OBJECTIVES There is limited research on racial/ethnic variation in sleep disturbances. This study aimed to quantify the distributions of objectively measured sleep disordered breathing (SDB), short sleep duration, poor sleep quality, and self-reported sleep disturbances (e.g., insomnia) across racial/ethnic groups. DESIGN Cross-sectional study. SETTING Six US communities. PARTICIPANTS Racially/ethnically diverse men and women aged 54-93 y in the Multi-Ethnic Study of Atherosclerosis Sleep Cohort (n = 2,230). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Information from polysomnography-measured SDB, actigraphy-measured sleep duration and quality, and self-reported daytime sleepiness were obtained between 2010 and 2013. Overall, 15.0% of individuals had severe SDB (apnea-hypopnea index [AHI] ≥ 30); 30.9% short sleep duration (< 6 h); 6.5% poor sleep quality (sleep efficiency < 85%); and 13.9% had daytime sleepiness. Compared with Whites, Blacks had higher odds of sleep apnea syndrome (AHI ≥ 5 plus sleepiness) (sex-, age-, and study site-adjusted odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.20, 2.63), short sleep (OR = 4.95, 95% CI: 3.56, 6.90), poor sleep quality (OR = 1.57, 95% CI: 1.00, 2.48), and daytime sleepiness (OR = 1.89, 95% CI: 1.38, 2.60). Hispanics and Chinese had higher odds of SDB and short sleep than Whites. Among non-obese individuals, Chinese had the highest odds of SDB compared to Whites. Only 7.4% to 16.2% of individuals with an AHI ≥ 15 reported a prior diagnosis of sleep apnea. CONCLUSIONS Sleep disturbances are prevalent among middle-aged and older adults, and vary by race/ethnicity, sex, and obesity status. The high prevalence of sleep disturbances and undiagnosed sleep apnea among racial/ethnic minorities may contribute to health disparities.

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Racial/Ethnic Differences in Sleep Disturbances: The Multi-Ethnic Study of Atherosclerosis (MESA).

Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.

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British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders.

In this guideline on the diagnosis of obstructive sleep apnea in adults, the American College of Physicians recommends a sleep study for patients with unexplained daytime sleepiness, polysomnograph...

http://rossleep.ru/wp-content/uploads/2014/08/Rekomendatsii-ACH.pdf

Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians

Importance Older adults commonly report disturbed sleep, and recent studies in humans and animals suggest links between sleep and Alzheimer disease biomarkers. Studies are needed that evaluate whether sleep variables are associated with neuroimaging evidence of β-amyloid (Aβ) deposition. Objective To determine the association between self-reported sleep variables and Aβ deposition in community-dwelling older adults. Design, Setting, and Participants Cross-sectional study of 70 adults (mean age, 76 [range, 53-91] years) from the neuroimaging substudy of the Baltimore Longitudinal Study of Aging, a normative aging study. Exposure Self-reported sleep variables. Main Outcomes and Measures β-Amyloid burden, measured by carbon 11–labeled Pittsburgh compound B positron emission tomography distribution volume ratios (DVRs). Results After adjustment for potential confounders, reports of shorter sleep duration were associated with greater Aβ burden, measured by mean cortical DVR (B = 0.08 [95% CI, 0.03-0.14];P = .005) and precuneus DVR (B = 0.11 [0.03-0.18];P = .007). Reports of lower sleep quality were associated with greater Aβ burden measured by precuneus DVR (B = 0.08 [0.01-0.15];P = .03). Conclusions and Relevance Among community-dwelling older adults, reports of shorter sleep duration and poorer sleep quality are associated with greater Aβ burden. Additional studies with objective sleep measures are needed to determine whether sleep disturbance causes or accelerates Alzheimer disease.

https://jamanetwork.com/journals/jamaneurology/articlepdf/1788611/noi130061.pdf

Self-reported Sleep and β-Amyloid Deposition in Community-Dwelling Older Adults

STUDY OBJECTIVES: Evidence from cross-sectional studies shows that sleep is associated with cognitive function This study examines change in sleep duration as a determinant of cognitive function DESIGN: Prospective cohort SETTING: The Whitehall II study PARTICIPANTS: 1459 women and 3972 men aged 45-69 at baseline INTERVENTIONS: None MEASUREMENTS AND RESULTS: Sleep duration (≤ 5, 6, 7, 8, ≥ 9 h on an average week night) was assessed once between 1997-1999, baseline for the present study, and once between 2002-2004, average follow-up 54 years Cognitive function was measured (2002-2004) using 6 tests: verbal memory, inductive reasoning (Alice Heim 4-I), verbal meaning (Mill Hill), phonemic and semantic fluency, and the Mini Mental State Examination (MMSE) In analyses adjusted for age, sex, and education, and corrected for multiple testing, adverse changes in sleep between baseline and follow-up (decrease from 6, 7, or 8 h, increase from 7 or 8 h) were associated with lower scores on most cognitive function tests Exceptions were memory, and, for a decrease from 6-8 h only, phonemic fluency Further adjustment for occupational position attenuated the associations slightly However, firm evidence remained for an association between an increase from 7 or 8 h sleep and lower cognitive function for all tests, except memory, and between a decrease from 6-8 h sleep and poorer reasoning, vocabulary, and the MMSE The magnitude of these effects was equivalent to a 4-7 year increase in age CONCLUSIONS: These results suggest that adverse changes in sleep duration are associated with poorer cognitive function in the middle-aged CITATION: Ferrie JE; Shipley MJ; Akbaraly TN; Marmot MG; Kivimaki M; Singh-Manoux A Change in sleep duration and cognitive function: findings from the Whitehall II study SLEEP 2011;34(5):565-573

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Change in Sleep Duration and Cognitive Function: Findings from the Whitehall II Study

OBJECTIVES: To examine the extent to which subjective and objective sleep quality are related to age independent of chronic health conditions.



DESIGN: Cross-sectional study.



SETTING: The Sleep Heart Health Study (SHHS) is a multicenter study designed to determine the cardiovascular consequences and the natural history of sleep disordered breathing.



PARTICIPANTS: Five thousand four hundred seven community-dwelling adults who participated in the SHHS (mean age 63, range 45–99; 52% women).



MEASUREMENTS: Unattended home polysomnography (PSG) and sleep questionnaires.



RESULTS: Older age was associated with shorter sleep time, diminished sleep efficiency, and more arousals in men and women. In men, age was independently associated with more Stage 1 and Stage 2 sleep and less slow-wave (Stage 3 to 4) and rapid eye movement sleep. In women, older age was less strongly associated according to linear trend with sleep stage. Conversely, poor subjective sleep quality was not associated with older age in men, but older women had more trouble falling asleep, and there was a trend toward older women having more problems with waking up during the night and waking up too early. Associations between self-report and directly measured sleep time and sleep latency were low to moderate across age groups (correlation coefficient=0.06–0.32).



CONCLUSION: Older age was more strongly associated with poorer sleep according to PSG in men than women, yet the subjective report of poor sleep with older age was stronger in women. The higher prevalence of chronic health conditions, including sleep apnea, in older adults did not explain changes of sleep parameters with aging and age–sex differences in these relationships.

Subjective and objective sleep quality and aging in the sleep heart health study

SLEEP DISORDERED BREATHING (SDB) IS A COMMON DISORDER THAT AFFECTS 2% TO 4% OF THE ADULT POPULATION.1 SDB HAS BEEN ASSOCIATED WITH A wide range of morbidities, including obesity, hypertension, cardiovascular disease, and diabetes.2,3 Many patients with SDB experience excessive daytime sleepiness (EDS),4 considered to be the chief symptom responsive to SDB treatment. EDS, occurring secondary to SDB or to other factors, affects approximately 12% of the population5 and has been associated with poor cognitive performance,6 proneness to accidents,7 and poorer health-related quality of life.8

Cross-sectional associations between SDB and reduced quality of life have been shown in several patient and community studies.9,10 Results from clinic-based investigations11 have shown higher associations than those from population-based samples.12 Other studies have focused on evaluating quality of life after treatment for SDB, some of which have shown significant improvement in well being after treatment with continuous positive airway pressure.13 Although several studies have shown longitudinal progression of SDB,14,15 no study has yet evaluated the associations between changes in SDB and quality of life over time.

The present study assessed the associations among changes in SDB, sleep quality, daytime sleepiness, and health-related quality of life in participants from a multiethnic cohort study. We hypothesized that increases in severity of SDB and worsening of sleep symptoms would be associated with a decrease in quality of life.

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Ming Wen An

Papers

Subjective and objective sleep quality and aging in the sleep heart health study

Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS).