A Tailored Intervention for PAP Adherence: The SCIP-PA Trial.

OBJECTIVE/BACKGROUND: Positive airway pressure (PAP) is highly efficacious treatment but nonadherence is prevalent with little improvement over the last 15 years. Tailored interventions show promise for promoting adherence to other treatments. The study objective was to examine feasibility and acceptability of a tailored intervention to promote PAP adherence. PARTICIPANTS: The convenience sample met inclusion criteria: newly diagnosed OSA; treatment-naïve; ≥ 18 years. EXCLUSION CRITERIA: previous obstructive sleep apnea (OSA) diagnosis and treatment; new psychiatric diagnosis; use of oxygen/bilevel PAP; secondary sleep disorder. Adults (n = 118) were randomized to tailored intervention (TI; n = 61) or usual care (UC; n = 57); application of a priori exclusion criteria resulted in 30 participants per assignment who were middle-aged (51.3 ± 11.1 years) adults (70% male) with severe OSA (apnea hypopnea index [AHI], 35.9 ± 25.2). METHODS: Randomized, double-blind, single-site pilot controlled trial. A multiphased tailored intervention targeting social cognitive perceptions of OSA-PAP treatment was delivered at four intervals. Descriptive analysis, group differences, and self-efficacy change scores by t-test, and thematic analysis of acceptability data are reported. RESULTS: One-week PAP use among TI was 35 min greater than UC condition (p = 0.20; Cohen's d = 0.336). Treatment use decreased at 1 month and 3 months (NS). Per-protocol delivery of face-to-face intervention delivery was 100% but lower for telephone intervention delivery. Personalized approach was valued by participants. CONCLUSIONS: A tailored intervention approach is acceptable to participants and feasibly implemented in a clinical sleep center setting. The intervention effect size at 1 week is consistent with other educational PAP adherence interventions but was not sustained; further pilot testing is warranted to address pilot RCT limitations.

Physical Activity in Relation to Sleep Among Community-Dwelling Older Adults in China.

This cross-sectional study was conducted to describe the physical activity and sleep in 290 community-dwelling Chinese older adults and to examine the association between physical activity and poor sleep outcomes. Almost half of the samples were poor sleepers. The majority of the samples regularly participated in walking, some household activity, and light sports, yet only a small portion were involved in work-related activity or in strenuous sports. A greater level of overall physical activity (odds ratio = 0.79; 95% confidence interval = [0.73, 0.86]), leisure-time exercise (odds ratio = 0.77; 95% confidence interval = [0.68, 0.85]), and household activity (odds ratio = 0.66; 95% confidence interval = [0.56, 0.78]) were associated with reduced likelihood of being poor sleepers and other poor sleep outcomes, independent of covariates including age, sex, education, family income, the number of children, drinking, and sleep hygiene. Future larger-scale studies that incorporate both objective and subjective measures are needed to further examine the association and to explore the effects of different types of activity on sleep and other well-beings in older adults.

Sleep Among Long-Term Care Residents in China: A Narrative Review of Literature.

The objective of this study is to synthesize and evaluate the current body of sleep research among long-term care (LTC) residents in China and provide insights for future research. Systematic searches identified 15 studies that examined sleep in LTC residents in China. Sleep disturbances and poor sleep quality were prevalent in Chinese LTC residents. Eight cross-sectional studies reported that demographics, comorbidities, lifestyle, and environment were associated with sleep quality in Chinese LTC residents. Seven intervention studies, including exercise, traditional Chinese medicine, light therapy, and behavioral interventions resulted in improved sleep quality. Only subjective sleep measures were used in all 15 studies. Some methodological issues were identified in studies, especially those conducted in Mainland China. Sleep research in LTC residents in China is still at the beginning stages. Future studies should consider more rigorous designs and objective sleep measures, and develop target interventions based on factors associated with sleep disturbances.

Clinical Trial Enrollment Enrichment in Resource-Constrained Research Environments: Multivariable Apnea Prediction (MAP) Index in SCIP-PA Trial.

STUDY OBJECTIVES: Determine the Multivariable Apnea Prediction (MAP) index predictive utility for enrollment enrichment in a clinical trial wherein enrollment was prior to obstructive sleep apnea diagnosis. METHODS: Secondary analysis of screening data (n = 264) from randomized, double-blind, pilot trial. Clinical sleep center patients with complete screening and polysomnography data were included. To determine diagnostic test accuracy of the MAP index using apnea-hypopnea index criterion ≥ 10 events/h (primary) and ≥ 5, ≥ 15, and ≥ 30 events/h (secondary), sensitivity, specificity, negative and positive predictive values, likelihood positive and negative ratios, and receiver operating characteristic curves were calculated. Predictive utility was examined by characteristic variables. RESULTS: Middle-aged, overweight or obese, men and women were included. Employing a MAP index threshold ≥ 0.5, sensitivity for obstructive sleep apnea (apnea-hypopnea index ≥ 10 events/h) was 83.6%; specificity was 46.4%; area under the curve = 0.74. Sensitivity was higher in males than females (95.3%, 68.7%, respectively); specificity was lower in males than females (30.4%, 57.6%, respectively) with similar area under the curve (0.74 versus 0.72, respectively). MAP accuracy was higher in younger versus older adults (younger than 50 years, or 50 years or older; area under the curve 0.82 versus 0.63, respectively). Varied apnea-hypopnea index criteria produced stable accuracy estimates. CONCLUSIONS: Recruitment/enrollment is a high-cost endeavor. Screening procedures may confer resource savings but careful evaluation prior to study implementation assures effectiveness and efficiency. CLINICAL TRIAL REGISTRATION: The secondary analysis reports data from the SCIP-PA Trial (NCT 01454830); study information available at: https://clinicaltrials.gov.

Intermediate, But Not Extended, Afternoon Naps May Preserve Cognition in Chinese Older Adults.

Background: The association between daytime napping and cognition is not well-studied in older adults. This study aimed to examine the associations between self-reported afternoon nap duration and change in cognition after 2-year follow-up in Chinese older adults. Methods: A total of 3,037 individuals aged 60 years and older from the China Health and Retirement Longitudinal Study baseline and 2-year follow-up were included. Overall cognition was assessed by three interview-based sub-measures of orientation to time and attention, episodic memory, and visuospatial abilities. Change scores in cognition were calculated within subjects as follow-up minus baseline levels. Based on self-reported nap duration, older adults were grouped into: (i) Non-nappers (0 minutes); (ii) Short nappers (<30 minutes); (iii) Moderate nappers (30-90 minutes); and (iv) Extended nappers (>90 minutes) at baseline and follow-up. Results: Change in cognition was significantly associated with both baseline napping and changes in napping habits from baseline to follow-up, controlling for age, gender, education, body mass index, depression, mobility, instrumental activities of daily living, nocturnal sleep duration, and cognition at baseline. Extended nappers at baseline performed significantly worse with respect to change of overall cognition from baseline to follow-up than non-nappers, short nappers, and moderate nappers. People who napped less than 90 minutes at both assessments performed significantly better from baseline to follow-up compared to non- or extended nappers at both assessments. Conclusion: Results suggest that afternoon naps less than 90 minutes may be beneficial for cognition in older adults, while long afternoon naps may be detrimental.

Determinants of Behavioral Alertness in Adults with Heart Failure.

STUDY OBJECTIVES: The primary objective of this study was to describe characteristics of sleep across the three domains of sleep quality, daytime sleepiness, and behavioral alertness in community-dwelling adults with heart failure. The secondary objective was to identify modifiable factors associated with behavioral alertness. METHODS: A sample of 280 adults with chronic heart failure was enrolled. Widely used, validated, and sensitive measures of sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale, Stanford Sleepiness Scale), and behavioral alertness (Psychomotor Vigilance Test [PVT]) were collected at baseline, 3 and 6 months. Sociodemographic and clinical characteristics, including exercise, were measured at baseline. RESULTS: Participants were primarily male and functionally compromised with a mean left ventricular ejection fraction of 35 percent. The majority of the sample (73%) reported poor sleep quality. The mean (± SD) Epworth Sleepiness Scale score was low (7.0 ± 4.6), indicating they did not perceive daytime sleepiness. In contrast, behavioral alertness was relatively poor as evidenced by a slow PVT mean response time (3.09 ± 0.76). Participants who reported exercising at least one hour in the past week were more alert and had faster response times than those reporting no exercise. CONCLUSIONS: Although sleep quality was poor and behavioral alertness was compromised, these heart failure patients did not feel sleepy. Exercise may help to promote behavioral alertness and reduce daytime sleepiness in adults with heart failure.

Exercise and Sleep in Community-Dwelling Older Adults.

Insomnia and other sleep complaints are highly prevalent in community-dwelling older adults yet often go under detected. Age-related physiological changes may affect sleep, but sleep disturbances and complaints should not be considered normal in this population. Various physiological, psychological, and social consequences have been associated with insomnia and sleep complaints. Treatment options are available so it is imperative to diagnose and treat these individuals to promote healthy aging. Exercise is known to have a wide variety of health benefits, but unfortunately most older adults engage in less exercise with advancing age. This paper describes age-related changes in sleep, clinical correlates of insomnia, consequences of untreated insomnia, and nonpharmacological treatments for insomnia in older adults, with a focus on the relationship between exercise and sleep in community-dwelling older adults with insomnia or sleep complaints. Possible mechanisms explaining the relationship between exercise and sleep are discussed. While the research to date shows promising evidence for exercise as a safe and effective treatment for insomnia and sleep complaints in community-dwelling older adults, future research is needed before exercise can be a first-line treatment for insomnia and sleep complaints in this population.

Sleep and Cognition in Community-Dwelling Older Adults: A Review of Literature.

Changes in sleep and cognition occur with advancing age. While both may occur independently of each other, it is possible that alterations in sleep parameters may increase the risk of age-related cognitive changes. This review aimed to understand the relationship between sleep parameters (sleep latency, wake after sleep onset, sleep efficiency, sleep duration, general sleep complaints) and cognition in community-dwelling adults aged 60 years and older without sleep disorders. Systematic, computer-aided searches were conducted using multiple sleep and cognition-related search terms in PubMed, PsycINFO, and CINAHL. Twenty-nine manuscripts met the inclusion criteria. Results suggest an inconsistent relationship between sleep parameters and cognition in older adults and modifiers such as depressive symptoms, undiagnosed sleep apnea and other medical conditions may influence their association. Measures of sleep and cognition were heterogeneous. Future studies should aim to further clarify the association between sleep parameters and cognitive domains by simultaneously using both objective and subjective measures of sleep parameters. Identifying which sleep parameters to target may lead to the development of novel targets for interventions and reduce the risk of cognitive changes with aging.