Description
Sleep evolves during life and with age these modifications are represented by a decrease in slow wave and REM sleep, as well as frequent awakenings during the night [1]. Total sleep time and sleep efficiency decrease with age, and the reactivity of circadian system leads to phase advance and difficulties with adjusting to phase shifts due to irregular schedule or life conditions. On micro-level, a decrease spectral power in delta frequencies along with a decrease in amplitude and density of slow waves, low density of fast spindle during N2 stage and an increase in the occurrence of cyclic alternating patterns leading to a fragmented sleep. The cognitive impact of sleep disruptions is also accentuated by age. Sleep disturbances are also thought to be associated with a reduced brain β-amyloid clearance and a precursor of Alzheimer’s Disease. [2] Age-related changes in sleep physiology may also induce insomnia symptoms in the elderly, for which treatment is frequently sought. Insomnia is also the most common sleep complaint among older adults with a prevalence estimated between. In the community-based studies, the prevalence of insomnia is between 11.6% to 70% and is comprised between from 23% and 27% from the hospitalized elderly [3]. Unfortunately, insomnia complaints are often managed with hypnosedative drugs (e.g., benzodiazepines), which may induce adverse drug reactions such as drowsiness, dizziness, cognitive impairment, and fall-injuries with potential lethal complications and increase the odds of institutionalization in this population [1], [4]. In addition, conditions of hospitalization such as e.g., inactivity due to prolonged bed rest and pain, further impair sleep. In fact, sleep complaints during hospitalization therefore further decrease the mental and physical health of the elderly hospitalized patient [5]. Patients in a variety of hospitalized care environments report difficulty initiating and maintaining sleep, non-restorative sleep, increased daytime napping, and reduced sleep quality [6].Additionally, a study conducted in our institution showed a 3-fold increase in insomnia prevalence in the general population since the Sars-CoV-2 pandemic [7], as well as a rise in hospitalization in the elderly. The COVID-19 pandemic seems to have impacted sleep as suggested by the increase in the prevalence of insomnia in recent publications where it ranges from 16.5% to 18.2% in the general population to 36.5% to 47.3% among health professionals. This increase is consistent with the pathophysiological model of insomnia of Spielmann and colleagues, which postulates that the accumulation of precipitating factors (stressful life events, medical or psychiatric problems, etc.) associated with predisposing factors (being a woman, divorced, separated, widowed, low level of activity, etc.) is involved in the development of acute insomnia. This can evolve into chronic insomnia following the appearance of perpetuating factors (behavioral and cognitive changes linked to the sleep problem). The prevalence of insomnia symptoms is higher among elderly people who accumulate predisposing and precipitating factors, which is not always found for clinical insomnia. Firstly, to this date, little to nothing is known about the specific behavioral and objective micro- and macroscopic modifications of sleep in the hospitalized elder, and secondly to which extent this may precede or exacerbate insomnia symptomatology in the current pandemic.
The primary objective of this study is to investigate the objective, behavioral and subjective parameters of sleep by means of polysomnography, actigraphy, and self-report questionnaires in patients hospitalized in the geriatric ward. The second objective is to assess the impact of the patient activity (heart rate, energy spent and number of daily steps) on these objective and subjective parameters of sleep as a mediating factor in insomnia symptomatology.
| Periode | 25 okt. 2021 |
|---|---|
| Gehouden op | Brugmann University Hospital, Belgium |
| Mate van erkenning | Local |