Association of Sleep Duration and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults

Aim: This study aims to investigate the association of the Cardio-Ankle Vascular Index (CAVI) with self-reported sleep duration and sleep quality in community-dwelling older adults aged ≥ 65 years. Methods: The Tarumizu Study was a cohort of community-based health checkups conducted in the Tarumizu City, Japan, in 2018 and 2019. In total, 997 participants aged ≥ 65 years (median age, 74 years) were examined. We obtained the average sleep duration and sleep quality using self-reported questionnaires and classified them into three separate groups according to sleep duration (＜6 h, 6–8 h, and ≥ 8 h) and sleep quality (good, medium, and poor). The arterial stiffness was measured using the CAVI. Results: As per our findings, the CAVI was significantly higher in the ≥ 8 h sleep group (CAVI=9.6±1.3) than in the ＜6 h (CAVI=9.1±1.1) or 6–8 h (CAVI=9.1±1.2) groups (p＜0.001). After adjustment for age, sex, systolic blood pressure, current smoking status, body mass index, frequency of exercise, educational background, frailty, sleep medication, sleep quality, and nap duration, multivariable regression analysis demonstrated that the CAVI was significantly higher in the ≥ 8 h group than in the 6–8 h group (p=0.016). In contrast, multivariable regression analysis showed that there was no significant association between sleep quality and CAVI. Conclusions: A significant association was noted between long sleep duration (≥ 8 h) and elevated CAVI in community-dwelling older adults aged ≥ 65 years. We, therefore, suggest that long sleep duration, not sleep quality, is correlated with arterial stiffness in older adults.     

The mediating role of low-grade inflammation on the prospective association between sleep and cognitive function in older men and women: 8-year follow-up from the English Longitudinal Study of Ageing

Suboptimal sleep patterns predict poorer cognitive function in older adults and induce inflammatory responses. Inflammation could also adversely affect cognitive function. This study explored whether systemic inflammation may be one biological mechanism through which sleep influences cognitive performance. Participants were 4877 men and women from the English Longitudinal Study of Ageing who were followed-up for 8 years starting at wave 4 (2008-09), through wave 6 (2012-13), and until wave 8 (2016–17). Sleep quality and duration were measured with self-reported questionnaires. Cognitive function was assessed objectively with tests of verbal fluency, memory (immediate and delayed recall) and time orientation. Analyses were stratified by sex and adjusted for socio-economic circumstances, health behaviours, limiting long-standing illness, medication, depressive symptoms, and baseline inflammation and cognition. In men, in comparison with optimal sleep duration, short sleep (≤6 h: β = -0.343, C.I. -0.611 to -0.076; >6-7 h: β = -0.263, C.I. -0.506 to -0.020) and long sleep (β = -0.536, C.I. -1.019 to -0.053) measured at baseline predicted lower scores in delayed memory recall at follow-up. In women, sleep duration was unrelated to cognitive performance at follow-up, and in both sexes, there was no relationship between sleep quality and follow-up cognitive performance. There was no evidence of mediating effects of inflammatory markers in the relationship between sleep measures and cognitive performance in both sexes. In conclusion, baseline short and long sleep duration is associated with follow-up cognitive performance in older men, but we found no evidence of any mediating effects of inflammation.     

Sleep disturbances and mortality: results from the Canadian Study of Health and Aging

OBJECTIVES: To cross-validate, in a secondary analysis, the observation that daytime sleepiness is associated with an increased risk of death. DESIGN: Prospective cohort study. SETTING: Canada, a nationally representative sample of people age 65 and older. PARTICIPANTS: Nine thousand and eight community-dwelling participants in the Canadian Study of Health and Aging. MEASUREMENTS: Exposures: self-reported sleep disturbances. Outcomes: Cox hazard ratios (HRs) for death. RESULTS: The unadjusted analysis showed a small increased risk of death from daytime sleepiness (HR = 1.89; 95% confidence interval (CI) = 1.44-2.46), but this finding did not persist in a multivariate model adjusted for age, depression, cognition, comorbid illness, and function. CONCLUSION: Daytime sleepiness itself is not associated with an increased risk of death when other factors are taken into account. Daytime sleepiness may be a proxy for other morbid conditions and therefore for overall tiredness.     

睡眠时间与动脉粥样硬化的关系研究进展

作为可调节的行为因素,睡眠与心血管事件的相关性正逐渐引起人们的关注。越来越多的研究显示,睡眠时间过长或过短,都会增加心血管事件的风险。其作用机制可能与内分泌、代谢因素、炎症反应以及血管内皮细胞功能损伤等机制相关。本文从流行病学、机制及干预措施等方面阐述睡眠时间对动脉粥样硬化发病率的影响及可能的病理生理学机制。     

Prevalence of sleep disturbances: Sleep disordered breathing,short sleep duration,and non-restorative sleep

Recently, interest in sleep disturbances, such as sleep disordered breathing (SDB), short sleep duration, and non-restorative sleep (NRS), has been increasing. The potentially large public health implications of sleep disturbances indicate a need to determine their prevalence in a general population. This review describes the characteristics of population-based sleep cohorts from past to present. Unavoidable methodological and baseline characteristic heterogeneity was found between studies. The prevalence of SDB (apnea hypopnea index (AHI), respiratory disturbance index (RDI), or oxygen desaturation index (ODI) ≥5/h) was 24.0–83.8% in men and 9.0–76.6% in women, and that of moderate-to-severe SDB (AHI, RDI, or ODI ≥15/h) was 7.2–67.2% in men and 4.0–50.9% in women. Additionally, the prevalence of SDB in post-menopausal women was 3–6 times higher than in pre-menopausal women. The prevalence of subjective short sleep duration (<6 h) was 7.5–9.6%, while that of objective short sleep duration (<6 h) was 22.1–53.3%. The prevalence of NRS was 19.2–31.0% in men and 26.3–42.1% in women, as determined from studies using a yes-no questionnaire, while a multi-national survey using a telephone-based expert system showed a wide range of prevalence between countries, from 2.4% to 16.1%. An association between SDB, short sleep duration, and NRS has recently been suggested. To gain a better understanding of the burden of sleep disturbances, a consensus on the definition of several sleep disturbances is needed, as methodological heterogeneity exists, including SDB scoring rules, subjective versus objective data collection for short sleep duration, and the definition of NRS itself.     

Investigating the relationship between reduced self-awareness of falls risk,rehabilitation engagement and falls in older adults

The present study aimed to investigate whether self-awareness of falls risk is associated with rehabilitation engagement, motivation for rehabilitation, and number of falls after hospital discharge. The sample comprised 91 older adults (M_age = 77.97, SD = 8.04) undergoing inpatient rehabilitation. The Self-Awareness of Falls Risk Measure (SAFRM) was used to measure different aspects of self-awareness. The treating physiotherapist and occupational therapist rated the patient’s engagement in rehabilitation and the patient reported his/her motivation for treatment. Falls information was collected from the patient and significant other once a month for three months following hospital discharge. Significant correlations were found between physiotherapist-rated engagement and intellectual (r_s = −0.22, p <0.05) and anticipatory awareness (r_s = −0.24, p <0.05). Occupational therapist-rated engagement and patient-reported motivation for rehabilitation was correlated with emergent awareness (r_s = −0.38 and −0.31, p <0.05, respectively) and overall self-awareness (r_s = −0.31 and −0.26, p <0.05, respectively). Regression analyses indicated that overall self-awareness provided a unique contribution to occupational therapist-rated engagement when controlling for age, gender, cognition and functional ability. Falls were reported by 29.9% of participants, however, self-awareness did not differ significantly between fallers and non-fallers. The findings suggest that self-awareness of falls risk is associated with rehabilitation engagement and motivation. Therefore, improving patient self-awareness of falls risk may increase engagement in therapy leading to better patient outcomes.     

Association of sleep quality and dementia among long-lived Chinese older adults

In this study, we examined the existence of relationship between sleep quality and dementia in subjects aged 90 years and above. The sample included 216 men and 444 women. Dementia and sleep quality were measured with 30-item mini-mental state examination (MMSE) and the Pittsburgh sleep quality index, respectively. Subjects with dementia had higher sleep quality score (7.83 ± 2.15 vs. 5.22 ± 2.49; P < 0.0001), longer sleep latency (50.97 ± 21.33 vs. 37.61 ± 12.53; P < 0.0001), and a lower sleep efficiency percentage (73.95 ± 8.783 vs. 81.32 ± 10.21; P < 0.0001) and more likely to report poor sleep quality (25.42 vs.17.13 %; P = 0.035). Subjects with poor sleep quality had significantly lower MMSE scores (P = 0.007) and higher prevalence of dementia (P = 0.042). Multiple logistic regressions were performed by adjusting clinical factors that are thought to be associated with dementia or sleep quality. We found that poor sleep quality was a risk factor for dementia (unadjusted odds ratio (OR) 1.719, 95 % confidence interval (CI) 1.138–2.597; adjusted OR 1.759, 95 % CI 1.012–3.057). There was no significant difference in MMSE scores (11.25 ± 3.40, 16.26 ± 5.14, and 15.43 ± 5.51; P = 0.105) among participants with daily average sleep durations of <5, 5–9, and >9 h, respectively. Among Chinese nonagenarians and centenarians, dementia was correlated with poor sleep quality, longer sleep latency, and lower sleep efficiency percentage.     

老年痴呆患者跌倒危险因素的临床分析

目的 探讨老年痴呆患者跌倒的危险因素. 方法 选取北京老年医院118例(73.1±6.1)岁临床诊断痴呆患者,将入选病例按跌倒和未跌倒分为两组,即跌倒组、未跌倒组,给予患者行简易智能状态量表(MMSE)、临床痴呆量表(CDR)、日常生活能力量表(ADL)、神经精神科问卷(NPI)及统一帕金森病量表(UPDRS)运动评分并对数值进行对照研究.以logistic回归模型分析各种危险因素如体位性低血压、服用抗精神药物、服用镇静催眠药物、运动障碍及精神行为异常和跌倒之间的关系. 结果 NPI和UPDRS在跌倒组及未跌倒组中差异有统计学意义(t值分别为2.237和2.213,P均<0.05),单因素及多因素回归分析显示精神行为异常、运动障碍和跌倒有密切相关性(β=0.77和0.86,P均<0.05). 结论 在老年痴呆患者中运动障碍、精神行为异常和跌倒密切相关,为减少患者骨折及其他并发症,针对以上情况给予干预措施是十分必要的.     

Sleep quality among Chinese elderly people: A population-based study

Little was known about sleep quality among Chinese population. Using data from a population-based survey, we aimed to describe the prevalence of poor sleep quality among Chinese elderly people, to analyze factors associated with poor sleep quality, and to explore the relation between sleep quality and life quality as well as the risk for mental disorders. Data was derived from the Tianjin Mental Health Survey. The 19-item Pittsburg Sleep Quality Index was used to assess sleep quality. Life quality was evaluated using a Chinese version of Quality of Life Scale. To investigate the risk for mental disorders, the Chinese version of General Health Questionnaire was administered. Female gender, older age, low educational attainment, poor subject family economic status, and not having health insurance were significantly associated with elevated risk of poor sleep quality. Poor sleep quality was associated with poor life quality and increased odds of mental disorders. Further studies are warranted for the evaluation of effectiveness of screening tools for sleep problems and the generalization of early screening and diagnosing programs in the nation. Early screening is necessary and appropriate intervention programs should be conducted in the population with high risk.     

Sleep quality,sleep duration and sexual health among older people: Findings from the English Longitudinal Study of Ageing

ContextHow sleep quality and sexual health are associated among community-dwelling individuals remains largely unknown.ObjectiveWe examined the association of sleep disturbance and sleep duration with a range of measures assessing sexual activities, functioning and concerns in a representative sample of older people.MethodsParticipants were community-dwelling adults aged 50-90+ years from wave 6 (2012/2013) of the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. Sleep disturbance, sleep duration and sexual health were measured by self-report at wave 6. Retrospective reports of restless sleep (waves 1–6 [2002–2013]) were also examined. The association between sleep measures and sexual health was assessed using logistic regressions stratified by gender and adjusted for demographic, health and lifestyle factors with results expressed as odds ratios (OR) and 95% confidence intervals (CI).ResultsAmong both men and women disturbed sleep was associated with reported declines in sexual activity and function over the last year, and increased concern about their sexual desire, frequency of sexual activity and sexual functioning. Robust associations between high sleep disturbance and vaginal pain (OR = 1.67, 95% CI = 1.21, 2.31) and vaginal dryness (OR = 1.69, 95% CI = 1.24, 2.30) were also observed among women. Retrospective reports of restless sleep showed a dose-response relationship with reported declines in sexual health over the last year, and increased concerns about sexual expression and functioning.ConclusionsSelf-reported sleep disturbance and retrospective restless sleep were mainly associated with subjective assessments of recent declines in sexual activity and functioning, and higher levels of sexual concerns.     

Frailty status and increased risk for falls: The role of anticholinergic burden

Purpose of the studyFrailty leads to serious adverse outcomes including falls. The relationship between frailty and falls has not been evaluated in the context of the side effects of drugs with anticholinergic properties. The aim of this study was to examine the potential association of anticholinergic burden (ACB) with the risk of falls among frail older adults.Design and methodsCommunity-dwelling older adults were consecutively selected from the geriatrics outpatient clinic. Based on a fall history in the last 12 months, the participants were grouped as fallers and non-fallers. Frailty status was assessed by Fried’s phenotype method. Exposure to anticholinergic medications was estimated using the ACB scale, and the participants were classified into ACB_0 (none), ACB_1 (possible) and ACB_2+ (definite).ResultsThe study included 520 older adults (mean age 77.7 years, 62.7 % female), with a fall prevalence of 25.8 % 12 months past. The proportions of frailty and pre-frailty were 33.1 % and 57.4 %, respectively. After adjustment for study confounders, receiving at least 1 drug with either possible or definite anticholinergic properties was independently associated to falls in frail [OR = 3.84 (1.48−9.93), p = 0.006] and pre-frail participants [OR = 2.71 (1.25−5.89); p = 0.012], but not in robust subjects. Moreover, ACB was significantly associated with the frailty components on adjusted analysis (p’s<0.05).ImplicationsCurrent study showed that the use of any drugs with possible or definite anticholinergic properties was associated with an increased risk of falls in frail older adults. The results emphasize the importance of medication management with respect to fall prevention in these patients.     

Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression

This study investigated whether sleep duration and quality were related to life satisfaction (LS) among older Chinese adults and whether depression mediated those relationships. Cross-sectional data from the aging arm of the Rugao Longevity and Aging Study were used. Sleep duration, sleep quality, depression, LS and covariates were analyzed using logistic regressions. To assess the potential mediation of depression on the association between sleep duration and quality and LS, Aroian tests were used. Of 1756 older Chinese adults aged 70–84 years, 90.7% of the men and 83.3% of the women reported being satisfied with their lives. After adjusting for covariates, older adults who slept ≤6 h per night were more likely to suffer from life dissatisfaction compared with those who slept 7–8 h (OR = 2.67, 95% CI 1.86–3.79), and individuals who slept poorly were almost 2 times (OR = 2.91, 95% CI 2.16–3.91) more likely to have life dissatisfaction. The Aroian tests confirmed that these relationships were partially mediated by depression (p < 0.001). Between short sleep and LS, the mediating effect of depression accounted for 13.9% of the total effects. Moreover, the mediating effect of depression on the association between sleep quality and LS was 13.3%. Short sleep duration and poor sleep quality were inversely associated with LS, and the relationships were partially mediated by depression. Our study suggests that both sleep and depression status are important factors for LS among the elderly.     

Diurnal changes of critical flicker frequency in patients with liver cirrhosis and their relationship with sleep disturbances

BackgroundWe aimed to measure the diurnal changes of critical flicker frequency in healthy subjects and cirrhotic patients and to investigate their relationship with sleep disturbance.MethodsCirrhotic patients and healthy volunteers were included. All groups completed the Pittsburgh Sleep Quality Index and a simple sleep questionnaire. Sleep disturbance was defined as a Pittsburgh Sleep Quality Index score of >5. Critical flicker frequency was measured twice a day to detect diurnal abnormalities.ResultsOverall, 59 cirrhotic patients (54.2% males, Mean Age 59 ± 11 years) and 18 controls (39.9% males, Mean Age 58 ± 9 years) were included. Sleep disturbances were more common in cirrhotics (66.1%) than controls (38.9%, p < 0.05). In cirrhotics, the critical flicker frequency was not related to decompensation. The nocturnal values were higher than the morning values in cirrhotics (64.4%), but not in controls (p < 0.0001). Additionally, sleep disturbances were more common in cirrhotics who had higher nocturnal values (p < 0.05).ConclusionsChanges in the diurnal critical flicker frequency were observed in cirrhotics but not in controls. Sleep disturbances in cirrhotics appear to be associated with deviations of the diurnal rhythm of critical flicker frequency rather than with clinical parameters such as the clinical stages of cirrhosis and the Model For End-Stage Liver Disease and Child–Pugh scores.     

The role of the environment in falls among stroke survivors

BackgroundStroke survivors’ risk of falls may be particularly sensitive to the environment due to deficits such as visuospatial neglect or homonymous hemianopia. We sought to identify the prevalence of falls among stroke survivors and investigate the possible role of the environment in falling.Materials and methodsData from the National Health and Aging Trends Study (NHATS), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of falling in the past month between stroke survivors and demographic and comorbidity matched controls using sequential Poisson regression models.ResultsThe proportion of stroke survivors reporting a fall in the previous month was 18.8% compared to 10.8% among matched controls (PR: 1.74; 95% CI: 1.36–2.25). These differences were attenuated after adjusting for known confounders, mediators and aspects of the environment (PR: 1.17; 95% CI: 0.86–1.60). Indoor tripping hazards were associated with falls (PR: 1.24; 95% CI: 1.01–1.53). The association between stroke and falls was modified by neighborhood social disorder, such that in areas of low social disorder, falls in the previous month were more common in stroke survivors compared to non-stroke controls.ConclusionsThe difference in falls among stroke survivors and matched controls is largely explained by known risk factors and physical capacity. Indoor tripping hazards were associated with falls among stroke survivors and matched controls. Explanations of why the association between stroke and falls was protective in areas of high social disorder are unclear, but may warrant additional research.     

Sleep duration as a risk factor for cardiovascular disease- a review of the recent literature

Sleep loss is a common condition in developed countries, with evidence showing that people in Western countries are sleeping on average only 6.8 hour (hr) per night, 1.5 hr less than a century ago. Although the effects of sleep deprivation on our organs have been obscure, recent epidemiological studies have revealed relationships between sleep deprivation and hypertension (HT), coronary heart disease (CHD), and diabetes mellitus (DM). This review article summarizes the literature on these relationships. Because sleep deprivation increases sympathetic nervous system activity, this increased activity serves as a common pathophysiology for HT and DM. Adequate sleep duration may be important for preventing cardiovascular diseases in modern society.     

Footwear style and risk of falls in older adults

OBJECTIVES: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. DESIGN: Nested case-control study. SETTING: Group Health Cooperative, a large health maintenance organization in Washington state. PARTICIPANTS: A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. MEASUREMENTS: Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. RESULTS: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4-51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9-1.9), varying somewhat by style. CONCLUSION: Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.     

Sleep duration and mortality among older adults in a 22-year follow-up study: an analysis of possible effect modifiers

The aim of this study was to assess the relationship of sleep duration and all-cause mortality among 2,449 Polish community-dwelling older citizens of Krakow observed during 22 years of follow-up. In particular, the role of some demographic, psychosocial and health-related conditions were investigated in terms of modification effect. In the prospective study, background information was gathered by face-to-face interview. Vital data were obtained from the population registry. Cox regression models were used to assess the role of sleep duration in mortality, in the analyses of potential effect modifiers and the shape of the relationship. Sleep duration was observed to be a significant predictor of all-cause mortality. Life-weariness, functional activity, total number of chronic diseases and age (65–79, 80+) were found to be effect modifiers for the relationship between sleep duration and mortality. Further investigation showed a U-shaped mortality risk associated with the duration of sleep among individuals with a high level of life-weariness, high functional activity and in individuals aged 80 and over. On the other hand, a linear relationship between longer sleep duration and mortality was observed among older people with no experience of life-weariness, without chronic diseases, with medium functional activity and aged 65–79, but also among those who reported three and more chronic conditions. Results of our study support available evidence showing the relationship between sleep duration and mortality among older adults and suggest that any public health intervention in this area should consider also other coexisting modifiable psychosocial and functional determinants.     

消化性溃疡患者主观睡眠质量及其与心身状况相关分析

目的 探讨消化性溃疡患者的主观睡眠质量与心身状况以及二者之间的相关性.方法 采用匹茨馒睡眠质量指数馈表(PSQI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和症状自评量表(SCL-90)对60例消化性溃疡患者及60例正常对照组进行调查,并通过相关分析探讨消化性溃疡患者主观睡眠质量和心身状况之间的关系.结果 患者组与对照组在各项量表分的差异均有统计学意义(P＜0.05).消化性溃疡患者的PSQI与SAS、SDS、SCL-90之间呈正相关关系(P＜0.05).结论 消化性溃疡患者主观睡眠质量较差,并存在与精神症状相关的睡眠障碍.