Subsequently, we performed a within-group linear regression across each network and ROI. Finally, we correlated observed abnormalities with changes in cognitive and affective scores.

RESULTS

Insomnia symptoms were associated with FC alterations across all groups. The AD group also demonstrated an interaction between insomnia and diagnosis. Within-group analyses revealed that in CN and MCI, insomnia symptoms were characterized by within-network hyperconnectivity, while in AD, within- and between-network hypoconnectivity was ubiquitous. SC and GMV alterations were nonsignificant in the presence of insomnia symptoms, and DC indices only showed network-level alterations in the CEN of AD individuals. Abnormal FC within and between DMN and CEN hubs was additionally associated with reduced cognitive function across all groups, and increased depressive symptoms in AD.

CONCLUSIONS

We conclude that patients with clinical AD present with a unique pattern of insomnia-related functional alterations, highlighting the profound interaction between both conditions.

Demographic, socioconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India

BACKGROUND

Recent research has revealed that today's older adults report more sleep problems than their predecessors, a trend compounded by expanding social stratification. As such, this study examined the demographic, socioeconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India.

METHODS

The current study sample draws on data from 7118 respondents aged 50 years and over participating in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) wave-2 dataset. Sleep quality (good, moderate, and poor) and sleep duration (in hours and minutes) were self-reported. Adjusted multivariable logistic regression models were employed to examine the associations between sleep quality and sleep duration and several demographic, socioeconomic, and health indicators.

RESULTS

A total of 12.84% and 36.1% of older adults reported long (> 8 h) and short (< 7 h) sleep, respectively. Older adults with primary education had lower odds of poor sleep [aOR: 0.85, CI: 0.73-0.99] than peers with no formal education. The odds of poor sleep were lower among those in higher wealth quintiles than those in the poorest quintile. Older adults with higher education had higher odds of short sleep [aOR: 1.36, CI: 1.06-1.74], and those with primary education had lower odds of long sleep [aOR: 0.70, CI: 0.54-0.91] than those without formal education (base category: age-appropriate sleep, i.e., 7-8 h). Older adults who were widowed had lower odds of both short [aOR: 0.82, CI: 0.68-0.98] and long sleep [aOR:0.74, CI: 0.58-0.95] compared to those who were currently married. Older individuals with adequate nutritional intake reported lower odds of short [aOR:0.59, CI: 0.49-0.72] and higher odds of long sleep [aOR:1.52, CI: 1.20-1.93] relative to their counterparts. Older adults who reported chronic conditions and body pain had higher odds of poor sleep and short sleep than their counterparts.

CONCLUSIONS

We identified significant associations between several unmodifiable factors, including age, education, and marital status, and modifiable factors such as dietary intake, body pain, and pre-existing chronic ailments, and sleep quality and sleep duration. Our findings can assist health care providers and practitioners in developing a more holistic and empathic approach to care. Moreover, that several demographic, socioeconomic, and health-related factors are consequential for older adults' sleep health suggests that early detection through screening programs and community-based interventions is vital to improving sleep among older Indians who are most susceptible to sleep problems.

Efficacy of Mind-body Exercise to Reduce Sleep Disturbance and Depression Among Older Adults: A Systematic Review and Meta-analysis

PURPOSE

Mind-body exercise is a promising non-pharmacological approach for managing sleep disturbance and depression that are prevalent among older adults, but its efficacy remains inconclusive across the studies. This study aimed to systematically evaluate and quantify the overall effectiveness of mind-body exercises on sleep disturbance and depression in older adults.

METHODS

We searched eight databases to identify relevant articles from their inception to April 2024. Experimental studies that evaluate the effects of mind-body movement therapy on sleep disturbance and depression in older adults were included. The Cochrane Risk of Bias tool version 2.0 was used to appraise included studies. The pairwise meta-analysis was performed through the software Comprehensive Meta-Analysis Version 3.0. Moreover, subgroup analysis was utilized to understand the effect size on each form of mind-body exercise and to determine the source of heterogeneity.

RESULTS

A total of 27 studies were eligible and synthesized. The mind-body exercise appears statistically significant in reducing sleep disturbance (SMD = -0.60, 95% CI: 0.76 ∼ 0.44) and depression (SMD = -0.56, 95% CI: 0.75 ∼ 0.36) among older adults. Each form of mind-body exercise, including pilates, yoga, qigong, and tai-chi, effectively decreases sleep disturbance and depression, but there were no significant differences in the effects between these practices.

CONCLUSION

The cumulative evidence concludes that older adults who participated in mind-body exercise programs showed potential improvements in sleep disturbance and depression. This finding may serve as evidence for professionals to use this approach as a non-pharmacological approach to help older adults in the community and long-term care facilities who are having sleep disturbance and depression. More clinical trials are needed for an in-depth meta-analysis that can rank and compare the efficacy of each mind-body exercise practice.

Harnessing the Power of Integrated Behavioral Health to Enhance Insomnia Intervention in Primary Care

Insomnia is prevalent in primary care and associated with co-morbid physical and mental health conditions and poor health outcomes. While there are effective treatments for insomnia in specialty mental health care, many patients have difficulty accessing these interventions. To begin, patients do not always report their sleep challenges to physicians; meanwhile, primary care providers often do not screen for insomnia symptoms. Furthermore, patients may experience several barriers to accessing specialty care for insomnia treatment, such as a limited number of available providers, financial burden, lack of transportation, and low perceptions of treatment effectiveness. Primary care behavioral health (PCBH) is well-equipped to address the challenges of accessing evidence-based care for insomnia through (1) identifying sleep issues, (2) providing psychoeducation on the possible treatments for insomnia, (3) intervening with poor sleep habits and acute insomnia early to prevent chronic insomnia, and (4) delivering appropriate evidence-based interventions for chronic insomnia. Primary care clinics should leverage behavioral health providers to increase screening and embed interventions into routine care for the benefit of improved outcomes for patients with insomnia and other sleep challenges.

Association between waist circumference and sleep disorder in the elderly: Based on the NHANES 2005-2018

The existing data do not consistently support the link between elderly adults' waist circumferences and sleep disorders. This study aimed to evaluate whether waist circumference was connected with sleep disorder in the elderly. This cross-sectional study utilized data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) regarding waist circumference, sleep disorders, and confounding factors. Included in the study were participants older than 60 who completed sleep questionnaires and waist circumference measurements. Using a multivariate logistic regression model and subgroup analyses, the relationship between waist circumference and sleep disorder was evaluated. To explore the non-linear relationship, restricted cubic spline (RCS) with three knots coupled with a logistic regression model to assess the dose-response relationship between waist circumference (continuous variables) and sleep disorder. A total of 2,545 (Weighted 14,682,916.3) elderly participants with complete information were included in the analysis and 312 (Weighted 1,777,137.8) subjects met the definition of sleep disorder. Compared with participants without sleep disorder, those with sleep disorder had a higher waist circumference (100.80 cm vs. 108.96 cm, P< 0.001). The results of the multivariable adjusted logistic regression model suggested that those in quartiles 4 (≥ 75th percentile) for their waist circumference had higher odds of sleep disorder [adjusted odds ratio (AOR) = 2.75, 95% confidence interval (CI) = 1.66-4.54, P < 0.001] compared with those in quartile 1. The RCS result showed that the OR of sleep disorder and waist circumference displayed a linear relationship (P <0.001, Non-linear P = 0.642). Age and gender subgroup analysis revealed comparable relationships between waist circumference and sleep disorder among elderly individuals. Waist circumference was associated with sleep disorders in the elderly. There was a dose-response relationship between waist circumference and the likelihood of sleep disorder. Those with a larger waist circumference were more likely to have a sleep disorder than those with a smaller waist circumference.

Metabolic and vascular imaging markers for investigating Alzheimer's disease complicated by sleep fragmentation in mice

Background

Sleep problem is a common complication of Alzheimer's disease (AD). Extensive preclinical studies have been performed to investigate the AD pathology. However, the pathophysiological consequence of AD complicated by sleep problem remains to be further determined.

Purpose

To investigate brain metabolism and perfusion in an AD mouse model complicated by sleep problem, and subsequently identify potential imaging markers to better understand the associated pathophysiology.

Methods

We examined the oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO2), and cerebral blood flow (CBF) using state-of-the-art MRI techniques in a cohort of 5xFAD model mice. Additionally, neuroinflammation, indicated by activated microglia, was assessed using histology techniques. Sleep fragmentation (SF) was utilized as a representative for sleep problems.

Results

SF was associated with significant increases in OEF (P = 0.023) and CMRO2 (P = 0.029), indicating a state of hypermetabolism. CBF showed a significant genotype-by-sleep interaction effect (P = 0.026), particularly in the deep brain regions such as the hippocampus and thalamus. Neuroinflammation was primarily driven by genotype rather than SF, especially in regions with significant interaction effect in CBF measurements.

Conclusion

These results suggest that brain metabolism and perfusion measurements are promising markers for studying the co-pathogenesis of AD and SF.

A 6-month educational program improves sleep behaviour in community-dwelling frail older adults: A randomised controlled trial

BACKGROUND

The prevalence of sleep-related issues among older adults is a significant concern, with half of the older population reporting these problems. Consequently, strategies to improve sleep are needed for this population. This study aims to assess the effects of a health educational program on sleep behaviour among pre-frail or frail older adults residing in the community and to explore possible associations with frailty.

METHODS

This randomised controlled trial (NCT05610605) included a total of 197 community-dwelling older adults with frailty/pre-frailty, divided into control (n = 88) and educational (n = 109) groups, were assessed at baseline, after the 6-month educational program (6 months), and 6 months after the intervention (12 months). The intervention comprised four group sessions and six follow-up phone calls, focusing on frailty, physical activity, dietary habits, and cognitive training. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and wrist-worn accelerometry.

RESULTS

At 6 months, a significant time-by-group interaction was found for self-reported [β = -0.449, 95%CI (-0.844, -0.053), p = 0.026] and accelerometer-measured [β = 0.505, 95%CI (0.085, 0.926), p = 0.019] sleep efficiency, showing improved sleep efficiency in the intervention group vs. controls. A significant time-by-group interaction at 6 months was noted for sleep awakenings [β = -0.402, 95%CI (-0.825, -0.020), p = 0.047]. The educational program led to a significant decrease in awakenings, while the control group experienced an increase. The change in the number of awakenings (Rs = 0.183, p = 0.020) at 6 months was significantly associated with changes in frailty. Moreover, a significant time-by-group interaction was reported at the 12-month assessment [β = -0.449, 95%CI (-0.844, -0.053), p = 0.026] for self-reported sleep quality, indicating better results in the intervention group compared to controls.

CONCLUSION

The educational program improved sleep quality and sleep efficiency while reducing the number of awakenings per night among community-dwelling frail older adults, offering a practical approach to addressing sleep-related challenges in this demographic.

The mediating and moderating effects of psychological distress on the relationship between social media use with perceived social isolation and sleep quality of late middle-aged and older adults

OBJECTIVES

Older adults are more likely to have poor sleep quality and be socially isolated. The present study examined the potential benefits and disadvantages of social media use (SMU) with respect to sleep quality and perceived social isolation among Iranian late-middle-aged and older adults with focus a on both the mediating and moderating role of psychological distress.

METHODS

A population-based cross-sectional study was conducted among 900 older community-dwellers living in Shiraz using a structured questionnaire. Social media use was assessed by estimating the frequency of social networking site visits per week. Data concerning self-rated physical health, chronic medical and mental health conditions, perceived social isolation, sleep quality, and psychological distress were also collected. Multiple linear regression was used to identify independent variables associated with outcomes. Then, mediation and moderation models were used to examine the potential mediating and moderating effects of psychological distress and SMU on their relationships with the study variables.

RESULTS

Higher social media use was associated with better sleep quality and less perceived social isolation. Nevertheless, the relationships between SMU and participants' sleep quality and perceived social isolation were largely mediated by their level of psychological distress. Furthermore, SMU had a significant moderating effect in the relationship between the psychological distress and the levels of perceived social isolation, so that participants with higher frequency of SMU per week felt less loneliness.

CONCLUSIONS

The study findings suggest that SMU has a positive buffering effect regarding late middle-aged and older adults' mental health mainly through moderation of their perceived social isolation. The mediating role of psychological distress in research examining the relationship between SMU and older adults' mental health outcomes should be considered in future research.

Biomarkers of sleep-wake disturbance as predictors of cognitive decline and accelerated disease progression

INTRODUCTION

In older adults, where sleep disturbances and cognitive impairment are common, mounting evidence suggests a potential connection between sleep and cognitive function, highlighting the significance of utilizing sleep as a biomarker for early detection of cognitive impairment to improve clinical outcomes in a noninvasive, cost-effective manner.

AREAS COVERED

This review describes the relationship between sleep and cognitive function in older adults, encompassing both subjective and objective measures of sleep quality, duration, architecture, and sleep-disordered breathing. The authors consider the directionality of the associations observed in prospective and cross-sectional studies, exploring whether sleep disturbances precede cognitive decline or vice versa. Furthermore, they discuss the potential bidirectional relationships between sleep and Alzheimer's disease (AD) risks in older adults while also examining the neurodegenerative pathways of this relationship.

EXPERT OPINION

Routine sleep monitoring in primary care settings has the potential to bolster early detection and treatment of sleep disturbance, and by extension, reduce the risk of dementia. Improving sleep assessment tools, such as wearables, provide scalable alternatives to traditional methods like polysomnography, potentially enabling widespread monitoring of sleep characteristics. Standardized measurement and inclusive participant recruitment are needed to enhance generalizability, while longitudinal studies are essential to understand the interaction between sleep and AD pathology.

Insomnia Severity and Daytime Sleepiness in Caregivers of Advanced Age

OBJECTIVE

Aging-related changes and caregiver burden may increase the risk for sleep disturbances among older caregivers, yet few studies have examined the prevalence of insomnia and daytime sleepiness in this group. We examined the relationship of caregiver status with insomnia and daytime sleepiness among persons of advanced age (>75 years of age).

DESIGN

Cross-sectional.

SETTING

Community.

PARTICIPANTS

Yale Precipitating Events Project participants (n=383, mean age 84.4 years, 67% female, 12% African American, 25% caregivers).

MEASUREMENTS

Caregivers were persons who reported caring for another person in the past week or caring for/helping a friend or relative >4 times in the past month. We examined the correlates of caregiver status, including demographic (age, sex, race/ethnicity, education, marital status), psychosocial (living alone, Medicaid eligibility, depressive symptoms, social support, hours volunteered), and physical (obesity, chronic conditions, medication use, self-rated health status, physical activity, functional disability, cognitive impairment) factors. We used the Insomnia Severity Index (ISI) to establish insomnia severity (ISI score 0-28) or clinically significant insomnia symptoms (ISI ≥8). We used the Epworth Sleepiness Scale to establish daytime sleepiness (ESS score 0-24) or hypersomnia (ESS ≥10). In nonparametric multivariable regression analyses, we examined the relationship of caregiver status with insomnia or daytime sleepiness.

RESULTS

Compared to non-caregivers, caregivers were younger, more educated, less likely to be Medicaid eligible and had lower rates of depression, obesity, poor self-rated health, low physical activity, functional disability, and cognitive impairment. Mean ISI and ESS scores were in the normal range and similar among non-caregivers and caregivers (ISI scores of 6.9±5.6 and 6.9±5.4, and ESS scores of 6.4±4.7 and 6.1±4.3, in non-caregivers and caregivers, respectively). Multivariable-adjusted models demonstrated no significant differences in ISI and ESS scores between non-caregivers and caregivers (regression coefficients for ISI and ESS scores of -0.01 [95% CI= -1.58, 1.21] and -0.10 [-1.05, 1.21], respectively).

CONCLUSION

When compared to older non-caregivers, older caregivers had more advantageous demographic, psychosocial, and physical profiles and had similar levels of insomnia and daytime sleepiness on standardized questionnaires. Future research is needed to elucidate contextual factors (e.g., caregiving intensity and care partner disease) that may increase the risk of sleep disturbances among caregivers of advanced age.

Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay

Background

In modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality.

Methods

To assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings.

Results

Participants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. -0.34 ± 0.31%, p = 0.007).

Conclusion

Our findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.

Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life

This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults' ADL and depression as integral components of promoting older adults' HRQOL.

Is the insomnia phenotype the common denominator in LUTS during transition periods? An expert NOPIA research group review

AIMS

As people age, sleep stages and characteristics transition over time, but sleep deficits can profoundly impact health and cognitive functioning. Chronic sleep deprivation is linked to impaired attention and productivity, weakened immunity, increased risk of cardiovascular disease, obesity, and mental health disorders. Insomnia, obstructive sleep apnea syndrome, hormonal changes, nocturia, neurological disorders, and life events interfere with sleep patterns and some are linked to lower urinary tract symptoms (LUTS). This NOPIA symposium on Lifelong LUTS aimed to analyze the literature on associations between sleep and LUTS, generate ideas for future research, and explore whether there is support for the concept of lifelong LUTS in relation to changes in sleep throughout the lifespan.

METHODS

An international panel of experts took part in an online meeting addressing the role of lifelong LUTS in relationship to sleep and the brain organized by the NOPIA research group. The manuscript summarizes existing literature, hypotheses, future research ideas, and clinical recommendations.

RESULTS

Insomnia, sleep fragmentation, hyperarousal, and sensory processing disorders emerged as potential factors in the relationship between sleep and LUTS. Insomnia is often a persistent factor and may have been the initial symptom; however, it is often unrecognized and/or unaddressed in healthcare settings. By recognizing insomnia as a primary driver of various health issues, including nocturia, transitional care aims to address root causes and underlying problems earlier to initiate appropriate treatment.

CONCLUSIONS

A multidisciplinary approach with collaboration between healthcare professionals from various disciplines, such as urology, sleep medicine, gynecology, pediatrics, and geriatrics, is needed and should include validated measurements such as the insomnia severity index and sleep and voiding diaries. Ensuring ongoing follow-up and monitoring through transitional care is crucial for individuals with persistent sleep problems and LUTS, allowing issues that arise or fluctuate over the lifespan to be addressed.

Poor sleep quality and reduced immune function among college students: Perceived stress and depression as mediators

OBJECTIVES

Sleep problems are highly prevalent among college students and are linked to a multitude of detrimental consequences, among which are heightened perceived stress and symptoms of depression. The present study investigated the effect of poor sleep quality on the immune function of college students. A serial mediation model was developed to test the prediction that perceived stress and depression sequentially mediate the relationship between poor sleep quality and reduced immune function among college students.

PARTICIPANTS

137 undergraduates were recruited from a large Midwestern university (103Females, 34Males; Mage = 19.47, SDage = ± 1.54).

METHODS

Cross-sectional based online survey administered in Spring 2021.

RESULTS

Analyses revealed a significant total effect of sleep quality on immune function. Perceived stress and depression symptoms serially mediated the relationship between sleep quality and immune function.

CONCLUSIONS

Results underscore the importance of college students' sleep in relation to their mental health and subsequent immune function.

Association between self-perception of the neighborhood environment and sleep problems in older Brazilian adults: findings from ELSI-Brazil

This study aimed to investigate associations between neighborhood perception and sleep problems in older Brazilian adults. A cross-sectional study was conducted with 5,719 community-dwelling older adults (≥ 60 years) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021). The outcomes were self-reported sleep problems: poor sleep quality, daytime sleepiness, primary insomnia complaints, difficulty staying asleep, and waking up at dawn. The exposure variables were questions about the perception of participants about the physical and social environment of the neighborhood. Logistic regression was used in data analysis. Garbage, rubbish, or tall grass on the streets and the desire to move were associated with higher odds of poor sleep quality. Concern about falling due to damaged sidewalks, concern about having difficulties taking transportation, and concern about having difficulties crossing the street were associated with higher odds of all sleep problems. Sound/noise of buses and cars was associated with higher odds of some sleep problems. Perceiving the neighborhood as a good place to live was associated with lower odds of daytime sleepiness and primary insomnia complaints. Trusting most people in the neighborhood and perceiving that kids and younger people treat adults with respect were associated with lower odds of daytime sleepiness, primary insomnia complaints, and waking up at dawn. Being a good place for kids to play and raise teenagers was associated with lower odds of daytime sleepiness. These results can assist public administrators in creating urban planning policies aimed at improving neighborhood environments as a means of health promotion.

Sleep and circadian biomarkers of postoperative delirium (SLEEP-POD): protocol for a prospective and observational cohort study

INTRODUCTION

Surgical patients over 70 experience postoperative delirium (POD) complications in up to 50% of procedures. Sleep/circadian disruption has emerged as a potential risk factor for POD in epidemiological studies. This protocol presents a single-site, prospective observational study designed to examine the relationship between sleep/circadian regulation and POD and how this association could be moderated or mediated by Alzheimer's disease (AD) pathology and genetic risk for AD.

METHODS AND ANALYSIS

Study staff members will screen for eligible patients (age ≥70) seeking joint replacement or spinal surgery at Massachusetts General Hospital (MGH). At the inclusion visit, patients will be asked a series of questionnaires related to sleep and cognition, conduct a four-lead ECG recording and be fitted for an actigraphy watch to wear for 7 days before surgery. Blood samples will be collected preoperatively and postoperatively and will be used to gather information about AD variant genes (APOE-ε4) and AD-related pathology (total and phosphorylated tau). Confusion Assessment Method-Scale and Montreal Cognitive Assessment will be completed twice daily for 3 days after surgery. Seven-day actigraphy assessments and Patient-Reported Outcomes Measurement Information System questionnaires will be performed 1, 3 and 12 months after surgery. Relevant patient clinical data will be monitored and recorded throughout the study.

ETHICS AND DISSEMINATION

This study is approved by the IRB at MGH, Boston, and it is registered with the US National Institutes of Health on ClinicalTrials.gov (NCT06052397). Plans for dissemination include conference presentations at a variety of scientific institutions. Results from this study are intended to be published in peer-reviewed journals. Relevant updates will be made available on ClinicalTrials.gov.

TRIAL REGISTRATION NUMBER

NCT06052397.

Effectiveness of multi-modal home-based videoconference interventions on sleep in older adults: study protocol for a randomized controlled trial

Aging is characterized by substantial changes in sleep architecture that negatively impact fitness, quality of life, mood, and cognitive functioning. Older adults often fail to reach the recommended level of physical activity to prevent the age-related decline in sleep function, partly because of geographical barriers. Implementing home-based interventions could surmount these obstacles, thereby encouraging older adults to stay active, with videoconference administration emerging as a promising solution. Increasing the availability of biological rhythms synchronizers, such as physical activity, light exposure, or vestibular stimulation, represents a viable non-pharmacological strategy for entraining circadian rhythms and potentially fortifying the sleep-wake cycle, thereby enhancing sleep in aging. This study aims to (1) assess the impact of remote physical exercise training and its combination with bright light exposure, and (2) investigate the specific contribution of galvanic vestibular stimulation, to sleep quality among healthy older adults with sleep complaints. One hundred healthy older adults aged 60-70 years with sleep complaints will be randomly allocated to one of four groups: a physical exercise training group (n = 25), a physical exercise training combined with bright light exposure group (n = 25), a galvanic vestibular stimulation group (n = 25) or a control group (i.e., health education) (n = 25). While physical exercise training and health education will be supervised via videoconference at home, bright light exposure (for the physical exercise training combined with bright light exposure group) and vestibular stimulation will be self-administered at home. Pre-and post-tests will be conducted to evaluate various parameters, including sleep (polysomnography, subjective questionnaires), circadian rhythms (actigraphy, temperature), fitness (physical: VO2 peak, muscular function; and motor: balance, and functional mobility), cognition (executive function, long-term memory), quality of life and mood (anxiety and depression). The findings will be anticipated to inform the development of recommendations and non-pharmaceutical preventive strategies for enhancing sleep quality in older adults, potentially leading to improvements in fitness, cognition, quality of life, and mood throughout aging.

A cross-sectional study of sleep disturbance among middle-aged cancer patients at Vietnam National Cancer Hospital

AIM

Sleep disorders are common in cancer patients and have negative consequences for patient well-being and treatment outcomes. This study aimed to investigate sleep quality and related factors in Vietnamese middle-aged cancer patients.

METHODS

A cross-sectional study was conducted on 246 middle-aged in-patient cancer patients at Vietnam National Cancer Hospital (VNCH) from 1/2021 to 7/2021. Sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), with a cutoff of 5.

RESULTS

The results showed a male/female ratio of 0.85 with an average age of 52. The five most prevalent cancer types were breast, colorectal, lung, and esophagus-stomach cancer, primarily in the late stage and treated with chemotherapy. The prevalence of sleep disturbances was 58.5%. The mean PSQI score was 7.5, with sleep duration and latency of 5.4 h and 1 h, respectively. Approximately 44% of participants reported poor sleep quality, nearly 9% had daytime dysfunction, and 10.6% used sleep medication. The multivariate logistic regression results indicate that people with depression were 8.89 times more likely to have poor sleep than those without depression (95% CI:2.63-28.27, p < .001).

CONCLUSION

Sleep problems are common among middle-aged people with cancer in Vietnam, especially individuals with depression. It is necessary to have more effective approaches to sleep management for cancer patients with limited resources.

Sleep disturbances and change in multiple cognitive domains among older adults: a multicenter study of five Nordic cohorts

STUDY OBJECTIVES

We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years).

METHODS

Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies.

RESULTS

While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates.

CONCLUSION

This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.

Effects of Temperature, Duration, and Heating Height of Foot Thermal Therapy on Sleep Quality of Older Adults: A Systematic Review and Meta-Analysis

Background: Sleep disturbances, which are common problems in older adults, often lead to cognitive decline and depression and may even increase mortality risk. Foot thermal therapy is a simple and safe approach for improving sleep and is associated with relatively few side effects. However, the effect of different operations of foot thermal therapy on sleep quality in older adults is inconclusive. This study aimed to access the effects of temperature, duration, and heating height of foot thermal therapy (administered through a footbath) on the subjective and objective sleep quality of older adults. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, eight databases were searched for all relevant articles published up to July 2023, and a rigorous systematic review and meta-analysis was conducted. This study was registered in the PROSPERO database (CRD42022383460). Inclusion criteria were: (1) participants with a mean age ≥60 years; (2) interventions that included foot thermal therapy; (3) a control group that received routine care but no thermal therapy; (4) outcome measurements that assessed sleep quality; and (5) the studies that utilized randomized controlled trials or quasi-experimental studies. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The meta-analysis was performed using RevMan version 5.4. Results: A total of 11 studies were included. Foot thermal therapy before bedtime improved subjective sleep quality in older adults, with optimal parameters of 40°C temperature (standardized mean difference [SMD] = 0.66, 95% confidence interval [CI]: 0.33 to 0.99), ≤20-min duration (SMD = 0.66, 95% CI: 0.39 to 0.93), and 10 cm heating height (SMD = 0.78, 95% CI: 0.45 to 1.11). Subgroup analyses revealed that a temperature of 41°C-42°C can improve objective sleep latency (SMD = 0.54, 95% CI: 0.09 to 0.99). Conclusions: It is recommended to administer foot thermal therapy (40°C; ≤20 min; 10 cm above the ankle) to older adults 1 h before their bedtime. If they have trouble falling asleep, the temperature can be increased to 41°C-42°C.

Effect of mindfulness-based stress reduction (MBSR) program on depression, emotion regulation, and sleep problems: A randomized controlled trial study on depressed elderly

BACKGROUND

Entering old age is associated with various physical and psychological disabilities. Therefore, the aim of this study is to determine the effect of mindfulness-based stress reduction program on emotion regulation and sleep problems in depressed elderly.

METHODS

This study was a clinical trial conducted on 60 elderly individuals with depression using purposive sampling. These elderly were referred by geriatricians and were included in the study based on the inclusion criteria. The participants were randomly assigned to two groups: the Mindfulness-Based Stress Reduction (MBSR) group and the control group. Both groups completed the Geriatric Depression Scale (GDS), the Gratz and Roemer Emotion Regulation Questionnaire, and the Pittsburgh Sleep Quality Index before and after the intervention. The MBSR sessions were held for the experimental group in 8 sessions of 90 min each, once a week. Finally, all the data were analyzed using SPSS software version 26 through descriptive and analytical statistics such as mean and standard deviation, t-tests and mixed analysis of covariance (ANCOVA) with repeated measures.

RESULTS

The results showed that the MBSR intervention led to a significant reduction in depression symptoms (p < 0.001) and improvement in emotion regulation and sleep quality (p < 0.001) among the elderly participants with depression in the intervention group.

DISCUSSION

The results of this study showed that MBSR can be effective in reducing depression levels, improving emotion regulation, and sleep quality among depressed elderly individuals compared to the control group. Caregivers and psychotherapists of nursing homes can use care programs such as MBSR program to improve the physical and mental condition of the elderly.

TRIAL REGISTRATION

First Registration: 13/01/2022, Registration Number: IRCT20211118053099N1, Access: https://www.irct.ir/trial/61207 .

Sleep and cognition in South African patients with non-functioning pituitary adenomas

Strong lines of evidence in the neuroscience literature indicate that (a) healthy sleep facilitates cognitive processing, and (b) sleep disruption is associated with cognitive dysfunction. Despite the fact that patients with pituitary disease often display both disrupted sleep and cognitive dysfunction, few previous studies investigate whether these clinical characteristics in these patients might be related. Hence, we explored whether sleep disruption in patients with pituitary disease mediates their cognitive dysfunction. We recruited 18 patients with non-functioning pituitary adenomas (NFPA) and 19 sociodemographically matched healthy controls. They completed the Global Sleep Assessment Questionnaire (thus providing self-report data regarding sleep disruption) and were administered the Brief Test of Adult Cognition by Telephone, which assesses cognitive functioning in the domains of processing speed, working memory, episodic memory, inhibition, and reasoning. We found no significant differences in cognition between patients and controls. Furthermore, spectra of sleep disturbance did not differ significantly between patients and controls. Our data suggest that NFPA patients' cognition and sleep quality is relatively intact, and that sleep disruption does not mediate cognitive dysfunction. Larger studies should characterize sleep and cognition in patients with NFPA (and other pituitary diseases) to confirm whether disruption of the former mediates impairment in the latter.