David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
J Clin Sleep Med. 2015 Jan 15;11(1):45-51. doi: 10.5664/jcsm.4362.
The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep.
This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission.
Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged.
Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.
老年人住院对睡眠的影响尚未得到充分探索。本研究考察了住院前、住院期间和住院后睡眠质量的变化模式，探讨了睡眠质量模式的预测因素，并研究了两种用于区分睡眠不良/良好的临床切点建议之间分类不一致的预测因素。
本研究纳入了接受住院后康复治疗的老年患者（n=163；平均年龄 79.7±6.9 岁，31%为女性）。患者在入住住院后康复病房时，使用匹兹堡睡眠质量指数（PSQI）回顾性地评估他们在住院前的睡眠情况。随后，他们在出院时、出院后 3 个月、6 个月、9 个月和 1 年时完成 PSQI 评估。在入院时收集了患者的人口统计学和临床特征（疼痛、抑郁、认知、合并症）。
使用潜在类别分析方法，根据患者在患病前、住院期间和住院后 1 年的自我报告睡眠质量模式，可以将老年人分为（1）持续良好睡眠者和（2）慢性睡眠不良者。无论采用何种临床切点（>5 或>8），该模式均保持不变。逻辑回归分析表明，较高的疼痛和抑郁症状与被归类为慢性睡眠不良者的可能性增加相关。尽管基于采用的临床切点存在大量分类不一致，但未出现显著的分类不一致预测因素。
临床医生在评估住院患者的睡眠质量时应谨慎。改变采用的切点可能导致对老年人的临床分类不一致。在关注老年人的住院治疗时，疼痛和抑郁需要详细考虑。
