Excessive Sleepiness is Predictive of Cognitive Decline in the Elderly

Study Objectives: This questionnaire-based cross-sectional study was conducted (1) to estimate the prevalence of sleep-related problems, and (2) to explore factors associated with lower physical/mental quality of life (QOL), particularly addressing sleep-related problems among Japanese visually impaired people. Methods: This nationwide questionnaire-based survey was administered to visually impaired individuals through the Japan Federation of the Blind. Visually impaired individuals without light perception (LP) (n = 311), those with LP (n = 287), and age-matched and gender-matched controls (n = 615) were eligible for this study. Study questionnaires elicited demographic information, and information about visual impairment status, sleep-related problems, and health-related quality of life. Results: Visually impaired individuals with and without LP showed higher prevalence rates of irregular sleep-wake patterns and difficulty maintaining sleep than controls (34.7% and 29.4% vs. 15.8%, 60.1% and 46.7% vs. 26.8%, respectively; p < 0.001). These sleep-related problems were observed more frequently in visually impaired individuals without LP than in those with LP. Non-restorative sleep or excessive daytime sleepiness was associated with lower mental/physical QOL in visually impaired individuals with LP and in control subjects. However, visually impaired individuals without LP showed irregular sleepwake pattern or difficulty waking up at the desired time, which was associated with lower mental/physical QOL. Conclusions: Sleep-related problems were observed more frequently in visually impaired individuals than in controls. Moreover, the rates of difficulties were higher among subjects without LP. Sleep-related problems, especially circadian rhythm-related ones, can be associated with lower mental/physical QOL in visually impaired individuals without LP. Keywords: circadian rhythm sleep-wake disorder, health-related quality of life, light perception, prevalence, sleep-related problems, visual impairment I NTRO DUCTI O NVisually impaired individuals are likely to have any of several comorbid mental/physical disorders including diabetes mellitus, hypertension, cognitive impairment, and depression/ anxiety. [1][2][3][4][5][6] The severity of these mental/physical disorders is reportedly correlated with visual impairment.1-9 Therefore, those individuals might be at risk for lower health-related quality of life (QOL). 7-10Sleep-related problems have been observed frequently in visually impaired individuals.11-15 Reportedly, especially in people without light perception (LP), inhibited transmission of light signals to the suprachiasmatic nuclei might cause sleeprelated problems because of external desynchronization of the biological clock. 16,17 Indeed, the rate of circadian-related sleepwake disorders is likely to be higher among visually impaired individuals without LP than among those with LP.12 In Japan, no large nationwide study of this subject has ever been reported. The actual prevalence of sleep-related problems amon...

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“…[34][35][36] Therefore, the present results of the association between these sleep disturbances and lower mental/physical QOL are reasonable.…”

Section: Discussionmentioning

confidence: 70%

A Nationwide Cross-Sectional Survey of Sleep-Related Problems in Japanese Visually Impaired Patients: Prevalence and Association with Health-Related Quality of Life

Tamura

Sasai-Sakuma

Morita

et al. 2016

Journal of Clinical Sleep Medicine

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“…11,39 It is plausible that poor sleep differentially affects executive function by disrupting corticalsubcortical connections within the prefrontal cortex through vascular damage. 3,19,30,40 This study has several important limitations. We were unable to rule out potential selection bias; it is plausible that those with the greatest cognitive decline were less likely to return for a follow-up assessment.…”

Section: Resultsmentioning

confidence: 99%

“…1 Observational studies suggest that sleep duration, daytime sleepiness, and sleep-disordered breathing (SDB), including frequent snoring, increases the risk of cognitive impairment. 2,3 Improving sleep might be an avenue for early intervention in those at risk of cognitive decline and dementia. 1 However, there are little data evaluating self-reported sleep symptoms and cognitive decline across different cognitive domains.…”

mentioning

confidence: 99%

Sleep disturbances and cognitive decline in the Northern Manhattan Study

et al. 2016

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Objective: To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. Methods:The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 6 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 6 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis-derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain.

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“…Depressive symptomatology and insomnia are both common in the elderly and in France there are no official guidelines for management, so antidepressants are often used to treat sleep disorder and hypnotics to treat depression, especially where sleep disturbance is one of the presenting symptoms [2]. EDS is also of multifactorial origin, and commonly associated with depression [7], cognitive decline [38], physical illness (particularly CVD), and mortality in older adults [5,6,13]. Thus, all these conditions may increase the risk of mortality in elderly patients through pathways independently of hypnotics.…”

Section: Discussionmentioning

confidence: 99%

Hypnotics and mortality in an elderly general population: A 12-year prospective study

et al. 2013

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Background: Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. Methods: Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. Results: At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with hypnotics, particularly benzodiazepines, and this increased with the number of hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. Conclusions: When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.

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Excessive Sleepiness is Predictive of Cognitive Decline in the Elderly

Cited by 186 publications

References 37 publications

A Nationwide Cross-Sectional Survey of Sleep-Related Problems in Japanese Visually Impaired Patients: Prevalence and Association with Health-Related Quality of Life

A Nationwide Cross-Sectional Survey of Sleep-Related Problems in Japanese Visually Impaired Patients: Prevalence and Association with Health-Related Quality of Life

Sleep disturbances and cognitive decline in the Northern Manhattan Study

Hypnotics and mortality in an elderly general population: A 12-year prospective study

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