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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Migraines worse for women during menopause

A study claims that women's migraines may get worse during menopause.

New research confirms what women with migraine headaches have told their doctors for years: migraine attacks seem to get worse in the years before and during menopause.

"In women who have migraine, headaches increase by 50 to 60 percent when they go through the perimenopause and menopausal time periods," said Dr. Vincent Martin, professor of medicine and co-director of the Headache and Facial Pain Program at the University of Cincinnati.

The new finding, Martin said, "basically confirms what women have been telling us physicians for decades. We finally have some evidence."

The perimenopausal period is the time when the body is transitioning to menopause -- when monthly periods end. Perimenopause can last several years, and is often marked by irregular periods, hot flashes and sleep problems. Perimenopause can begin in the 40s, and menopause occurs, on average, at age 51, according to the U.S. National Institute on Aging.

The study is due to be presented on Wednesday at the American Headache Society annual meeting in Los Angeles. Findings presented at meetings are generally considered preliminary until they've been published in a peer-reviewed journal.

Martin and his colleagues surveyed just over 3,600 women, aged 35 to 65, in a mailed questionnaire that asked about their menopausal status and whether they had migraines and, if they did, how often. The women were classified as having high frequency headaches if they had 10 or more headache days a month.

The women in the study were about evenly divided among the three groups: premenopausal, perimenopausal and postmenopausal.

While 8 percent of the premenopausal group had frequent headaches, 12.2 percent of the perimenopausal group did along with 12 percent of the menopausal women.

At first, the results might seem puzzling, since experts know that younger women often get migraines right before and at the beginning of the menstrual cycle, said study researcher Dr. Richard Lipton, director of the Montefiore Medical Center Headache Center and professor of neurology at the Albert Einstein College of Medicine, in New York City.

"Women with migraine are most likely to get them a couple days before bleeding through the first few days of the cycle, when estrogen and progesterone both fall. The idea that women who have fewer periods [during perimenopause] would get more migraines seems paradoxical," said Lipton.

However, he said, experts believe decreasing estrogen levels explain the headaches in both cases.

The study provides welcome information on the problem of migraines, according to Dr. Elizabeth Loder, chief of the division of headache and pain in the department of neurology at Brigham & Women's Hospital in Boston.

"I think this study is particularly valuable because they went to the trouble of carefully determining what phase the women were in," she said.

Loder agreed that the study validates what patients have been telling doctors for years. Its size also lends credibility.

However, she said, it's important to put the study in perspective. "Although the relative differences [in headache frequency] between groups look big, the absolute numbers are not," Loder said. She pointed out that 8 percent of premenopausal women and about 12 percent of older women had frequent headaches.

For relief, Martin suggested, women could ask their headache specialist about adjusting or switching their migraine medicine.

The women might also ask about taking hormone replacement therapy for a brief time, he added, reasoning that raising estrogen might help decrease headaches. However, women and their doctors should discuss the benefits and the risks -- such as an increased risk of stroke -- with hormone use.

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Too much and too little sleep indicate memory problems

This article claims that both too much and too little sleep can lead to memory problems in older women.

Seniors who slept too little or too much during midlife or after are at increased risk for memory problems, as are those whose sleep habits changed over time, a new study suggests.

Researchers looked at more than 15,000 women, 70 and older, who took part in a large study of health professionals. The women were depression- and stroke-free when they underwent their initial assessment.

Participants who slept five hours or less, or nine hours or more a day -- either in midlife or later life -- had worse memory than those who slept seven hours a day. The difference in memory was equivalent to nearly two extra years of age, the researchers said.

Women whose amount of sleep changed by more than two hours a night over time had poorer memory than those who had no sleep changes, according to the study published May 1 in the Journal of the American Geriatrics Society.

"Given the importance of preserving memory into later life, it is critical to identify modifiable factors, such as sleeping habits, that may help achieve this goal," study leader Elizabeth Devore, of Brigham and Women's Hospital in Boston, said in a hospital news release.

"Our findings suggest that getting an 'average' amount of sleep, seven hours per day, may help maintain memory in later life and that clinical interventions based on sleep therapy should be examined for the prevention of [mental] impairment," she added.

The study adds "to our knowledge about how sleep impacts memory. More research is needed to confirm these findings and explore possible mechanisms underlying these associations," Devore concluded.

While the study found an association between sleep time during midlife and older age and memory function in older women, it did not prove a cause-and-effect relationship.

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