Changes in Cognitive Performance Are Associated with Changes in Sleep in Older Adults With Insomnia

The present study examined sleep features associated with cognition in older adults and examined whether sleep changes following insomnia treatment were associated with cognitive improvements. Polysomnography and cognition (recall, working memory, and reasoning) were assessed before and after an insomnia intervention (Brief Behavioral Treatment of Insomnia [BBTI] or information control [IC]) in 77 older adults with insomnia. Baseline wake-after-sleep-onset (WASO) was associated with recall. Greater NREM (nonrapid eye movement) delta power and lower NREM sigma power were associated with greater working memory and reasoning. The insomnia intervention did not improve performance. However, increased absolute delta power and decreased relative sigma power were associated with improved reasoning. Findings suggest that improvements in executive function may occur with changes in NREM architecture.     

Psychological Factors Associated with Poor Sleep Prior to Breast Surgery: An Exploratory Study

This study explored the relationship between psychological factors (including intrusive thoughts, anxiety, well-being, depressed mood) and poor sleep the night before surgery. Patients (N = 39) scheduled for breast surgery (mean age = 47 years) wore an actiwatch at home the night before surgery to provide an objective indication of sleep duration and sleep efficiency. Participants also completed 3 measures of their psychological experience during the week prior to surgery. In separate regression analyses, intrusive thoughts, anxiety, and emotional well-being were each related to sleep duration the night before surgery, when controlling for age, body mass index, ethnicity, and marital status. No relationships were found between depressed mood, physical or social well-being, and sleep duration. In a multiple regression model that included all significant variables, intrusive thoughts were most strongly associated with sleep duration. Intrusive thoughts were also significantly related to sleep efficiency. Results suggest that patients’ intrusions about impending surgery are associated with lower sleep duration and sleep efficiency the night before surgery. Additional research is warranted to explore the implications of these associations for patients, as well as possible interventions to improve sleep in this clinical setting.     

Social Cognitive Factors,Physical Activity,and Mobility Impairment in Adults with Multiple Sclerosis

Among those with multiple sclerosis (MS), mobility impairment is common and significantly affects independent functioning and quality of life. The purpose of the study was to examine the role of physical activity in mobility impairment in individuals with MS and explore the social cognitive factors of social support, outcome expectations, and self-efficacy that facilitate physical activity among those with the disease. A sample of 319 individuals with MS were assessed on the following: family and friend social support, self-efficacy, and physical and social outcome expectations. Self-reported physical activity, perceived ambulation disability, balance confidence, and fall history were also measured. The structural model fit the data (χ² (29) = 24.49, p = 0.70; Root Mean Square Error of Approximation < 0.01; Comparative Fit Index = 1.0; Normed Fit Index = 0.96; Goodness of Fit Index = 0.98; Standardized Root Mean Square Residual = 0.03). The primary findings of the study revealed that physical activity was strongly linked to mobility impairment (path coefficient, –0.43), such that increasing levels of physical activity were associated with less mobility impairment. The most important predictors of health-promoting levels of physical activity were self-efficacy (path coefficient, 0.48) and social support (path coefficient, 0.38), with support from friends being a stronger indicator of social support than support from family. It may be prudent to design interventions aimed at increasing physical activity, especially in regard to helping individuals become more efficacious and building larger social networks, as this may serve to forestall advancing mobility impairment in those with MS.     

EEG Sleep Spectra in Older Adults Across All Circadian Phases During NREM Sleep

Study Objectives:

Healthy aging is associated with changes in sleep-wake regulation, and those changes often lead to problems sleeping, both during the night and during daytime. We aimed to examine the electroencephalographic (EEG) sleep spectra during non-rapid eye movement (NREM) sleep when sleep was scheduled at all times of day.

Design/Interventions:

After three 24-h baseline (BL) days, participants were scheduled to live on 20-hour “days” consisting of 6.7 hours of bed rest and 13.3 hours of wakefulness for 12 consecutive days (forced desynchrony, FD). The EEG was recorded from a central derivation during all scheduled sleep episodes, with subsequent visual scoring and spectral analysis.

Setting:

Intensive Physiological Monitoring Unit of the Brigham & Women''s Hospital General Clinical Research Center.

Participants:

Twenty-four healthy older subjects (64.2 ± 6.3 yr; 13 women, 11 men)

Measurements and Results:

Compared with BL nights, EEG activity in the slow wave (0.5 to 5.25 Hz), theta (6 to 6.25 and 7 Hz), alpha (10 to 11.25 Hz), and high spindle range (14.5 to 15.5 Hz) was significantly greater during FD, when subjects slept across many times of day and night. During FD, there was a significant interaction between homeostatic and circadian factors, such that EEG delta activity (0.5 to 1.5 Hz) was higher in the biological morning/early afternoon than at other times. EEG activity was significantly increased in almost all frequency ranges (0.5 to 21 Hz) during the biological day, as compared with the biological night, except for the lower EEG spindle range (12.25 to 14 Hz). Overall, EEG beta activity was positively correlated with wakefulness and negatively correlated with total sleep time.

Conclusion:

Our findings provide some new evidence for the underlying mechanisms that contribute to age-related difficulties in sleep consolidation, especially when sleep occurs during the daytime.

Citation:

Münch M; Silva EJ; Ronda JM; Czeisler CA; Duffy JF. EEG sleep spectra in older adults across all circadian phases during NREM sleep. SLEEP 2010;33(3):389-401.     

Poor Sleep Quality is Associated with Depressive Symptoms in Patients with Heart Disease

Background

Depression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression.

Purpose

This cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients.

Methods

Two hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3?±?14.3?years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6?±?13.0?years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms.

Results

Poor sleep quality (PSQI?>?5) was reported in all comorbid DCP (PSQI 12.00?±?3.53, BDI 17.86?±?4.28), in 60% of the 80 non-DCP (PSQI 5.59?±?3.73, BDI 4.47?±?3.07), and in 86.4% of the DP (PSQI 11.76?±?4.77, BDI 27.11?±?10.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (r?=?0.40) and daytime dysfunction (r?=?0.34). Both sleep components were significant predictors of self-rated depression (R2?=?0.404).

Conclusions

Most cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.     

Effects of Aquatic Exercise on Sleep in Older Adults with Mild Sleep Impairment: a Randomized Controlled Trial

Background

Exercise has been found to be associated with improved sleep quality. However, most of the evidence is based on resistance exercise, walking, or gym-based aerobic activity.

Purpose

This study aimed to examine the effects of an 8-week aquatic exercise program on objectively measured sleep parameters among older adults with mild sleep impairment.

Methods

A total of 67 eligible older adults with sleep impairment were selected and randomized to exercise and control groups, and 63 participants completed the study. The program involved 2?×?60-min sessions of aquatic exercise for 8 weeks. Participants wore wrist actigraphs to assess seven parameters of sleep for 1 week before and after the intervention. Mixed-design analysis of variance (ANOVA) was used to assess the differences between groups in each of the sleep parameters.

Results

No significant group differences on demographic variables, life satisfaction, percentage of body fat, fitness, seated blood pressure, and any parameter of sleep were found at baseline. Significant group?×?time interaction effects were found in sleep onset latency, F(1,58)?=?6.921, p?=?.011, partial eta squared?=?.011, and in sleep efficiency, F(1, 61)?=?16.909, p?<?0.001, partial eta squared?=?.217. The exercise group reported significantly less time on sleep onset latency (mean difference?=?7.9 min) and greater sleep efficiency (mean difference?=?5.9 %) than the control group at posttest. There was no significant difference between groups in change of total sleep time, wake after sleep onset, activity counts, or number and length of awakenings.

Conclusions

An 8-week aquatic exercise has significant benefits on some sleep parameters, including less time for sleep onset latency and better sleep efficiency in older adults with mild sleep impairment.

     

老年人主观幸福感的影响因素

目的探讨老年期个体主观幸福感的影响因素。方法选择经济水平、社会支持、健康状况、受教育水平、年龄、性别、一般自我效能感7个因素,对北京市236名60-85岁老年人进行测查。结果主观幸福感与年龄、性别、经济水平、受教育程度相关不显著;社会支持、健康状况、一般自我效能感能预测主观幸福感(标准化回归系数分别为0.27、0.19、0.15),可解释总变异的16.4%;社会支持、健康状况直接影响主观幸福感的同时,还通过自我效能感影响主观幸福感。结论外在主观资源(社会支持)、内在客观资源(健康状况)和内在主观资源(一般自我效能感)对主观幸福感有直接影响,同时外在主观资源、内在客观资源还通过内在主观资源对主观幸福感产生影响。     

Patient-Provider Communication With Older Adults About Sleep Apnea Diagnosis and Treatment

Patient–provider communication impacts adherence to therapy. We explored older adults’ communication with their providers, preferences for communication, and views on communication attributes and decision aid characteristics, by conducting four focus groups. Several participants reported they had received insufficient information about their sleep apnea diagnosis and treatment options. Most participants felt that it would be helpful to have treatment information tailored to their needs, including information on the negative impact of treatment on comfort and convenience and disclosure about common barriers to adherence. Participants provided desired characteristics for a decision aid, including their preferred delivery method, content, and format. These findings have implications for how to design useful decision aids for older adults with newly diagnosed sleep apnea.     

Long Sleepers Sleep More and Short Sleepers Sleep Less: A Comparison of Older Adults Who Sleep Well

To determine some of the risks and benefits of being a long or short sleeper, psychological adjustment, lifestyle, and sleep parameters were investigated in 239 older adults. Responses of people who slept well and who were either long or short sleepers were studied on 48 variables investigating sleep parameters and sleep-related affect and beliefs; daytime fatigue and sleepiness; demographic factors, including age, sex, and income satisfaction; sleep lifestyle factors, including naps, bedtimes, arising times, and the regularity of these; general lifestyle factors, including regularity of mealtimes, overall daytime pleasantness, perceived busyness, diversity and valence of daily activities, and potentially stressful major life events. In addition, 14 variables evaluated aspects of psychological adjustment, including cognitive and somatic arousal, nocturnal tension, anxious, negative, unpleasant and worrying self-talk, depression, anxiety, overall psychopathology, neuroticism, and life satisfaction. Overall, the results indicate that short sleepers get up earlier, spend less time in bed, and have lower sleep efficiencies than their long sleeper counterparts. They eat breakfast earlier, and of course, they sleep less. Only one of the 14 psychological adjustment variables was significant. In view of the many differences between short and long sleepers described in prior research, the lack of differences observed between long and short sleepers is noteworthy.     

Sleep Variability Among Older Adults With Insomnia: Associations With Sleep Quality and Cardiometabolic Disease Risk

Sleep variability has been linked to poor subjective sleep quality, but few studies have investigated effects on physical health. In this study, we evaluated cross sectional associations and change over time in objective sleep variability of adults with insomnia and short sleep duration who were participating in a non-pharmacologic intervention study. Results indicated greater variability in objective sleep measures were associated with poorer subjective sleep quality (p < 0.05). Higher sleep duration variability was associated with higher HbA1c (p < 0.01) and sleep onset time variability was associated with higher BMI (p < 0.05). Sleep efficiency and WASO variability decreased with intervention (p < 0.05). These results indicate that objective sleep variability may be an important feature for the assessment of insomnia outcomes.     

Lymphocyte Proliferation Is Associated with Gender, Caregiving, and Psychosocial Variables in Older Adults

We examined lymphocyte responses to mitogens [phytohemagglutinin (PHA), concanavalin A, pokeweed] in spouse caregivers of persons with Alzheimer's disease (n = 82; mean age = 69.4) and noncaregiver spouses (n = 83) group matched on age and gender. Data were collected at study entry (T1) and 15–18 months later (T2). In men (n = 52), a depressed mood factor was negatively related to all mitogen responses at T1 and PHA at T2. Loneliness was the most important variable in the depressed mood factor. No relationships occurred in women (n = 113). At T2 an anger expression factor (anger-out – anger-control) was negatively related to all mitogen responses in caregivers. Anger-out was the most important variable for anger expression. Depressed mood at T1 predicted residualized changes in PHA at T2 in men. In conclusion, men with higher depressed mood and caregivers with higher anger expression may be at risk for lower proliferation responses.     

Association Between Sleep Problems and Perceived Cognitive Dysfunction Over 12 Months in Individuals with Multiple Sclerosis

Sleep problems are highly prevalent among individuals with multiple sclerosis (MS); however, the relationship between sleep problems and cognitive dysfunction is poorly understood in this population. In the present study, 163 individuals with MS and depression, fatigue, or pain completed self-report measures of sleep, cognitive dysfunction, and relevant demographic and clinical characteristics (e.g., disability severity, depressive symptomatology, pain intensity, fatigue impact) at four time points over 12 months. Mixed-effects regression demonstrated that poorer sleep was independently associated with worse perceived cognitive dysfunction (β = –0.05, p = .001), beyond the influence of depressive symptomatology. Fatigue impact was found to partially mediate this relationship. Results suggest that for individuals with MS and depression, fatigue, or pain, self-reported sleep problems are related to perceived cognitive dysfunction, and that fatigue impact accounts for part of this relationship.     

Detection of Multiple Pathogenic Species in Saliva Is Associated with Periodontal Infection in Adults

We investigated whether certain bacterial species and their combinations in saliva can be used as markers for periodontitis. In 1,198 subjects, the detection of multiple species, rather than the presence of a certain pathogen, in saliva was associated with periodontitis as determined by the number of teeth with deepened periodontal pockets.     

Higher Gait Variability is Associated with Decreased Parietal Gray Matter Volume Among Healthy Older Adults

The objectives of this study were to examine the association of stride time variability (STV) with gray and white matter volumes in healthy older adults, and to determine the specific location of any parenchymal loss associated with higher STV. A total of 71 participants (mean age 69.0 ± 0.8 years; 59.7 % female) were included in this study. All participants had a 1.0 Tesla 3D T₁-weighted MRI of the brain to measure gray and white matter volumes. STV was measured at steady-state self-selected walking speed using an electronic footswitch system. We found an association between higher STV and lower gray matter volume in the right parietal lobe (e.g., angular gyrus, Brodmann area 39, cluster corrected pFWE = 0.035). There were no significant associations between STV and higher gray matter volume or change in white matter volume. To the best of our knowledge this study is the first to identify a significant association of higher STV with lower right parietal gray matter volume in healthy older adults.     

Limitation in Patient-Reported Function Is Associated with Inferior Survival in Older Adults Undergoing Autologous Hematopoietic Cell Transplantation

Although the use of geriatric assessment (GA) in the allogeneic hematopoietic cell transplantation (HCT) setting has been reported, few studies have evaluated the impact of patient-reported function on autologous HCT (autoHCT) outcomes. In this study, GA, including the administration of Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) quality of life tool, was performed in 184 patients age ≥50 years (median age, 61 years; range, 50 to 75 years) before autoHCT. Associations among GA findings, quality of life metrics, and post-transplantation outcomes were evaluated using Cox regression. Indications for autoHCT included multiple myeloma (73%), non-Hodgkin lymphoma (20%), and other disorders (7%). The median progression-free survival (PFS) was 28 months, whereas the median overall survival (OS) was not reached. In unadjusted analysis, both PFS and OS were significantly associated with 5 GA components: limitation in instrumental activities of daily living, patient-reported Karnofsky Performance Status (KPS), and the Physical, Functional, and BMT subscale scores of the FACT-BMT. In multivariate analysis, 3 components—limitation in instrumental activities of daily living, patient-reported KPS, and FACT-BMT Physical subscale—remained predictive of both PFS and OS when adjusted for age, provider-reported KPS, disease status, and HCT comorbidity index. In older adults undergoing autoHCT, limitation in any 1 of 3 patient-reported measures of functional status was independently associated with inferior PFS and OS, even after adjusting for known prognostic factors.     

Psychological Factors Associated With Sleep Disturbance Among Perimenopausal Women

The complex nature of sleep among perimenopausal women warrants a biopsychosocial conceptualization; however, research on the psychological factors that contribute to the increased prevalence of poor sleep quality during this time is limited. We conducted a survey study of perimenopausal women (N = 168) to investigate the relations among nocturnal hot flashes, mood, dysfunctional beliefs and attitudes about sleep (DBAS), and subjective sleep quality. Self-report ratings of depressive symptoms, trait anxiety, hot flashes, and DBAS significantly correlated with poor sleep quality. Ratings on the DBAS Scale-Short Form mediated the relations both between nocturnal hot flashes and sleep quality and between mood and sleep quality. The interplay between physiological and psychological mechanisms among perimenopausal women is highlighted.     

Prevalence of Chronic Sputum and Associated Factors in Korean Adults

Chronic sputum is a troublesome symptom in many respiratory diseases. The prevalence of chronic sputum varies from 1.2% to 13% according to the country. The purpose of this study was to estimate the prevalence of chronic sputum and to find its associated factors in a general Korean population. We analyzed the data of the Korea National Health and Nutrition Examination Survey 2010 and 2011. A total number of 6,783 subjects aged 40 yr or more were enrolled in this study with 3,002 men and 3,781 women. As a result, the prevalence of chronic sputum was 6.3% (n=430). Significant risk factors for chronic sputum by multivariate analysis were: age (≥70 yr) (odds ratio [OR], 1.954; 95% confidence interval [CI], 1.308-2.917), current smoking (OR, 4.496; 95% CI, 3.001-6.734), chronic obstructive pulmonary disease (COPD) (OR, 1.483; 95% CI, 1.090-2.018), and tuberculosis (OR, 1.959; 95% CI, 1.307-2.938). In conclusion, the prevalence of chronic sputum in Korea was in the intermediate range compared with other countries. Smoking is a preventable risk factor identified in this study, and major respiratory diseases, such as COPD and tuberculosis, should be considered in subjects with chronic sputum.

Graphical Abstract

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