Sleep In Older Adults Research Articles

The effect of restricted and free-living conditions on light exposure and sleep in older adults

ABSTRACT During the COVID-19 pandemic, studies reported that restricted living conditions were associated with worse subjective sleep quality. This effect might have been caused by reduced light exposure during lockdowns. We investigated light exposure levels, subjective and objective sleep and physical activity levels in older adults during restricted and free-living conditions after the pandemic. Ninety-one participants (62.7 ± 8.4 years) recruited from the community using social media with 44 participants (63.4 ± 8.9 years) completed follow-up during free-living conditions. Participants wore an actigraphy device and completed sleep diaries for 7 days during each condition. Light values were extracted in hourly bins across the 24-h period and objective and subjective sleep were compared between the conditions. There was an increase in mean 24-h light exposure during restricted-living (1103.7 ± 1024.8 lux) compared to free-living (803.0 ± 803.6 lux; p < 0.001). This was partially related to participants spending 18 min more in bright light conditions (>1,000 lux) during wakefulness in restricted living (2.6 ± 1.9 h) compared to free-living (2.3 ± 2.0 h; p = 0.036). Despite differences in light exposure, there were no significant differences in objective and subjective sleep parameters between the two conditions. More research is required to better understand behaviours related to light exposure and how this may impact on sleep.

A Randomized-Controlled Trial Targeting Cognition in Early Alzheimer's Disease by Improving Sleep with Trazodone (REST).

Alzheimer's disease (AD) is a leading cause of mortality and morbidity among aging populations worldwide. Despite arduous research efforts, treatment options for this devastating neurodegenerative disease are limited. Sleep disturbances, through their link to changes in neural excitability and impaired clearance of interstitial abnormal protein aggregates, are a key risk factor for the development of AD. Research also suggests that the neuroprotective effects of sleep are particularly active during slow wave sleep. Given the strong link between sleep disturbance and AD, targeting sleep in the prodromal stages of AD, such as in mild cognitive impairment (MCI), represents a promising avenue for slowing the onset of AD-related cognitive decline. In efforts to improve sleep in older individuals, several pharmacologic approaches have been employed, but many pose safety risks, concern for worsening cognitive function, and fail to effectively target slow wave sleep. Trazodone, a safe and widely used drug in the older adult population, has shown promise in inducing slow wave sleep in older adults, but requires more rigorous research to understand its effects on sleep and cognition in the prodromal stages of AD. In this review, we present the rationale and study design for our randomized, double-bind, placebo-controlled, crossover trial (NCT05282550) investigating the effects of trazodone on sleep and cognition in 100 older adults with amnestic MCI and sleep complaints.

A Compensatory Role of Physical Activity in the Association Between Sleep and Cognition.

We synthesize evidence investigating the hypothesis that greater engagement in physical activity (PA) may compensate for some of the negative cognitive consequences associated with poor sleep in older adults. Potential mechanistic pathways include glymphatic clearance, influences on depression, and other comorbidities. The evidence base is largely cross-sectional and observational, and further experimental studies are required.

Association between magnesium deficiency score and sleep quality in adults: A population-based cross-sectional study

BackgroundThe association between magnesium status and sleep quality is unclear. The aim of this study was to determine the relationship between renal reabsorption-related magnesium depletion score (MDS) and sleep quality. MethodsThis study was conducted through a cross-sectional survey of adults aged ≥20 years who participated in NHANES 2005–2014. We used weighted logistic regression to examine the association between MDS and sleep quality and performed trend tests to analyze for the presence of a dose-response relationship. Subgroup analyses were performed based on various sleep outcomes and covariates. ResultsA total of 20,585 participants were included in the study, with a mean age of 48.8 years and 50.7 % female. After adjusting for all covariates, we found a graded dose-response relationship between MDS and sleep trouble as well as sleep disorder. Further analyses revealed a significant positive association between MDS and sleep apnea (OR = 3.01; 95 % CI 1.37–6.62), but no association with restless legs, insomnia or insufficient sleep. In addition, subgroup analyses revealed that middle-aged, male, obese, low magnesium intake, and depressed patients were more prone to sleep trouble and sleep disorder; interestingly, MDS was positively associated with excessive sleep in subjects ≥60 years and without depression. ConclusionsOur study found a significant association between MDS and sleep quality, particularly sleep apnea, but adequate magnesium intake may be beneficial in mitigating this association. MDS may be associated with excessive sleep in older adults, but not with insufficient sleep or insomnia.

A mobile app providing individually-tailored psychoeducation about sleep for older adults with chronic health conditions and low health literacy.

This paper reports on a study of a mobile app that provides tailored information about sleep to individuals aged 40 and older who have chronic health conditions and low health literacy. The sleep module was a part of a multitopic app focused on chronic disease self-management. Participants were randomly assigned to receive sleep psychoeducation at reading levels equivalent to 3rd, 6th or 8th grade. The primary outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was completed at baseline, after the intervention, and again three months later. Outcomes were assessed using repeated measures mixed effects models. Most participants were Black, Indigenous, or Other Persons of Color (BIPOC; 87%); they had average reading level at the 7th grade. Health literacy, socioeconomic status, and number of health conditions were related to the PSQI. The PSQI score decreased over the course of the three study visits for all groups, consistent with a small to medium effect size (d = 0.40). No effect of treatment group was observed. Participants were positive about the usefulness and helpfulness of the app. Results suggest that a brief tailored information intervention may be beneficial for individuals aged 40 and older who have low health literacy and chronic health conditions. Further development of the intervention may enhance its clinical effectiveness.

Subjective sleep more predictive of global cognitive function than objective sleep in older adults: A specification curve analysis

ObjectivesSleep is associated with cognitive function in older adults. In the current study, we examined this relationship from subjective and objective perspectives, and determined the robustness and dimensional specificity of the associations using a comprehensive modelling approach. MethodsMultiple dimensions of subjective (sleep quality and daytime sleepiness) and objective sleep (sleep stages, sleep parameters, sleep spindles, and slow oscillations), as well as subjectively reported and objectively measured cognitive function were collected from 55 older adults. Specification curve analysis was used to examine the robustness of correlations for the effects of sleep on cognitive function. ResultsRobust associations were found between sleep and objectively measured cognitive function, but not with subjective cognitive complaints. In addition, subjective sleep showed robust and consistent associations with global cognitive function, whereas objective sleep showed a more domain-specific association with episodic memory. Specifically, subjective sleep quality and daytime sleepiness correlated with global cognitive function, and objective sleep parameters correlated with episodic memory. ConclusionsOverall, associations between sleep and cognitive function in older adults depend on how they are measured and which specific dimensions of sleep and domains of cognitive function are considered. It highlights the importance of focusing on specific associations to ameliorate the detrimental effects of sleep disturbance on cognitive function in later life.

0758 Associations Between Actigraphy-Assessed Step Activity and Sleep in Older Adults Following Acute Hospitalization

0758 Associations Between Actigraphy-Assessed Step Activity and Sleep in Older Adults Following Acute Hospitalization

0861 Beat Right, Sleep Tight: Pilot Study of Depression’s Role on Blood Pressure and Sleep in Older Adults with Insomnia

0861 Beat Right, Sleep Tight: Pilot Study of Depression’s Role on Blood Pressure and Sleep in Older Adults with Insomnia

Midpoint of sleep is associated with sleep quality in older adults with and without symptomatic Alzheimer's disease.

Disrupted sleep is common in individuals with Alzheimer's disease (AD) and may be a marker for AD risk. The timing of sleep affects sleep-wake activity and is also associated with AD, but little is known about links between sleep architecture and the midpoint of sleep in older adults. In this study, we tested if the midpoint of sleep is associated with different measures of sleep architecture, AD biomarkers, and cognitive status among older adults with and without symptomatic AD. Participants (N = 243) with a mean age of 74 underwent standardized cognitive assessments, measurement of CSF AD biomarkers, and sleep monitoring via single-channel EEG, actigraphy, a home sleep apnea test, and self-reported sleep logs. The midpoint of sleep was defined by actigraphy. A later midpoint of sleep was associated with African-American race and greater night-to-night variability in the sleep midpoint. After adjusting for multiple potential confounding factors, a later sleep midpoint was associated with longer rapid-eye movement (REM) onset latency, decreased REM sleep time, more actigraphic awakenings at night, and higher < 2 Hz non-REM slow-wave activity. Noninvasive in vivo markers of brain function, such as sleep, are needed to track both future risk of cognitive impairment and response to interventions in older adults at risk for AD. Sleep timing is associated with multiple other sleep measures and may affect their utility as markers of AD. The midpoint of sleep may be changed through behavioral intervention and should be taken into account when using sleep as a marker for AD risk.

Effectiveness of multi-modal home-based videoconference interventions on sleep in older adults: study protocol for a randomized controlled trial.

Aging is characterized by substantial changes in sleep architecture that negatively impact fitness, quality of life, mood, and cognitive functioning. Older adults often fail to reach the recommended level of physical activity to prevent the age-related decline in sleep function, partly because of geographical barriers. Implementing home-based interventions could surmount these obstacles, thereby encouraging older adults to stay active, with videoconference administration emerging as a promising solution. Increasing the availability of biological rhythms synchronizers, such as physical activity, light exposure, or vestibular stimulation, represents a viable non-pharmacological strategy for entraining circadian rhythms and potentially fortifying the sleep-wake cycle, thereby enhancing sleep in aging. This study aims to (1) assess the impact of remote physical exercise training and its combination with bright light exposure, and (2) investigate the specific contribution of galvanic vestibular stimulation, to sleep quality among healthy older adults with sleep complaints. One hundred healthy older adults aged 60-70 years with sleep complaints will be randomly allocated to one of four groups: a physical exercise training group (n = 25), a physical exercise training combined with bright light exposure group (n = 25), a galvanic vestibular stimulation group (n = 25) or a control group (i.e., health education) (n = 25). While physical exercise training and health education will be supervised via videoconference at home, bright light exposure (for the physical exercise training combined with bright light exposure group) and vestibular stimulation will be self-administered at home. Pre-and post-tests will be conducted to evaluate various parameters, including sleep (polysomnography, subjective questionnaires), circadian rhythms (actigraphy, temperature), fitness (physical: VO2 peak, muscular function; and motor: balance, and functional mobility), cognition (executive function, long-term memory), quality of life and mood (anxiety and depression). The findings will be anticipated to inform the development of recommendations and non-pharmaceutical preventive strategies for enhancing sleep quality in older adults, potentially leading to improvements in fitness, cognition, quality of life, and mood throughout aging.

Socially-supported sleep in older adults aged 50 and older: a concept analysis.

The population of older adults is growing disproportionately, constituting 13% of the global population in 2022, and is expected to double by 2050. One of public health's priorities is healthy aging, the maintenance of functional ability aligned with well-being. As many as 50% of older adults report poor sleep quality, leading to an increased risk of morbidity and mortality. The quality and quantity of social relationships may broadly benefit sleep in older adults. However, the concept of socially-supported sleep is underdeveloped as a basis for intervention. Existing literature was searched without time restriction in PubMed, CINAHL, PsycINFO, and Scopus ending in August 2022. Thematic analysis was used to determine the defining attributes, antecedents, and consequences of socially-supported sleep guided by Rodgers' evolutionary concept analysis. Twenty-nine articles written in English, peer-reviewed, and examined social support and sleep in participants aged ≥50 were included. The defining attributes reflect dimensions of sleep quality. The antecedents are safe and secure, belonging and connection, and warmth and comfort. The consequences of socially-supported sleep include improved regulatory capabilities, physical and emotional well-being, and quality of life. Socially-supported sleep has the potential to inform interventions that promote sleep in older adults. Ongoing research is needed to address the antecedents and mechanisms through which socially-supported sleep may promote sleep quality for healthy aging.

Abstract MP40: Associations Between Meal Timing and Sleep in Older Adults

Introduction: Poor sleep health has been associated with increased risk and worse outcomes for a number of diseases such as cognitive dysfunction, dementia and Alzheimer’s disease. An emerging area of research has highlighted the association between dietary factors and sleep. Meal timing is one aspect of diet that has unclear effects on sleep. Few studies have examined this relationship in older adults, an important distinction because sleep architecture and dietary habits change significantly across the lifespan. By identifying the involvement of meal timing in sleep health, specific behavioral interventions can be developed for older adults with sleep-related morbidity. Hypotheses: We tested the hypothesis that a longer time duration between the last meal of the day and bedtime is associated with positive changes in sleep quality Methods: Forty-six healthy older adults (72% (33 of 46) female, 13% (6 of 46) Black, mean age=70.1 years) recruited from the community in Chicago were included in the analysis. Participants underwent sleep assessment with 7 days of sleep actigraphy, one night of sleep profiler, and sleep questionnaires. Two 24-hour diet recalls within 1 week were administered with the ASA24 tool to evaluate meal timing. The data was analyzed with linear regression models adjusting for age, sex, educational attainment, and BMI. Results: For every 1-hour increase in time from last meal to bedtime, sleep onset latency (SOL) increased by 7.4 minutes (SE=3.0, p=0.019), total sleep time (measured from actigraphy) decreased by 10.6 minutes (SE=4.4, p=0.022), and sleep midpoint was delayed by 17.5 minutes (SE=0.09, p=0.002). Other sleep measures showed no significant associations with time from last meal to bedtime. Conclusions: Meals consumed closer to bedtime were associated with shorter SOL, longer total sleep time, and delayed sleep midpoint in older adults. These findings suggest that meal timing may correlate with sleep, however further investigation with larger sample sizes should be done to clarify this link.

The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis.

Sleep loss is associated with reduced health and quality of life, and increased risk of Alzheimer's disease and related dementias. Up to 66% of persons with Alzheimer's disease and related dementias experience poor sleep, which can predict or accelerate the progression of cognitive decline. Exercise is a widely accessible intervention for poor sleep that can protect against functional and cognitive decline. No previous systematic reviews have investigated the effectiveness of exercise for sleep in older adults with mild cognitive impairment or Alzheimer's disease and related dementias. We systematically reviewed controlled interventional studies of exercise targeting subjectively or objectively (polysomnography/actigraphy) assessed sleep in persons with mild cognitive impairment or Alzheimer's disease and related dementias. We conducted searches in PubMed, Embase, Scopus and Cochrane-Library (n = 6745). Nineteen randomised and one non-randomised controlled interventional trials were included, representing the experiences of 3278 persons with mild cognitive impairment or Alzheimer's disease and related dementias. Ten had low-risk, nine moderate-risk, and one high-risk of bias. Six studies with subjective and eight with objective sleep outcomes were meta-analysed (random-effects model). We found moderate- to high-quality evidence for the beneficial effects of exercise on self-reported and objectively-measured sleep outcomes in persons with mild cognitive impairment or Alzheimer's disease and related dementias. However, no studies examined key potential moderators of these effects, such as sex, napping or medication use. Our results have important implications for clinical practice. Sleep may be one of the most important modifiable risk factors for a range of health conditions, including cognitive decline and the progression of Alzheimer's disease and related dementias. Given our findings, clinicians may consider adding exercise as an effective intervention or adjuvant strategy for improving sleep in older persons with mild cognitive impairment or Alzheimer's disease and related dementias.

Electroencephalographic slowing during REM sleep in older adults with subjective cognitive impairment and mild cognitive impairment.

In older adults with Alzheimer's disease, slowing of electroencephalographic (EEG) activity during REM sleep has been observed. Few studies have examined EEG slowing during REM in those with mild cognitive impairment (MCI) and none have examined its relationship with cognition in this at-risk population. Two hundred and ten older adults (mean age = 67.0, SD = 8.2 years) underwent comprehensive neuropsychological, medical, and psychiatric assessment and overnight polysomnography. Participants were classified as subjective cognitive impairment (SCI; n = 75), non-amnestic MCI (naMCI, n = 85), and amnestic MCI (aMCI, n = 50). REM EEG slowing was defined as (δ + θ)/(α + σ + β) power and calculated for frontal, central, parietal, and occipital regions. Analysis of variance compared REM EEG slowing between groups. Correlations between REM EEG slowing and cognition, including learning and memory, visuospatial and executive functions, were examined within each subgroup. The aMCI group had significantly greater REM EEG slowing in the parietal and occipital regions compared to the naMCI and SCI groups (partial η2 = 0.06, p < 0.05 and 0.06, p < 0.05, respectively), and greater EEG slowing in the central region compared to SCI group (partial η2 = 0.03, p < 0.05). Greater REM EEG slowing in parietal (r = -0.49) and occipital regions (r = -0.38 [O1/M2] and -0.33 [O2/M1]) were associated with poorer visuospatial performance in naMCI. REM EEG slowing may differentiate older adults with memory impairment from those without. Longitudinal studies are now warranted to examine the prognostic utility of REM EEG slowing for cognitive and dementia trajectories.

Changes in sleep effort mediate insomnia severity in older adults following online cognitive behavioural therapy.

To examine treatment mechanisms of digitally delivered cognitive behavioural therapy for insomnia (CBT-I), this study assessed the mediating effects of dysfunctional beliefs, hyperarousal, locus of control, self-efficacy, sleep effort, and safety behaviours on self-reported insomnia severity in older adults before and following the completion of a self-guided, online CBT-I program. The baseline and follow-up measurements were completed by 62 older adults (55 female, 89%). This was a two-condition within-participant design. Mediation analysis using a parallel mediation model was conducted using the MEMORE macro for repeated measure designs. Out of all the included mediator variables, only a reduction in sleep effort scores (0.88; SE 0.51; 95% CI 0.001-2.00) significantly mediated changes in insomnia severity scores following the intervention. Insomnia severity scores significantly reduced following the intervention (Mpre = 9.84, SD = 5.89, Mpost = 6.87, SD = 4.90); t(61) = 5.19, P = <0.001; d = 0.55 95% CI 0.38-0.93. Sleep in older adults improved following digitally delivered CBT-I, and these changes were influenced by a reduction in sleep control efforts exerted by participants. These findings highlight possible treatment pathways of CBT-I. Further investigation of CBT-I as a strategy to prevent sleep problems is warranted. Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451.

ASSOCIATIONS BETWEEN FRAILTY AND SLEEP IN OLDER ADULTS WITH CANCER TREATED WITH CHEMOTHERAPY

Abstract Little is known about the association between frailty and sleep after starting chemotherapy. The goal of this study was to examine frailty and sleep in older adults (65+ years old) with cancer. Patients newly diagnosed with cancer and starting chemotherapy were recruited to a multi-site study. Participants completed questionnaires before chemotherapy (i.e., baseline) and 5 days after their first infusion. A pre-treatment frailty score was derived using a 59-item deficit accumulation index and dichotomized (frail vs. robust). Sleep was assessed with the PROMIS Sleep Disturbance 8a (difficulty sleeping) and Sleep Impairment 8a (daytime sleepiness). Repeated measures ANOVAs adjusted for age, sex, cancer stage, and cancer type evaluated change in sleep over time. Participants were 402 older adults with cancer (M age=72, SD=5). Most were female (65%), non-Hispanic (96%), and married (67%). Difficulty sleeping was higher in frail participants (26%) than robust participants at baseline (p&amp;lt; 0.001). Over time, difficulty sleeping decreased in frail participants but increased in robust participants (p=0.02). Difficulty sleeping remained higher in frail participants post-infusion (p=0.01). Daytime sleepiness at baseline did not differ by frailty status (p=0.86) and was higher than population norms. Frail participants reported smaller reductions in daytime sleepiness over time (p&amp;lt; 0.01), and more daytime sleepiness after infusion (p&amp;lt; 0.0001) than robust participants. Despite improvements in sleep from pre-treatment to 5 days after infusion, frail participants reported more difficulty sleeping and daytime sleepiness than robust participants after infusion. Additional research is needed to better understand the association of frailty with health outcomes in older adults with cancer.

INTRAINDIVIDUAL VARIABILITY IN SLEEP DURATION IS ASSOCIATED WITH HIPPOCAMPAL VOLUME IN MID LIFE

Abstract Sleep is associated with global cognition, consolidation of memories, and structural &amp; functional integrity of areas of the brain that support healthy cognition. While there has been research on sleep in older adults that indicates associations between poor sleep, cognitive decline, memory performance, and changes in the brain, there has been comparatively little work assessing the impact of sleep on the structure of the brain during middle adulthood. Changes in the brain begin much earlier than older adulthood, with midlife seeing cortical thinning and a decrease in brain volume in areas that support healthy cognitive functioning and memory, such as the hippocampus. Understanding how sleep may contribute to hippocampal volume in midlife may help inform how changing poor sleep is important for supporting successful aging. The current study examines the associations between 7 days of actigraphy measured sleep and hippocampal volume (MRI) in 82 midlife adults (Mage = 49.13 years, SD = 11.74; 28-76 years old) who completed the Biomarker and Neuroscience projects in the Midlife in the United States Refresher study. Results indicated that bi-lateral hippocampal volume was negatively associated with high (vs low) intraindividual total sleep time variability (&amp;gt;= 60 min; mean average deviation), with a 280 and 252 mm3 (p’s = .006 &amp; .035) volume reduction for left and right hemispheres respectively. This relationship was not seen for other measures of sleep quality and the analysis additionally controlled for age, sex, BMI, race, depression status, education, and subjective physical &amp; mental/emotional health.

Associations Between Physical Activity and Inactivity Levels on Physical Function and Sleep Parameters of Older Adults With Frailty Phenotype.

This study investigated the relationship between physical activity, inactivity, physical function, and sleep in older adults with a frailty phenotype. A total of 184 pre-frail/frail older adults were included. Physical activity, inactive behavior, and sleep parameters were assessed using a wrist-worn accelerometer. Participants were categorized into four groups based on their levels of inactivity and physical activity. The results showed that individuals with lower levels of inactivity had better lower body mean velocity and sleep regularity than those with higher levels of inactivity. Physically active older adults exhibited faster gait speed and performed better in lower body strength tests than physically inactive participants. Further analysis revealed that specific combinations of inactivity and physical activity were associated with varying levels of physical function. The findings highlight the importance of physical activity and the negative impact of inactivity on physical function and sleep in older adults with a frailty phenotype.

Differential Heart Rate Variability Profiles During Sleep in Older Adults with Remitted Early‐onset versus Late‐onset Depression

AbstractBackgroundSleep is a physiological state involving a dynamic autonomic profile that is ideal for detecting subtle changes in autonomic nervous system functioning. The current study sought to determine if heart rate variability (HRV) during different periods of sleep is impaired in older adults with early‐onset (EOD), late‐onset (LOD), and no history of lifetime depression (NOD).MethodA total of 188 older adults aged 50‐90 years were recruited from the Healthy Brain Ageing clinic at the Brain and Mind Centre, University of Sydney. This samples comprised 49 participants with EOD, 37 with LOD, and 102 with NOD. Each participant underwent medical, psychiatric and neuropsychological assessments, as well as overnight polysomnography.ResultFindings show that for HRV during wake‐after‐sleep‐onset (WASO), only older adults with remitted EOD have significantly lower SDNN and Shannon Entropy, two HRV indices of interest, in comparison to the NOD group, suggesting that those with EOD have diminished overall autonomic function and cardiac complexity respectively. By contrast, older adults with remitted LOD have significantly lower parasympathetic activities during deeper sleep stages (i.e. N2 and N3), as evidenced by a reduction in high‐frequency HRV relative to the EOD group. Overall, our findings suggest that the EOD and LOD phenotypes have differential heart rate profiles during sleep.ConclusionA history of depression, in particular whether this history is early‐ or late‐ onset, is associated with the integrity of autonomic functioning during both wakefulness and sleep in older adults. HRV may have potential as a biomarker of depression and could complement other biomarkers to enhance diagnostic accuracy and prognostic monitoring. As older adults with early‐life depression seem to experience more pronounced autonomic dysfunction, this further emphasizes the need for early and effective interventions, as well as proactive preventative strategies for those with remitted major depressive disorder.

The temporal relationship between physical activity, mood and sleep in older adults via a lead-lag analysis

The temporal relationship between physical activity, mood and sleep in older adults via a lead-lag analysis