Sleep patterns and physical function in older adults attending primary health care.

BACKGROUND: Sleep disturbances may contribute to physical function impairment among older adults. OBJECTIVE: To examine the associations between sleep quality and duration and impaired physical function among older adults. METHODS: Cross-sectional study involving 392 non-institutionalized adults aged ≥65 years, who were recruited from primary health care centres in Spain. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index (PSQI). The FRAIL scale was used to identify physical frailty, the short physical performance battery to assess lower extremity functional impairment (LEFI) and grip strength was measured using a hand-held dynamometer to assess muscle weakness. Statistical analyses were performed with logistic regression models adjusted for potential confounders. RESULTS: Participants with poor sleep quality (PSQI global score ≥10) were more likely to have functional limitations; the odds ratio (95% confidence interval) was 2.90 (1.10-7.64) for physical frailty, 2.73 (1.34-5.58) for LEFI and 2.32 (1.14-4.75) for muscle weakness. Sleep quality components associated with frailty were sleep disturbances, use of sleeping medication and daytime dysfunction. The only quality component associated with LEFI was poor sleep efficiency, while subjective poor sleep quality and daytime dysfunction were linked to muscle weakness. No associations were observed between night-time sleep duration and physical function indicators. CONCLUSIONS: Poor self-reported sleep quality, but not sleep duration, was associated with an increased frequency of physical frailty, LEFI and muscle weakness. Interventions to improve sleep quality could contribute to healthy ageing.

Impact of a Nurse Intervention to Improve Sleep Quality in Intensive Care Units: Results From a Randomized Controlled Trial.

BACKGROUND: Patients of adult intensive care units (ICUs) often suffer from a lack of sleep. Reducing anxiety by promoting adaptation to the ICU prior to admission may be an appropriate way to increase sleep quality. OBJECTIVE: The aim of this study was to evaluate the impact on sleep quality of a brief nurse intervention. METHODS: This was a pilot randomized controlled trial in Spain. Forty patients admitted in hospital for valve cardiac surgery were randomly allocated to (1) control group (n = 20), receiving usual care, and to (2) experimental group (EG, n = 20), receiving a nurse intervention the day before surgery and admission in the ICU. The intervention was based on Roy Adaptation Model. A trained nurse anticipated the stressful stimulus to patients in order to develop functional adaptive behaviors. A set of photographs and videos was used to illustrate the environment and assistance in the ICU. Sleep quality in the ICU was measured with the Richards-Campbell Sleep Questionnaire and usual sleep quality with the Pittsburgh Sleep Quality Index. RESULTS: After the intervention, sleep quality was lower in the EG compared with the control group (-4 points in Richards-Campbell Sleep Questionnaire, P = .69). Adjustment for main confounders led this reduction to -1.9 points (P = .87) among patients in EG. Stratified analyses shown a positive impact for people who usually slept well (+5.2 points, P = .77), but negative for those who had previous poor sleep quality (-20.0 points, P = .24). CONCLUSION: A nurse intervention prior to ICU admission did not increase patients' sleep quality. In addition, the intervention could have incremented anxiety over the patients who used to sleep poorly at their homes.