Sleep problems in the community elderly as predictors of death and nursing home placement

Abstract

In 1984-85, 1855 elderly residents of an urban community responded to a comprehensive baseline interview that included questions regarding an extensive set of sleep characteristics and problems. During the subsequent 3 1/2 years of follow-up, 16.7% of the respondents died and 3.5% were placed in nursing homes. The predictive significance of each sleep characteristic for mortality and for nursing home placement was determined separately for males and females, using Cox proportional hazards models. Selected demographic and psychosocial variables were also entered into the models. Age, problems with activities of daily living (ADL), self-assessed health, income, cognitive impairment, depression and whether respondents were living alone were controlled for statistically. Of the many variables analyzed, in males insomnia was the strongest predictor of both mortality and nursing home placement. For mortality, the relative hazard associated with insomnia exceeded the hazards associated with age, ADL problems, fair-poor health and low income. For nursing home placement, the hazard associated with insomnia exceeded that associated with cognitive impairment. The relationships of insomnia to mortality and nursing home placement were U-shaped, with a worse outcome if insomnia complaints over the preceding 2 weeks were either prominent (numerous or frequent) or absent. For females, insomnia was a borderline predictor of mortality and did not predict nursing home placement at all. Symptoms of the restless legs syndrome predicted mortality for females in some Cox regression models. Reported sleep duration, symptoms of sleep apnea and frequent use of hypnotic drugs did not predict mortality or nursing home placement in either sex.

Recurrent restriction of sleep and inadequate recuperation induce both adaptive changes and pathological outcomes

“…Epidemiological studies show strong linkages between sleep loss and comorbid conditions and mortality (56,73,80; reviewed in Refs. 1 and 44) but do not establish causal relationships between regulatory processes and outcomes.…”

Sleep Duration and Mortality in Japan: the Jichi Medical School Cohort Study

“…Although there were some studies examining the relationship between sleep duration and mortality, [1][2][3][4][5][6][7][8][9][10] it has not been fully discussed. Most previous reports have found that there was a Ushaped relationship between sleep duration and all-cause mortality in both males and females.…”

“…Many previous studies, [1][2][3][4][5][6] though not all, [7][8][9][10] reported that both long and short sleep duration increased risk of death. However, there have been only a few studies controlling for various relevant confounding factors.…”

Timing of Activities and their Effects on Circadian Rhythm in the Elderly with Dementia: A Literature Review

“…Sleep provides neurological and physiological benefits that are crucial to promoting health and bodily function [9]. No other timed activity synchrony is more important to brain plasticity and resilience than the one between sleep and the sleep/wake cycle [10].…”

“…Circadian rhythm disorders (CRDs) occur in over 60 percent of patients with Alzheimer's disease and related dementias and are associated with increased morbidity and mortality and poor quality of life [10,11]. CRD symptoms include late afternoon/evening agitation (e.g., "sundowning") and irregular sleep-wake rhythms such as daytime hypersomnia, frequent night wakenings, and poor sleep efficiency [12][13][14].…”