Nguyen-Michel Vi-Huong, Lévy Pierre-P, Pallanca Olivier, Kinugawa Kiyoka, Banica-Wolters Raluca, Sebban Claude, Mariani Jean, Fournier Emmanuel, Arnulf Isabelle
Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France.
Geriatric Department, Consultation and Investigation Center for the Elderly, Paris, France.
J Am Geriatr Soc. 2015 Oct;63(10):2001-7. doi: 10.1111/jgs.13660. Epub 2015 Sep 29.
To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment.
Prospective study.
Outpatient geriatric sleep clinic.
Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135).
Tests included clinical interview, sleepiness scale, anxiety and depression scale, Insomnia Severity Index (ISI), Mini-Mental State Examination (MMSE), and overnight polysomnography, followed by multiple sleep latency tests. At the end of each of four nap opportunities, participants answered whether they had slept during the test. Nap underperception was defined as two or more unperceived naps.
Of the 105 participants who napped at least twice, 42 (40%) did not perceive at least two naps. These participants had lower MMSE scores (P = .01) and were more likely to be taking benzodiazepines (P = .008) than the 63 participants who did not underperceive their naps but had similar demographic characteristics, sleep diagnoses, depression and anxiety scores, and polysomnography measures. Both groups had similarly short mean daytime sleep latencies (9.7 ± 4.5 minutes and 9.8 ± 3.7 minutes), but participants who underperceived their naps scored lower on the Epworth Sleepiness Scale (5.6 ± 4.0, vs 9.6 ± 4.8, P < .001). An ISI of 11 or greater, a MMSE score of 26 or less, and a sleepiness score of 8 or less were each independently associated with underperception of naps. The combination of these three factors yielded a positive predictive value of 93% and a negative predictive value of 71% for nap underperception.
Older adults referred for sleep consultation with cognitive impairment and greater insomnia symptoms frequently underperceive naps, leading them to underestimate their level of sleepiness. In such cases, objective measures of daytime sleepiness would be better than the Epworth Sleepiness Scale.
研究因睡眠评估前来就诊的老年人中未察觉小睡情况的频率及影响因素。
前瞻性研究。
门诊老年睡眠诊所。
因失眠主诉或疑似睡眠呼吸暂停前来就诊的60岁及以上个体（N = 135）。
测试包括临床访谈、嗜睡量表、焦虑和抑郁量表、失眠严重程度指数（ISI）、简易精神状态检查表（MMSE）以及夜间多导睡眠图，随后进行多次睡眠潜伏期测试。在四次小睡机会中的每次结束时，参与者回答他们在测试期间是否入睡。未察觉小睡被定义为两次或更多次未被察觉的小睡。
在至少小睡两次的105名参与者中，42名（40%）至少有两次未察觉小睡。与63名未出现未察觉小睡情况但具有相似人口统计学特征、睡眠诊断、抑郁和焦虑评分以及多导睡眠图测量结果的参与者相比，这些参与者的MMSE评分较低（P = 0.01），且更有可能正在服用苯二氮䓬类药物（P = 0.008）。两组的平均日间睡眠潜伏期同样较短（分别为9.7±4.5分钟和9.8±3.7分钟），但未察觉小睡的参与者在爱泼沃斯嗜睡量表上的得分较低（分别为5.6±4.0和9.6±4.8，P < 0.001）。ISI为11或更高、MMSE评分为26或更低以及嗜睡评分为8或更低均与未察觉小睡独立相关。这三个因素的组合对未察觉小睡的阳性预测值为93%，阴性预测值为71%。
因睡眠问题前来咨询且存在认知障碍和更严重失眠症状的老年人经常未察觉小睡，导致他们低估自己的嗜睡程度。在这种情况下，日间嗜睡的客观测量方法比爱泼沃斯嗜睡量表更好。
