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Sleep Initiation and Maintenance Disorders: HELP
Articles by Dr. Susan Ancoli-Israel
Based on 26 articles published since 2008
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Between 2008 and 2019, S. Ancoli-Israel wrote the following 26 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review The effect of nocturia on sleep. 2011

Ancoli-Israel, Sonia / Bliwise, Donald L / Nørgaard, Jens Peter. ·Department of Psychiatry, University of California, San Diego, San Diego, CA 92093-0733, USA. sancoliisrael@ucsd.edu ·Sleep Med Rev · Pubmed #20965130.

ABSTRACT: Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.

2 Review Sleep disorders in the elderly. 2010

Roepke, Susan K / Ancoli-Israel, Sonia. ·Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, USA. ·Indian J Med Res · Pubmed #20308755.

ABSTRACT: Nearly half of older adults report difficulty initiating and maintaining sleep. With age, several changes occur that can place one at risk for sleep disturbance including increased prevalence of medical conditions, increased medication use, age-related changes in various circadian rhythms, and environmental and lifestyle changes. Although sleep complaints are common among all age groups, older adults have increased prevalence of many primary sleep disorders including sleep-disordered breathing, periodic limb movements in sleep, restless legs syndrome, rapid eye movement (REM) sleep behaviour disorder, insomnia, and circadian rhythm disturbances. The present review discusses age-related changes in sleep architecture, aetiology, presentation, and treatment of sleep disorders prevalent among the elderly and other factors relevant to ageing that are likely to affect sleep quality and quantity.

3 Review Sleep disorders in the older adult - a mini-review. 2010

Neikrug, Ariel B / Ancoli-Israel, Sonia. ·Department of Psychiatry, University of California, San Diego, 92093-0733, USA. ·Gerontology · Pubmed #19738366.

ABSTRACT: Approximately 50% of older adults complain of difficulty sleeping. Poor sleep results in increased risk of significant morbidity and mortality. The decrements seen in the sleep of the older adult are often due to a decrease in the ability to get needed sleep. However, the decreased ability is less a function of age and more a function of other factors that accompany aging, such as medical and psychiatric illness, increased medication use, advances in the endogenous circadian clock and a higher prevalence of specific sleep disorders. Given the large number of older adults with sleep complaints and sleep disorders, there is a need for health care professionals to have an increased awareness of these sleep disturbances to better enable them to assess and treat these patients. A thorough sleep history (preferably in the presence of their bed partner) is required for a proper diagnosis, and when appropriate, an overnight sleep recording should be done. Treatment of primary sleep problems can improve the quality of life and daytime functioning of older adults. This paper reviews the diagnoses and characteristics of sleep disorders generally found in the older adult. While aimed at the practicing geriatrician, this paper is also of importance for any gerontologist interested in sleep.

4 Review Sleep and its disorders in aging populations. 2009

Ancoli-Israel, Sonia. ·Department of Psychiatry, University of California, San Diego, CA, USA. sancoliisrael@ucsd.edu ·Sleep Med · Pubmed #19647483.

ABSTRACT: Most surveys confirm that older adults report sleeping about 7h a night. While sleep architecture does change with age, most age-related sleep architecture changes occur in early and mid-years. Nevertheless, the incidence of insomnia is higher in older adults than younger adults, but is most often associated with other age-related conditions, rather than age per se. The consequences of poor sleep in older adults are substantial and include poor health, cognitive impairment and mortality. Sleep difficulties are significantly associated with medical and psychiatric comorbidities and the presence of multiple medical conditions has been found to be detrimental to sleep quality. Careful health assessment is necessary to screen out sleep complaints and disorders in older populations.

5 Review Sleep in the elderly: normal variations and common sleep disorders. 2008

Ancoli-Israel, Sonia / Ayalon, Liat / Salzman, Carl. ·Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0603, USA. sancoliisrael@ucsd.edu ·Harv Rev Psychiatry · Pubmed #18803103.

ABSTRACT: The most common complaints of older adults concern their difficulty initiating or maintaining sleep, which results in insufficient sleep and an increased risk of falls, difficulty with concentration and memory, and overall decreased quality of life. Difficulties sleeping are not, however, an inevitable part of aging. Rather, the sleep complaints are often comorbid with medical and psychiatric illness, associated with the medications used to treat those illnesses, or the result of circadian rhythm changes or other sleep disorders. Health care professionals specializing in geriatrics need to learn to recognize the different causes of sleep disturbances in this population and to initiate appropriate treatment. Nonpharmacological treatment techniques are discussed; pharmacological treatments are discussed in a companion article.

6 Clinical Trial Decreased health-related quality of life in women with breast cancer is associated with poor sleep. 2013

Liu, Lianqi / Fiorentino, Lavinia / Rissling, Michelle / Natarajan, Loki / Parker, Barbara A / Dimsdale, Joel E / Mills, Paul J / Sadler, Georgia Robins / Ancoli-Israel, Sonia. ·Department of Psychiatry, University of California, San Diego, USA. ·Behav Sleep Med · Pubmed #23205513.

ABSTRACT: This study examined the longitudinal relation between health-related quality of life (HR-QOL) and subjective and objective sleep quality in 166 women with newly diagnosed Stage-1 through Stage-3 breast cancer, who were scheduled to receive ≥ 4 cycles of adjuvant/neoadjuvant chemotherapy. HR-QOL was assessed with the Medical Outcomes Study 36-item Short Form, Physical Component Scale (PCS), and Mental Component Scale (MCS) scores; subjective sleep was assessed with the Pittsburgh Sleep Quality Index; and objective sleep was measured with actigraphy. Data were collected before starting chemotherapy and during the last week of Cycle 4 of chemotherapy. Patients reported poor HR-QOL and poor sleep quality before and during chemotherapy. Short sleep time and long naps were recorded at both time points. The MCS score was related to reports of poor sleep, but not to recorded sleep; worse PCS scores were associated with reports of poor sleep and less recorded naptime, suggesting sleep plays an important role in cancer patients' HR-QOL.

7 Clinical Trial A 12-week, randomized, double-blind, placebo-controlled study evaluating the effect of eszopiclone 2 mg on sleep/wake function in older adults with primary and comorbid insomnia. 2010

Ancoli-Israel, Sonia / Krystal, Andrew D / McCall, W Vaughn / Schaefer, Kendyl / Wilson, Amy / Claus, Raymond / Rubens, Robert / Roth, Thomas. ·Department of Psychiatry, University of California San Diego, San Diego, CA 92093-0733, USA. sancoliisrael@ucsd.edu ·Sleep · Pubmed #20175406.

ABSTRACT: BACKGROUND: Longer-term pharmacologic studies for insomnia in older individuals are sparse. OBJECTIVE: To evaluate the efficacy and safety of 12 weeks of nightly eszopiclone in elderly outpatients with insomnia. METHODS: Participants (65-85 years) met DSM-IV-TR criteria for insomnia with total sleep times (TST) < or = 6 h, and wake time after sleep onset (WASO) > or = 45 min. Participants were randomized to 12 weeks of eszopiclone 2 mg (n = 194) or placebo (n = 194), followed by a 2-week single-blind placebo run-out. Subject-reported measures of sleep (sTST, sleep latency [sSL], sWASO) and daytime function (alertness, concentration, wellbeing, ability to function) were assessed. AEs were monitored. RESULTS: Subjects treated with 2 mg eszopiclone slept longer at night on average and at every individual time point compared to baseline than placebo subjects, as measured by TST over the 12-week double-blind period (P < 0.0001). Mean sTST over the double-blind period for eszopiclone-treated subjects was 360.08 min compared to 297.86 min at baseline, a mean change of 63.24 min. Over the double-blind period, eszopiclone-treated subjects also experienced a significantly greater improvement in sSL compared to placebo, with a mean decrease of 24.62 min versus a mean decrease of 19.92 min, respectively (P = 0.0014). Eszopiclone subjects also experienced a significantly greater decrease in WASO (mean decrease of 36.4 min) compared to placebo subjects (decrease of 14.8 min) (P < 0.0001). Post-discontinuation, sleep parameters were statistically improved versus baseline for eszopiclone (P-values < or = 0.01), indicating no rebound. The most common AEs (> or = 5%) were headache (eszopiclone 13.9%, placebo 12.4%), unpleasant taste (12.4%, 1.5%), and nasopharyngitis (5.7%, 6.2%). CONCLUSION: In this Phase IV trial of older adults with insomnia, eszopiclone significantly improved patient-reported sleep and daytime function relative to placebo. Improvements occurred within the first week and were maintained for 3 months, with no evidence of rebound insomnia following discontinuation. The 12 weeks of treatment were well tolerated. CLINICAL TRIAL INFORMATION: A Long-Term Safety and Efficacy Study of Eszopiclone in Elderly Subjects With Primary Chronic Insomnia; Registration #NCT00386334; URL - http://www.clinicaltrials.gov/ct2/show/NCT00386334?term=eszopiclone&rank=24

8 Article Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures. 2017

Fung, Constance H / Vaughan, Camille P / Markland, Alayne D / Huang, Alison J / Mitchell, Michael N / Bliwise, Donald L / Ancoli-Israel, Sonia / Redline, Susan / Alessi, Cathy A / Stone, Katie. ·Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California. · Department of Medicine, University of California Los Angeles, Los Angeles, California. · Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama. · Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. · Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Medicine, University of California San Francisco, San Francisco, California. · Sleep Program, Emory University School of Medicine, Atlanta, Georgia. · Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California. · Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts. · California Pacific Medical Center, San Francisco, California. ·J Am Geriatr Soc · Pubmed #28914959.

ABSTRACT: OBJECTIVES: (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING: Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS: Community-dwelling women aged ≥80 years. MEASUREMENTS: Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS: Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R CONCLUSIONS: Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.

9 Article Sleep Disturbances and Risk of Hospitalization and Inpatient Days Among Older Women. 2017

Paudel, Misti L / Taylor, Brent C / Vo, Tien N / Kats, Allyson M / Schousboe, John T / Lui, Li-Yung / McCulloch, Charles E / Langsetmo, Lisa / Ancoli-Israel, Sonia / Redline, Susan / Yaffe, Kristine / Stone, Katie L / Hillier, Teresa A / Ensrud, Kristine E / Anonymous5480900. ·Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. · Department of Medicine, University of Minnesota, Minneapolis, MN. · Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN. · Park Nicollet Clinic, St. Louis Park, MN. · Division of Health Policy and Management, University of Minnesota, Minneapolis, MN. · California Pacific Medical Center Research Institute, San Francisco, CA. · Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. · Departments of Psychiatry and Medicine, University of California-San Diego, La Jolla, CA. · Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, CA. · Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, OR. ·Sleep · Pubmed #28329356.

ABSTRACT: Study Objectives: Determine the associations of sleep disturbances with hospitalization risk among older women. Methods: One thousand eight hundred and twenty-seven women (mean age 83.6 years) participating in Study of Osteoporotic Fractures Year 16 (Y16) examination (2002-2004) linked with Medicare and/or HMO claims. At Y16 examination, sleep/wake parameters were measured by actigraphy (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], and wake after sleep onset [WASO]) and subjective sleep measures (sleep quality [Pittsburgh Sleep Quality Index] and daytime sleepiness [Epworth Sleepiness Scale]) were assessed by questionnaire. Measures except TST were dichotomized based on clinical thresholds. Incident hospitalizations were determined from claims data. Results: Nine hundred and seventy-six women (53%) had ≥1 hospitalization in the 3 years after the Year 16 examination. Reduced SE (odds ratio [OR] = 2.39, 95% confidence interval [CI] 1.69-3.39), prolonged SL (OR = 1.41, 95% CI 1.11-1.78), greater WASO (OR = 1.57, 95% CI 1.28-1.93), shorter TST (OR = 1.98, 95% CI 1.42-2.77) and poorer sleep quality (OR = 1.33, 95% CI 1.07-1.65) were each associated with a higher age and site-adjusted odds of hospitalization; associations were attenuated after multivariable adjustment for traditional prognostic factors with the OR for reduced SE (OR = 1.60, 95% CI 1.08-2.38) and shorter TST (OR = 1.63, 95% CI 1.12-2.37) remaining significant. Among women who were hospitalized, greater WASO (rate ratio [RR] = 1.20, 95% CI 1.04-1.37) and poorer sleep quality (RR = 1.18, 95% CI 1.02-1.35) were each associated with a greater age and site-adjusted RR of inpatient days, but associations did not persist after multivariate adjustment. Conclusions: Older women with sleep disturbances have an increased risk of hospitalization partially attributable to demographics, poorer health status, and comorbidities.

10 Article Measures of Sleep-Wake Patterns and Risk of Mild Cognitive Impairment or Dementia in Older Women. 2016

Diem, Susan J / Blackwell, Terri L / Stone, Katie L / Yaffe, Kristine / Tranah, Greg / Cauley, Jane A / Ancoli-Israel, Sonia / Redline, Susan / Spira, Adam P / Hillier, Teresa A / Ensrud, Kristine E. ·Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN. Electronic address: sdiem@umn.edu. · California Pacific Medical Center Research Institute, San Francisco, CA. · Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA. · Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. · Departments of Medicine and Psychiatry, University of California, San Diego, CA. · Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. · Kaiser Permanente Center for Health Research, Portland, OR. · Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN; Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN. ·Am J Geriatr Psychiatry · Pubmed #26964485.

ABSTRACT: OBJECTIVE: Sleep disturbances are common in older adults. Little is known about the sleep of cognitively intact older adults and its relationship to subsequent cognitive impairment. The objective of this study was to examine the association between objective sleep-wake measures and risk of incident cognitive impairment. METHODS: In this prospective cohort study encompassing four U.S. sites, 1,245 women (mean age: 82.6 years) without dementia participated in the Study of Osteoporotic Fractures and completed actigraphy at the baseline visit and comprehensive cognitive assessment at follow-up. The association between sleep-wake patterns measured by actigraphy and risk of incident mild cognitive impairment (MCI) and dementia was examined. RESULTS: A total of 473 women (38%) developed cognitive impairment during an average (SD) follow-up of 4.9 (0.6) years; 290 (23.3%) developed MCI and 183 (14.7%) developed dementia. After controlling for multiple potential confounders, women in the lowest quartile of average sleep efficiency (<74%) had a 1.5-fold higher odds of developing MCI or dementia compared with women in the highest quartile of sleep efficiency (>86%) (odds ratio: Q1 versus Q4 1.53; 95% CI: 1.07, 2.19; Wald χ(2) [1, N = 1,223] = 5.34 for p for trend = 0.03). Longer average sleep latency, but not total sleep time, was also associated with higher odds of developing cognitive impairment. Greater variability in both sleep efficiency and total sleep time was associated with an increased odds of developing MCI or dementia. CONCLUSION: Lower average sleep efficiency, longer average sleep latency, and greater variability in sleep efficiency and total sleep time are associated with increased odds of developing cognitive impairment. Further research is needed to explore the mechanisms underlying these associations.

11 Article Vitamin D and actigraphic sleep outcomes in older community-dwelling men: the MrOS sleep study. 2015

Massa, Jennifer / Stone, Katie L / Wei, Esther K / Harrison, Stephanie L / Barrett-Connor, Elizabeth / Lane, Nancy E / Paudel, Misti / Redline, Susan / Ancoli-Israel, Sonia / Orwoll, Eric / Schernhammer, Eva. ·Department of Nutrition, Harvard School of Public Health, Boston, MA. · California Pacific Medical Center Research Institute, San Francisco, CA, for the Osteoporotic Fractures in Men (MrOS) Study Group. · Department of Family and Preventive Medicine, University California San Diego, La Jolla, CA. · Department of Medicine, University of California at San Diego, La Jolla, CA. · Department of Medicine, University of California at Davis School of Medicine, Sacramento, CA. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN. · Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Departments of Psychiatry and Medicine, University of California, San Diego, CA. · Department of Veterans Affairs San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA. · Oregon Clinical and Translational Research Institute and School of Medicine, Oregon Health and Science University, Portland, OR. · Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. · Department of Epidemiology, Harvard School of Public Health, Boston, MA. ·Sleep · Pubmed #25581929.

ABSTRACT: STUDY OBJECTIVES: Maintaining adequate serum levels of vitamin D may be important for sleep duration and quality; however, these associations are not well understood. We examined whether levels of serum 25(OH)D are associated with objective measures of sleep in older men. SETTING AND PARTICIPANTS: Cross-sectional study within a large cohort of community-dwelling older men, the MrOS study. INTERVENTIONS: Among 3,048 men age 68 years or older, we measured total serum vitamin D. Objective estimates of nightly total sleep time, sleep efficiency, and wake time after sleep onset (WASO) were obtained using wrist actigraphy worn for an average of 5 consecutive 24-h periods. RESULTS: 16.4% of this study population had low levels of vitamin D (< 20.3 ng/mL 25(OH)D). Lower serum vitamin D levels were associated with a higher odds of short (< 5 h) sleep duration, (odds ratio [OR] for the highest (≥ 40.06 ng/mL) versus lowest (< 20.3 ng/mL) quartile of 25(OH)D, 2.15; 95 % confidence interval (CI), 1.21-3.79; Ptrend = 0.004) as well as increased odds of actigraphy-measured sleep efficiency of less than 70% (OR, 1.45; 95% CI, 0.97-2.18; Ptrend = 0.004), after controlling for age, clinic, season, comorbidities, body mass index, and physical and cognitive function. Lower vitamin D levels were also associated with increased WASO in age-adjusted, but not multivariable adjusted models. CONCLUSIONS: Among older men, low levels of total serum 25(OH)D are associated with poorer sleep including short sleep duration and lower sleep efficiency. These findings, if confirmed by others, suggest a potential role for vitamin D in maintaining healthy sleep.

12 Article Circadian rest/activity rhythms in knee osteoarthritis with insomnia: a study of osteoarthritis patients and pain-free controls with insomnia or normal sleep. 2015

Spira, Adam P / Runko, Virginia T / Finan, Patrick H / Kaufmann, Christopher N / Bounds, Sara C / Liu, Lianqi / Buenaver, Luis F / McCauley, Lea M / Ancoli-Israel, Sonia / Smith, Michael T. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA . ·Chronobiol Int · Pubmed #25290041.

ABSTRACT: Aberrant circadian rest/activity rhythms (RARs) may promote poor aging-related health outcomes. Osteoarthritis and chronic insomnia are common age-related conditions, but the circadian RARs of each group have not been well characterized or compared. We evaluated actigraphic RARs in individuals with: (1) knee osteoarthritis (KOA) only; (2) chronic insomnia only; (3) KOA + insomnia; and (4) pain-free good sleepers. Compared to participants with KOA only, those with KOA + insomnia had less robust RARs. There were no differences between other groups. Further research is needed to evaluate whether aberrant RARs contribute to arthritis symptoms and insomnia in KOA, and whether strengthening RARs ameliorates arthritis symptoms.

13 Article Periodic leg movements are associated with reduced sleep quality in older men: the MrOS Sleep Study. 2013

Claman, David M / Ewing, Susan K / Redline, Susan / Ancoli-Israel, Sonia / Cauley, Jane A / Stone, Katie L / Anonymous4130775. ·University of California, San Francisco, San Francisco, CA. ·J Clin Sleep Med · Pubmed #24235891.

ABSTRACT: STUDY OBJECTIVES: Periodic limb movements in sleep (PLMS) are common in the elderly. A previous large polysomnographic (PSG) study examining the relationship of PLMS to sleep architecture and arousals from sleep in women found that leg movements were common in elderly women, and PLMS which were associated with EEG arousals had a strong and consistent association with markers of disturbed sleep. Since sleep differs in men and women, we now investigate the association between PLMS and PSG indices of sleep quality in a large community-based sample of older men. DESIGN: Observational study, cross-sectional analyses. SETTING: Six clinical sites participating in the Osteoporotic Fractures in Men (MrOS) Study. PARTICIPANTS: 2,872 older community-dwelling men (mean age 76.4 years) who completed in-home PSG from 2003-2005. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In-home PSG was performed which included bilateral measurement of leg movements. The total number of leg movements per hour of sleep (PLMI) and the number of leg movements causing EEG-documented arousals per hour of sleep (PLMA) were computed. A PLMI ≥ 5 (70.8%) and PLMA ≥ 5 (27.4%) were both prevalent. Linear regression models were used to examine the relationship between PLMS as predictors and sleep architecture, arousal index, and sleep efficiency as outcomes. The highest quintiles of PLMI (≥ 65.1) and PLMA (≥ 6.8) showed the largest association with indices of sleep architecture; PLMA showed a larger magnitude of effect. After multivariate adjustment, participants with a higher PLMA had a small but significantly higher arousal index, lower sleep efficiency, higher percentages of stages 1 and 2 sleep, and lower percentages of stage 3-4 and REM sleep (p < 0.01). An increased PLMI was similarly associated with a higher arousal index, higher percentage of stage 2 sleep, and lower percentage of stage 3-4 (p < 0.0001), but not with an increase in stage 1, REM sleep, or sleep efficiency. Neither PLMI nor PMLA was associated with subjective sleepiness measured by the Epworth Sleepiness Scale. CONCLUSIONS: This study demonstrated that periodic leg movements are very common in older community-dwelling men and regardless of associated arousals, are associated with evidence of lighter and more fragmented sleep.

14 Article Total sleep time and other sleep characteristics measured by actigraphy do not predict incident hypertension in a cohort of community-dwelling older men. 2013

Fung, Maple M / Peters, Katherine / Ancoli-Israel, Sonia / Redline, Susan / Stone, Katie L / Barrett-Connor, Elizabeth / Anonymous3400761. ·San Diego Veterans Affairs Healthcare System, Medicine Service, 3550 La Jolla Village Dr., San Diego, CA, USA. mafung@Ucsd.edu ·J Clin Sleep Med · Pubmed #23772192.

ABSTRACT: STUDY OBJECTIVE: To evaluate whether actigraphy-measured total sleep time and other sleep characteristics predict incident hypertension in older men. METHODS: Study subjects were community-dwelling participants in the ancillary sleep study of the Osteoporotic Fractures in Men Study (MrOS) who were normotensive at the time of actigraphy (based on self-report, lack of antihypertensive medication use, and with systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg). In 853 community-dwelling men 67 years and older (mean 75.1 years), sleep measures (total sleep time [TST]), percent sleep [%-sleep], latency, and wake after sleep onset [WASO]) were obtained using validated wrist actigraphy with data collected over a mean duration of 5.2 consecutive 24-h periods. We evaluated incident hypertension (based on self-report, use of antihypertensive medication, or measured systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg) at a follow-up visit an average of 3.4 years later. Baseline prehypertension was defined as a systolic blood pressure 120 to < 140 mm Hg or diastolic blood pressure 80 to < 90 mm Hg. RESULTS: At follow-up, 31% of initially normotensive men were hypertensive (264 of 853). Those with incident hypertension had higher baseline body mass index (BMI; kg/m(2)) and were more likely to have had prehypertension at the sleep visit than those men who remained normotensive. However, neither TST (reference 6 to < 8 h; < 6 h OR 0.96 [95% CI 0.7, 1.3] and ≥ 8 h OR 0.93 [0.5, 1.7]) nor the other actigraphic-measured sleep variables, including % -sleep (reference > 85%; < 70% OR 1.17 [0.66, 2.08]) and 70% to ≤ 85% OR 1.23 (0.9, 1.68), sleep latency (reference < 30 min; ≥ 30 min OR 1.29 [0.94, 1.76]), or WASO (reference < 30 min; 30 to < 60 min OR 0.7 [0.43, 1.14] and ≥ 60 min OR 0.92 [0.58, 1.47]) differed in those community-dwelling men who developed incident hypertension compared to those who remained normotensive. CONCLUSION: TST and other sleep parameters determined by wrist actigraphy were not associated with incident hypertension in community-dwelling older men.

15 Article The consensus sleep diary: standardizing prospective sleep self-monitoring. 2012

Carney, Colleen E / Buysse, Daniel J / Ancoli-Israel, Sonia / Edinger, Jack D / Krystal, Andrew D / Lichstein, Kenneth L / Morin, Charles M. ·Ryerson University, Toronto, Canada. ccarney@ryerson.ca ·Sleep · Pubmed #22294820.

ABSTRACT: STUDY OBJECTIVES: To present an expert consensus, standardized, patient-informed sleep diary. METHODS AND RESULTS: Sleep diaries from the original expert panel of 25 attendees of the Pittsburgh Assessment Conference(1) were collected and reviewed. A smaller subset of experts formed a committee and reviewed the compiled diaries. Items deemed essential were included in a Core sleep diary, and those deemed optional were retained for an expanded diary. Secondly, optional items would be available in other versions. A draft of the Core and optional versions along with a feedback questionnaire were sent to members of the Pittsburgh Assessment Conference. The feedback from the group was integrated and the diary drafts were subjected to 6 focus groups composed of good sleepers, people with insomnia, and people with sleep apnea. The data were summarized into themes and changes to the drafts were made in response to the focus groups. The resultant draft was evaluated by another focus group and subjected to lexile analyses. The lexile analyses suggested that the Core diary instructions are at a sixth-grade reading level and the Core diary was written at a third-grade reading level. CONCLUSIONS: The Consensus Sleep Diary was the result of collaborations with insomnia experts and potential users. The adoption of a standard sleep diary for insomnia will facilitate comparisons across studies and advance the field. The proposed diary is intended as a living document which still needs to be tested, refined, and validated.

16 Article Reliability and validity of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older men. 2012

Spira, Adam P / Beaudreau, Sherry A / Stone, Katie L / Kezirian, Eric J / Lui, Li-Yung / Redline, Susan / Ancoli-Israel, Sonia / Ensrud, Kristine / Stewart, Anita / Anonymous5000705. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. aspira@jhsph.edu ·J Gerontol A Biol Sci Med Sci · Pubmed #21934125.

ABSTRACT: BACKGROUND: The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) are commonly used to quantify sleep and excessive daytime sleepiness in older adults. These measures, however, have not been comprehensively evaluated for their psychometrics in older men. We determined the internal consistency reliability and construct validity of the PSQI and ESS in a sample of older men. METHODS: Participants were 3,059 men (mean age = 76.4 years) in the Osteoporotic Fractures in Men Study (MrOS) who completed the two questionnaires, wrist actigraphy, and a range of additional psychosocial and health measures. RESULTS: Internal consistency was adequate for the PSQI (Cronbach's α =.69) and the ESS (α = .70) total scores. PSQI daytime dysfunction and sleep medications components were weakly associated with the total score, but their removal did not notably improve internal consistency. PSQI and ESS totals were associated with each other and with theoretically related variables (ie, actigraphic variables, depressive symptoms, mobility/instrumental activities of daily living, health-related quality of life) in expected directions. The PSQI differentiated participants reporting no sleep disorder from those reporting particular disorders more reliably than the ESS. CONCLUSIONS: In general, we found evidence of the internal consistency reliability and construct validity of the PSQI and ESS in older men. Despite low correlation with the PSQI global score, the PSQI daytime dysfunction and sleep medications components do not appreciably reduce the PSQI total score's reliability or validity in older men.

17 Article Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study. 2011

Ross, Craig / Ancoli-Israel, Sonia / Redline, Susan / Stone, Katie / Fredman, Lisa. ·Epidemiology Department, School of Public Health, Boston University, Boston, Massachusetts, USA. ·J Am Geriatr Soc · Pubmed #21883114.

ABSTRACT: OBJECTIVES: To determine whether self-reported insomnia symptoms were associated with weight change in older women and whether caregiving, comorbidities, sleep medication, or stress modified this association. DESIGN: One-year prospective study conducted in four communities from 1999 to 2003 nested within a larger cohort study. SETTING: Home-based interviews. PARTICIPANTS: Nine hundred eighty-eight participants (354 caregivers and 634 noncaregivers) from the Caregiver--Study of Osteoporotic Fractures. MEASUREMENTS: Self-reported insomnia symptoms in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble getting back to sleep. Weight was measured at baseline and 12 months. RESULTS: The average weight change was -1.9 ± 7.8 pounds. Trouble staying asleep was significantly associated with an average weight loss of 1.3 pounds (P = .03) in multivariable analyses. Neither of the other insomnia symptoms was associated with weight change. Use of sleep medications modified the association between trouble falling asleep (interaction term P = .03) and weight change. Insomnia symptoms were associated with weight loss only in women not taking sleep medications. Neither caregiving status, presence of multiple comorbidities, nor stress modified the association. CONCLUSION: Trouble staying asleep was associated with weight loss over 12 months in older women. Practitioners should inquire about sleep habits of patients presenting with weight loss, because this may identify a marker of declining health and may be a factor that can be modified.

18 Article Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. 2010

Palesh, Oxana G / Roscoe, Joseph A / Mustian, Karen M / Roth, Thomas / Savard, Josée / Ancoli-Israel, Sonia / Heckler, Charles / Purnell, Jason Q / Janelsins, Michelle C / Morrow, Gary R. ·Department of Radiation Oncology, Department of Psychiatry, University of Rochester Medical Center, James P. Wilmot Cancer Center, 601 Elmwood Ave, Box 704, Rochester, New York, NY 14642, USA. oxana_palesh@urmc.rochester.edu ·J Clin Oncol · Pubmed #19933917.

ABSTRACT: PURPOSE: Sleep disruption is prevalent in patients with cancer and survivors, but the prevalence of insomnia, a distressing sleep disorder, in these populations has yet to be determined in large-scale studies. PATIENTS AND METHODS: A total of 823 patients with cancer receiving chemotherapy (mean age, 58 years; 597 female patients) reported on sleep difficulties in a prospective study. RESULTS: During day 7 of cycle 1 of chemotherapy, 36.6% (n = 301) of the patients with cancer reported insomnia symptoms, and 43% (n = 362) met the diagnostic criteria for insomnia syndrome. Patients with cancer younger than 58 years were significantly more likely to experience either symptoms of insomnia or insomnia syndrome (chi(2) = 13.6; P = .0002). Patients with breast cancer had the highest number of overall insomnia complaints. A significant positive association was found between symptoms of insomnia during cycles 1 and 2 of chemotherapy (phi = .62, P < .0001), showing persistence of insomnia during the first two cycles of chemotherapy. Sixty percent of the patient sample reported that their insomnia symptoms remained unchanged from cycle 1 to cycle 2. Those with insomnia complaints had significantly more depression and fatigue than good sleepers (all P < .0001). CONCLUSION: The proportions of patients with cancer in this sample reporting symptoms of insomnia and meeting diagnostic criteria for insomnia syndrome during chemotherapy are approximately three times higher than the proportions reported in the general population. Insomnia complaints persist throughout the second chemotherapy cycle for the majority of patients with cancer in this study. Insomnia is prevalent, underrecognized, undermanaged, and understudied among patients with cancer receiving chemotherapy.

19 Article Sleep disturbances and frailty status in older community-dwelling men. 2009

Ensrud, Kristine E / Blackwell, Terri L / Redline, Susan / Ancoli-Israel, Sonia / Paudel, Misti L / Cawthon, Peggy M / Dam, Thuy-Tien L / Barrett-Connor, Elizabeth / Leung, Ping C / Stone, Katie L / Anonymous9360639. ·Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA. ensru001@umn.edu ·J Am Geriatr Soc · Pubmed #19793160.

ABSTRACT: OBJECTIVES: To test the hypothesis that sleep disturbances are independently associated with frailty status in older men. DESIGN: Cross-sectional analysis of prospective cohort study. SETTING: Six U.S. centers. PARTICIPANTS: Three thousand one hundred thirty-three men aged 67 and older. MEASUREMENTS: Self-reported sleep parameters (questionnaire); objective parameters of sleep-wake patterns (actigraphy data collected for an average of 5.2 nights); and objective parameters of sleep-disordered breathing, nocturnal hypoxemia, and periodic leg movements with arousals (PLMAs) (in-home overnight polysomnography). Frailty status was classified as robust, intermediate stage, or frail using criteria similar to those used in the Cardiovascular Health Study frailty index. RESULTS: The prevalence of sleep disturbances, including poor sleep quality, excessive daytime sleepiness, short sleep duration, lower sleep efficiency, prolonged sleep latency, sleep fragmentation (greater nighttime wakefulness and frequent, long wake episodes), sleep-disordered breathing, nocturnal hypoxemia, and frequent PLMAs, was lowest in robust men, intermediate in men in the intermediate-stage group, and highest in frail men (P-for-trend < or =.002 for all sleep parameters). After adjusting for multiple potential confounders, self-reported poor sleep quality (Pittsburgh Sleep Quality Index > 5, multivariable odds ratio (MOR)=1.28, 95% confidence interval (CI)=1.09-1.50), sleep efficiency less than 70% (MOR=1.37, 95% CI=1.12-1.67), sleep latency of 60 minutes or longer (MOR=1.42, 95% CI=1.10-1.82), and sleep-disordered breathing (respiratory disturbance index > or =15, MOR=1.38, 95% CI=1.15-1.65) were each independently associated with higher odds of greater frailty status. CONCLUSION: Sleep disturbances, including poor self-reported sleep quality, lower sleep efficiency, prolonged sleep latency, and sleep-disordered breathing, are independently associated with greater evidence of frailty.

20 Article Behavioral correlates of sleep-disordered breathing in older men. 2009

Kezirian, Eric J / Harrison, Stephanie L / Ancoli-Israel, Sonia / Redline, Susan / Ensrud, Kristine / Goldberg, Andrew N / Claman, David M / Spira, Adam P / Stone, Katie L / Anonymous1361184. ·Department of Otolaryngology--Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA. ekezirian@ohns.ucsf.edu ·Sleep · Pubmed #19238813.

ABSTRACT: STUDY OBJECTIVES: To examine the association between sleep-disordered breathing (SDB) and subjective measures of daytime sleepiness, sleep quality, and sleep-related quality of life in a large cohort of community-dwelling older men and to determine whether any association remained after adjustment for sleep duration. DESIGN: Cross-sectional. The functional outcome measures of interest were daytime sleepiness (Epworth Sleepiness Scale, ESS), sleep-related symptoms (Pittsburgh Sleep Quality Index, PSQI), and sleep-related quality of life (Functional Outcomes of Sleep Questionnaire, FOSQ). Analysis of variance and adjusted regression analyses examined the association between these outcome measures and SDB severity and actigraphy-determined total sleep time (TST). We then explored whether associations with SDB were confounded by sleep duration by adjusting models for TST. SETTING: Community-based sample in home and research clinic settings. PARTICIPANTS: Two-thousand eight-hundred forty-nine older men from the multicenter Osteoporotic Fractures in Men Study that began in 2000. All participants underwent in-home polysomnography for 1 night and wrist actigraphy for a minimum of 5 consecutive nights. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Participants were aged 76.4 + 5.5 years and had an apnea-hypopnea index (AHI) of 17.0 + 15.0. AHI and TST were weakly correlated. ESS scores individually were modestly associated with AHI and TST, but the association with AHI was attenuated by adjustment for TST. PSQI and FOSQ scores were largely not associated with measures of SDB severity but were modestly associated with TST. CONCLUSIONS: Daytime sleepiness, nighttime sleep disturbances, and sleep-related quality of life were modestly associated with TST. After adjustment for TST, there was no independent association with SDB severity. These results underscore the potential differences in SDB functional outcomes in older versus young and middle-aged adults.

21 Article Anxiety symptoms and objectively measured sleep quality in older women. 2009

Spira, Adam P / Stone, Katie / Beaudreau, Sherry A / Ancoli-Israel, Sonia / Yaffe, Kristine. ·Division of Geriatrics and Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA. aspira@jhsph.edu ·Am J Geriatr Psychiatry · Pubmed #19155746.

ABSTRACT: OBJECTIVES: Few studies have examined the association between anxiety symptoms and objectively measured sleep quality in older adults. The authors determined this association in a large cohort of very old community-dwelling women. DESIGN: Cross-sectional. SETTING: Participants' homes, sites of the Study of Osteoporotic Fractures. PARTICIPANTS: Three thousand forty women (mean age: 83.6 years) enrolled in a prospective study of aging. MEASUREMENTS: Participants completed the Goldberg Anxiety Scale (ANX), the 15-item Geriatric Depression Scale (GDS), and > or = 3 nights of actigraphy--a method of measuring sleep by recording wrist movement with a device called an actigraph. Elevated anxiety symptoms were defined as ANX > or = 6. Elevated depressive symptoms were defined as GDS > or = 6. RESULTS: Participants' mean ANX score was 1.4 (standard deviation: 2.2); 9.2% (N = 280) had ANX > or = 6. Elevated anxiety symptoms were associated with greater odds of poor sleep efficiency (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.34, 2.23) and time awake after sleep onset (OR: 1.64, 95% CI: 1.27, 2.11). Associations remained after adjustment for GDS > or = 6, antianxiety medications, and other potential confounders (sleep efficiency OR: 1.50, 95% CI: 1.15, 1.97; time awake after sleep onset OR: 1.33, 95% CI: 1.01, 1.75). Anxiety symptoms were not associated with other sleep parameters. CONCLUSION: Findings suggest that elevated anxiety symptoms are independently associated with poor objectively measured sleep efficiency and elevated sleep fragmentation in very old women, after accounting for significant depressive symptoms, medical comorbidities, and use of antianxiety medications.

22 Article Effects of gender and dementia severity on Alzheimer's disease caregivers' sleep and biomarkers of coagulation and inflammation. 2009

Mills, Paul J / Ancoli-Israel, Sonia / von Känel, Roland / Mausbach, Brent T / Aschbacher, Kirstin / Patterson, Thomas L / Ziegler, Michael G / Dimsdale, Joel E / Grant, Igor. ·Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA. pmills@ucsd.edu ·Brain Behav Immun · Pubmed #18930805.

ABSTRACT: BACKGROUND: Being a caregiver for a spouse with Alzheimer's disease is associated with increased risk for cardiovascular illness, particularly for males. This study examined the effects of caregiver gender and severity of the spouse's dementia on sleep, coagulation, and inflammation in the caregiver. METHODS: Eighty-one male and female spousal caregivers and 41 non-caregivers participated (mean age of all participants 70.2 years). Full-night polysomnography (PSG) was recorded in each participants home. Severity of the Alzheimer's disease patient's dementia was determined by the Clinical Dementia Rating (CDR) scale. The Role Overload scale was completed as an assessment of caregiving stress. Blood was drawn to assess circulating levels of D-dimer and Interleukin-6 (IL-6). RESULTS: Male caregivers who were caring for a spouse with moderate to severe dementia spent significantly more time awake after sleep onset than female caregivers caring for spouses with moderate to severe dementia (p=.011), who spent a similar amount of time awake after sleep onset to caregivers of low dementia spouses and to non-caregivers. Similarly, male caregivers caring for spouses with worse dementia had significantly higher circulating levels of D-dimer (p=.034) than females caring for spouses with worse dementia. In multiple regression analysis (adjusted R(2)=.270, p<.001), elevated D-dimer levels were predicted by a combination of the CDR rating of the patient (p=.047) as well as greater time awake after sleep onset (p=.046). DISCUSSION: The findings suggest that males caring for spouses with more severe dementia experience more disturbed sleep and have greater coagulation, the latter being associated with the disturbed sleep. These findings may provide insight into why male caregivers of spouses with Alzheimer's disease are at increased risk for illness, particularly cardiovascular disease.

23 Article Nocturia and disturbed sleep in the elderly. 2009

Bliwise, Donald L / Foley, Daniel J / Vitiello, Michael V / Ansari, Farzaneh Pour / Ancoli-Israel, Sonia / Walsh, James K. ·Program in Sleep, Aging and Chronobiology, Emory University School of Medicine, Wesley Woods Center, Atlanta, GA 30329, USA. dbliwis@emory.edu ·Sleep Med · Pubmed #18703381.

ABSTRACT: BACKGROUND: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. METHODS: We examined the prevalence of nocturia and examined its role in self-reported insomnia and poor sleep quality in a survey of 1424 elderly individuals, ages 55-84. Data were derived from a 2003 National Sleep Foundation telephone poll conducted in a representative sample of the United States population who underwent a 20-min structured telephone interview. Nocturia was not a focus of the survey, but data collected relevant to this topic allowed examination of relevant associations with sleep. RESULTS: When inquired about in a checklist format, nocturia was listed as a self-perceived cause of nocturnal sleep "every night or almost every night" by 53% of the sample, which was over four times as frequently as the next most often cited cause of poor sleep, pain (12%). In multivariate logistic models, nocturia was an independent predictor both of self-reported insomnia (75% increased risk) and reduced sleep quality (71% increased risk), along with female gender and other medical and psychiatric conditions. CONCLUSIONS: Nocturia is a frequently overlooked cause of poor sleep in the elderly and may warrant targeted interventions.

24 Article The association between sleep duration and obesity in older adults. 2008

Patel, S R / Blackwell, T / Redline, S / Ancoli-Israel, S / Cauley, J A / Hillier, T A / Lewis, C E / Orwoll, E S / Stefanick, M L / Taylor, B C / Yaffe, K / Stone, K L / Anonymous2410613 / Anonymous2420613. ·Division of Pulmonary, Critical Care, and Sleep Medicine and Center for Clinical Investigation, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH 44106, USA. srp20@case.edu ·Int J Obes (Lond) · Pubmed #18936766.

ABSTRACT: BACKGROUND: Reduced sleep has been reported to predict obesity in children and young adults. However, studies based on self-report have been unable to identify an association in older populations. In this study, the cross-sectional associations between sleep duration measured objectively and measures of weight and body composition were assessed in two cohorts of older adults. METHODS: Wrist actigraphy was performed for a mean (s.d.) of 5.2 (0.9) nights in 3055 men (age: 67-96 years) participating in the Osteoporotic Fractures in Men Study (MrOS) and 4.1 (0.8) nights in 3052 women (age: 70-99 years) participating in the Study of Osteoporotic Fractures (SOF). A subgroup of 2862 men and 455 women also underwent polysomnography to measure sleep apnea severity. RESULTS: Compared to those sleeping an average of 7-8 h per night, and after adjusting for multiple risk factors and medical conditions, a sleep duration of less than 5 h was associated with a body mass index (BMI) that was on average 2.5 kg/m(2) (95% confidence interval (CI): 2.0-2.9) greater in men and 1.8 kg/m(2) (95% CI: 1.1-2.4) greater in women. The odds of obesity (BMI >or= 30 kg/m(2)) was 3.7-fold greater (95% CI: 2.7-5.0) in men and 2.3-fold greater in women (95% CI: 1.6-3.1) who slept less than 5 h. Short sleep was also associated with central body fat distribution and increased percent body fat. These associations persisted after adjusting for sleep apnea, insomnia and daytime sleepiness. CONCLUSIONS: In older men and women, actigraphy-ascertained reduced sleep durations are strongly associated with greater adiposity.

25 Article Sleep, insomnia and falls in elderly patients. 2008

Stone, Katie L / Ensrud, Kristine E / Ancoli-Israel, Sonia. ·California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA. kstone@sfcc-cpmc.net ·Sleep Med · Pubmed #18929314.

ABSTRACT: Insomnia is common in older people and can be associated with significant daytime dysfunction. Sleep problems, and the medications used to treat them, may contribute to the risk of falls and fractures in this population; however, the independent effects of disturbed sleep or the risk of hypnotic use are not well understood. Data arising from the Study of Osteoporotic Fractures (SOF) cohort of elderly women have confirmed the link between sleep problems (measured subjectively or objectively) and an increased risk of falls after taking into account the use of insomnia medications (benzodiazepines) in a community-dwelling population of older women. The data also suggest that benzodiazepine use is associated with increased risk of falls, although this association is less clear-cut when insomnia/sleep problems are taken into consideration. The risk of falls should be considered when prescribing benzodiazepines in this population. So far no data exist concerning whether the effective treatment of insomnia in the elderly may help prevent falls. Furthermore, studies are warranted to evaluate the efficacy and safety of the non-benzodiazepine BZRAs (benzodiazepine receptor agonists) in relation to risk of falls. In addition, there is a need to include fall risk factors such as postural sway and reaction time as outcomes for trials of new insomnia treatments.

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