1
|
Hartmann S, Parrino L, Ensrud K, Stone KL, Redline S, Clark SR, Baumert M. Association between psychotropic medication and sleep microstructure: evidence from large population studies. J Clin Sleep Med 2023; 19:581-589. [PMID: 36546402 PMCID: PMC9978436 DOI: 10.5664/jcsm.10394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. METHODS We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders. RESULTS CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between benzodiazepine usage and CAP rate and A2 + 3 index, respectively, in older men, and between CAP rate and SSRI usage in older women. CONCLUSIONS We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF, highlighting the importance of comprehensive sleep analysis, including CAP. Our results may improve understanding of the differences in sleep-wake mechanisms based on psychotropic usage. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Outcomes of Sleep Disorders in Older Men; Identifier: NCT00070681; URL: https://clinicaltrials.gov/ct2/show/record/NCT00070681. CITATION Hartmann S, Parrino L, Ensrud K, et al. Association between psychotropic medication and sleep microstructure: evidence from large population studies. J Clin Sleep Med. 2023;19(3):581-589.
Collapse
Affiliation(s)
- Simon Hartmann
- The University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, South Australia, Australia
- The University of Adelaide, Discipline of Psychiatry, Adelaide Medical School, Adelaide, South Australia, Australia
| | - Liborio Parrino
- Sleep Disorders Center, Department of Neurology, University of Parma, Parma, Emilia-Romagna, Italy
| | - Kristine Ensrud
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Susan Redline
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott R. Clark
- The University of Adelaide, Discipline of Psychiatry, Adelaide Medical School, Adelaide, South Australia, Australia
| | - Mathias Baumert
- The University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Clinical Features and Correlates of Poor Nighttime Sleepiness in Patients with Parkinson's Disease. PARKINSONS DISEASE 2020; 2020:6378673. [PMID: 33005317 PMCID: PMC7509546 DOI: 10.1155/2020/6378673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
Objective The present study investigated the clinical features and correlates of poor nighttime sleepiness (PNS) in patients with Parkinson's disease (PD). Methods One hundred ten patients with PD (divided into PD-PNS group and PD-nPNS group) and forty-seven controls (nPD-PNS group) were enrolled in this study. Demographic information was collected. Patients were assessed according to the unified Parkinson's disease rating scale (UPDRS) and Hoehn–Yahr (H&Y) stage scale. Patients were also evaluated according to the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), rapid eye movement sleep behavior disorder screening questionnaire (RBD-SQ), restless leg syndrome (RLS) diagnosis, Hamilton's depression scale (HAMD), and Hamilton's anxiety scale (HAMA). Results The prevalence of PNS was 55.45% (61/110) in patients with PD. The PD-PNS group tended to have a longer duration of disease, higher UPDRS-I and UPDRS-III scores, a higher percentage of RLS patients, and higher HAMA and HAMD scores than those of the PD-nPNS group. The PD-PNS group tended to have a higher percentage of RBD and RLS patients and higher HAMA and HAMD scores than those of the nPD-PNS group. Analysis of the PSQI components and PSQI impact factors showed that the PD-PNS group had worse subjective sleep quality (χ2 = −2.267, P = 0.023), shorter sleep latency (χ2 = −2.262, P = 0.024), fewer sleep medications (χ2 = −4.170, P ≤ 0.001), worse daytime functioning (χ2 = −2.347, P = 0.019), and an even higher prevalence of increased nocturia (χ2 = 4.447, P = 0.035), nightmares (χ2 = 7.887, P = 0.005), and pain (χ2 = 9.604, P = 0.002) than those of the nPD-PNS group. Analysis also indicated that the PSQI global score positively correlated with BMI (r = 0.216, P < 0.05), H&Y stage (r = 0.223, P < 0.05), UPDRS-I (r = 0.501, P < 0.01), UPDRS-III (r = 0.425, P < 0.01), ESS (r = −0.296, P < 0.01), RBD (r = 0.227, P < 0.05), RLS (r = 0.254, P < 0.01), HAMA (r = 0.329, P < 0.01), and HAMD (r = 0.466, P < 0.01). In the final model, H&Y stage, RLS, UPDRS-III, and HAMD remained associated with the PQSI score (P ≤ 0.001, P ≤ 0.001, P = 0.049, P ≤ 0.001, respectively). Conclusions Our data showed that PNS was common in patients with PD. H&Y stage, UPDRS-III, HAMD, and RLS were positively associated with PNS. Attention to the management of motor symptoms, RLS, and depression may be beneficial to nighttime sleep quality in patients with PD.
Collapse
|
3
|
Desjardins S, Lapierre S, Hudon C, Desgagné A. Factors involved in sleep efficiency: a population-based study of community-dwelling elderly persons. Sleep 2019; 42:zsz038. [PMID: 30768200 PMCID: PMC6519908 DOI: 10.1093/sleep/zsz038] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/07/2019] [Indexed: 02/02/2023] Open
Abstract
STUDY OBJECTIVES Research indicates that sleep efficiency below 80% substantially increases mortality risk in elderly persons. The aim of this study was to identify factors that would best predict poor sleep efficiency in the elderly, and to determine whether associations between these factors and sleep efficiency were similar for men and women and for younger and older elderly persons. METHODS A total of 2468 individuals aged 65-96 years (40.7% men) participated. They were recruited via random generation of telephone numbers according to a geographic sampling strategy. The participants agreed to have health professionals visit their home and to answer structured interview questions. Sleep efficiency was calculated based on interview responses. Descriptive statistics and logistic regressions were conducted. RESULTS The factors most strongly associated with sleep efficiency below 80% were pain, nocturia, sleep medication use, and awakening from bad dreams. Some factors varied by sex: women aged 75 years and older or who had an anxiety disorder were more likely to have sleep efficiency below 80%, whereas being single or having painful illness raised the likelihood for men only. Except for sex, all the factors that showed associations with sleep efficiency affected younger and older elderly persons similarly. CONCLUSIONS Poor sleep efficiency is prevalent among elderly persons. The results shed new light on factors associated with poor sleep efficiency, highlighting the presence of sex differences and that certain factors make no significant contribution, such as typically proscribed sleep hygiene behaviors, mood disorders, and illness in general.
Collapse
Affiliation(s)
- Sophie Desjardins
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
| | - Carol Hudon
- School of Psychology, Université Laval, Québec, Canada
| | - Alain Desgagné
- Department of Mathematics, Université du Québec à Montréal, Québec, Canada
| |
Collapse
|
4
|
Carrière I, Farré A, Norton J, Wyart M, Tzourio C, Noize P, Pérès K, Fourrier-Réglat A, Ancelin ML. Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort. Osteoporos Int 2016; 27:3187-3195. [PMID: 27311722 DOI: 10.1007/s00198-016-3667-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/10/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED In this population-based elderly cohort, participants using selective serotonin reuptake inhibitor (SSRI) antidepressants have an increased risk of falls and fractures notably when the treatment was continued over 4 years. Among the various SSRI types, citalopram only was at significant risk for falls and fluoxetine for fractures. INTRODUCTION Increased risk of falls and fractures has been reported in elderly users of SSRIs. However, biases were insufficiently addressed notably temporality between exposure and outcome and confounding by residual depression. Our objective was to examine the associations between SSRIs and fall or fracture incidence focusing on their chronic use and different types of SSRIs. METHODS The population-based cohort included participants aged 65 years and above, who had not fallen before inclusion (n = 6599) or were free of recent fracture (n = 6823) and were followed up twice over 4 years. New fall and fracture events were self-reported and defined as at least two falls and one fracture, respectively, during the previous 2 years. SSRI users were compared with those taking no antidepressants. Hazard ratios (HRs) were estimated using Cox models with delayed entry and adjusted for many confounders including residual depressive symptoms. RESULTS Incidence of falls was 19.3 % over 4 years and that of fractures 9.5 %. After multi-adjustment, SSRI intake was significantly associated with a higher risk of falls (HR, 95 % CI = 1.58, 1.23-2.03) and fractures (HR, 95 % CI = 1.61, 1.16-2.24). The risks were significantly increased by 80 % in those continuing the treatment over 4 years. Citalopram intake only was at significant risk for falls and fluoxetine for fractures. CONCLUSIONS In this large community-dwelling elderly sample, SSRI users were at higher risk of falls and fractures. This association was not due to reverse causality or residual depressive symptoms. Different SSRI drugs may have specific adverse effects on falls and fractures.
Collapse
Affiliation(s)
- I Carrière
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, 39 Avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France.
- University of Montpellier, U1061, Montpellier, France.
| | - A Farré
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, 39 Avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France
- University of Montpellier, U1061, Montpellier, France
| | - J Norton
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, 39 Avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France
- University of Montpellier, U1061, Montpellier, France
| | - M Wyart
- Department of Psychiatry, CHU Caremeau, Nîmes, France
| | - C Tzourio
- Inserm, ISPED, Centre U1219 - Bordeaux Population Health Research Center, Bordeaux, France
- University of Bordeaux, ISPED, Centre U1219, Bordeaux, France
| | - P Noize
- Inserm, ISPED, Centre U1219 - Bordeaux Population Health Research Center, Bordeaux, France
- Department of Clinical Pharmacology, CHU Bordeaux, Bordeaux, France
| | - K Pérès
- Inserm, ISPED, Centre U1219 - Bordeaux Population Health Research Center, Bordeaux, France
- University of Bordeaux, ISPED, Centre U1219, Bordeaux, France
| | - A Fourrier-Réglat
- Inserm, ISPED, Centre U1219 - Bordeaux Population Health Research Center, Bordeaux, France
- Department of Clinical Pharmacology, CHU Bordeaux, Bordeaux, France
| | - M L Ancelin
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, 39 Avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France
- University of Montpellier, U1061, Montpellier, France
| |
Collapse
|
5
|
Lehnich AT, Kowall B, Kuß O, Schmidt-Pokrzywniak A, Weinreich G, Dragano N, Moebus S, Erbel R, Jöckel KH, Stang A. Do patients with intake of drugs labelled as sleep disturbing really sleep worse? A population based assessment from the Heinz Nixdorf Recall Study. Br J Clin Pharmacol 2016; 82:869-77. [PMID: 27279554 DOI: 10.1111/bcp.13015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 12/20/2022] Open
Abstract
AIM The sleep disturbing effect of many drugs is derived from clinical trials with highly selected patient collectives. However, the generalizability of such findings to the general population is questionable. Our aim was to assess the association between intake of drugs labelled as sleep disturbing and self-reported nocturnal sleep disturbances in a population-based study. METHODS We used data of 4221 participants (50.0% male) aged 45 to 75 years from the baseline examination of the Heinz Nixdorf Recall Study in Germany. The interview provided information on difficulties falling asleep, difficulties maintaining sleep and early morning arousal. We used the summary of product characteristics (SPC) for each drug taken and assigned the probability of sleep disturbances. Thereafter, we calculated cumulative probabilities of sleep disturbances per subject to account for polypharmacy. We estimated prevalence ratios (PR) using log Poisson regression models with robust variance. RESULTS The adjusted PRs of any regular nocturnal sleep disorder per additional sleep disturbing drug were 1.01 (95% confidence interval (CI) 0.97, 1.06) and 1.03 (95% CI 1.00, 1.07) for men and women, respectively. Estimates for each regular nocturnal sleep disturbance were similarly close to 1. PRs for regular nocturnal sleep disturbances did not increase with rising cumulative probability for drug-related sleep disturbances. CONCLUSIONS SPC-based probabilities of drug-related sleep disturbances showed barely any association with self-reported regular nocturnal sleep disturbances. We conclude that SPC-based probability information may lack generalizability to the general population or may be of limited data quality.
Collapse
Affiliation(s)
- Anna-Therese Lehnich
- Institute of Medical Informatics, Biometry and Epidemiology Medical Faculty, University of Duisburg-Essen, Essen
| | - Bernd Kowall
- Institute of Medical Informatics, Biometry and Epidemiology Medical Faculty, University of Duisburg-Essen, Essen
| | - Oliver Kuß
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf
| | - Andrea Schmidt-Pokrzywniak
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle
| | - Gerhard Weinreich
- Department of Pneumology, Ruhrlandklinik, West German Lung Centre, University Hospital of Essen, University of Duisburg-Essen, Essen
| | - Nico Dragano
- Institute for Medical Sociology, Centre for Health and Society, University of Düsseldorf, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Susanne Moebus
- Institute of Medical Informatics, Biometry and Epidemiology Medical Faculty, University of Duisburg-Essen, Essen
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology Medical Faculty, University of Duisburg-Essen, Essen
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology Medical Faculty, University of Duisburg-Essen, Essen
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology Medical Faculty, University of Duisburg-Essen, Essen.,Department of Epidemiology, Boston University, School of Public Health, MA, Boston, USA
| |
Collapse
|
6
|
Massa J, Stone KL, Wei EK, Harrison SL, Barrett-Connor E, Lane NE, Paudel M, Redline S, Ancoli-Israel S, Orwoll E, Schernhammer E. Vitamin D and actigraphic sleep outcomes in older community-dwelling men: the MrOS sleep study. Sleep 2015; 38:251-7. [PMID: 25581929 DOI: 10.5665/sleep.4408] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 11/15/2014] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES Maintaining adequate serum levels of vitamin D may be important for sleep duration and quality; however, these associations are not well understood. We examined whether levels of serum 25(OH)D are associated with objective measures of sleep in older men. SETTING AND PARTICIPANTS Cross-sectional study within a large cohort of community-dwelling older men, the MrOS study. INTERVENTIONS Among 3,048 men age 68 years or older, we measured total serum vitamin D. Objective estimates of nightly total sleep time, sleep efficiency, and wake time after sleep onset (WASO) were obtained using wrist actigraphy worn for an average of 5 consecutive 24-h periods. RESULTS 16.4% of this study population had low levels of vitamin D (< 20.3 ng/mL 25(OH)D). Lower serum vitamin D levels were associated with a higher odds of short (< 5 h) sleep duration, (odds ratio [OR] for the highest (≥ 40.06 ng/mL) versus lowest (< 20.3 ng/mL) quartile of 25(OH)D, 2.15; 95 % confidence interval (CI), 1.21-3.79; Ptrend = 0.004) as well as increased odds of actigraphy-measured sleep efficiency of less than 70% (OR, 1.45; 95% CI, 0.97-2.18; Ptrend = 0.004), after controlling for age, clinic, season, comorbidities, body mass index, and physical and cognitive function. Lower vitamin D levels were also associated with increased WASO in age-adjusted, but not multivariable adjusted models. CONCLUSIONS Among older men, low levels of total serum 25(OH)D are associated with poorer sleep including short sleep duration and lower sleep efficiency. These findings, if confirmed by others, suggest a potential role for vitamin D in maintaining healthy sleep.
Collapse
Affiliation(s)
- Jennifer Massa
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, for the Osteoporotic Fractures in Men (MrOS) Study Group
| | - Esther K Wei
- California Pacific Medical Center Research Institute, San Francisco, CA, for the Osteoporotic Fractures in Men (MrOS) Study Group
| | - Stephanie L Harrison
- California Pacific Medical Center Research Institute, San Francisco, CA, for the Osteoporotic Fractures in Men (MrOS) Study Group
| | | | - Nancy E Lane
- Department of Medicine, University of California at San Diego, La Jolla, CA.,Department of Medicine, University of California at Davis School of Medicine, Sacramento, CA
| | - Misti Paudel
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, CA.,Department of Veterans Affairs San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
| | - Eric Orwoll
- Oregon Clinical and Translational Research Institute and School of Medicine, Oregon Health and Science University, Portland, OR
| | - Eva Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA
| |
Collapse
|
7
|
Geoffroy PA, Scott J, Boudebesse C, Lajnef M, Henry C, Leboyer M, Bellivier F, Etain B. Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Acta Psychiatr Scand 2015; 131:89-99. [PMID: 25430914 DOI: 10.1111/acps.12367] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Sleep dysregulation is highly prevalent in bipolar disorders (BDs), with previous actigraphic studies demonstrating sleep abnormalities during depressive, manic, and interepisode periods. We undertook a meta-analysis of published actigraphy studies to identify whether any abnormalities in the reported sleep profiles of remitted BD cases differ from controls. METHOD A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis. Effect sizes for actigraphy parameters were expressed as standardized mean differences (SMD) with 95% confidence intervals (95% CI). RESULTS Nine of 248 identified studies met eligibility criteria. Compared with controls (N=210), remitted BD cases (N=202) showed significant differences in SMD for sleep latency (0.51 [0.28-0.73]), sleep duration (0.57 [0.30-0.84]), wake after sleep onset (WASO) (0.28 [0.06-0.50]) and sleep efficiency (-0.38 [-0.70-0.07]). Moderate heterogeneity was identified for sleep duration (I2=44%) and sleep efficiency (I2=44%). Post hoc meta-regression analyses demonstrated that larger SMD for sleep duration were identified for studies with a greater age difference between BD cases and controls (β=0.22; P=0.03) and non-significantly lower levels of residual depressive symptoms in BD cases (β=-0.13; P=0.07). CONCLUSION This meta-analysis of sleep in remitted bipolar disorder highlights disturbances in several sleep parameters. Future actigraphy studies should pay attention to age matching and levels of residual depressive symptoms.
Collapse
Affiliation(s)
- P A Geoffroy
- Inserm, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris Cedex 10, France; Université Paris Descartes, UMR-S 1144, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation FondaMental, Créteil, France
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Datto C, Svedsäter H, Locklear JC, Endicott J. Effect of extended-release quetiapine fumarate on quality of life and sleep in elderly patients with generalized anxiety disorder. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Effects of once-daily extended release quetiapine fumarate (quetiapine XR) on quality of life and sleep in elderly patients with major depressive disorder. J Affect Disord 2013; 149:189-95. [PMID: 23639212 DOI: 10.1016/j.jad.2013.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/11/2012] [Accepted: 01/28/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is frequently associated with reduced quality of life (QoL) and sleep disturbance. We investigated the effects of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy on QoL and sleep in elderly patients with MDD. METHODS Prospectively planned analysis of patient-reported data from an 11-week (9-week randomized; 2-week post-treatment), double-blind, placebo-controlled, Phase III study. Elderly patients (≥66 years; DSM-IV MDD; Hamilton Rating Scale for Depression [HAM-D] total score ≥22, HAM-D Item 1 score ≥2) were randomized to quetiapine XR (flexible dosing 50-300 mg/day) or placebo. PRIMARY OUTCOME MADRS total score change from randomization at Week 9. Patient-reported outcomes: Quality of Life, Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) % of maximum total score (Items 1-14), Q-LES-Q-SF Item 15 ('satisfaction with medication'), Q-LES-Q-SF Item 16 ('overall life satisfaction'), and Pittsburgh Sleep Quality Index (PSQI) global score. RESULTS In total, 338 patients were randomized (166 quetiapine XR; 172 placebo). At Week 9, quetiapine XR significantly reduced MADRS total score (-16.33; difference: -7.54; 95% CI: -9.23, -5.85; p<0.001) versus placebo (-8.79). Quetiapine XR significantly improved Q-LES-Q-SF % of maximum total score (16.86; difference: 7.69; 95% CI: 4.99, 10.39; p<0.001) versus placebo (9.17), with numerical improvement in Q-LES-Q-SF Item 15 and improvement in Item 16. Improvement in PSQI global score was observed with quetiapine XR (-6.42; difference: -3.52; 95% CI: -4.26, -2.79; p<0.001) versus placebo (-2.89). LIMITATIONS Lack of active-comparator arm, flexible-dose design, acute treatment period. CONCLUSIONS Quetiapine XR monotherapy improved QoL and sleep in elderly patients with MDD.
Collapse
|
10
|
Parimi N, Blackwell T, Stone KL, Lui LY, Ancoli-Israel S, Tranah GJ, Hillier TA, Nevitt ME, Lane NE. Hip pain while using lower extremity joints and sleep disturbances in elderly white women: results from a cross-sectional analysis. Arthritis Care Res (Hoboken) 2012; 64:1070-8. [PMID: 22298286 DOI: 10.1002/acr.21630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate sleep quality in women with hip pain due to daily activities involving the lower extremity joints. METHODS We evaluated the association of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) hip pain severity score with objective sleep measures obtained by wrist actigraphy in 2,225 white women ≥ 65 years of age enrolled in the Study of Osteoporotic Fractures. RESULTS Women had an increased odds of spending ≥ 90 minutes awake after sleep onset (odds ratio [OR] 1.28, 95% confidence interval [95% CI] 1.11-1.50) for every 5-point increase in hip pain score after adjustment for all covariates. Hip pain when sitting or lying was the strongest predictor of sleep fragmentation (OR 2.0, 95% CI 1.47-2.73); however, standing pain was associated with a higher number of awake minutes in bed scored from sleep onset to the end of the last sleep episode, independent of pain while in bed (OR 1.41, 95% CI 1.07-2.01). Sleep disturbances increased significantly after the first 2 hours of sleep in women with severe hip pain compared to those without hip pain (mean ± SD 1.4 ± 0.47 minutes per hour of sleep; P < 0.003). Similar associations were observed for long wake episodes >5 minutes. There were no associations between daytime napping, sleep latency, sleep efficiency, and total sleep minutes and WOMAC hip pain. CONCLUSION Fragmented sleep was greater in women with hip pain compared to those without hip pain; however, fragmented sleep in women with severe hip pain compared to those without hip pain was unchanged until after the first 2 hours of sleep. Further investigations into pain medications wearing off over time or the prolonged periods of inactivity decreasing the pain threshold are warranted.
Collapse
Affiliation(s)
- Neeta Parimi
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107-1762, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
SummaryInsomnia and other sleep disturbances are common in older people, with up to 40% reporting some difficulty sleeping. Insomnia is a syndrome with multiple causes including medications, other illnesses and environmental factors. An accurate diagnosis is needed for effective management. Sleep disturbances are associated with functional and cognitive impairment and excess mortality. Management should initially be non-pharmacological including sleep hygiene education and behavioural therapy. Medications, including benzodiazepines (BZDs), are second-line with little evidence to support long-term usage. BZD usage in older people is associated with a range of disorders including falls, accidents and cognitive impairment. The management of insomnia in specific situations such as residential care, those with dementia and depressed older people can be challenging. Additional research is needed, particularly on the risks/benefit of long-term pharmacotherapy and to determine whether therapy reduces the consequences of sleep disturbances.
Collapse
|
12
|
Abstract
OBJECTIVE To present a case of primary menopausal insomnia with hot flashes to introduce recent changes in technology and nomenclature of sleep medicine and to review presentation, diagnosis, and therapies for menopausal insomnia. METHODS Clinical findings and results of sleep evaluation in the menopausal study patient are presented with details about polysomnography performed before and after therapy with pregabalin. RESULTS A 56.5-year-old female athlete with severe hot flashes and insomnia of 12 years' duration was treated with pregabalin, which ameliorated the hot flashes and sweats and improved sleep quality and architecture. Menopause is associated with hormonal and metabolic changes that disrupt sleep. Disruption of sleep can in turn lead to morbidity and metabolic sequelae. Hormonal treatment, although effective, carries risks unacceptable to many patients and physicians. To date, nonhormonal therapies of symptomatic menopause have not been objectively studied for effects on sleep efficiency and architecture. Primary menopausal insomnia is insomnia associated with menopause and not attributable to secondary causes. Polysomnographically, it seems characterized by a high percentage of slow-wave (N3) sleep, decreased rapid eye movement sleep, cyclic alternating pattern, and arousals. CONCLUSIONS Primary menopausal insomnia is probably mediated through a mechanism separate from hot flashes, and one can occur without the other. Thermal dys-regulation and sleep abnormalities of menopause are probably related to more general changes mediated through loss of estrogenic effects on neuronal modulation of energy metabolism, and more clinical direction is expected as this research field develops. Identification of sleep disorders in menopausal women is important, and polysomnographic evaluation is underused in both clinical and research evaluations of metabolic disturbances.
Collapse
Affiliation(s)
- Raymond E Bourey
- Center for Diabetes and Endocrine Research, Division of Endocrinology and Division of Pulmonary, Critical Care, and Sleep Medicine, University of Toledo College of Medicine, Toledo, Ohio 43614, USA.
| |
Collapse
|
13
|
Ensrud KE, Taylor BC. RESPONSE LETTER TO DR. MOREIRA ET AL. J Am Geriatr Soc 2010. [DOI: 10.1111/j.1532-5415.2009.02692.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
&NA;. Weigh the benefits of treatment against the increase in the risk of falls when using antidepressant therapy in the elderly. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11204060-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
15
|
Moret C, Isaac M, Briley M. Problems associated with long-term treatment with selective serotonin reuptake inhibitors. J Psychopharmacol 2009; 23:967-74. [PMID: 18635702 DOI: 10.1177/0269881108093582] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although the selective serotonin reuptake inhibitors (SSRIs), which are now widely used as a first-line treatment for depression and many other psychiatric conditions, are generally well tolerated, they are not devoid of side effects. Most short-term treatment-related side effects of SSRIs are transient and disappear after a few days or weeks. However, following long-term treatment with the SSRIs, some serious adverse events may occur. Some of them can be difficult to recognise because they can resemble residual symptoms of depression. The most serious can be life threatening. They all have a negative influence on the patient's quality of life and are frequently a prime reason for a lack of long-term compliance with the associated increased risk of recurrence of a depressive episode. This article is an overview of the more common adverse events, which are seen with non-acute treatment with the SSRIs.
Collapse
Affiliation(s)
- C Moret
- NeuroBiz Consulting & Communication, Castres, France.
| | | | | |
Collapse
|
16
|
van den Brand MWM, Samson MM, Pouwels S, van Staa TP, Thio B, Cooper C, Leufkens HGM, Egberts ACG, Verhaar HJJ, de Vries F. Use of anti-depressants and the risk of fracture of the hip or femur. Osteoporos Int 2009; 20:1705-13. [PMID: 19238308 PMCID: PMC2744781 DOI: 10.1007/s00198-009-0849-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 01/16/2009] [Indexed: 12/02/2022]
Abstract
SUMMARY Anti-depressants are used largely, but have serious side effects. We show that both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) increase the risk of hip/femur fracture and that this risk is time related and depends on the degree of serotonin transporter inhibition. This should be considered when prescribing anti-depressants to patients. INTRODUCTION Anti-depressants are known to have serious side effects. We examined the association between the use of anti-depressants and the risk of hip/femur fractures with a special focus on the relation with the degree of 5-hydroxytryptamine transporter (5-HTT) inhibition and the duration of use. METHODS A case-control study was conducted within the Dutch PHARMO-RLS database. Cases (n = 6,763) were adult patients with a first hip/femur fracture during the study period. For each case, four controls (n = 26341) were matched by age, gender and geographic region. RESULTS The risk of hip/femur fracture increased with current use of SSRIs (adjusted odds ratio (OR(adj)) 2.35 [95% confidence interval (CI) 1.94-2.84]) and TCAs (ORadj 1.76 [95% CI 1.45-2.15]). The risk of hip/femur fracture declined rapidly after discontinuation of use. The risk of hip/femur fracture increased as the degree of 5-HTT inhibition of all anti-depressants increased from OR(adj) 1.64 [95% CI 1.14-2.35] for drugs with low 5-HTT inhibition to OR(adj) 2.31 [95% CI 1.94-2.76] for those with high 5-HTT inhibiting properties. CONCLUSION Current use of both SSRIs and TCAs increase hip/femur fracture risk. Further studies are needed to elucidate the mechanistic pathways and the relation with the underlying pathophysiology. Until then, the elevated fracture risk should be considered when prescribing anti-depressants.
Collapse
Affiliation(s)
- M. W. M. van den Brand
- Department of Geriatric Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M. M. Samson
- Department of Geriatric Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - S. Pouwels
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
| | - T. P. van Staa
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
- Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- General Practice Research Database, Medicines and Healthcare products Regulatory Agency, 19 Elmslane, SW8 5NQ, London, UK
| | - B. Thio
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
| | - C. Cooper
- Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - H. G. M. Leufkens
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
| | - A. C. G. Egberts
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H. J. J. Verhaar
- Department of Geriatric Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - F. de Vries
- Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Universiteit Utrecht, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands
- Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- General Practice Research Database, Medicines and Healthcare products Regulatory Agency, 19 Elmslane, SW8 5NQ, London, UK
| |
Collapse
|
17
|
Ensrud KE, Blackwell TL, Redline S, Ancoli-Israel S, Paudel ML, Cawthon PM, Dam TTL, Barrett-Connor E, Leung PC, Stone KL. Sleep disturbances and frailty status in older community-dwelling men. J Am Geriatr Soc 2009; 57:2085-93. [PMID: 19793160 DOI: 10.1111/j.1532-5415.2009.02490.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To test the hypothesis that sleep disturbances are independently associated with frailty status in older men. DESIGN Cross-sectional analysis of prospective cohort study. SETTING Six U.S. centers. PARTICIPANTS Three thousand one hundred thirty-three men aged 67 and older. MEASUREMENTS Self-reported sleep parameters (questionnaire); objective parameters of sleep-wake patterns (actigraphy data collected for an average of 5.2 nights); and objective parameters of sleep-disordered breathing, nocturnal hypoxemia, and periodic leg movements with arousals (PLMAs) (in-home overnight polysomnography). Frailty status was classified as robust, intermediate stage, or frail using criteria similar to those used in the Cardiovascular Health Study frailty index. RESULTS The prevalence of sleep disturbances, including poor sleep quality, excessive daytime sleepiness, short sleep duration, lower sleep efficiency, prolonged sleep latency, sleep fragmentation (greater nighttime wakefulness and frequent, long wake episodes), sleep-disordered breathing, nocturnal hypoxemia, and frequent PLMAs, was lowest in robust men, intermediate in men in the intermediate-stage group, and highest in frail men (P-for-trend < or =.002 for all sleep parameters). After adjusting for multiple potential confounders, self-reported poor sleep quality (Pittsburgh Sleep Quality Index > 5, multivariable odds ratio (MOR)=1.28, 95% confidence interval (CI)=1.09-1.50), sleep efficiency less than 70% (MOR=1.37, 95% CI=1.12-1.67), sleep latency of 60 minutes or longer (MOR=1.42, 95% CI=1.10-1.82), and sleep-disordered breathing (respiratory disturbance index > or =15, MOR=1.38, 95% CI=1.15-1.65) were each independently associated with higher odds of greater frailty status. CONCLUSION Sleep disturbances, including poor self-reported sleep quality, lower sleep efficiency, prolonged sleep latency, and sleep-disordered breathing, are independently associated with greater evidence of frailty.
Collapse
Affiliation(s)
- Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Antidepressants have long been recognized as a contributory factor to falls and many studies show an association between antidepressants and falls. There are extensive data for tricyclic antidepressants (TCAs) and related drugs, and for selective serotonin reuptake inhibitors (SSRIs), but few data for other classes of antidepressants. Sedation, insomnia and impaired sleep, nocturia, impaired postural reflexes and increased reaction times, orthostatic hypotension, cardiac rhythm and conduction disorders, and movement disorders have all been postulated as contributing factors to falls in patients taking antidepressants. Sleep disturbance is a cardinal feature of depression, and all antidepressants have effects on sleep. TCAs and related drugs cause marked sedation with daytime drowsiness. SSRIs and related drugs have an alerting effect, impairing sleep duration and quality and causing insomnia, which may result in nocturia and daytime drowsiness. Daytime drowsiness is a significant risk factor for falls, both in untreated depression and in depression treated with antidepressants. Clinically significant orthostatic hypotension is common with TCAs and related drugs, the older monoamine oxidase inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs). It occurs less commonly with SSRIs, and rarely with moclobemide and bupropion, and is not reported as a significant adverse effect of hypericum (St John's wort). Cardiac rhythm and conduction disturbances are well recognized with TCAs, tetracyclics and SNRIs, but have also been reported with SSRIs. The contribution of antidepressant-induced conduction and rhythm disturbances to falls cannot be assessed with current data. There are insufficient data to exonerate any individual antidepressant or class of antidepressants as a potential cause of falls. The magnitude of the increased risk of falling with an antidepressant is about the same as the excess risk found in patients with untreated depression.
Collapse
|
19
|
Krueger PM, Friedman EM. Sleep duration in the United States: a cross-sectional population-based study. Am J Epidemiol 2009; 169:1052-63. [PMID: 19299406 DOI: 10.1093/aje/kwp023] [Citation(s) in RCA: 529] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sleep duration is associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, and prospective mortality. Little is known, however, about sleep patterns in the US population. The 2004-2007 National Health Interview Survey-Sample Adult Files provide nationally representative data for 110,441 noninstitutionalized US adults aged 18 years or older, and multinomial logistic regression examines whether variables in 5 domains-demographic, family structure, socioeconomic, health behavior, and health status-are associated with long or short sleep duration. Being older, non-Hispanic black, or a current or former smoker; having low levels of education, income, or few income sources; consuming few or numerous drinks in a week; or reporting cardiovascular disease, diabetes, depression, underweight, or activity limitations is associated with increased odds of both long and short sleep duration. Other variables are associated with shorter (e.g., living with young children, being unmarried, working long hours, more frequent binge drinking) or longer (e.g., being younger, Mexican American, pregnant, or having low levels of physical activity) sleep hours. The authors identify numerous risk factors for long and short sleep; many of those variables are potential confounders of the relation between sleep hours and other health outcomes.
Collapse
Affiliation(s)
- Patrick M Krueger
- School of Public Health, University of Texas, Houston, TX 77030, USA.
| | | |
Collapse
|
20
|
Blackwell T, Redline S, Ancoli-Israel S, Schneider JL, Surovec S, Johnson NL, Cauley JA, Stone KL. Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study. Sleep 2008; 31:283-91. [PMID: 18274276 PMCID: PMC2225568 DOI: 10.1093/sleep/31.2.283] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO) as assessed by actigraphy gathered in 3 different modes were compared to polysomnography (PSG) measurements. Each mode was compared to PSG to determine which was more accurate. Associations of the difference in TST measurement with demographics and sleep characteristics were examined. DESIGN Observational study. SETTING Community-based. PARTICIPANTS Sixty-eight women (mean age 81.9 years) from the latest visit of the Study of Osteoporotic Fractures who were concurrently measured with PSG and actigraphy. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS In-home 12-channel PSG was gathered along with actigraphy data in 3 modes: proportional integration mode (PIM), time above threshold (TAT) and zero crossings mode (ZCM). The PIM mode corresponded better to PSG, with a mean overestimation of TST of 17.9 min. For the PIM mode, the estimation of TST and SE by PSG and actigraphy significantly differed (P < 0.01), while the estimation of WASO was similar (P = 0.27). The intraclass correlation between the 2 procedures was moderate to high (PIM mode: TST 0.76; SE 0.61; WASO 0.58). On average, the PIM mode underestimated TST by 68 min for those who slept < or = 5 hr, overestimated TST by 31 min for those with SE < 70%, and underestimated TST by 24 min for self-reported poor sleepers (P < 0.05). CONCLUSIONS Sleep parameters from actigraphy corresponded reasonably well to PSG in this population, with the PIM mode of actigraphy correlating highest. Those with poor sleep quality had the largest measurement error between the 2 procedures.
Collapse
Affiliation(s)
- Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW This article focuses on recent research into depression, bipolar disorder and anxiety in older people. RECENT FINDINGS Many physical illnesses are associated with a high prevalence of depression but overall medical burden may largely account for this. The relationship between depression and vascular disease is two way. Frontal brain dysfunction may underlie depression both in cerebrovascular disease and neurodegenerative disorders. Besides antidepressants, psychological treatments, psychosocial interventions and enhanced primary care services are effective. Longer-term outcomes are poor but preventive strategies show promise. Medical and psychiatric comorbidity are also important themes in later-life anxiety and bipolar disorders. SUMMARY Improving prognosis is a key concern and more research into novel pharmacological approaches (including vasoprotection), psychological interventions and prevention is needed.
Collapse
|
22
|
Kochar J, Fredman L, Stone KL, Cauley JA. Sleep problems in elderly women caregivers depend on the level of depressive symptoms: results of the Caregiver--Study of Osteoporotic Fractures. J Am Geriatr Soc 2007; 55:2003-9. [PMID: 17944894 DOI: 10.1111/j.1532-5415.2007.01434.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women. DESIGN Cross-sectional study conducted in four communities in 1999 to 2001. SETTING Home-based interviewer-administered questionnaires. PARTICIPANTS Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures. MEASUREMENTS Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item. RESULTS In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES-D > or = 16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems (adjusted odds ratios ranging from 2.5, 95% confidence interval (CI)=1.2-5.2 for trouble falling asleep to 4.0, 95% CI=2.0-7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations (e.g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems. CONCLUSION Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems.
Collapse
Affiliation(s)
- Jinesh Kochar
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|