Study: Older women with sleep disordered breathing find it harder to perform activities

A study shows that older women who have sleep disordered breathing find it harder to perform daily activities.

Older women with disordered breathing during sleep were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco.

The study was published Nov. 6 in the online edition of the Journal of the American Geriatrics Society.

The findings are notable given the aging of the population -- an estimated 3.7 million Americans will turn 65 in 2015, and by 2030, 19 percent of the U.S. population will be 65 or older -- and the fact that sleep-disordered breathing is treatable. Older adults are as much as four times as likely as middle-aged individuals to have problems with breathing during sleep.

Sleep-disordered breathing involves repeated interruptions or decreases in breathing during sleep, which often leads to fragmented sleep and hypoxemia, or low blood oxygen levels. Doctors rate the severity of sleep-disordered breathing with the apnea-hypopnea index (AHI), which reflects the number of breathing interruptions (apneas) and the number of significant decreases in breathing (hypopneas) per hour of sleep.

The study found that women with an AHI on the moderate to severe side, with 15 or more breathing disruptions per hour of sleep, had a 2.2 times greater odds of decline in daily activity functions during the evaluation period, which averaged five years between baseline evaluation and follow-up.

"Because sleep-disordered breathing can be treated effectively, it is possible that treatment could help prevent decline in important areas of functioning that allow older adults to remain independent," says Adam Spira, PhD, an associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health and the study's lead author. "As is often the case, more research is needed to investigate this possibility."

Because the study was observational, the researchers can't conclusively state that sleep-disordered breathing caused the functional decline, but the research does point to a strong link.

Earlier studies involving older men have linked sleep-disordered breathing with frailty and death. The authors believe this is one of the first studies to assess the impact of sleep-disordered breathing on decline in older women's ability to perform basic functions associated with independent living.

The study included 302 women, with a mean age of 82.3 years. At the start of the study, participants underwent an in-home sleep evaluation. They were also asked whether they had any difficulty performing daily activities, including heavy housework, shopping and preparing meals, or any challenges with mobility, such as walking several blocks or climbing or descending stairs. Participants' self-reported daily activities and mobility were assessed once again in a follow-up evaluation.

The researchers say they believe it is the low blood-oxygen levels caused by sleep-disordered breathing that cause the trouble with daily tasks, and not sleep fragmentation, which is also increased by sleep-disordered breathing.

The authors note that women who reported no difficulties with daily activities during their baseline evaluation but a moderate-to-high AHI had a somewhat higher risk of reporting deterioration in daily-activity function in the follow-up evaluation. No links between sleep-disordered breathing severity and decline in mobility were observed.

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Study: Self-reported sleep issues increase Alzheimer's riskhttp://i.dailymail.co.uk/i/pix/2012/03/01/article-2108664-11FCB218000005DC-905_468x338.jpg

According to a study, older males self-reporting sleep issues increases his risk of developing Alzheimer's disease.

In a new study, researchers from Uppsala University demonstrate that elderly men with self-reported sleep disturbances run a higher risk of developing Alzheimer's disease than men without self-reported sleep disturbances. The results are published in the scientific journal Alzheimer's & Dementia.

The researchers followed more than 1,000 men, who were initially 50 year old, between the years 1970 and 2010. The results of the study show that self-reported sleep disturbances were linked to an increased risk for Alzheimer's disease during the 40-year follow-up period, particularly if they occurred late in life. The data suggest that a regular good night's sleep could support brain health in men.

'We demonstrate that men with self-reported sleep disturbances run a 1.5-fold higher risk to develop Alzheimer's disease than those without reports of sleep disturbances during a 40-year follow-up period. The later the self-reported sleep disturbance was found the higher the risk was for developing Alzheimer's disease. These findings suggest that strategies aimed at improving sleep quality in late life may help reduce the risk to develop Alzheimer's disease', says Christian Benedict, sleep researcher at Uppsala University, who led the study.

"Importantly, there are several lifestyle factors, such as exercise, that can influence your brain's health. Thus, it must be borne in mind that a multifaceted lifestyle approach comprising good sleep habits is essential for maintaining brain health as you age," says Christian Benedict.

In an earlier article published in the journal Sleep, Christian Benedict and colleagues showed that a single night of total sleep deprivation increased blood concentrations of brain molecules in young men that typically rise in blood upon acute brain damage.

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Insomnia in older adults affects sleep quality

A study showed that older adults who have insomnia have their sleep quality affected, but not their sleep duration.

Reports of insomnia are common among the elderly, but a new study finds that sleep problems may stem from the quality of rest and other health concerns more than the overall amount of sleep that patients get.

An estimated 30 percent of adults report having some symptoms of insomnia, which includes difficulty falling asleep, staying asleep or waking up too early and then not feeling well rested during the daytime. Prior studies suggest that nearly half of older adults report at least one insomnia symptom and that lack of restorative sleep might be linked to heart disease, falls, and declines in cognitive and daytime functioning.

The new study found discrepancies between self-reported insomnia and outcomes recorded on a sleep-monitoring device. Older adults' perception of sleep does not always match what's actually happening when a more objective assessment is used to monitor sleep patterns and behaviors.

A study, published online by Journals of Gerontology: Medical Sciences, used data from 727 participants in the National Social Life, Health and Aging Project who were randomly invited to participate in an "Activity and Sleep Study." The activity and sleep study had two components: a self-administered sleep booklet, which included questions about the person's sleep experience, (e.g., "how often do you feel really rested when you wake up in the morning?") and 72-hours of wrist actigraphy, which is a wristwatch-like sensor that monitors sleep patterns and movements.

An author on the study, Linda Waite, the University of Chicago Lucy Flower Professor in Urban Sociology and the director of the Center on Aging at NORC at UChicago, said the researchers wanted to objectively evaluate several aspects of older adults' sleep characteristics, which is why they used the actigraphs in addition to the survey questions.

"Older adults may complain of waking up too early and not feeling rested despite accumulating substantial hours of sleep," Waite said.

The actigraph measurements showed that most of the older adults got sufficient amounts of sleep.

Even though reported sleep problems are common among older individuals, according to the survey only about 13 percent of older adults in the study said that they rarely or never feel rested when waking up in the morning. About 12 percent reported often having trouble falling asleep, 30 percent indicated they regularly had problems with waking up during the night and 13 percent reported problems with waking up too early and not being able to fall asleep again most of the time.

The actigraph provided data that showed the average duration of sleep period among the study participants was 7.9 hours and the average total sleep time was 7.25 hours. Waite said this indicates that the majority of older adults are getting the recommended amount of sleep and usually not having common sleep problems.

One other unexpected finding for the researchers was that respondents who reported waking up more frequently during the night had more total sleep time. "This suggests that a question about feeling rested may tap into other aspects of older adults' everyday health or psychological experience," said Waite.

"Our findings suggest that reports of what seem like specific sleep problems from survey questions may be more accurately viewed as indicators of general problems or dissatisfaction with sleep that may be due to other issues in their lives affecting their overall well-being. These survey questions and actigraphy may measure different aspects of sleep experience."

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Suicide risk increased by sleep disorder presence

This article discusses the association seen between presence of a sleep disorder in older adults and increased suicide risk.

Sleep quality influences suicide risks for older adults, according to a research undertaken by scientists from Stanford University School of Medicine. Rebecca Bernert, the study’s author, says this is a highly treatable condition. Bernert, PhD, is the director of the Suicide Prevention Research Laboratory at Stanford. The fact that sleep disorder increases suicide risks for older adults comes after a complex research.

Another research carried earlier this year involvedblood analysis to determine suicide risks.

“Suicide is the outcome of multiple, often interacting biological, psychological and social risk factors,” Bernert said. “Disturbed sleep stands apart as a risk factor and warning sign in that it may be undone, which highlights its importance as a screening tool and potential treatment target in suicide prevention.

To reach the conclusion, the team of scientists from Stanford looked at data from 14.456 adults over 65 years old. Out of this group, they chose 400 individuals who had similar sleeping patterns to 20 people who committed suicide. Scientists followed the sleeping behavior over a 10 years period. In the end, researchers concluded that older people with sleeping disorders have a suicide risk 1.4 times higher than their counterparts with high sleep quality.

The comparison between the two groups was done by looking at a series of data obtained through interviews. The questions addressed topics such as depression signs, and mental and physical functioning. Even after taking out the depression variable, the lack of quality sleep remained an important factor determining an increased risk of committing suicide.

Suicide is associated with stigma, so people suffering suicidal thoughts or attempts have troubles talking about the issue. However, if a disturbed sleeping pattern accounts for such a high influence in determining suicide, there is a ray of hope. If trouble sleeping is not a stigmatized disorder, focusing on improving the older adults’ sleep quality might reduce the suicide rates.

The subjects involved in the study were mostly white males. A group of twenty suicide victims is surely not enough to draw the definitive conclusion that sleep disorder increases suicide risks, but is a start. Further research involving data from cases involving women and minority groups may shed additional light on the issue.

People who are at risk of committing suicide should ask for help by calling the National Suicide Prevention Lifeline (1-800-273-TALK).

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Less sleep may mean faster brain aging for older adults

When older adults get less sleep, it may mean their brains age faster according to a recent study.

Researchers at Duke-NUS Graduate Medical School Singapore (Duke-NUS) have found evidence that the less older adults sleep, the faster their brains age. These findings, relevant in the context of Singapore's rapidly ageing society, pave the way for future work on sleep loss and its contribution to cognitive decline, including dementia.

Past research has examined the impact of sleep duration on cognitive functions in older adults. Though faster brain ventricle enlargement is a marker for cognitive decline and the development of neurodegenerative diseases such as Alzheimer's, the effects of sleep on this marker have never been measured.

The Duke-NUS study examined the data of 66 older Chinese adults, from the Singapore-Longitudinal Aging Brain Study(1). Participants underwent structural MRI brain scans measuring brain volume and neuropsychological assessments testing cognitive function every two years. Additionally, their sleep duration was recorded through a questionnaire. Those who slept fewer hours showed evidence of faster ventricle enlargement and decline in cognitive performance.

"Our findings relate short sleep to a marker of brain aging," said Dr June Lo, the lead author and a Duke-NUS Research Fellow. "Work done elsewhere suggests that seven hours a day(2) for adults seems to be the sweet spot for optimal performance on computer based cognitive tests. In coming years we hope to determine what's good for cardio-metabolic and long term brain health too," added Professor Michael Chee, senior author and Director of the Centre for Cognitive Neuroscience at Duke-NUS.

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Older migraine sufferers have more brain injuries

This article discusses that older people who suffer from migraines are more likely to have silent brain injuries which could have implications for having a stroke.

Older migraine sufferers may be more likely to have silent brain injury, according to research published in the American Heart Association’s journal Stroke.

In a new study, people with a history of migraine headaches had double the odds of ischemic silent brain infarction compared to people who said they didn’t have migraines. Silent brain infarction is a brain injury likely caused by a blood clot interrupting blood flow to brain tissue. Sometimes called “silent strokes,” these injuries are symptomless and are a risk factor for future strokes.

Previous studies indicated migraine could be an important stroke risk factor for younger people.

“I do not believe migraine sufferers should worry, as the risk of ischemic stroke in people with migraine is considered small,” said Teshamae Monteith, M.D., lead author of the study and assistant professor of clinical neurology and chief of the Headache Division at the University of Miami Miller School of Medicine. “However, those with migraine and vascular risk factors may want to pay even greater attention to lifestyle changes that can reduce stroke risk, such as exercising and eating a low-fat diet with plenty of fruits and vegetables.”

High blood pressure, another important stroke risk factor, was more common in those with migraine. But the association between migraine and silent brain infarction was also found in participants with normal blood pressure.

Because Hispanics and African-Americans are at increased stroke risk, researchers from the Northern Manhattan Study (NOMAS) – a collaborative investigation between the University of Miami and Columbia University – studied a multi-ethnic group of older adults (41 percent men, average age 71) in New York City. About 65 percent of participants were Hispanic. Comparing magnetic resonance imaging results between 104 people with a history of migraine and 442 without, they found:

• A doubling of silent brain infarctions in those with migraine even after adjusting for other stroke risk factors;
• No increase in the volume of white-matter hyperintensities (small blood vessel abnormalities) that have been associated with migraine in other studies;
• Migraines with aura — changes in vision or other senses preceding the headache — wasn’t common in participants and wasn’t necessary for the association with silent cerebral infarctions.

“While the lesions appeared to be ischemic, based on their radiographic description, further research is needed to confirm our findings,” Monteith said.

The research raises the question of whether preventive treatment to reduce the severity and number of migraines could reduce the risk of stroke or silent cerebral infarction.

“We still don’t know if treatment for migraines will have an impact on stroke risk reduction, but it may be a good idea to seek treatment from a migraine specialist if your headaches are out of control,” Monteith said.

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Aging and impaired sleep

A study shows that the way that aging impairs a person's sleep may be reversible.

Sleep is essential for human health. But with increasing age, many people experience a decline in sleep quality, which in turn reduces their quality of life. In a new study publishing April 1 in the Open Access journal PLOS Biology, Scientists at the Max Planck Institute (MPI) for Biology of Ageing in Cologne have investigated the mechanisms by which ageing impairs sleep in the fruit fly. Their findings suggest that age-related sleep decline can be prevented and might even be reversible.

To uncover basic age-related sleep mechanisms, the Max Planck scientists studied the fruit flyDrosophila melanogaster, a classical model organism in ageing research. "Drosophila's sleep has many features in common with that of humans, including the decline in quality," says Luke Tain of the MPI for Biology of Ageing. "Like humans, flies sleep at night and are active during the day. We can observe when and how long flies sleep. We can also determine their sleep quality by measuring how often they wake. This allows us to study the effects of specific substances or other sleep-influencing factors such as age and genetic disposition."

Ageing researchers Athanasios Metaxakis, Luke Tain, and Sebastian Grönke, in the department of MPI Director Linda Partridge, discovered that a reduced activity in the IIS signalling pathway leads to improved sleep quality at night and higher activity levels at day. A signalling pathway is a biological method of transferring information, and via those pathways, the cell can respond to external conditions like the state of food supply. "In our study, we described the role of the IIS pathway in regulating sleep and activity through the neurotransmitters octopamine and dopamine," explains Tain. "What makes this pathway so interesting to us is the fact that it is evolutionarily conserved. This means that its components and functions are similar in diverse species from simple organisms like fruit flies to mice and even humans. Furthermore, we were able to improve sleep quality by administering therapeutic agents."

Moreover, the scientists found out that day activity and night sleep are regulated by two distinct signalling pathways, night sleep being mediated through TOR and dopaminergic signalling. Surprisingly, if TOR's activity is acutely inhibited by treatment with the therapeutic agent Rapamycin, sleep quality improves even in old flies, suggesting that age-related sleep decline is not only preventable, but also reversible.

The scientists will follow up on their findings. Luke Tain: "Given the high evolutionarily conservation of IIS and TOR function, our results implicate potential therapeutic targets to improve sleep quality in humans. This would be our longer-term goal. The next step however, is to find out whether these mechanisms also work in higher animals like mice."

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Study: Poor sleep is linked to cognitive decline in older men

A study found that poor sleep quality in old men is liked to their cognitive decline over a few years.

A new study of older men found a link between poor sleep quality and the development of cognitive decline over three to four years.

Results show that higher levels of fragmented sleep and lower sleep efficiency were associated with a 40 to 50 percent increase in the odds of clinically significant decline in executive function, which was similar in magnitude to the effect of a five-year increase in age. In contrast, sleep duration was not related to subsequent cognitive decline.

"It was the quality of sleep that predicted future cognitive decline in this study, not the quantity," said lead author Terri Blackwell, MA, senior statistician at the California Pacific Medical Center Research Institute (CPMCRI) in San Francisco, Calif. "With the rate of cognitive impairment increasing and the high prevalence of sleep problems in the elderly, it is important to determine prospective associations with sleep and cognitive decline."

The study involved 2,822 community-dwelling older men at six clinical centers in the U.S. Participants had a mean age of 76 years. The study is published in the April 1 issue of the journal Sleep.

"This study provides an important reminder that healthy sleep involves both the quantity and quality of sleep," said American Academy of Sleep Medicine President Dr. M. Safwan Badr. "As one of the pillars of a healthy lifestyle, sleep is essential for optimal cognitive functioning."

The population-based, longitudinal study was conducted by a research team led by Dr. Katie Stone, senior scientist at CPMCRI in San Francisco, Calif. Institutions represented by study collaborators include the University of California, San Francisco; University of California, San Diego; Harvard Medical School; University of Minnesota; and several Veterans Affairs medical centers.

An average of five nights of objective sleep data were collected from each participant using a wrist actigraph. Cognitive function assessment included evaluation of attention and executive function using the Trails B test. According to the authors, executive function is the ability for planning or decision making, error correction or trouble shooting, and abstract thinking. Results were adjusted for potential confounding factors such as depressive symptoms, comorbidities and medication use.

The underlying mechanisms relating disturbed sleep to cognitive decline remain unknown, the authors noted. They added that additional research is needed to determine if these associations hold after a longer follow-up period.

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CDC's report on sleeping pills

This article discusses the recent report by the CDC on sleep pill usage that showed 4% of adults have used sleep aids in the past month, that more older people use sleeping aids, and that more women than men use sleep aids.

A new study shows that many Americans continually look to sleep aids in order to get a good night's rest. In fact, around 4 percent of Americans use prescription sleep aids, according to the Centers for Disease Prevention and Control (CDC). Yet many still question the drug's side effects and effectiveness.

A national survey between 2005 and 2010 showed that about 4 percent of adults ages 20 and over reported taking prescription sleep aids in the past 30 days. Approximately 2 percent of the younger age group, 20 to 39, reported using sleeping pills, while 6 percent ranging in age from 50 to 59 reported using them. Ages 80 and up reported a 7 percent use.

The study showed that the rate of use also depended on gender, race and ethnicity. For instance, about 5 percent of women used prescription sleep aids compared to about 3 percent of men. While adults were also more likely to use sleep aids than black or Mexican-American men.

"More authorities think that use of sleeping pills should be minimized," said Dr. Daniel Kripke, professor emeritus of psychiatry at the University of California, San Diego, via Live Science.

Prescription sleep aids can be used as a treatment for those who have trouble falling asleep as many of the medications can work by suppressing activities in the nervous system. In fact, some estimates show that 50 to 70 million Americans suffer from sleep disorders or deprivation. This problem can greatly harm their daily function and may also adversely affect their health, according to CDC researchers.

Researchers looked at 33,000 people to find that the use of common sleep medications caused a greater risk of dying prematurely and even some type of cancer.

The CDC survey showed that when people slept for durations of greater or less than 7 hours, sleep aids use often increased. As for people who slept less than five hours a day, they were more likely to sleep nine hours a day and had the highest use of prescription sleep aid compared to those who reported getting seven hours a day.

Findings also showed that one in six people were diagnosed with a sleep disorder and up to one in eight reported problems with sleep. However, it's not clear whether the medications are effective at helping patients get a good night's rest or helping them feel refreshed in the morning.

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