Abstract
The manifestation of older adults with poor sleep quality is heterogeneous. Using data-driven classifying methods, the study aims to subgroup community-dwelling older adults with poor sleep quality. Adults aged 65 and older participated in the Yilan study. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index. Latent class analysis with the 7 subscores of the Pittsburgh Sleep Quality Index as the indicators was used to generate empirical subgroups. Differences in comorbidity patterns between subgroups were compared. A total of 2622 individuals, of which 1011 (38.6%) had Pittsburgh Sleep Quality Index -defined poor sleep quality, participated. Three groups for poor sleep quality were specified in the latent class analysis: High Insomnia (n = 191, 7.3%), Mild Insomnia (n = 574, 21.9%), and High Hypnotics (n = 246, 9.4%). The High Insomnia and Mild Insomnia groups shared similar profiles but different severities in the 7 domains of the Pittsburgh Sleep Quality Index. In contrast, the High Hypnotics group had the lowest Pittsburgh Sleep Quality Index total scores and insomnia severity but had similar mental and physical comorbid patterns as the High Insomnia group. This finding suggests that poor sleep quality in community-dwelling older adults had various feature-based subgroups. It also implicates the development of group-centered interventions.
Highlights
Sleep quality deteriorates along with aging, and it is partly related to the normal aging process and is a significant result of ill health[1]
The main attributes of poor sleep quality highly vary in different characteristic populations, a one-size-fits-all approach will not satisfy the multifactorial features of poor sleep quality
Hypnotics treatment for insomnia could alleviate insomnia symptoms, it may not improve subjective sleep quality[13,14]. These evidences suggest that numerous clusters of individuals with different manifestations of sleep disturbances and sleep-related pathological mechanisms are included in the Pittsburgh Sleep Quality Index (PSQI)-defined poor sleep quality group
Summary
Sleep quality deteriorates along with aging, and it is partly related to the normal aging process and is a significant result of ill health[1]. Hypnotics treatment for insomnia could alleviate insomnia symptoms, it may not improve subjective sleep quality[13,14] These evidences suggest that numerous clusters of individuals with different manifestations of sleep disturbances and sleep-related pathological mechanisms are included in the PSQI-defined poor sleep quality group. To the best of our knowledge, no studies have used LCA to classify the PSQI-defined poor sleep quality in large-scale, community-dwelling older adults with poor sleep quality. This study intended to determine whether LCA can subgroup community-dwelling older adults with a similar profile of poor sleep quality and examine whether an overarching variable can explain the sleep disturbance patterns. The validity and clinical significance of feature-based clusters were examined by several external validators to compare the between-cluster differences in terms of sleep-wake related symptoms, the use of medical resources, comorbid mental and physical conditions, physical function, physical disability, and the quality of life
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