Sleep in the Aging Population

Miner, Brienne; Kryger, Meir H.

doi:10.1016/j.jsmc.2016.10.008

Cited by 247 publications

(166 citation statements)

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“…Specifically, male sex, nonwhite race, arthritis, depressive symptoms, low physical activity, RLS, SDB, CNS depressant medication use, and insomnia severity were associated with patient‐reported hypersomnia and/or with the severity of hypersomnia symptoms. While we cannot infer causation in this analysis, prior work suggests these factors may contribute to hypersomnia via sleep fragmentation, less restorative sleep, or disruption of sleep‐wake scheduling …”

Section: Discussionmentioning

confidence: 97%

“…First, our modest sample size and cross‐sectional design limited statistical power and precluded a determination of causation. Second, SDB was assessed by self‐report rather than polysomnography, which likely underestimated the prevalence and association of this condition with hypersomnia . Similarly, medical conditions were examined by self‐report rather than by objective measures, which may have underestimated the association of more severe disease with hypersomnia.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we examined the associations of key demographic and clinical characteristics with patient‐reported hypersomnia. We hypothesized that patient‐reported hypersomnia would be highly prevalent and severe in persons with advanced age, given their high medical burden and sedentary lifestyles …”

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confidence: 99%

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The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age

Miner

Gill

Yaggi

et al. 2019

J American Geriatrics Society

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OBJECTIVE To examine the epidemiology and key demographic and clinical correlates of patient‐reported hypersomnia in persons with advanced age. DESIGN Cross‐sectional design. SETTING Community. PARTICIPANTS A total of 357 community‐dwelling persons from the Yale Precipitating Events Project with a mean age of 84.2 years (range = 78‐102 years). MEASUREMENTS We studied patient‐reported hypersomnia, defined categorically by an Epworth Sleepiness Scale (ESS) score of 10 or greater; as well as the severity of hypersomnia symptoms, defined continuously by an ESS score range of 0 to 24 (higher scores denote greater sleepiness). In multivariable regression models, we examined cross‐sectional associations between key correlates and ESS score, expressed as categorical and continuous variables. Key correlates included: demographics, education, smoking status, body mass index, self‐reported medical conditions, Center for Epidemiologic Studies Depression score, Mini‐Mental State Examination score, Physical Activity Scale for the Elderly, restless legs syndrome (RLS), self‐reported sleep‐disordered breathing (SDB), medications, and Insomnia Severity Index. RESULTS Mean ESS score for all participants was 6.4. Patient‐reported hypersomnia (ESS score ≥10) was established in 82 participants (23.0%)—their mean ESS score was 13.0. In multivariable models, male sex, nonwhite race, arthritis, depressive symptoms, low physical activity, RLS, SDB, central nervous system depressant medications, and insomnia severity were cross‐sectionally associated with patient‐reported hypersomnia (higher adjusted odds ratios, ranging from 1.93‐2.86) and/or with the severity of hypersomnia symptoms (higher ESS scores, ranging from 0.11‐2.86 points). CONCLUSION Patient‐reported hypersomnia was prevalent in a sample of community‐dwelling persons with advanced age. In addition, based on cross‐sectional associations with the ESS score, key demographic and clinical characteristics were identified that may inform screening strategies for hypersomnia in advanced age. J Am Geriatr Soc 67:2545–2552, 2019

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age

Miner

Gill

Yaggi

et al. 2019

J American Geriatrics Society

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“…[1][2][3][4][5] Self-reported, physician-diagnosed myocardial infarction, stroke, or congestive heart failure. Thus, our observation that insomnia is highly prevalent in older persons with high medical burden and polypharmacy but mild in severity is surprisingly discordant.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] As to mechanisms underlying this lack of association, we again postulate that advanced age may be increasingly associated with the paradox of well-being, reduced sensory awareness to symptom severity, and lower daily demands that allow older persons to better tolerate less restorative sleep do not require. [14][15][16] In contrast, the strong associations between depressive symptoms and RLS and insomnia in our study sample may reflect shared diagnostic features of these conditions.…”

Section: Discussionmentioning

confidence: 99%

Insomnia in Community‐Living Persons with Advanced Age

Miner

Gill

Yaggi

et al. 2018

J American Geriatrics Society

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OBJECTIVE:To evaluate the epidemiology of insomnia, including demographic and clinical correlates, in older adults. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Yale Precipitating Events Project participants (N5379; mean age 84.3; 67.8% female; 11.9% African American). MEASUREMENTS: Insomnia Severity Index (ISI), with scores of 8 and higher indicating insomnia, which was further stratified according to ISI score as mild (8)(9)(10)(11)(12)(13)(14), moderate (15-21), or severe (22-28). Baseline characteristics included age, sex, race, education, smoking, obesity, medical conditions, depressive symptoms (Center for Epidemiologic Studies Depression score 16), cognitive impairment (Mini-Mental State Examination score <24), restless legs syndrome (RLS), self-reported sleep-disordered breathing (SDB), medications, and daytime sleepiness (Epworth Sleepiness Scale (ESS), range 0-24). RESULTS: Insomnia was established in 163 (43.0%) participants (average ISI score 12.3 (mild)). For the entire sample, average baseline characteristics were as follows: 30.1% did not complete high school, 5% were current smokers, 19.2% were obese, 28.2% had cardiovascular disease, 19.3% had chronic lung disease, 27.2% had depressive symptoms, 16.1% had cognitive impairment, 36.8% had RLS, and 3.4% had self-reported SDB; mean number of medications was 9.2, and mean ESS was 6.4. In multivariable regression models, only depressive symptoms (adjusted odds ratio (aOR)58.34, 95% confidence interval (CI)54.49, 15.47) and RLS (aOR52.49, 95% CI51.48, 4.21) were significantly associated with insomnia. CONCLUSION: In a sample of older adults with high medical burden and polypharmacy, insomnia was highly prevalent but unexpectedly mild and associated only with depressive symptoms and RLS. The discordance of high prevalence but mild severity of insomnia in the oldest adults highlights the need for diagnostic confirmation with objective measures of sleep disturbances, whereas the strong associations with depressive symptoms and RLS inform priorities in managing insomnia. J Am Geriatr Soc 2018.Key words: insomnia; epidemiology; aging; restless legs syndrome; depression A lthough prior work has shown that insomnia commonly occurs in older persons, 1-5 the oldest adults (80) have been underrepresented. There was also heterogeneity in the methods used to evaluate insomnia, with some studies including single-item sleep questions, 3,4 which do not distinguish between insomnia symptoms and insomnia diagnosis (defined as insomnia symptoms with a negative effect on daytime functioning). 2,6,7 In contrast, the Insomnia Severity Index (ISI) is a validated screening questionnaire that captures self-reported insomnia symptoms and daytime impairments and is thus useful for identifying insomnia and its severity in epidemiological studies. 6,7 We evaluated the epidemiology of insomnia and its severity, measured using the ISI, in a sample of communityliving persons with a mean age of 84.3 (range 78-102) years. We hypothesized that insomnia would be more preva...

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Insomnia symptoms, fatigue, and future job exit in American older adults

Sagherian

Byon

Zhu

et al. 2020

American J Industrial Med

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BackgroundAs older adults prolong working life and face age‐related health changes, insomnia symptoms and fatigue may jeopardize their ability to stay in the labor force. Our study explored the relationships between insomnia symptoms, fatigue, and job exit in workers aged 65 years and older.MethodsData from the National Health and Aging Trends Study were used (2011–2017). The sample included 953 Medicare beneficiaries with paid work at the time of the interview. Workers were followed annually for 6 years to the time of job exit. Insomnia measures included the number and type of symptoms, and fatigue (measured as low energy). Crude and adjusted odds ratios and 95% confidence intervals were estimated within discrete‐time survival analysis. Models were adjusted for health, lifestyle, and sociodemographic characteristics.ResultsAt baseline, approximately 49% of workers had either one or two insomnia symptoms. Difficulty falling asleep and difficulty maintaining asleep were prevalent in 35% and 37% of the sample. Fatigue was common in <30% of the sample. Workers with difficulty falling asleep were 1.29 times at higher odds to have job exit when compared with workers with no insomnia (p = 0.033). Conversely, fatigued workers were 0.73–0.77 times at lower odds to have job exit when compared with nonfatigued workers (p < 0.05).ConclusionDifficulty falling asleep negatively affects future work status, unlike feeling fatigued. Healthcare providers are encouraged to assess for insomnia and discuss treatments with workers, and workplaces should be flexible with the start of workdays to support worker longevity.

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Sleep in the Aging Population

Cited by 247 publications

References 43 publications

The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age

The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age

Insomnia in Community‐Living Persons with Advanced Age

Insomnia symptoms, fatigue, and future job exit in American older adults

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