1
|
Alessi CA, Fung CH, Dzierzewski JM, Fiorentino L, Stepnowsky C, Rodriguez Tapia JC, Song Y, Zeidler MR, Josephson K, Mitchell MN, Jouldjian S, Martin JL. Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea. Sleep 2021; 44:zsaa235. [PMID: 33221910 PMCID: PMC8033453 DOI: 10.1093/sleep/zsaa235] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. METHODS 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. RESULTS Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). CONCLUSIONS An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. TRIAL REGISTRATION ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558.
Collapse
Affiliation(s)
- Cathy A Alessi
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | - Lavinia Fiorentino
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Carl Stepnowsky
- Department of Medicine, University of California, San Diego, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | | | - Yeonsu Song
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Michelle R Zeidler
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
2
|
Ryden AM, Martin JL, Matsuwaka S, Fung CH, Dzierzewski JM, Song Y, Mitchell MN, Fiorentino L, Josephson KR, Jouldjian S, Alessi CA. Insomnia Disorder Among Older Veterans: Results of a Postal Survey. J Clin Sleep Med 2019; 15:543-551. [PMID: 30952212 DOI: 10.5664/jcsm.7710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 01/04/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To estimate the prevalence of insomnia disorder among older veterans and to study relationships among age and self-rated health, with insomnia disorder, self-reported sleep duration and sleep efficiency. METHODS A cross-sectional postal survey of community-dwelling older veterans (older than 60 years) seen at one VA Healthcare System in the prior 18 months was performed, which was constructed to align with the general diagnostic criteria for insomnia disorder (International Classification of Sleep Disorders, Second Edition [ICSD-2]). The survey also queried self-reported sleep duration, bedtime, and wake time, which were used to calculate sleep efficiency. The survey also asked about race/ethnicity and self-rated health (using the general health item from the Short Form-36). RESULTS A completed survey was returned by 4,717 individuals (51.9% response rate; mean age 74.1 years). Of those, 2,249 (47.7%) met ICSD-2 diagnostic criteria for insomnia disorder. In logistic regression analyses, insomnia disorder was more likely among younger age categories (odds ratios [OR] 1.4-2.5) and in those with worse self-rated health (OR 2.1-14.4). Both total nocturnal sleep time and time in bed increased with older age (all P < .001), whereas sleep efficiency did not differ. Worse self-rated health was associated with shorter total nocturnal sleep time, more time in bed, and lower (worse) sleep efficiency. CONCLUSIONS Results of the postal survey suggest that almost half of community-dwelling older veterans have insomnia disorder, which was more common in young-old and among those with worse self-rated health. Additional work is needed to address the high burden of insomnia among older adults, including those with poor health.
Collapse
Affiliation(s)
- Armand M Ryden
- Pulmonary/Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Jennifer L Martin
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Sean Matsuwaka
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington
| | - Constance H Fung
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Yeonsu Song
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Lavinia Fiorentino
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Karen R Josephson
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A Alessi
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
3
|
Dzierzewski JM, Martin JL, Fung CH, Song Y, Fiorentino L, Jouldjian S, Rodriguez JC, Mitchell M, Josephson K, Alessi CA. CBT for late-life insomnia and the accuracy of sleep and wake perceptions: Results from a randomized-controlled trial. J Sleep Res 2019; 28:e12809. [PMID: 30609099 DOI: 10.1111/jsr.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 01/26/2023]
Abstract
Subjective and objective estimates of sleep are often discordant among individuals with insomnia who typically under-report sleep time and over-report wake time at night. This study examined the impact and durability of cognitive-behavioural therapy for insomnia on improving the accuracy of sleep and wake perceptions in older adults, and tested whether changes in sleep quality were related to changes in the accuracy of sleep/wake perceptions. One-hundred and fifty-nine older veterans (97% male, mean age 72.2 years) who met diagnostic criteria for insomnia disorder were randomized to: (1) cognitive-behavioural therapy for insomnia (n = 106); or (2) attention control (n = 53). Assessments were conducted at baseline, post-treatment, 6-months and 12-months follow-up. Sleep measures included objective (via wrist actigraphy) and subjective (via self-report diary) total sleep time and total wake time, along with Pittsburgh Sleep Quality Index score. Discrepancy was computed as the difference between objective and subjective estimates of wake and sleep. Minutes of discrepancy were compared between groups across time, as were the relationships between Pittsburgh Sleep Quality Index scores and subsequent changes in discrepancy. Compared with controls, participants randomized to cognitive-behavioural therapy for insomnia became more accurate (i.e. minutes discrepancy was reduced) in their perceptions of sleep/wake at post-treatment, 6-months and 12-months follow-up (p < .05). Improved Pittsburgh Sleep Quality Index scores at each study assessment preceded and predicted reduced discrepancy at the next study assessment (p < .05). Cognitive-behavioural therapy for insomnia reduces sleep/wake discrepancy among older adults with insomnia. The reductions may be driven by improvements in sleep quality. Improving sleep quality appears to be a viable path to improving sleep perception and may contribute to the underlying effectiveness of cognitive-behavioural therapy for insomnia.
Collapse
Affiliation(s)
- Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| | - Constance H Fung
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| | - Yeonsu Song
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| | - Lavinia Fiorentino
- School of Medicine, Psychiatry Department, University of California, San Diego, California, USA
| | - Stella Jouldjian
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| | - Juan Carlos Rodriguez
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA.,Department of Internal Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Michael Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| | - Karen Josephson
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| | - Cathy A Alessi
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California, USA
| |
Collapse
|
4
|
Yeung T, Martin JL, Fung CH, Fiorentino L, Dzierzewski JM, Rodriguez Tapia JC, Song Y, Josephson K, Jouldjian S, Mitchell MN, Alessi C. Sleep Outcomes With Cognitive Behavioral Therapy for Insomnia Are Similar Between Older Adults With Low vs. High Self-Reported Physical Activity. Front Aging Neurosci 2018; 10:274. [PMID: 30271340 PMCID: PMC6146107 DOI: 10.3389/fnagi.2018.00274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
We examined whether baseline self-reported physical activity is associated with the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older veterans. Community-dwelling veterans aged 60 years and older with insomnia received CBT-I in a randomized controlled trial. Participants who received active treatment were divided into low and high physical activity based on self-report. Sleep outcomes were measured by sleep diary, questionnaire and wrist actigraphy; collected at baseline, post-treatment, 6-month and 12-month follow-up. Mixed-effects models compared differences between physical activity groups in change in sleep outcome from baseline to each follow-up, and equivalence tests examined if physical activity groups were clinically equal. There were no significant differences in sleep outcomes between physical activity groups. Equivalence tests suggested possible equality in physical activity groups for five of seven sleep outcomes. Efficacy of CBT-I in older veterans was not associated with self-reported physical activity at baseline. Older adults with insomnia who report low levels of physical activity can benefit from CBT-I.
Collapse
Affiliation(s)
- Timothy Yeung
- Washington & Jefferson College, Washington, PA, United States
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lavinia Fiorentino
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Juan C Rodriguez Tapia
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States
| | - Cathy Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
5
|
Alessi CA, Martin JL, Fung CH, Dzierzewski JM, Fiorentino L, Stepnowsky C, Song Y, Rodriguez JC, Zeidler M, Mitchell M, Jouldjian S, Josephson K. 0407 Randomized Controlled Trial of an Integrated Behavioral Treatment in Veterans with Obstructive Sleep Apnea and Coexisting Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C A Alessi
- VA Greater Los Angeles, Los Angeles, CA
- University of California, Los Angeles, Los Angeles, CA
| | - J L Martin
- VA Greater Los Angeles, Los Angeles, CA
- University of California, Los Angeles, Los Angeles, CA
| | - C H Fung
- VA Greater Los Angeles, Los Angeles, CA
- University of California, Los Angeles, Los Angeles, CA
| | | | - L Fiorentino
- University of California, San Diego, San Diego, CA
| | - C Stepnowsky
- University of California, San Diego, San Diego, CA
- VA San Diego, San Diego, CA
| | - Y Song
- University of California, Los Angeles, Los Angeles, CA
| | - J C Rodriguez
- Pontificia Universidad Catolica de Chile, Santiago, CHILE
| | - M Zeidler
- VA Greater Los Angeles, Los Angeles, CA
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | |
Collapse
|
6
|
Vaughan S, Arvai K, Jouldjian S, Mitchell M, Salloum A, Chowdhuri S, Shamim-Uzzaman A, Henzel M, Sankari A, Martin J, Badr M. 1043 Pulmonary Function and Sleep Quality in Patients with Spinal Cord Injury and Disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - K Arvai
- John D. Dingell VAMC, Detroit, MI
| | - S Jouldjian
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - M Mitchell
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | | | | | - M Henzel
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | | | - J Martin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - M Badr
- John D. Dingell VAMC, Detroit, MI
| |
Collapse
|
7
|
Song Y, Fung CH, McGowan S, Jouldjian S, Josephson KR, Mitchell MN, McCurry SM, Irwin MR, Teng E, Alessi CA, Martin JL. 0708 Sleep and Daytime Dysfunction Among Women Veterans: The Impact of Caregiving. Sleep 2018. [DOI: 10.1093/sleep/zsy061.707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Song
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - C H Fung
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - S McGowan
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - S Jouldjian
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - K R Josephson
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - M N Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - S M McCurry
- University of Washington, School of Nursing, Department of Psychosocial and Community Health, Seattle, WA
| | - M R Irwin
- University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior, Cousins Center for Psychoneuroimmunology, Los Angeles, CA
| | - E Teng
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - C A Alessi
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| | - J L Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA
| |
Collapse
|
8
|
Fung CH, Alessi C, Mitchell MN, Vaughan EC, Huang AJ, Markland AD, Mc Gowan S, Lee D, Song Y, Jouldjian S, Josephson K, Martin JL. 0913 Nocturia Improves Among Women Treated With Behavioral Therapy For Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C H Fung
- VA Greater Los Angeles, North Hills, CA
- UCLA, Los Angeles, CA
| | - C Alessi
- VA Greater Los Angeles, North Hills, CA
- UCLA, Los Angeles, CA
| | | | | | | | - A D Markland
- VA Birmingham, Birmingham, AL
- University of Alabama at Birminghman, Birmingham, AL
| | | | - D Lee
- VA Greater Los Angeles, North Hills, CA
| | - Y Song
- VA Greater Los Angeles, North Hills, CA
| | | | | | - J L Martin
- VA Greater Los Angeles, North Hills, CA
- UCLA, Los Angeles, CA
| |
Collapse
|
9
|
Hughes JM, Song Y, Fung CH, Dzierzewski JM, Mitchell MN, Jouldjian S, Josephson KR, Alessi CA, Martin JL. Measuring Sleep in Vulnerable Older Adults: A Comparison of Subjective and Objective Sleep Measures. Clin Gerontol 2018; 41:145-157. [PMID: 29283797 PMCID: PMC5809246 DOI: 10.1080/07317115.2017.1408734] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study compared subjective (questionnaire) and objective (actigraphy) sleep assessments, and examined agreement between these methods, in vulnerable older adults participating in a Veterans Administration Adult Day Health Care (ADHC) program. METHODS 59 ADHC participants (95% male, mean age = 78 years) completed sleep questionnaires and 72 continuous hours of wrist actigraphy. Linear regression was used to examine agreement between methods and explore discrepancies in subjective/objective measures. RESULTS Disturbed sleep was common, yet there was no agreement between subjective and objective sleep assessment methods. Compared with objective measures, one-half of participants reported worse sleep efficiency (SE) on questionnaires while one-quarter over-estimated SE. Participants reporting worse pain had a greater discrepancy between subjective and objective SE. CONCLUSIONS Vulnerable older adults demonstrated unique patterns of reporting sleep quality when comparing subjective and objective methods. Additional research is needed to better understand how vulnerable older adults evaluate sleep problems. CLINICAL IMPLICATIONS Objective and subjective sleep measures may represent unique and equally important constructs in this population. Clinicians should consider utilizing both objective and subjective sleep measures to identify individuals who may benefit from behavioral sleep treatments, and future research is needed to develop and validate appropriate sleep assessments for vulnerable older adults.
Collapse
Affiliation(s)
- Jaime M Hughes
- a Center for Health Services Research in Primary Care , Durham VA Medical Center , Durham , North Carolina , USA
| | - Yeonsu Song
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Constance H Fung
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Joseph M Dzierzewski
- d Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Michael N Mitchell
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Stella Jouldjian
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Karen R Josephson
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Cathy A Alessi
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Jennifer L Martin
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| |
Collapse
|
10
|
Fung CH, Martin JL, Josephson K, Fiorentino L, Dzierzewski JM, Jouldjian S, Song Y, Rodriguez Tapia JC, Mitchell MN, Alessi CA. Cognitive Expectancies for Hypnotic Use among Older Adult Veterans with Chronic Insomnia. Clin Gerontol 2018; 41:130-135. [PMID: 28960164 PMCID: PMC5775935 DOI: 10.1080/07317115.2017.1356895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine relationships between cognitive expectancies about sleep and hypnotics and use of medications commonly used for insomnia (hypnotics). METHODS We analyzed baseline data from older veterans who met diagnostic criteria for insomnia and were enrolled in a trial comparing CBTI delivered by a supervised, sleep educator to an attention control condition (N = 159; 97% male, mean age 72 years). We classified individuals as hypnotic users (N = 23) vs. non-users (N = 135) based upon medication diaries. Associations between hypnotic status and Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS) total score (0-10, higher = worse) and two DBAS medication item scores (Item 1: "…better off taking a sleeping pill rather than having a poor night's sleep;" Item 2: "Medication… probably the only solution to sleeplessness"; 0-10, higher = worse) were examined in logistic regression models. RESULTS Higher scores on the DBAS medication items (both odds ratios = 1.3; p-values < .001) were significantly associated with hypnotic use. DBAS-16 total score was not associated with hypnotic use. CONCLUSION Cognitive expectancy (dysfunctional beliefs) about hypnotics was associated with hypnotic use in older adults with chronic insomnia disorder. CLINICAL IMPLICATIONS Strategies that specifically target dysfunctional beliefs about hypnotics are needed and may impact hypnotic use in older adults.
Collapse
Affiliation(s)
- Constance H Fung
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,b David Geffen School of Medicine at UCLA , Los Angeles , California , USA
| | - Jennifer L Martin
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,b David Geffen School of Medicine at UCLA , Los Angeles , California , USA
| | - Karen Josephson
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Lavinia Fiorentino
- c School of Medicine , University of California , San Diego, San Diego , California , USA
| | - Joseph M Dzierzewski
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,d Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Stella Jouldjian
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Yeonsu Song
- b David Geffen School of Medicine at UCLA , Los Angeles , California , USA
| | | | - Michael N Mitchell
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Cathy A Alessi
- a Geriatric Research, Education and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,b David Geffen School of Medicine at UCLA , Los Angeles , California , USA
| |
Collapse
|
11
|
Song Y, Washington DL, Yano EM, McCurry SM, Fung CH, Dzierzewski JM, Rodriguez JC, Jouldjian S, Mitchell MN, Alessi CA, Martin JL. Caregiving-Related Sleep Problems and Their Relationship to Mental Health and Daytime Function in Female Veterans. Behav Sleep Med 2018; 16:371-379. [PMID: 27690634 PMCID: PMC5378653 DOI: 10.1080/15402002.2016.1228640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/BACKGROUND To identify caregiving-related sleep problems and their relationship to mental health and daytime function in female Veterans. PARTICIPANTS Female Veterans (N = 1,477) from cross-sectional, nationwide, postal survey data. METHODS The survey respondent characteristics included demographics, comorbidity, physical activity, health, use of sleep medications, and history of sleep apnea. They self-identified caregiving- related sleep problems (i.e., those who had trouble sleeping because of caring for a sick adult, an infant/child, or other respondents). Patient Health Questionnaire (PHQ-4) was used to assess mental health, and daytime function was measured using 11 items of International Classification of Sleep Disorders-2 (ICSD-2). RESULTS Female Veterans with self-identified sleep problems due to caring for a sick adult (n = 59) experienced significantly more symptoms of depression and anxiety (p < 0.001) and impairment in daytime function (e.g., fatigue, daytime sleepiness, loss of concentration, p < 0.001) than those with self-identified sleep problems due to caring for an infant or child (n = 95) or all other respondents (n = 1,323) after controlling for the respondent characteristics. CONCLUSIONS Healthcare providers should pay attention to assessing sleep characteristics of female Veterans with caregiving responsibilities, particularly those caregiving for a sick adult.
Collapse
Affiliation(s)
- Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | - Donna L. Washington
- David Geffen School of Medicine, University of California, Los Angeles, California. VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M. Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California. Fielding School of Public Health, University of California, Los Angeles, California
| | - Susan M. McCurry
- Department of Psychosocial and Community Health, University of Washington, School of Nursing, Seattle, Washington
| | - Constance H. Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Juan Carlos Rodriguez
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N. Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A. Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennifer L. Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California. David Geffen School of Medicine, University of California, Los Angeles, California
| |
Collapse
|
12
|
Fung CH, Martin JL, Hays RD, Patterson ES, Aysola R, Col N, Mitchell MN, Truong C, Dzierzewski JM, Jouldjian S, Song Y, Rodriguez JC, Josephson K, Alessi C. Patient-Reported Usability of Positive Airway Pressure Equipment Is Associated With Adherence in Older Adults. Sleep 2017; 40:2970288. [PMID: 28364429 DOI: 10.1093/sleep/zsx007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study objectives To examine the usability of positive airway pressure (PAP) devices and its association with PAP adherence among older adults with sleep-disordered breathing. Methods We mailed questionnaires to patients aged ≥65 years prescribed PAP therapy during the prior 36 months from two large healthcare systems. Survey participants completed the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire, which assessed the usability of their PAP device. Other questionnaire items included demographics and self-rated health. We also abstracted adherence data (mean nightly hours of PAP use available from one site) and interface type from the electronic health record. Results Five hundred sixty-four patients completed the survey (response rate = 33%). The mean USE-PAP score (0 = best to 100 = worst) was 20 (SD ± 20). Mean duration of PAP use (available in 189 respondents) was 5.2 hours per night (SD ± 2.0). In a nested regression model predicting nightly hours of PAP use, a 10-point (0.5 SD) increase in USE-PAP score corresponded to a 0.37 hour/night reduction in PAP use. The model including the USE-PAP score explained a significant proportion (R2 = 15%) of the variation in nightly hours of PAP use above and beyond demographics, self-reported health, and interface type (∆R2 = 12%). Conclusions Our results demonstrate that PAP usability varies among older patients and is associated with PAP adherence, above and beyond other predictors of adherence. These results support measuring and improving PAP usability to further improve PAP adherence for older patients.
Collapse
Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ron D Hays
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emily S Patterson
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio
| | - Ravi Aysola
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cindy Truong
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Juan Carlos Rodriguez
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.,Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
13
|
Martin JL, Song Y, Hughes J, Jouldjian S, Dzierzewski JM, Fung CH, Rodriguez Tapia JC, Mitchell MN, Alessi CA. A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial. Sleep 2017; 40:3800305. [PMID: 28482053 PMCID: PMC5804980 DOI: 10.1093/sleep/zsx079] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objective To test the effectiveness of a 4-week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4-week information-only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double-blind, randomized, clinical trial. Methods Forty-two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in-person sleep and health assessments at baseline, post-treatment and 4-months follow-up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post-treatment and 4-months follow-up, with baseline values as covariates. Results SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post-treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4-month follow-up (all p's < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4-month follow-up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post-treatment or 4-month follow-up. Conclusions A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.
Collapse
Affiliation(s)
- Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Jaime Hughes
- University of North Carolina, Chapel Hill, NC
- Health Services Research & Development, Durham VA Medical Center, Durham, NC
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
| | | | - Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Juan Carlos Rodriguez Tapia
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
14
|
Song Y, Dzierzewski J, Fung C, Rodriguez J, Jouldjian S, Josephson K, Alessi C, Martin J. SLEEP AND CAREGIVING AMONG ADULT DAY HEALTH CARE PROGRAM CAREGIVERS: A PILOT STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y. Song
- VA Greater Los Angeles Healthcare System, North Hills, California,
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,
| | - J.M. Dzierzewski
- Virginia Commonwealth University, Department of Psychology, Richmond, Virginia,
| | - C. Fung
- VA Greater Los Angeles Healthcare System, North Hills, California,
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,
| | - J.C. Rodriguez
- VA Greater Los Angeles Healthcare System, North Hills, California,
- Pontificia Universidad Catolica, Santiago, Chile
| | - S. Jouldjian
- VA Greater Los Angeles Healthcare System, North Hills, California,
| | - K. Josephson
- VA Greater Los Angeles Healthcare System, North Hills, California,
| | - C.A. Alessi
- VA Greater Los Angeles Healthcare System, North Hills, California,
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,
| | - J.L. Martin
- VA Greater Los Angeles Healthcare System, North Hills, California,
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,
| |
Collapse
|
15
|
Petro A, Dzierzewski JM, Martin JL, Alessi C, Jouldjian S, Josephson K, Suarez A, Fung C. 0573 A SURVEY TO ASSESS PATIENTS’ INTEREST IN THE DIDGERIDOO AS AN ALTERNATIVE THERAPY FOR OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Alessi CA, Martin JL, Fung CH, Dzierzewski JM, Rodriguez Tapia JC, Song Y, Fiorentino L, Stepnowsky C, Zeidler M, Jouldjian S, Mitchell M, Josephson K. 0329 INSOMNIA PREVALENCE AMONG VETERANS REFERRED FOR DIAGNOSTIC TESTING FOR SLEEP DISORDERED BREATHING. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Zeidler MR, Oldenkamp C, De Cruz S, Alessi CA, Ancoli-Israel S, Badr M, Littner M, Jouldjian S, Mitchell M, Martin JL. 0667 WRIST ACTIGRAPHY IN THE ASSESSMENT OF HYPERSOMNIA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Fung CH, Jackson N, Martin JL, Col N, Hays RD, Patterson ES, Jouldjian S, Josephson K, Alessi C. 1190 OLDER ADULTS’ PREFERENCES FOR OBSTRUCTIVE SLEEP APNEA TREATMENT ELICITED FROM A PILOT DISCRETE CHOICE EXPERIMENT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
19
|
Martin JL, Schweizer CA, Hughes JM, Fung CH, Dzierzewski JM, Washington DL, Kramer BJ, Jouldjian S, Mitchell MN, Josephson KR, Alessi CA. Estimated Prevalence of Insomnia among Women Veterans: Results of a Postal Survey. Womens Health Issues 2017; 27:366-373. [PMID: 28110799 DOI: 10.1016/j.whi.2016.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 12/03/2016] [Accepted: 12/07/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Insomnia is a significant public health concern known to particularly impact women and the veteran population; however, rates of insomnia disorder among women veterans are not known. METHOD Women veterans who had received health care at VA Greater Los Angeles Healthcare System between 2008 and 2010 and resided within 25 miles of the facility were sent a postal survey assessing sleep, demographics, and other related patient characteristics. RESULTS A total of 660 women (43.1% of potential responders) returned the postal survey and provided sufficient information for insomnia diagnosis. On average, women reported 6.2 hours of sleep per night. The prevalence of insomnia, determined according to diagnostic criteria from the International Classification of Sleep Disorders-2, was 52.3%. Women with insomnia reported more severely disturbed sleep, and more pain, menopausal symptoms, stress/worries, and nightmares compared with women without insomnia. There was a quadratic relationship between age and insomnia with women in their mid-40s, most likely to have insomnia. CONCLUSIONS This survey study found that insomnia symptoms were endorsed by more than one-half of the women veterans in this sample of VA users, highlighting the critical need for enhanced clinical identification and intervention. Further research is needed to establish national rates of insomnia among women veterans and to improve access to evidence-based treatment of insomnia disorder.
Collapse
Affiliation(s)
- Jennifer L Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California.
| | - C Amanda Schweizer
- VA Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Jaime M Hughes
- Durham VA Healthcare System, Center for Health Services Research in Primary Care, Durham, North Carolina
| | - Constance H Fung
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California
| | | | - Donna L Washington
- David Geffen School of Medicine at the University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - B Josea Kramer
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Stella Jouldjian
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| | - Michael N Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| | - Karen R Josephson
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| | - Cathy A Alessi
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California
| |
Collapse
|
20
|
Culver NC, Song Y, Kate McGowan S, Fung CH, Mitchell MN, Rodriguez JC, Dzierzewski JM, Josephson KR, Jouldjian S, Washington DL, Yano EM, Schweizer CA, Alessi CA, Martin JL. Acceptability of Medication and Nonmedication Treatment for Insomnia Among Female Veterans: Effects of Age, Insomnia Severity, and Psychiatric Symptoms. Clin Ther 2016; 38:2373-2385. [PMID: 28314434 DOI: 10.1016/j.clinthera.2016.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Female veterans are at high risk for sleep problems, and there is a need to provide effective treatment for this population who experience insomnia. This study's primary goal was to compare the acceptability of medication versus nonmedication treatments for insomnia among female veterans. In addition, we examined the role of patient age, severity of sleep disturbance, and psychiatric symptoms on acceptability of each treatment approach and on the differences in acceptability between these approaches. METHODS A large nationwide postal survey was sent to a random sample of 4000 female veterans who had received health care at a Veterans Administration (VA) facility in the previous 6 months (May 29, 2012-November 28, 2012). A total of 1559 completed surveys were returned. Survey items used for the current analyses included: demographic characteristics, sleep quality, psychiatric symptoms, military service experience, and acceptability of medication and nonmedication treatments for insomnia. For analysis, only ratings of "very acceptable" were used to indicate an interest in the treatment approach (vs ratings of "not at all acceptable," "a little acceptable," "somewhat acceptable," and "no opinion/don׳t know"). FINDINGS In the final sample of 1538 women with complete data, 57.7% rated nonmedication treatment as very acceptable while only 33.5% rated medication treatment as very acceptable. This difference was statistically significant for the group as a whole and when examining subgroups of patients based on age, sleep quality, psychiatric symptoms, and military experience. The percentage of respondents rating medication treatment as very acceptable was higher for women who were younger, had more severe sleep disturbances, had more psychiatric symptoms, who were not combat exposed, and who had experienced military sexual trauma. By contrast, the percentage of respondents rating nonmedication treatment as very acceptable differed only by age (younger women were more likely to find nonmedication treatment acceptable) and difficulty falling asleep. IMPLICATIONS Female veterans are more likely to find nonmedication insomnia treatment acceptable compared with medication treatment. Thus, it is important to match these patients with effective behavioral interventions such as cognitive behavioral therapy for insomnia. Efforts to educate providers about these preferences and about the efficacy of cognitive behavioral therapy for insomnia may serve to connect female veterans who have insomnia to the treatment they prefer. These findings also suggest that older female veterans may be less likely to find either approach as acceptable as their younger counterparts.
Collapse
Affiliation(s)
- Najwa C Culver
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System.
| | - Yeonsu Song
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sarah Kate McGowan
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Constance H Fung
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Michael N Mitchell
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Juan Carlos Rodriguez
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Medicine, Pontificia Universidad Catolica de Chile
| | - Joseph M Dzierzewski
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Psychology, Virginia Commonwealth University, Virginia
| | - Karen R Josephson
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Stella Jouldjian
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Donna L Washington
- David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California
| | - C Amanda Schweizer
- David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A Alessi
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennifer L Martin
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California
| |
Collapse
|
21
|
Carballo NJ, Alessi CA, Martin JL, Mitchell MN, Hays RD, Col N, Patterson ES, Jouldjian S, Josephson K, Fung CH. Perceived Effectiveness, Self-efficacy, and Social Support for Oral Appliance Therapy Among Older Veterans With Obstructive Sleep Apnea. Clin Ther 2016; 38:2407-2415. [PMID: 27751674 DOI: 10.1016/j.clinthera.2016.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea is a prevalent sleep disorder among older adults. Oral appliances are increasingly prescribed as therapy for obstructive sleep apnea. Adherence to oral appliance therapy is highly variable. Based on value-expectancy theory and other social-psychological theories, adherence to oral appliance therapy may be influenced by patients' perceived effectiveness of the therapy, self-efficacy, and availability of social support. We examined these perceptions among older adults with obstructive sleep apnea who were prescribed oral appliance therapy. METHODS We mailed surveys to all patients aged ≥65 years who had been prescribed oral appliance therapy for obstructive sleep apnea over the prior 36 months at a Veterans Affairs medical center. We examined frequencies of responses to items that assessed perceived effectiveness, self-efficacy, and social support for nightly use of oral appliances from friends, family, or health care staff. FINDINGS Thirty-nine individuals responded (response rate, 30%; mean [SD] age 71.4 [SD 6.3] years; 97% male). Thirty-six percent of the respondents perceived regular use of oral appliance therapy to be effective in managing obstructive sleep apnea; 39% agreed that they felt confident about using oral appliances regularly; 41% felt supported by people in their life in using oral appliance therapy; and 38% agreed that health care staff would help them to use their oral appliance regularly. These rates represented less than half of respondents despite the finding that 65% of patients believed that they would use their oral appliance regularly. IMPLICATIONS Although oral appliance therapy is increasingly prescribed for obstructive sleep apnea, only about one third of older adults prescribed it perceived it to be an effective treatment, were confident about oral appliance use, and/or believed that they would receive needed support. Future research is needed to better understand older adults' perceptions so that interventions can be designed to improve the effectiveness of oral appliances, their self-efficacy for using oral appliances, and their social support for this therapy, which may, in turn, improve oral appliance therapy adherence.
Collapse
Affiliation(s)
- Nancy J Carballo
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles.
| | - Cathy A Alessi
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles
| | - Jennifer L Martin
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles
| | - Michael N Mitchell
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ron D Hays
- Department of Medicine, University of California, Los Angeles, California
| | - Nananda Col
- Center of Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Emily S Patterson
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Stella Jouldjian
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karen Josephson
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Constance H Fung
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles
| |
Collapse
|
22
|
Alessi C, Martin JL, Fiorentino L, Fung CH, Dzierzewski JM, Rodriguez Tapia JC, Song Y, Josephson K, Jouldjian S, Mitchell MN. Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:1830-8. [PMID: 27550552 DOI: 10.1111/jgs.14304] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To test a new cognitive behavioral therapy for insomnia (CBT-I) program designed for use by nonclinicians. DESIGN Randomized controlled trial. SETTING Department of Veterans Affairs healthcare system. PARTICIPANTS Community-dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159). INTERVENTION Nonclinician "sleep coaches" delivered a five-session manual-based CBT-I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education. MEASUREMENTS Primary outcomes, including self-reported (7-day sleep diary) sleep onset latency (SOL-D), wake after sleep onset (WASO-D), total wake time (TWT-D), and sleep efficiency (SE-D); Pittsburgh Sleep Quality Index (PSQI); and objective sleep efficiency (7-day wrist actigraphy, SE-A) were measured at baseline, at the posttreatment assessment, and at 6- and 12-month follow-up. Additional measures included the Insomnia Severity Index (ISI), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and quality of life (Medical Outcomes Study 12-item Short-form Survey version 2 (SF-12v2)). RESULTS Intervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6-month assessments, and the baseline and 12-month assessments in SOL-D (-23.4, -15.8, and -17.3 minutes, respectively), TWT-D (-68.4, -37.0, and -30.9 minutes, respectively), SE-D (10.5%, 6.7%, and 5.4%, respectively), PSQI (-3.4, -2.4, and -2.1 in total score, respectively), and ISI (-4.5, -3.9, and -2.8 in total score, respectively) (all P < .05). There were no significant differences in SE-A, PHQ-9, or SF-12v2. CONCLUSION Manual-based CBT-I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.
Collapse
Affiliation(s)
- Cathy Alessi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. .,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Lavinia Fiorentino
- Department of Psychiatry, University of California at San Diego, San Diego, California
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Juan C Rodriguez Tapia
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
23
|
Rodriguez JC, Dzierzewski JM, Fung CH, Jouldjian S, Josephson KR, Mitchell MN, Song Y, Martin JL, Alessi CA. Association Between Pain and Functional Independence in Older Adults During and After Admission to Rehabilitation After an Acute Illness or Injury. J Am Geriatr Soc 2015; 63:2275-81. [PMID: 26531809 DOI: 10.1111/jgs.13792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the association between pain and functional independence in older adults during and after admission to rehabilitation after an acute illness or injury. DESIGN Prospective, observational cohort study. SETTING One community and one Veterans Affairs rehabilitation center. PARTICIPANTS Individuals aged 65 and older admitted for rehabilitation after an acute illness or injury (postacute rehabilitation) (N = 245; mean age 80.6, 72% male)). MEASUREMENTS Pain was assessed using the Geriatric Pain Measure (GPM, score 0-100). Functional independence was measured using the motor component of the Functional Independence Measure (mFIM, score 13-91). Both scores were obtained at admission; discharge; and 3-, 6-, and 9-month follow-up. In bivariate analyses, discharge GPM and persistent pain (lasting >3 months) were evaluated as predictors of mFIM score at 9 months. Applying a multilevel modeling (MLM) approach, individual deviations in GPM scores were used to predict variations in mFIM. RESULTS At admission, 210 participants (87.9%) reported pain (16.3% mild (GPM<30); 49.3% moderate (GPM: 30-69); 22.1% severe (GPM>70)); 21.3% reported persistent pain after discharge. The bivariate analyses did not find statistically significant associations between discharge GPM or persistent pain and mFIM score at 9 months, but in the MLM analysis, deviations in GPM were significant predictors of deviations in mFIM score, suggesting that, when individuals experienced above-average levels of pain (GPM > their personal mean GPM), they also experienced worse functional independence (mFIM < their personal mean mFIM). CONCLUSION Twenty-one percent of older adults undergoing postacute rehabilitation reported persistent pain after discharge from rehabilitation. The bivariate analysis did not find association between pain and functional independence, but MLM analysis showed that, when participants experienced more pain than their average, they had less functional independence.
Collapse
Affiliation(s)
- Juan C Rodriguez
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California.,Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karen R Josephson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
24
|
Song Y, Dzierzewski JM, Fung CH, Rodriguez JC, Jouldjian S, Mitchell MN, Josephson KR, Alessi CA, Martin JL. Association Between Sleep and Physical Function in Older Veterans in an Adult Day Healthcare Program. J Am Geriatr Soc 2015. [PMID: 26200520 DOI: 10.1111/jgs.13527] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine whether sleep disturbance is associated with poor physical function in older veterans in an adult day healthcare (ADHC) program. DESIGN Cross-sectional. SETTING One ADHC program in a Veterans Affairs Ambulatory Care Center. PARTICIPANTS Older veterans (N = 50) enrolled in a randomized controlled trial of a sleep intervention program who had complete baseline data. MEASUREMENTS Information on participant characteristics (e.g., age, depression, relationship to caregiver, pain, comorbidity) was collected using appropriate questionnaires. Physical function was measured using activity of daily living (ADL) and instrumental ADL (IADL) total scores from the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Sleep was assessed subjectively (Pittsburgh Sleep Quality Index, Insomnia Severity Index) and objectively (wrist actigraphy). RESULTS Participants required substantial assistance with ADLs and IADLs. A regression model showed that participant characteristics (marital status, use of sleep medication, comorbidity, posttraumatic stress disorder) and living arrangement (living with a spouse or others) were significantly associated with poor physical function. Poorer objective sleep (total sleep time, total numbers of awakenings, total wake time) was significantly associated with poor physical function, accounting for a significant proportion of the variance other than participant characteristics. CONCLUSION Objective measures of nighttime sleep disturbance were associated with poor physical function in older veterans in an ADHC program. Further research is needed to determine whether interventions to improve sleep will delay functional decline in this vulnerable population.
Collapse
Affiliation(s)
- Yeonsu Song
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Juan C Rodriguez
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Medicine, Pontificia Universidad Catolica, Santiago, Chile
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karen R Josephson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
25
|
Dzierzewski JM, Song Y, Fung CH, Rodriguez JC, Jouldjian S, Alessi CA, Breen EC, Irwin MR, Martin JL. Self-reported sleep duration mitigates the association between inflammation and cognitive functioning in hospitalized older men. Front Psychol 2015; 6:1004. [PMID: 26257670 PMCID: PMC4508491 DOI: 10.3389/fpsyg.2015.01004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/03/2015] [Indexed: 01/08/2023] Open
Abstract
Examination of predictors of late-life cognitive functioning is particularly salient in at-risk older adults, such as those who have been recently hospitalized. Sleep and inflammation are independently related to late-life cognitive functioning. The potential role of sleep as a moderator of the relationship between inflammation and global cognitive functioning has not been adequately addressed. We examined the relationship between self-reported sleep duration, inflammatory markers, and general cognitive functioning in hospitalized older men. Older men (n = 135; Mean age = 72.9 ± 9.7 years) were recruited from inpatient rehabilitation units at a VA Medical Center to participate in a cross-sectional study of sleep. Participants completed the Mini-Mental State Examination and Pittsburgh Sleep Quality Index, and underwent an 8 a.m. blood draw to measure inflammatory markers [i.e., C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), soluble intercellular adhesion molecule-1 (sICAM-1), and interleukin-6 (IL-6)]. Hierarchical regression analyses (controlling for age, education, race, depression, pain, health comorbidity, and BMI) revealed that higher levels of CRP and sICAM are associated with higher global cognitive functioning in older men with sleep duration ≥6 h (β = −0.19, β = −0.18, p's < 0.05, respectively), but not in those with short sleep durations (p's > 0.05). In elderly hospitalized men, sleep duration moderates the association between inflammation and cognitive functioning. These findings have implications for the clinical care of older men within medical settings.
Collapse
Affiliation(s)
- Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA ; David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA ; David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Juan C Rodriguez
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA ; David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA ; David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Elizabeth C Breen
- David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA ; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles Los Angeles, CA, USA
| | - Michael R Irwin
- David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA ; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles Los Angeles, CA, USA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA ; David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| |
Collapse
|
26
|
Fung CH, Martin JL, Hays RD, Rodriguez JC, Igodan U, Jouldjian S, Dzierzewski JM, Kramer BJ, Josephson K, Alessi C. Development of the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire. Sleep Med 2015; 16:645-51. [PMID: 25890783 DOI: 10.1016/j.sleep.2015.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND A growing number of positive airway pressure (PAP) device users will develop physical/sensory impairments such as arthritis. For these individuals, the usability of their PAP devices (e.g., efficiency and satisfaction) may impact the frequency and safety of device usage. Questionnaires to assess PAP usability are unavailable; therefore, we developed the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire. METHODS Questionnaire development included in-depth interviews to identify relevant content areas, a technical advisory panel to review/edit items, cognitive interviews to refine items, and a cross-sectional survey of Veterans Affairs sleep clinic patients assessing PAP device usability overall (one multi-item scale), usability of PAP components (multi-item scales for machine controls, mask/headgear, tubing, and humidifier), frequency of usability-related issues (one multi-item scale), PAP device characteristics, and demographics. RESULTS After conducting 19 in-depth interviews, a panel meeting, and 10 cognitive interviews, we administered the survey to 100 PAP device users (67% ≥60 years; 90% male). The items assessing machine control usability received the least favorable ratings. Twenty percent of respondents reported difficulty getting equipment ready for use, and 33 percent had difficulty cleaning equipment. The six multi-item scales had excellent internal consistency reliability (alpha ≥0.84) and item-rest correlations (≥0.39). CONCLUSIONS This study provides initial support for the USE-PAP for measuring PAP device usability. Studies that include large samples are needed to further evaluate the psychometric properties of the USE-PAP. In addition, comparisons of USE-PAP responses with direct observations of PAP-related tasks and objectively measured PAP adherence are needed to fully evaluate the questionnaire.
Collapse
Affiliation(s)
- Constance H Fung
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Jennifer L Martin
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ron D Hays
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Juan Carlos Rodriguez
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Medicine Department, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Uyi Igodan
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Stella Jouldjian
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Joseph M Dzierzewski
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - B Josea Kramer
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Karen Josephson
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Cathy Alessi
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
27
|
Dzierzewski JM, Mitchell M, Rodriguez JC, Fung CH, Jouldjian S, Alessi CA, Martin JL. Patterns and predictors of sleep quality before, during, and after hospitalization in older adults. J Clin Sleep Med 2015; 11:45-51. [PMID: 25325580 DOI: 10.5664/jcsm.4362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/11/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. METHODS This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. RESULTS Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. CONCLUSIONS Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.
Collapse
Affiliation(s)
- Joseph M Dzierzewski
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA
| | - Michael Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA
| | - Juan Carlos Rodriguez
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.,School of Medicine, Pontificia Universidad Catolica de Chile
| | - Constance H Fung
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA
| | - Stella Jouldjian
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA
| | - Cathy A Alessi
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA
| | - Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA
| |
Collapse
|
28
|
Abstract
Women will account for 10% of the Veteran population by 2020, yet there has been little focus on sleep issues among women Veterans. In a descriptive study of 107 women Veterans with insomnia (mean age = 49 years, 44% non-Hispanic white), 55% had probable post traumatic stress disorder (PTSD) (total score ≥33). Probable PTSD was related to more severe self-reported sleep disruption and greater psychological distress. In a regression model, higher PTSD Checklist-Civilian (PCL-C) total score was a significant independent predictor of worse insomnia severity index score while other factors were not. Women Veterans preferred behavioral treatments over pharmacotherapy in general, and efforts to increase the availability of such treatments should be undertaken. Further research is needed to better understand the complex relationship between insomnia and PTSD among women Veterans.
Collapse
Affiliation(s)
- Jaime Hughes
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System
| | | | | | | | | |
Collapse
|
29
|
Dzierzewski JM, Fung CH, Jouldjian S, Alessi CA, Irwin MR, Martin JL. Decrease in Daytime Sleeping Is Associated with Improvement in Cognition After Hospital Discharge in Older Adults. J Am Geriatr Soc 2014; 62:47-53. [DOI: 10.1111/jgs.12622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Joseph M. Dzierzewski
- Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare; Los Angeles California
- David Geffen School of Medicine; University of California Los Angeles; Los Angeles California
| | - Constance H. Fung
- Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare; Los Angeles California
- David Geffen School of Medicine; University of California Los Angeles; Los Angeles California
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare; Los Angeles California
| | - Cathy A. Alessi
- Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare; Los Angeles California
- David Geffen School of Medicine; University of California Los Angeles; Los Angeles California
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior; University of California Los Angeles; Los Angeles California
| | - Jennifer L. Martin
- Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare; Los Angeles California
- David Geffen School of Medicine; University of California Los Angeles; Los Angeles California
| |
Collapse
|
30
|
Fung CH, Martin JL, Dzierzewski JM, Jouldjian S, Josephson K, Park M, Alessi C. Prevalence and symptoms of occult sleep disordered breathing among older veterans with insomnia. J Clin Sleep Med 2013; 9:1173-8. [PMID: 24235899 DOI: 10.5664/jcsm.3162] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES To determine the prevalence of occult sleep disordered breathing (SDB) and describe the relationship between classic SDB symptoms (e.g., loud snoring) and occult SDB in older veterans with insomnia. METHODS We analyzed baseline survey and in-home sleep study data for 435 veterans (mean age = 72.0 years [SD 8.0]) who had no known history of SDB, met International Classification of Sleep Disorders 2(nd) Edition criteria for insomnia, and were enrolled in a behavioral intervention trial for insomnia. Variables of interest included apnea-hypopnea index (AHI) ≥ 15, age, race/ethnicity, marital status, body mass index (BMI), insomnia subtype (i.e., onset, maintenance, or terminal), self-reported excessive daytime sleepiness, snoring, and witnessed breathing pause items from the Berlin Questionnaire. We computed the frequency of AHI ≥ 15 and assessed whether each classic SDB symptom was associated with an AHI ≥ 15 in 4 separate multivariate logistic regression models. RESULTS Prevalence of AHI ≥ 15 was 46.7%. Excessive daytime sleepiness (adjusted odds ratio 1.63, 95% CI 1.02, 2.60, p = 0.04), but not snoring loudness, snoring frequency, or witnessed breathing pauses was associated with occult SDB (AHI ≥ 15). Insomnia subtypes were not significantly associated with occult SDB (p > 0.38). CONCLUSIONS In our sample of older veterans with insomnia, nearly half had occult SDB, which was characterized by reported excessive daytime sleepiness, but not loud or frequent snoring or witnessed breathing pauses. Insomnia subtype was unrelated to the presence of occult SDB.
Collapse
Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center (GRECC): Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA ; David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | |
Collapse
|
31
|
Martin JL, Dzierzewski JM, Mitchell M, Fung CH, Jouldjian S, Alessi CA. Patterns of sleep quality during and after postacute rehabilitation in older adults: a latent class analysis approach. J Sleep Res 2013; 22:640-7. [PMID: 23834036 DOI: 10.1111/jsr.12066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/12/2013] [Indexed: 12/01/2022]
Abstract
Sleep quality is related to emotional, physical, psychological and cognitive functioning and functional independence in later life. After acute health events, older adults are likely to utilize postacute rehabilitation services to improve functioning and facilitate return to independent living. Patterns of how sleep changes with postacute rehabilitation, and predictors of such patterns, are unknown. The current investigation employed latent class analysis (LCA) methods to classify older adults (n = 233) into groups based on patterns of self-reported sleep quality pre-illness, during postacute rehabilitation and up to 1 year following postacute rehabilitation. Using LCA, older adults were grouped into (1) consistently good sleepers (46%), (2) good sleepers who transitioned into poor sleepers (34%), (3) consistently poor sleepers (14%) and (4) poor sleepers who transitioned into good sleepers (6%). In three planned analyses, pain was an independent predictor of membership in classes 1 or 2 (good pre-illness sleep quality) versus classes 3 or 4 (poor pre-illness sleep quality), and of membership in class 1 (consistently good sleep) versus class 2 (good sleep that transitioned to poor sleep). A lower Mini-Mental State Examination score was a predictor of membership in class 1 versus class 2. There were no statistically significant predictors of membership in class 3 versus class 4. Demographics, comorbidities and depressive symptoms were not significant predictors of class membership. These findings have implications for identification of older adults at risk for developing poor sleep associated with changes in health and postacute rehabilitation. The findings also suggest that pain symptoms should be targeted to improve sleep during postacute rehabilitation.
Collapse
Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA, USA
| | | | | | | | | | | |
Collapse
|
32
|
Fung CH, Jouldjian S, Kierlin L. Depictions of insomniacs' behaviors and thoughts in music lyrics. Sleep Disord 2013; 2013:106492. [PMID: 23471424 PMCID: PMC3581261 DOI: 10.1155/2013/106492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/21/2012] [Indexed: 11/17/2022]
Abstract
Study Objectives. Studies have found that depictions of unhealthy behaviors (e.g., illicit substance use, violence) are common in popular music lyrics; however, we are unaware of any studies that have specifically analyzed the content of music lyrics for unhealthy sleep-related behaviors. We sought to determine whether behaviors known to perpetuate insomnia symptoms are commonly depicted in the lyrics of popular music. Methods. We searched three online lyrics sites for lyrics with the word "insomnia" in the title and performed content analysis of each of the lyrics. Lyrics were analyzed for the presence/absence of the following perpetuating factors: extending sleep opportunity, using counter fatigue measures, self-medicating, and engaging in rituals or anti-stimulus control behaviors. Results. We analyzed 83 music lyrics. 47% described one or more perpetuating factor. 30% described individual(s) engaging in rituals or antistimulus control strategies, 24% described self-medicating, 7% described engaging in counter fatigue measures, and 2% described extending sleep opportunity (e.g., napping during daytime). Conclusion. Maladaptive strategies known to perpetuate insomnia symptoms are common in popular music. Our results suggest that listeners of these sleep-related songs are frequently exposed to lyrics that depict maladaptive coping mechanisms. Additional studies are needed to examine the direct effects of exposing individuals to music lyrics with this content.
Collapse
Affiliation(s)
- Constance H. Fung
- Geriatric Research Education and Clinical Center (GRECC), Veterans Administration Greater Los Angeles Healthcare System, North Hills, CA 91343, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Stella Jouldjian
- Geriatric Research Education and Clinical Center (GRECC), Veterans Administration Greater Los Angeles Healthcare System, North Hills, CA 91343, USA
| | - Lara Kierlin
- Oregon Sleep Associates, Portland, OR 97210, USA
| |
Collapse
|
33
|
Martin JL, Jouldjian S, Mitchell MN, Josephson KR, Alessi CA. A longitudinal study of poor sleep after inpatient post-acute rehabilitation: the role of depression and pre-illness sleep quality. Am J Geriatr Psychiatry 2012; 20:477-84. [PMID: 22617164 PMCID: PMC3377443 DOI: 10.1097/jgp.0b013e31824877c1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore the unique impact of poor sleep and symptoms of depression on sleep quality for up to 1 year after inpatient post-acute rehabilitation among older adults. DESIGN Prospective longitudinal cohort study. SETTING Two inpatient post-acute rehabilitation facilities. PARTICIPANTS A total of 245 individuals older than 65 years (mean age = 80 years, 38% women). INTERVENTIONS None. MEASUREMENTS Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) during the post-acute care stay twice to evaluate pre-illness sleep quality and sleep quality during the post-acute care stay, and again at 3-, 6-, 9-, and 12-month follow-up. Demographics, symptoms of depression, cognitive functioning, and comorbidities were also assessed. RESULTS Across time points, sleep was significantly disturbed for many individuals. Nested regression models predicting PSQI total score at 3, 6, 9, and 12 months showed that variables entered in Block 1 (age, gender, cognitive functioning, and comorbidities) were significant predictors of poor sleep at 6-month follow-up but not at 3-, 9-, or 12-month follow-up. Depression (Block 2) and pre-illness PSQI total score (Block 3) were significant predictors of PSQI total score at all follow-up time points. PSQI total score during post-acute care (Block 4) explained a significant proportion of variance only at the 3-month follow-up. CONCLUSIONS This study confirms that chronic poor sleep is common among older adults during post-acute rehabilitation and resolution of sleep disturbance after acute health events may be a lengthy process. Our findings expand understanding of the role of depressive symptoms and preexisting sleep complaints in predicting poor sleep over time among these vulnerable older adults.
Collapse
Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | | | | | | | | |
Collapse
|
34
|
Martin JL, Fiorentino L, Jouldjian S, Mitchell M, Josephson KR, Alessi CA. Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults. Sleep 2011; 34:1715-21. [PMID: 22131610 DOI: 10.5665/sleep.1444] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival. DESIGN Prospective, observational cohort study. SETTING Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration). PARTICIPANTS Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation. INTERVENTIONS None. MEASUREMENTS AND RESULTS Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk. CONCLUSIONS Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored.
Collapse
Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | | | | | | | | | | |
Collapse
|
35
|
Kramer BJ, Jouldjian S, Wang M, Dang J, Mitchell MN, Finke B, Saliba D. Do correlates of dual use by American Indian and Alaska Native Veterans operate uniformly across the Veterans Health Administration and the Indian Health Service? J Gen Intern Med 2011; 26 Suppl 2:662-8. [PMID: 21989619 PMCID: PMC3191227 DOI: 10.1007/s11606-011-1834-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine if the combined effects of patient-level (demographic and clinical characteristics) and organizational-level (structure and strategies to improve access) factors are uniformly associated with utilization of Indian Health Service (IHS) and/or Veterans Health Administration (VHA) by American Indian and Alaska Native (AIAN) Veterans to inform policy which promotes dual use. METHODS We estimated correlates and compared two separate multilevel logistic regression models of VHA-IHS dual versus IHS-only and VHA-IHS dual versus VHA-only in a sample of 18,892 AIAN Veterans receiving care at 201 VHA and IHS facilities during FY02 and FY03. Demographic, diagnostic, eligibility, and utilization data were drawn from administrative records. A survey of VHA and IHS facilities defined availability of services and strategies to enhance access to healthcare for AIAN Veterans. RESULTS Facility level strategies that are generally associated with enhancing access to healthcare (e.g., population-based services and programs, transportation or co-location) were not significant factors associated with dual use. In both models the common variable of dual use was related to medical need, defined as the number of diagnoses per patient. Other significant demographic, medical need and organizational factors operated in opposing manners. For instance, age increased the likelihood of dual use versus IHS-only but decreased the likelihood of dual use versus VHA-only. CONCLUSIONS Efforts to enhance access through population-based and consumer-driven strategies may add value but be less important to utilization than availability of healthcare resources needed by this population. Sharing health records and co-management strategies would improve quality of care while policies allow and promote dual use.
Collapse
Affiliation(s)
- B Josea Kramer
- VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center, 16111 Plummer Street (11E), Sepulveda, CA 91343, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Josea Kramer B, Finke B, Saliba D, Jouldjian S, Yano EM. Fostering Closer Alignment of the Veterans Health Administration and the Indian Health Service. Mil Med 2010; 175:463-5. [DOI: 10.7205/milmed-d-09-00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
37
|
Martin JL, Fiorentino L, Jouldjian S, Josephson KR, Alessi CA. Sleep quality in residents of assisted living facilities: effect on quality of life, functional status, and depression. J Am Geriatr Soc 2010; 58:829-36. [PMID: 20722819 PMCID: PMC3377484 DOI: 10.1111/j.1532-5415.2010.02815.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To describe sleep patterns in older adults living in assisted living facilities (ALFs) and to explore the relationship between sleep disturbance and quality of life, functional status, and depression over 6 months of follow-up. DESIGN Prospective, observational cohort study. SETTING Eighteen ALFs in the Los Angeles area. PARTICIPANTS One hundred twenty-one ALF residents aged 65 and older (mean age 85.3, 86% female, 88% non-Hispanic white). MEASUREMENTS Data were collected at baseline and 3 and 6 months after enrollment. Data collected were demographics, physical and cognitive functioning, depression, quality of life, comorbidities, medications, and subjective (i.e., questionnaires) and objective (i.e., 3 days and nights of wrist actigraphy) measures of sleep. RESULTS Sixty-five percent of participants reported clinically significant sleep disturbance on the Pittsburgh Sleep Quality Index, and objective wrist actigraphy confirmed poor sleep quality. In regression analyses including sleep variables and other predictors, more self-reported sleep disturbance at baseline was associated with worse health-related quality of life (Medical Outcomes Study 12-item Short Form Survey Mental Component Summary score) and worse depressive symptoms five-item Geriatric Depression Scale at follow-up. Worse nighttime sleep (according to actigraphy) at baseline was associated with worse activities of daily living functioning and more depressive symptoms at follow-up. CONCLUSIONS Sleep disturbance is common in older ALF residents, and poor sleep is associated with declining functional status and quality of life and greater depression over 6 months of follow-up. Studies are needed to determine whether improving sleep in ALF residents will result in improvements in these outcomes. Well-established treatments should be adapted for use in ALFs and systematically evaluated in future research.
Collapse
Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine and Cousin's Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California, USA.
| | | | | | | | | |
Collapse
|
38
|
Kramer BJ, Vivrette RL, Satter DE, Jouldjian S, McDonald LR. Dual use of veterans health administration and Indian Health Service: healthcare provider and patient perspectives. J Gen Intern Med 2009; 24:758-64. [PMID: 19381730 PMCID: PMC2686768 DOI: 10.1007/s11606-009-0962-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 01/22/2009] [Accepted: 03/12/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many American Indian and Alaska Native veterans are eligible for healthcare from Veterans Health Administration (VHA) and from Indian Health Service (IHS). These organizations executed a Memorandum of Understanding in 2003 to share resources, but little was known about how they collaborated to deliver healthcare. OBJECTIVE To describe dual use from the stakeholders' perspectives, including incentives that encourage cross-use, which organization's primary care is "primary," and the potential problems and opportunities for care coordination across VHA and IHS. PARTICIPANTS VHA healthcare staff, IHS healthcare staff and American Indian and Alaska Native veterans. APPROACH Focus groups were conducted using a semi-structured guide. A software-assisted text analysis was performed using grounded theory to develop analytic categories. MAIN RESULTS Dual use was driven by variation in institutional resources, leading patients to actively manage health-seeking behaviors and IHS providers to make ad hoc recommendations for veterans to seek care at VHA. IHS was the "primary" primary care for dual users. There was little coordination between VHA and IHS resulting in delays and treatment conflicts, but all stakeholder groups welcomed future collaboration. CONCLUSIONS Fostering closer alignment between VHA and IHS would reduce care fragmentation and improve accountability for patient care.
Collapse
Affiliation(s)
- B Josea Kramer
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Sepulveda, CA 91343, USA.
| | | | | | | | | |
Collapse
|
39
|
Kramer BJ, Jouldjian S, Washington DL, Harker JO, Saliba D, Yano EM. Health Care for American Indian and Alaska Native Women. Womens Health Issues 2009; 19:135-43. [DOI: 10.1016/j.whi.2008.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/13/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022]
|