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Sleep Initiation and Maintenance Disorders: HELP
Articles by Adam P. Spira
Based on 20 articles published since 2008
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Between 2008 and 2019, Adam P. Spira wrote the following 20 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
1 Review Optimizing sleep in older adults: treating insomnia. 2013

Wennberg, Alexandra M / Canham, Sarah L / Smith, Michael T / Spira, Adam P. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA. ·Maturitas · Pubmed #23746664.

ABSTRACT: As the world's population ages, the elevated prevalence of insomnia in older adults is a growing concern. Insomnia is characterized by difficulty falling or remaining asleep, or by non-restorative sleep, and resultant daytime dysfunction. In addition to being at elevated risk for primary insomnia, older adults are at greater risk for comorbid insomnia, which results from, or occurs in conjunction with another medical or psychiatric condition. In this review, we discuss normal changes in sleep that accompany aging, circadian rhythm changes and other factors that can contribute to late-life insomnia, useful tools for the assessment of insomnia and related problems in older people, and both non-pharmacological and pharmacological strategies for the management of insomnia and optimization of sleep in later life.

2 Article Association Between Non-Iron-Deficient Anemia and Insomnia Symptoms in Community-Dwelling Older Adults: The Baltimore Longitudinal Study of Aging. 2018

Chen-Edinboro, Lenis P / Murray-Kolb, Laura E / Simonsick, Eleanor M / Ferrucci, Luigi / Allen, Richard / Payne, Martha E / Spira, Adam P. ·School of Health and Applied Human Sciences, University of North Carolina Wilmington. · Department of Nutritional Sciences, The Pennsylvania State University, University Park. · Intramural Research Program, National Institute on Aging, Baltimore, Maryland. · Department of Neurology, Johns Hopkins University, Baltimore, Maryland. · Office of Research Development, Duke University School of Medicine, Durham, North Carolina. · Department of Mental Health, Johns Hopkins University, Baltimore, Maryland. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland. ·J Gerontol A Biol Sci Med Sci · Pubmed #28329301.

ABSTRACT: Background: Anemia is associated with poorer sleep in children, and clinically, anemia is linked to insomnia. However, the association between anemia and insomnia in older adults is understudied. Methods: We examined the cross-sectional association between anemia and insomnia in 1,053 adults (71.4 ± 10.6 years) in the Baltimore Longitudinal Study of Aging. Participants were classified as nonanemic, non-iron-deficient anemic, or iron-deficient anemic based on hemoglobin, ferritin, transferrin saturation, and mean cell volume. Insomnia symptoms were evaluated by the Women's Health Initiative Insomnia Rating Scale (WHIIRS). A total score (range 0-20) was generated, and participants were also classified as having 0, 1, or 2+ symptoms. Results: Overall, 10.5% of participants had non-iron-deficient anemia, 0.9% had iron-deficient anemia, and 88.5% had no anemia. Due to its low prevalence, the iron-deficient anemic group was dropped from analyses. In models adjusted for demographics, number of medical conditions, and Center for Epidemiologic Studies Depression Scale score, non-iron-deficient anemic individuals had significantly higher WHIIRS total scores, indicating greater insomnia severity, compared to those without anemia (predicted adjusted mean WHIIRS of 7.24 [95% confidence interval (CI): 6.40-8.08] vs 5.92 [95% CI: 5.65-6.19]). They also had twice the risk of reporting ≥2 insomnia symptoms (vs 0 symptoms; relative risk ratio = 2.20, 95% CI: 1.25-3.89). Conclusions: Results suggest that individuals with non-iron-deficient anemia are more likely to experience insomnia symptoms than those who are nonanemic. These results may have implications for insomnia treatment or the identification of underlying frailty in individuals with sleep problems.

3 Article Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study. 2017

Dong, Liming / Agnew, Jacqueline / Mojtabai, Ramin / Surkan, Pamela J / Spira, Adam P. ·Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. · Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. · Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. · Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. · Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA. ·J Epidemiol Community Health · Pubmed #28298414.

ABSTRACT: OBJECTIVES: Poor health is a recognised predictor of workforce exit, but little is known about the role of insomnia in workforce exit. We examined the association between insomnia symptoms and subsequent job exit among middle-aged and older adults from the Health and Retirement Study (HRS). METHODS: The study sample consisted of 5746 respondents aged between 50 and 70 who were working for pay when interviewed in the HRS 2004 and were followed up in the HRS 2006. Multinomial logistic regression was used to determine the association between number of insomnia symptoms (0, 1-2, 3-4) and job exit (no exit, health-related exit or exit due to other reasons). RESULTS: In models adjusting for demographic characteristics, baseline health status and baseline job characteristics, compared with respondents with no insomnia symptoms, those with 3-4 insomnia symptoms had approximately twice the odds of leaving the workforce due to poor health (adjusted relative risk ratio=1.93, 95% CI 1.04 to 3.58, p=0.036). There was no association between insomnia and job exit due to non-health reasons. CONCLUSIONS: An elevated number of insomnia symptoms is independently associated with leaving paid employment. Workplace screening for and treatment of insomnia symptoms may prolong labour force participation of middle-aged and older adults.

4 Article Racial/Ethnic Differences in Insomnia Trajectories Among U.S. Older Adults. 2016

Kaufmann, Christopher N / Mojtabai, Ramin / Hock, Rebecca S / Thorpe, Roland J / Canham, Sarah L / Chen, Lian-Yu / Wennberg, Alexandra M V / Chen-Edinboro, Lenis P / Spira, Adam P. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: cnkaufmann@ucsd.edu. · Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada. · School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA. · Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA. ·Am J Geriatr Psychiatry · Pubmed #27212222.

ABSTRACT: OBJECTIVES: Insomnia is reported to be more prevalent in minority racial/ethnic groups. Little is known, however, about racial/ethnic differences in changes in insomnia severity over time, particularly among older adults. We examined racial/ethnic differences in trajectories of insomnia severity among middle-aged and older adults. DESIGN: Data were drawn from five waves of the Health and Retirement Study (2002-2010), a nationally representative longitudinal biennial survey of adults aged > 50 years. SETTING: Population-based. PARTICIPANTS: 22,252 participants from non-Hispanic white, non-Hispanic black, Hispanic, and other racial/ethnic groups. MEASUREMENTS: Participants reported the severity of four insomnia symptoms; summed scores ranged from 4 (no insomnia) to 12 (severe insomnia). We assessed change in insomnia across the five waves as a function of race/ethnicity. RESULTS: Across all participants, insomnia severity scores increased 0.19 points (95% CI: 0.14-0.24; t = 7.52; design df = 56; p < 0.001) over time after adjustment for sex, race/ethnicity, education, and baseline age. After adjusting for the number of accumulated health conditions and body mass index, this trend decreased substantially and even changed direction (B = -0.24; 95% CI: -0.29 to -0.19; t = -9.22; design df = 56; p < 0.001). The increasing trajectory was significantly more pronounced in Hispanics compared with non-Hispanic whites, even after adjustment for number of accumulated health conditions, body mass index, and number of depressive symptoms. CONCLUSIONS: Although insomnia severity increases with age-largely due to the accumulation of health conditions-this trend appears more pronounced among Hispanic older adults than in non-Hispanic whites. Further research is needed to determine the reasons for a different insomnia trajectory among Hispanics.

5 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.

6 Article Being mindful of later-life sleep quality and its potential role in prevention. 2015

Spira, Adam P. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. ·JAMA Intern Med · Pubmed #25686155.

ABSTRACT: -- No abstract --

7 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.

8 Article National evaluation of the effectiveness of cognitive behavioral therapy for insomnia among older versus younger veterans. 2015

Karlin, Bradley E / Trockel, Mickey / Spira, Adam P / Taylor, C Barr / Manber, Rachel. ·Mental Health Services, US Department of Veterans Affairs Central Office, Washington, DC, 20420, USA; Education Development Center, Inc., New York, NY, 10014, USA; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA. ·Int J Geriatr Psychiatry · Pubmed #24890708.

ABSTRACT: OBJECTIVES: Limited research has examined the effects of cognitive behavioral therapy for insomnia (CBT-I) among older adults (age >65 years) receiving treatment in real-world clinical settings and even less has examined effects on outcomes beyond reducing insomnia, such as improved quality of life. The current article examines and compares outcomes of older versus younger (age 18-64 years) veterans receiving CBT-I nationally in nonsleep specialty settings. METHOD: Patient outcomes were assessed using the Insomnia Severity Index, Beck Depression Inventory-II, and the World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory-Short Revised. RESULTS: A total of 536 younger veterans and 121 older veterans received CBT-I; 77% of older and 64% of younger patients completed all sessions or finished early due to symptom relief. Mean insomnia scores declined from 19.5 to 9.7 in the older group and from 20.9 to 11.1 in the younger group. Within-group effect sizes were d = 2.3 and 2.2 for older and younger groups, respectively. CBT-I also yielded significant improvements in depression and quality of life for both age groups. High and increasing levels of therapeutic alliance were observed for both age groups. CONCLUSIONS: Older (and younger) patients receiving CBT-I from nonsleep specialists experienced large reductions in insomnia and improvements in depression and quality of life. Effects were similar for both age groups, and the rate of dropout was lower among older adults. The results provide strong support for the effectiveness and acceptability of CBT-I for older adults receiving care in routine treatment settings.

9 Article Binge drinking and insomnia in middle-aged and older adults: the Health and Retirement Study. 2015

Canham, Sarah L / Kaufmann, Christopher N / Mauro, Pia M / Mojtabai, Ramin / Spira, Adam P. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ·Int J Geriatr Psychiatry · Pubmed #24798772.

ABSTRACT: OBJECTIVE: Alcohol use in later life has been linked to poor sleep. However, the association between binge drinking, which is common among middle-aged and older adults, and insomnia has not been previously assessed. METHODS: We studied participants aged 50 years and older (n = 6027) from the 2004 Health and Retirement Study who reported the number of days they had ≥4 drinks on one occasion in the prior 3 months. Participants also reported the frequency of four insomnia symptoms. Logistic regression analyses assessed the association between binge drinking frequency and insomnia. RESULTS: Overall, 32.5% of participants had >0 to ≤2 binge drinking days/week; and 3.6% had >2 binge drinking days/week. After adjusting for demographic variables, medical conditions, body mass index, and elevated depressive symptoms, participants who binged >2 days/week had a 64% greater odds of insomnia than non-binge drinkers (adjusted odds ratio [aOR] = 1.64, 95% confidence interval [CI] = 1.09-2.47, p = 0.017). Participants reporting >0 to ≤2 binge days/week also had a 35% greater odds of insomnia than non-binge drinkers (aOR = 1.35, 95% CI = 1.15-1.59, p = 0.001). When smoking was added to the regression model, these associations fell just below the level of significance. CONCLUSIONS: Results suggest that binge drinking is associated with a greater risk of insomnia among adults aged 50 years and older, although this relationship may be driven in part by current smoking behavior. The relatively high prevalence of both binge drinking and sleep complaints among middle-aged and older populations warrants further investigation into binge drinking as a potential cause of late-life insomnia.

10 Article Association between insomnia symptoms and functional status in U.S. older adults. 2014

Spira, Adam P / Kaufmann, Christopher N / Kasper, Judith D / Ohayon, Maurice M / Rebok, George W / Skidmore, Elizabeth / Parisi, Jeanine M / Reynolds, Charles F. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. aspira@jhsph.edu. · Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. · Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland. · Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennysylvania. · Department of Psychiatry, University of Pittsburgh Medical Center and Graduate School of Public Health, Pittsburgh, Pennysylvania. ·J Gerontol B Psychol Sci Soc Sci · Pubmed #25342821.

ABSTRACT: OBJECTIVES: We studied the association between insomnia symptoms and late-life functioning, including physical capacity, limitations in household activities, and participation in valued activities. METHODS: Participants were 6,050 adults independent in self-care activities from a representative sample of older Medicare beneficiaries. They completed objective measures of physical capacity and self-report measures of insomnia symptoms, help and difficulty with household activities, and participation in valued activities. RESULTS: After adjustment, insomnia symptoms were associated with a greater odds of receiving help or having difficulty with selected household activities (laundry, shopping), greater odds of help or difficulty with ≥ 1 household activity [1 symptom vs. 0, odds ratio (OR)=1.27, p < .05; 2 symptoms vs. 0, OR = 1.35, p < .01), and of restricted participation in specific valued activities (attending religious services, going out for enjoyment) and in ≥ 1 valued activity (1 symptom vs. 0, OR = 1.29, p < .05; 2 symptoms vs. 0, OR = 1.50, p < .01). There was no independent association between insomnia symptoms and physical capacity. DISCUSSION: Among older adults, insomnia symptoms are associated with a greater odds of limitation in household activities and of restricted participation in valued activities. Insomnia interventions may improve functioning and quality of life among elders.

11 Article Insomnia and health services utilization in middle-aged and older adults: results from the Health and Retirement Study. 2013

Kaufmann, Christopher N / Canham, Sarah L / Mojtabai, Ramin / Gum, Amber M / Dautovich, Natalie D / Kohn, Robert / Spira, Adam P. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, Room 794, 624 North Broadway, Baltimore, MD 21205. aspira@jhsph.edu. ·J Gerontol A Biol Sci Med Sci · Pubmed #23666943.

ABSTRACT: BACKGROUND: Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults. METHODS: We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or ≥ 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics. RESULTS: Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [CI] = 1.15-1.43, p < .001), use of home health care services (AOR = 1.29, 95% CI = 1.09-1.52, p = .004), and any health service use (AOR = 1.28, 95% CI = 1.15-1.41, p < .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95% CI = 1.50-1.96, p < .001), use of home health care services (AOR = 1.64, 95% CI = 1.32-2.04, p < .001), nursing home use (AOR = 1.45, 95% CI = 1.10-1.90, p = .009), and any health service use (AOR = 1.72, 95% CI = 1.51-1.95, p < .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates. CONCLUSIONS: In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.

12 Article Sleep, function and HIV: a multi-method assessment. 2013

Gamaldo, Charlene E / Spira, Adam P / Hock, Rebecca S / Salas, Rachel E / McArthur, Justin C / David, Paula M / Mbeo, Gilbert / Smith, Michael T. ·Department of Neurology, The Johns Hopkins Outpatient Center, Johns Hopkins University, 600 N. Wolfe St., Meyer 6-119, Baltimore, MD, 21287, USA, cgamald1@jhmi.edu. ·AIDS Behav · Pubmed #23299876.

ABSTRACT: Amongst HIV+ individuals, sleep complaints have been recognized as common and debilitating; but have rarely been formally assessed or compared to controls using validated sleep tools. In this study we conducted structured interview for sleep disorders, polysomnography, 2-week home (ambulatory) monitoring and validated sleep/functional questionnaires. 56 % (14/25) of HIV+ participants and 0 % (0/19) of controls fulfilled the diagnostic criteria for insomnia. Insomnia severity scores were correlated with fatigue and anxiety symptoms. Sleep latency on 2-week actigraphy was significantly longer (P = 0.027) for HIV+ participants and associated with lower MOS-HIV scores. Sleep quality was significantly reduced in HIV+ participants based on validated questionnaires of overall sleep quality (P = 0.0017) and insomnia related symptoms (P < 0.001) even after adjusting for education and affective symptoms. HIV+ individuals are suffering with under-diagnosed sleep disorders that are negatively impacting quality of life and functional capabilities. Further studies aimed at improving recognition of sleep disorders and implementation of efficacious medical and behavioral treatment could improve functioning and disease management.

13 Article Poor sleep quality and functional decline in older women. 2012

Spira, Adam P / Covinsky, Kenneth / Rebok, George W / Punjabi, Naresh M / Stone, Katie L / Hillier, Teresa A / Ensrud, Kristine E / Yaffe, Kristine. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. aspira@jhsph.edu ·J Am Geriatr Soc · Pubmed #22690985.

ABSTRACT: OBJECTIVES: To determine whether objectively measured sleep quality predicts 5-year incident instrumental activity of daily living (IADL) impairment and decline in grip strength and gait speed in older women. DESIGN: Prospective cohort. SETTING: Participants' homes, Study of Osteoporotic Fractures sites. PARTICIPANTS: Eight hundred seventeen women with a mean age of 82.4 at baseline. MEASUREMENTS: Participants completed 4.1 ± 0.7 nights of wrist actigraphy at baseline and measures of IADL impairment, grip strength, and gait speed at baseline and 5-year follow-up. RESULTS: After 5 years of follow-up, approximately 41% of participants had incident impairment in one or more IADLs. The quartile of women with the shortest total sleep time (TST) had 93% greater odds of incident IADL impairment than the longest sleepers (adjusted odds ratio (AOR) = 1.93, 95% confidence interval (CI) = 1.25-2.97). Similarly, the quartile of women with the lowest sleep efficiency (SE) had 65% greater odds of impairment than those with the highest (AOR = 1.65, 95% CI = 1.06-2.57). Women in the shortest TST quartile had twice the odds of declining grip strength as those with the longest TST (AOR = 1.97, 95% CI = 1.17-3.32). Finally, women in the quartiles with the most wake after sleep onset (WASO) and the lowest SE had approximately 90% greater odds of grip strength decline than those with the least WASO (AOR = 1.90, 95% CI = 1.11-3.24) and SE (AOR = 1.92, 95% CI = 1.12-3.29). CONCLUSION: Findings indicate that shorter sleep duration, greater WASO, and lower SE are risk factors for functional or physical decline in older women.

14 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.

15 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 / Anonymous4620622. ·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.

16 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.

17 Article The relationship between objectively measured sleep disturbance and dementia family caregiver distress and burden. 2008

Beaudreau, Sherry A / Spira, Adam P / Gray, Heather L / Depp, Colin A / Long, James / Rothkopf, Mark / Gallagher-Thompson, Dolores. ·Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. sherryb@stanford.edu ·J Geriatr Psychiatry Neurol · Pubmed #18503035.

ABSTRACT: The aim of this study was to determine whether distress and burden were associated with objective measures of sleep disturbance in dementia caregivers. Using wrist actigraphy, sleep was measured in 60 female, Caucasian dementia family caregivers (mean age, 64.8 years). Caregivers completed questionnaires about demographics, health, depression, duration of caregiving and care recipient nighttime behavior. Care recipients completed a mental status exam. We investigated whether these measures were associated with actigraphic sleep parameters. Greater depressive symptoms among caregivers were associated with poorer sleep efficiency. Older caregiver age and poorer self-rated health were associated with longer time in bed. Sleep disturbance, which is common among dementia caregivers, might be an important index of caregiver distress (ie, depression) but might not be associated with burden (based on the care recipient's general cognitive impairment or nighttime awakenings.).

18 Article Subclinical anxiety symptoms, sleep, and daytime dysfunction in older adults with primary insomnia. 2008

Spira, Adam P / Friedman, Leah / Aulakh, Jasdeep S / Lee, Tina / Sheikh, Javaid I / Yesavage, Jerome A. ·University of California, San Francisco, Department of Medicine, Division of Geriatrics, San Francisco Veterans Affairs Medical Center, USA. adam.spira@ucsf.edu ·J Geriatr Psychiatry Neurol · Pubmed #18474724.

ABSTRACT: Both insomnia complaints and anxiety disorders are common in older adults, and are associated with poor daytime functioning. The present study investigated whether subclinical levels of anxiety were associated with sleep disturbance and daytime functioning in older adults who met diagnostic criteria for primary insomnia, and therefore did not meet criteria for depression or an anxiety disorder. After adjustment for depressive symptoms, elevated state anxiety was associated with higher levels of wake after sleep onset (measured by both actigraphy and sleep log) and shorter sleep onset latency (measured by sleep log). Higher levels of trait anxiety were associated with greater wake after sleep onset (measured by sleep log). Elevated state and trait anxiety were associated with worse social functioning, and higher levels of trait anxiety were associated with worse role functioning. Thus, subclinical anxiety symptoms may be an important target for clinical intervention to improve sleep and functioning in older adults with primary insomnia.

19 Article Subclinical anxiety symptoms, sleep, and daytime dysfunction in older adults with primary insomnia. 2008

Spira, Adam P / Friedman, Leah / Aulakh, Jasdeep S / Lee, Tina / Sheikh, Javaid I / Yesavage, Jerome A. ·University of California, San Francisco, Department of Medicine, Division of Geriatrics, San Francisco, CA, USA. adam.spira@ucsf.edu ·J Geriatr Psychiatry Neurol · Pubmed #18287171.

ABSTRACT: "Both Insomnia complaints and anxiety-related distress are common in older adults, and are associated with poor daytime functioning. We investigated whether subclinical levels of anxiety were associated with sleep disturbance and daytime functioning in older adults who met diagnostic criteria for primary insomnia, and therefore but did not meet criteria for depression or an anxiety disorder. After adjustment for depressive symptoms, elevated state anxiety was associated with higher levels of wake after sleep onset (measured by both actigraphy and sleep log) and shorter sleep sleep onset latency (measured by sleep log). Higher levels of trait anxiety were associated with greater wake after sleep onset (measured by sleep log). Elevated state and trait anxiety were associated with worse and social functioning, and higher levels of trait anxiety were associated with worse role functioning. Thus, subclinical anxiety symptoms may be an important target for clinical intervention to improve sleep and functioning in older adults with primary insomnia."

20 Unspecified Sleep and Health in Older Adulthood: Recent Advances and the Path Forward. 2018

Spira, Adam P. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. · Johns Hopkins Center on Aging and Health, Baltimore, Maryland. ·J Gerontol A Biol Sci Med Sci · Pubmed #29346511.

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