Actigraphic sleep characteristics among older Americans.
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ABSTRACT:
SUBMITTER: Kurina LM
PROVIDER: S-EPMC5555167 | biostudies-other | 2015 Dec
REPOSITORIES: biostudies-other
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Project description:ObjectivesTo estimate the proportion of older Americans at risk for obstructive sleep apnea (OSA) who receive OSA evaluations, diagnosis, and treatment.DesignCross sectional study.SettingNational Health and Aging Trends Study (NHATS), Round 3 survey.ParticipantsCommunity-dwelling Medicare beneficiaries age 65 and older (N=1,052).MeasurementsNHATS participants were asked specific questions about sleep disturbances, including items that resembled critical elements of a validated instrument used to assess OSA risk (the STOP-Bang questionnaire). The proportion of older Americans at risk for OSA who received evaluations with home or in-laboratory sleep studies, OSA diagnosis, and OSA treatment was examined, as well as clinical, social, and demographic correlates of OSA.ResultsOf 1,052 participants who completed the sleep module, 56% (95% confidence interval (CI)=53-59%) were estimated to be at high risk of OSA. Only 8% (95% CI=5-11%) of the high-risk individuals had been tested for it. Of those tested, 94% (95% CI=87-100%) were diagnosed with OSA. Treatment with positive airway pressure was prescribed for 82% (95% CI=65-99%) of participants with an OSA diagnosis.ConclusionsEvidence from this nationally representative sample of community-dwelling Medicare beneficiaries suggests that high OSA risk is common but seldom investigated. When investigated, OSA is almost always confirmed and usually treated. These findings suggest a significant gap in OSA assessment for older Americans that could have public health implications.
| S-EPMC6097901 | biostudies-literature
Project description:ObjectiveOlder adults frequently report sleep problems and are at increased risk of cardiometabolic disruption. Experimental sleep restriction of younger adults has suggested that cortisol may be on the pathway between sleep restriction and cardiometabolic disease. We investigated whether the natural variation in sleep among older adults is associated with daytime cortisol level.MethodsSalivary cortisol samples and actigraphy sleep data were collected from a random subsample of participants in the National Social Life, Health and Aging Project, a nationally representative probability sample of adults aged 62-90 (N = 672). Salivary cortisol was measured with 3 timed samples at the beginning, middle, and end of a 2-hr in-home interview. Sleep characteristics were derived from wrist actigraphy (fragmentation, wake after sleep onset [WASO], and duration) and from survey responses about usual sleep duration and sleep problems. For each individual, a single summary daytime cortisol level was estimated by fitting a marginal longitudinal model for the 3 time-stamped cortisol samples. The resulting estimates were then regressed on each sleep measure, adjusting for sociodemographics, health behaviors, and comorbidities.ResultsFrom actigraphy, both higher fragmentation score (? = 0.02; 95% confidence interval [CI] = 0.00 to 0.03) and longer WASO (? = 0.27; 95% CI = 0.04 to 0.51) were significantly associated with higher daytime cortisol; sleep duration was not. Self-reported sleep duration and sleep problems were also not associated with cortisol.ConclusionActigraph measures of sleep disturbance are associated with higher daytime cortisol among older adults. However, cross-sectional data cannot distinguish causal direction or whether cortisol and sleep disruption have a common cause.
| S-EPMC6251667 | biostudies-literature
Project description:There are differences in sleep duration between Blacks/African-Americans and Whites/European-Americans. Recently, we found differences between these ancestry groups in the circadian system, such as circadian period and the magnitude of phase shifts. Here we document the role of ancestry on sleep and cognitive performance before and after a 9-h advance in the sleep/wake schedule similar to flying east or having a large advance in sleep times due to shiftwork, both of which produce extreme circadian misalignment. Non-Hispanic African and European-Americans (N = 20 and 17 respectively, aged 21-43 years) were scheduled to four baseline days each with 8 h time in bed based on their habitual sleep schedule. This sleep/wake schedule was then advanced 9 h earlier for three days. Sleep was monitored using actigraphy. During the last two baseline/aligned days and the first two advanced/misaligned days, beginning 2 h after waking, cognitive performance was measured every 3 h using the Automated Neuropsychological Assessment Metrics (ANAM) test battery. Mixed model ANOVAs assessed the effects of ancestry (African-American or European-American) and condition (baseline/aligned or advanced/misaligned) on sleep and cognitive performance. There was decreased sleep and impaired performance in both ancestry groups during the advanced/misaligned days compared to the baseline/aligned days. In addition, African-Americans obtained less sleep than European-Americans, especially on the first two days of circadian misalignment. Cognitive performance did not differ between African-Americans and European-Americans during baseline days. During the two advanced/misaligned days, however, African-Americans tended to perform slightly worse compared to European-Americans, particularly at times corresponding to the end of the baseline sleep episodes. Advancing the sleep/wake schedule, creating extreme circadian misalignment, had a greater impact on the sleep of African-Americans than European-Americans. Ancestry differences in sleep appear to be exacerbated when the sleep/wake schedule is advanced, which may have implications for individuals undertaking shiftwork and transmeridian travel.
| S-EPMC5653363 | biostudies-literature
Project description:Study objectivesWe investigated cross-sectional associations of individual-level socioeconomic position (SEP) and neighborhood characteristics (social cohesion, violence, problems, disadvantage) with sleep duration and sleep quality in 5,301 African Americans in the Jackson Heart Study.MethodsAll measures were self-reported. Sleep duration was assessed as hours of sleep; sleep quality was reported as poor (1) to excellent (5). SEP was measured by categorized years of education and income. Multinomial logistic and linear regression models were fit to examine the associations of SEP and neighborhood characteristics (modeled dichotomously and tertiles) with sleep duration (short vs. normal, long vs. normal) and continuous sleep duration and quality after adjustment for demographics and risk factors.ResultsThe mean sleep duration was 6.4 ± 1.5 hours, 54% had a short (? 6 h) sleep duration, 5% reported long (? 9 h) sleep duration, and 24% reported fair to poor sleep quality. Lower education was associated with greater odds of long sleep (odds ratio [OR] = 2.19, 95% confidence interval [CI] = 1.42, 3.38) and poorer sleep quality (? = -0.17, 95% CI = -0.27, -0.07) compared to higher education after adjustment for demographics and risk factors. Findings were similar for income. High neighborhood violence was associated with shorter sleep duration (-9.82 minutes, 95% CI = -16.98, -2.66) and poorer sleep quality (? = -0.11, 95% CI = -0.20, 0.00) after adjustment for demographics and risk factors. Results were similar for neighborhood problems. In secondary analyses adjusted for depressive symptoms in a subset of participants, most associations were attenuated and only associations of low SEP with higher odds of long sleep and higher neighborhood violence with poorer sleep quality remained statistically significant.ConclusionsSocial and environmental characteristics are associated with sleep duration and quality in African Americans. Depressive symptoms may explain at least part of this association.
| S-EPMC4989264 | biostudies-literature
Project description:Sleep laboratory studies find that restricted sleep duration leads to worse short-term cognition, especially memory. Observational studies find associations between self-reported sleep duration or quality and cognitive function. However self-reported sleep characteristics might not be highly accurate, and misreporting could relate to cognition. In the Sleep Study of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative cohort of older US adults (2010-2015), we examined whether self-reported and actigraph-measured sleep are associated with cross-sectional cognitive function and 5-year cognitive decline. Cognition was measured with the survey adaptation of the multidimensional Montreal Cognitive Assessment (MoCA-SA). At baseline (n = 759), average MoCA-SA score was 14.1 (standard deviation, 3.6) points of a possible 20. In cross-sectional models, actigraphic sleep-disruption measures (wake after sleep onset, fragmentation, percentage sleep, and wake bouts) were associated with worse cognition. Sleep disruption measures were standardized, and estimates of association were similar (range, -0.37 to -0.59 MoCA-SA point per standard deviation of disruption). Actigraphic sleep-disruption measures were also associated with odds of 5-year cognitive decline (4 or more points), with wake after sleep onset having the strongest association (odds ratio = 1.43, 95% confidence interval: 1.04, 1.98). Longitudinal associations were generally stronger for men than for women. Self-reported sleep showed little association with cognitive function.
| S-EPMC6545284 | biostudies-literature
Project description:ObjectiveSleep disorders as a preclinical symptom of synucleinopathies become more prevalent in older adults. Synucleinopathies might be caused by the abnormal aggregation of alpha-synuclein in the brain, which was indicated by alpha-synuclein levels in cerebrospinal fluid (CSF). We aimed to investigate associations of sleep characteristics with CSF alpha-synuclein in older adults.MethodsOur study recruited 536 cognitively intact individuals (aged between 40 and 90 years old) from the Chinese Alzheimer's Biomarker and Lifestyle study. Sleep behaviors were assessed by Pittsburgh Sleep Quality Index and total alpha-synuclein in CSF was measured by enzyme-linked immune-sorbent assay. We used multiple linear and non-linear regression models for research.ResultsSignificant non-linear associations of CSF alpha-synuclein with sleep time and duration were revealed. Individuals who went to bed and fell asleep too early or late tended to have lower CSF alpha-synuclein (reflection point for time to bed and fall asleep were 10:26 p.m. and 10:40 p.m.). Lower CSF alpha-synuclein was also observed in individuals with either excessive or insufficient sleep duration (reflection point: 7.24 hours). Besides, overall poor sleep quality (β = -0.0621; P = 0.0242), longer sleep latency (β = -0.0415; P = 0.0174) and lower sleep efficiency (β = 0.0036; P = 0.0017) showed linear associations with lower CSF alpha-synuclein. Sleep disturbances and daytime dysfunction were not significantly associated with CSF alpha-synuclein.InterpretationPoor sleep was associated with lower levels of CSF alpha-synuclein in older adults, which may provide new insight into the prevention of synucleinopathies.
| S-EPMC7545588 | biostudies-literature
Project description:In the United States, public health insurance is available for nearly all persons with end-stage renal disease (ESRD). Little is known about the extent of health insurance coverage for persons with non-dialysis dependent chronic kidney disease (CKD).To describe patterns of health insurance coverage for adults with non-dialysis dependent CKD and to examine risk factors for progression of CKD to ESRD and management of hypertension among those lacking insurance.Cross-sectional analysis of data from a nationally representative sample of 16,148 US adults aged 20 years or older who participated in the National Health and Nutrition Examination Survey 1999-2006.National prevalence estimates of health insurance coverage, ESRD risk factors, and treatment of hypertension.An estimated 10.0% (95% CI, 8.3%-12.0%) of US adults with non-dialysis dependent CKD were uninsured, 60.9% (95% CI, 58.2%-63.7%) had private insurance and 28.7% (95% CI, 26.4%-31.1%) had public insurance alone. Uninsured persons with non-dialysis dependent CKD were more likely to be under the age of 50 (62.8% vs. 23.0%, P < 0.001) and nonwhite (58.7%, vs. 21.8%, P < 0.001) compared with their insured counterparts. Approximately two-thirds of uninsured adults with non-dialysis dependent CKD had at least one modifiable risk factor for CKD progression, including 57% with hypertension, 40% who were obese, 22% with diabetes, and 13% with overt albuminuria. In adjusted analyses, uninsured persons with non-dialysis dependent CKD were less likely to be treated for their hypertension (OR, 0.59; 95% CI, 0.40-0.85) and less likely to be receiving recommended therapy with angiotensin inhibitors (OR, 0.45; 95% CI, 0.26-0.77) compared with those with insurance coverage.Uninsured persons with non-dialysis dependent CKD are at higher risk for progression to ESRD than their insured counterparts but are less likely to receive recommended interventions to slow disease progression. Lack of public health insurance for patients with non-dialysis dependent CKD may result in missed opportunities to slow disease progression and thereby reduce the public burden of ESRD.
| S-EPMC2710472 | biostudies-other
Project description:Wild-type transthyretin cardiac amyloidosis (ATTRwt), formerly called senile cardiac amyloidosis (SCA), is almost exclusively a disorder of older adults. As the population ages, the diagnosis of ATTRwt will increase, making it the most common form of cardiac amyloidosis. An important precondition to reduce underdiagnosis and misdiagnosis is to maintain a high index of suspicion for cardiac amyloidosis. Several clues can be gleaned from the clinical history, physical exam, electrocardiography, and noninvasive imaging techniques. Nuclear scintigraphy agents using 99mTc-phosphate derivatives combined with assessment for monoclonal proteins are eliminating the need for tissue confirmation in ATTR. Morbidity and mortality from ATTRwt cardiac amyloid is high and the emergence of numerous therapies based on a biologic understanding of the pathophysiology of this condition, including drugs to inhibit the synthesis of TTR, stabilize TTR, and degrade or extract amyloid, provides new hope for those afflicted. This review briefly covers the epidemiology, pathophysiology, and clinical manifestations, as well as diagnostic strategies and treatment, of ATTR in older adults.
| S-EPMC5127719 | biostudies-literature
Project description:Abstract The number of people with dementia is increasing worldwide. Circadian rhythm disorders and sleep problems are very common in this population and can have profound effects on well-being. Healthy Patterns Clinical Trial (NCT03682185) is a home-based activity intervention designed to improve circadian rhythm disorders and quality of life in people with dementia and their family caregivers. This symposium is designed to discuss the relationship between sleep characteristics and neighborhood environment, function, and psychological well-being in people with dementia. All analyses in this session were conducted on baseline data from participants enrolled in the Healthy Patterns Clinical Trial. We enrolled 170 individuals (67% female), aged (73.35 ± 8.74) with mean Clinical Dementia Rating (CDR) scores of (0.74 ± 0.51). Session 1 describes the role of neighborhood factors as influencing factors affecting sleep. Session 2 focuses on the relationship between sleep and mood. Session 3 focuses on the relationship between sleep and function. Session 4 focuses on the relationship between sleep and quality of life. Implications for future research and intervention development for people with dementia will be discussed.
| S-EPMC7740600 | biostudies-literature
Project description:RationaleObstructive sleep apnea (OSA) is hypothesized to be influenced by genes within pathways involved with obesity, craniofacial development, inflammation, and ventilatory control.ObjectivesWe conducted the first candidate gene study of OSA using family data from European Americans and African Americans, selecting biologically plausible genes from within these pathways.MethodsA total of 1,080 single nucleotide polymorphisms (SNPs) were genotyped in 729 African Americans and 505 SNPs were genotyped in 694 European Americans. Coding for SNPs additively, association testing on the apnea-hypopnea index (AHI) as a continuous trait, and OSA as a dichotomous trait (AHI ≥15) was conducted using methods that account for familial correlations in models adjusted for age, age-squared, and sex, with and without body mass index.Measurements and main resultsIn European Americans, variants within C-reactive protein (CRP) and glial cell line-derived neurotrophic factor (GDNF) were associated with AHI (CRP: β = 4.6; SE = 1.1; P = 0.0000402) (GDNF: β = 4.3; SE = 1; P = 0.0000201) and with the dichotomous OSA trait (CRP: odds ratio = 2.4; 95% confidence interval, 1.5-3.9; P = 0.000170) (GDNF: odds ratio = 2; 95% confidence interval, 1.4-2.89; P = 0.0000433). In African Americans, rs9526240 within serotonin receptor 2a (HTR2A: odds ratio = 2.1; 95% confidence interval, 1.5-2.9; P = 0.00005233) was associated with OSA.ConclusionsThis candidate gene analysis identified the potential role of genes operating through intermediate disease pathways to influence sleep apnea phenotypes, providing a framework for focusing future replication studies.
| S-EPMC2970865 | biostudies-literature