Evaluating Sleep Deficiency in Older Persons
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PROJECT SUMMARY Sleep complaints occur in nearly half of older persons and are associated with cognitive decline, disability, and many other adverse outcomes. Accurate and feasible evaluation is needed to identify persons at risk for these adverse outcomes. However, the traditional approach to evaluating sleep complaints in older persons is limited for several reasons. First, because the underlying etiology is likely to be multifactorial in older persons, a comprehensive strategy that considers the multiple domains contributing to sleep complaints is needed. Second, reliance on self-report alone may miss severe sleep problems or specific sleep disorders in older persons. Third, polysomnography is the gold standard for evaluation of sleep apnea and sleep architecture (i.e., arousals from sleep and deeper, more restorative sleep stages), but it is costly, burdensome, and may not be feasible or reflect habitual sleep patterns. To address these limitations, we propose to evaluate sleep deficiency, a comprehensive construct aimed at identifying factors contributing to sleep complaints in three domains: 1) poor sleep quality, including sleep disorders; 2) insufficient sleep duration; and 3) non-circadian sleep (abnormalities of sleep timing, sleep regularity, and daytime alertness). Novel, home-based measures from sleep headbands and actigraphy will objectively evaluate sleep architecture and duration, detect sleep apnea, and assess non- circadian sleep. Measures of sleep quality, duration, and non-circadian sleep from the headbands and actigraphy can be performed over multiple nights in the home. They may be more feasible than laboratory- based measures and more reliable than self-reported measures. We will enroll 50 community dwelling persons 65 years with sleep complaints (insomnia or daytime sleepiness) to undergo evaluation of sleep deficiency using validated self-reported measures, single-night home-based polysomnography, 7 nights of the headband, and 7 days and nights of actigraphy. The aims of this study are to compare self-reported versus objective measures of sleep deficiency. We hypothesize that the headband measures will have stronger concordance with polysomnography than self-report and that concordance between self-reported and actigraphy measures of non-circadian sleep will be low. Collectively, such results would suggest the need for objective measures of sleep deficiency in older persons. The proposed work will develop robust objective measures of sleep deficiency that are feasible in this vulnerable and understudied population. These measures may advance the management of sleep deficiency in future work through enhanced identification of underlying sleep problems, improved targeting and monitoring of future interventions, and reduction of the risk of adverse health outcomes.
