03373nas a2200421 4500008004100000022001400041245013000055210006900185260001300254300000800267490000700275520218600282653000902468653002202477653002802499653002802527653001502555653001102570653002502581653001902606653001102625653000902636653001502645653002302660653002202683653001702705653001602722653002502738653001902763653003102782653001802813100001702831700001802848700001702866700001802883700001402901856003602915 1997 eng d a0002-861400aSleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study.0 aSleep disturbance psychosocial correlates and cardiovascular dis c1997 Jan a1-70 v453 a

OBJECTIVES: To describe the prevalence of self reported sleep disturbances in older men and women and to describe their relationships with health status and cardiovascular disease (CVD).

DESIGN: Cross-sectional study of sleep disturbance, CVD, general health, psychosocial factors, physical function, and use of psychotropic medications.

SETTING: Participants of the Cardiovascular Health Study, 5201 adults aged 65 and older recruited from a random sample of noninstitutionalized Medicare enrollees in four US communities.

MEASURES: Self-reported sleep disturbances and standardized questionnaires for cardiopulmonary symptoms and diseases, depression, social support, activities of daily living, physical activity, cognitive function, and current medications, spirometry, ECG, echocardiography, and carotid ultrasound.

RESULTS: Women were twice as likely as men to report difficulty falling asleep (30% vs 14%). Daytime sleepiness, difficulty falling asleep, and frequent awakenings increased in prevalence with age. All symptoms were related strongly to depression. Symptoms of daytime sleepiness were also related strongly to poor health and limitations in activities of daily living in men and women. In multivariate analysis, men taking benzodiazepines were likely to report difficulty falling asleep and daytime sleepiness, whereas women taking benzodiazepines reported difficulty falling asleep and waking up too early. After accounting for these factors, the only cardiovascular disease independently associated with sleep disturbances was angina. Men and women with confirmed angina were 1.6 times more likely to report trouble falling asleep. Independent relationships between sleep disturbances and cardiovascular risk factors such as obesity, hypertension, smoking, and diabetes were relatively weak and inconsistent, though smokers were less likely to report frequent awakenings.

CONCLUSIONS: Sleep disturbances are relatively common in older men and women and are associated with poor health, depression, angina, limitations in activities of daily living, and the use of benzodiazepines.

10aAged10aAged, 80 and over10aCardiovascular Diseases10aCross-Sectional Studies10aDepression10aFemale10aGeriatric Assessment10aHealth Surveys10aHumans10aMale10aPrevalence10aPsychotropic Drugs10aRandom Allocation10aRisk Factors10aSex Factors10aSleep Wake Disorders10aSocial Support10aSurveys and Questionnaires10aUnited States1 aNewman, A, B1 aEnright, P, L1 aManolio, T A1 aHaponik, E, F1 aWahl, P W uhttps://chs-nhlbi.org/node/147303916nas a2200469 4500008004100000022001400041245009500055210006900150260000900219300001000228490000700238520259600245653003102841653002102872653000902893653002202902653001002924653002802934653002102962653002402983653001903007653003403026653002803060653003803088653002403126653001103150653001803161653001903179653001103198653003103209653000903240653002903249653001503278653002103293100001803314700001803332700001703350700001503367700001303382700001503395856003603410 1998 eng d a0161-810500aCorrelates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study.0 aCorrelates of daytime sleepiness in 4578 elderly persons the Car c1998 a27-360 v213 a

OBJECTIVES: To describe the prevalence of self-reported daytime sleepiness in older men and women and to describe their relationships with demographic factors, nocturnal complaints, health status, and cardiovascular diseases (CVD).

DESIGN: Cross-sectional survey and clinical exam.

SETTING: Participants in the Cardiovascular Health Study, 4578 adults aged 65 and older, recruited from a random sample of non-institutionalized Medicare enrollees in four U.S. communities.

MEASURES: Daytime sleepiness measured by the Epworth Sleepiness Scale (ESS), magnetic resonance imaging of the brain (MRI), cognitive function tests, and standardized questionnaires for cardiopulmonary symptoms and diseases, depressive symptoms, social support, activities of daily living, physical activity, and current medications.

RESULTS: Approximately 20% of the participants reported that they were "usually sleepy in the daytime". Although elderly black men were less likely to report frequent awakenings than those in the other three race and gender groups, they had significantly higher mean ESS scores. The following were independently associated with higher ESS scores in gender-specific models: non-white race, depression, loud snoring, awakening with dyspnea or snorting, frequent nocturnal awakenings, medications used to treat congestive heart failure, non-use of sleeping pills, a sedentary lifestyle, and limitation of activities of daily living in both men and women; additional correlates included hip circumference and current smoking in men, and hayfever in women. The following were not independently associated with ESS in the models: age, education, use of wine or beer to aid sleep, use of tricyclic antidepressants, long- or short-acting benzodiazepines, asthma, angina, myocardial infarction, congestive heart failure itself, forced vital capacity, social support, cognitive function, or MRI evidence of global brain atrophy or white matter abnormality.

CONCLUSIONS: Daytime sleepiness is common in the elderly, probably due to nocturnal disturbances such as frequent awakenings and snoring. The occasional use of sleeping pills for insomnia is associated with reduced daytime sleepiness in the elderly, while the use of medications for congestive heart failure is associated with daytime sleepiness. Surprisingly, anatomic abnormalities such as evidence of previous strokes and brain atrophy (as seen on brain MRI scans) were not associated with daytime sleepiness in these non-institutionalized elderly persons.

10aActivities of Daily Living10aAge Distribution10aAged10aAged, 80 and over10aBrain10aCardiovascular Diseases10aCircadian Rhythm10aCognition Disorders10aCohort Studies10aContinental Population Groups10aCross-Sectional Studies10aDisorders of Excessive Somnolence10aElectrocardiography10aFemale10aHealth Status10aHealth Surveys10aHumans10aMagnetic Resonance Imaging10aMale10aNeuropsychological Tests10aPrevalence10aSex Distribution1 aWhitney, C, W1 aEnright, P, L1 aNewman, A, B1 aBonekat, W1 aFoley, D1 aQuan, S, F uhttps://chs-nhlbi.org/node/1497