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These are the final results of a survey of sleep-disordered breathing, which examined objective and subjective information from a large randomly selected elderly sample. We randomly selected 427 elderly people aged 65 yr and over in the city of San Diego, California. Twenty-four percent had an apnea index, AI, greater than or equal to 5 and 62% had a respiratory disturbance index, RDI, greater than or equal to 10. Correlates of sleep-disordered breathing included high relative weight and reports of snoring, breathing cessation at night, nocturnal wandering or confusion, daytime sleepiness and depression. Body mass index, falling asleep at inappropriate times, male gender, no alcohol within 2 hr of bedtime and napping were the best predictors of sleep-disordered breathing. Despite statistical significance, all of the associations between interview variables and apnea indices were small. No combination of demographic variables and symptoms allowed highly reliable prediction of AI or RDI.

Compared with healthy eyes, the diurnal IOP is higher, the diurnal-to-nocturnal change of habitual IOP is less, and the posture-independent IOP pattern around normal awakening time is different in eyes with early glaucomatous changes.

A nocturnal elevation of IOP can be detected in healthy young adults in both the sitting and the supine positions. There is a 24-hour rhythm of sitting IOP that is not different from the 24-hour rhythm of supine IOP.

ObjectivesAn estimated 6%–10% of US adults took a hypnotic drug for poor sleep in 2010. This study extends previous reports associating hypnotics with excess mortality.SettingA large integrated health system in the USA.DesignLongitudinal electronic medical records were extracted for a one-to-two matched cohort survival analysis.SubjectsSubjects (mean age 54 years) were 10 529 patients who received hypnotic prescriptions and 23 676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 years between January 2002 and January 2007.Main outcome measuresData were adjusted for age, gender, smoking, body mass index, ethnicity, marital status, alcohol use and prior cancer. Hazard ratios (HRs) for death were computed from Cox proportional hazards models controlled for risk factors and using up to 116 strata, which exactly matched cases and controls by 12 classes of comorbidity.ResultsAs predicted, patients prescribed any hypnotic had substantially elevated hazards of dying compared to those prescribed no hypnotics. For groups prescribed 0.4–18, 18–132 and >132 doses/year, HRs (95% CIs) were 3.60 (2.92 to 4.44), 4.43 (3.67 to 5.36) and 5.32 (4.50 to 6.30), respectively, demonstrating a dose–response association. HRs were elevated in separate analyses for several common hypnotics, including zolpidem, temazepam, eszopiclone, zaleplon, other benzodiazepines, barbiturates and sedative antihistamines. Hypnotic use in the upper third was associated with a significant elevation of incident cancer; HR=1.35 (95% CI 1.18 to 1.55). Results were robust within groups suffering each comorbidity, indicating that the death and cancer hazards associated with hypnotic drugs were not attributable to pre-existing disease.ConclusionsReceiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year. This association held in separate analyses for several commonly used hypnotics and for newer shorter-acting drugs. Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality.

The objective of this study was to investigate the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) in a non-clinical sample consisting of younger and older adults. There has been little research validating the PSQI with respect to multinight recording as with actigraphy, and more validation is needed in samples not specifically selected for clinical disturbance. Also, the degree to which the PSQI scores may reflect depressive symptoms versus actual sleep disturbance remains unclear. One-hundred and twelve volunteers (53 younger and 59 older) were screened for their ability to perform treadmill exercises; inclusion was not based on sleep disturbance or depression. Internal homogeneity was evaluated by correlating PSQI component scores with the global score. Global and component scores were correlated with a sleep diary, actigraphy, and centers for epidemiological studies -depression scale scores to investigate criterion validity. Results showed high internal homogeneity. PSQI global score correlated appreciably with sleep diary variables and the depression scale, but not with any actigraphic sleep variables. These results suggest that the PSQI has good internal homogeneity, but may be less reflective of actual sleep parameters than a negative cognitive viewpoint or pessimistic thinking. The sleep complaints measured may often be more indicative of general dissatisfaction than of any specifically sleep-related disturbance.