Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey

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Abstract

Objective

To assess the association between sleep problems and chronic disease in older adults.

Methods

Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55–84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers.

Results

A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65–84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly).

Conclusions

Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.

Introduction

The health of the elderly population in the United States has improved considerably over the decades as age-specific mortality rates have declined especially for cardiovascular disease; as a result, life expectancy continues to improve [1]. Rates for physical disability and cognitive impairment have been reported to show declines in recent years as well [2], [3]. Yet older adults continue to develop chronic diseases and other age-related medical conditions in large numbers. Approximately 80% of men and women 70 years of age and older have at least one of seven leading chronic diseases including hypertension, heart disease, arthritis, diabetes, cancer, stroke, respiratory diseases and many have several diseases or comorbidity [4], [5].

Epidemiological studies show that sleep disturbances are common among older adults and are frequently associated with existing chronic disease, physical and mental health [6], [7], [8], [9], [10], [11]. To increase public awareness about these relationships, the National Sleep Foundation conducted a survey of older adults' sleep behavior, sleep disturbances, their medical conditions including depression and diagnosed sleep disorders along with other perceptions and beliefs about health and sleep. Founded in 1990 by the American Academy of Sleep Medicine (formerly the American Association of Sleep Disorders), the National Sleep Foundation is an independent nonprofit organization that promotes public understanding of sleep and sleep disorders and supports sleep-related education, research and advocacy to improve public health and safety. We report and illustrate this year's survey findings regarding sleep and health among older adults in the United States.

Section snippets

Methods

Data are from the 2003 National Sleep Foundation's annual Sleep in America poll. A random sample of telephone numbers was purchased and quotas were established by region and age, based on U.S. Census household data. The total sample size was designed to be 1500 participants. Telephone interviews were conducted between September 17 and December 10, 2002 resulting in a random sample of 1506 older adults 55 to 84 years of age. The interview averaged 20 min long. In order to qualify for the survey,

Results

As shown in Table 1, many respondents reported medical conditions including hypertension (47%), arthritis (46%), heart disease (18%), diabetes (16%), depression (16%), cancer (14%), and lung diseases, osteoporosis, and memory problems, stroke and enlarged prostate (6–13%). Overall, four out of five participants reported one or more of these 11 medical conditions and nearly one in four older respondents (age 65–84 years) had major comorbidity (four or more conditions). More men than women had

Discussion

Multiple chronic diseases and other medical conditions such as bodily pain and obesity substantially reduced the quality of sleep among many of the older adults who responded to this survey. Having heart disease, arthritis, diabetes, stroke and lung diseases were independently associated with having one or more sleep problems nearly every night or day such as difficulty falling asleep and staying asleep, snoring, breathing pauses, restless legs or daytime sleepiness. This survey's findings of

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