Ganguli M, Reynolds C F, Gilby J E
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 1996 Jul;44(7):778-84. doi: 10.1111/j.1532-5415.1996.tb03733.x.
To determine the prevalence and 2-year persistence of subjective sleep complaints in a rural older population.
A prospective epidemiological study of an age-stratified random community sample.
The mid-Monongahela Valley, a rural area of Southwestern Pennsylvania.
A total of 1050 individuals with a mean age of 74.4 years (range, 66-97; SD = 5.5); 57.2% were women.
Subjective responses to questions about sleep complaints, classified as "never" experienced versus "sometimes" or "usually"; these questions reflected difficulty falling asleep (DFA), sleep continuity disturbance (SCD), early morning awakening (EMA), and uncontrollable daytime somnolence (DaSom). Subjects were also asked about snoring. Frequencies of these complaints were used to calculate their prevalence; those who remained in the study 2 years later were asked the same questions again to determine the persistence of sleep complaints. On the first occasions, subjects were also asked for "usual" estimates of how long they took to fall asleep, how many times they wakened during the night, and how many hours of sleep they obtained per night.
With regard to prevalence, 385 (36.7%) subjects reported DFA, 301 (28.7%) reported SCD, 201 (19.1%) reported EMA, and 198 individuals (18.9%) reported DaSom. Of those who knew whether they snored, 334 (40.0%) reported snoring loudly during sleep. Within the age range of this group, age was not associated with complaints of insomnia or somnolence; however, older age was associated with a significantly lower prevalence of snoring (P < .001). All three insomnia complaints were significantly more common among women (P < .001). Snoring was significantly more common among men (P < .005), but there was no gender difference in DaSom. With regard to subjective estimates, of those reporting DFA, 49.2% reported that sleep latency exceeded an hour; of those reporting SCD, 26.2% reported waking three or more times per night; and of the entire sample, 11.8% reported 5 hours or less, whereas 12.7% reported 9 to 12 hours, of sleep per night. Approximately 2 years later, among those who had reported insomnia previously and participated in the follow-up wave, the persistence of DFA was 74.9%, that of SCD 68.9%, that of EMA 47.3%, and that of known snoring was 59.6%. The persistence of DaSom, however, was only 5.7%; only DaSom was significantly (P = .049) associated with mortality.
Sleep complaints were common among these older individuals. Because these data were collected prospectively, they also provide objective evidence that insomnia is relatively persistent or chronic among older adults. This finding has implications for the diagnosis and long-term management of sleep disorders in older people. Derivation from a random community-based sample rather than from samples of patients or volunteers makes these data more generalizable to the general older population. Finally, these data describe a rural older populations, a group which, in general, is medically underserved and understudied.
确定农村老年人群主观睡眠问题的患病率及2年持续情况。
对按年龄分层的随机社区样本进行前瞻性流行病学研究。
宾夕法尼亚州西南部农村地区莫农加希拉河谷中部。
共1050人，平均年龄74.4岁（范围66 - 97岁；标准差 = 5.5）；57.2%为女性。
对关于睡眠问题的主观回答进行分类，分为“从未”经历过与“有时”或“经常”经历；这些问题反映入睡困难（DFA）、睡眠连续性紊乱（SCD）、早醒（EMA）和白天无法控制的嗜睡（DaSom）。还询问了受试者关于打鼾的情况。这些问题的频率用于计算其患病率；2年后仍参与研究的受试者再次被问及相同问题以确定睡眠问题的持续情况。第一次询问时，还要求受试者对自己入睡所需时间、夜间醒来次数以及每晚睡眠时间进行“通常”估计。
关于患病率，385名（36.7%）受试者报告有入睡困难，301名（28.7%）报告有睡眠连续性紊乱，201名（19.1%）报告有早醒，198名（18.9%）报告有白天嗜睡。在知道自己是否打鼾的人群中，334名（40.0%）报告睡眠时大声打鼾。在该组年龄范围内，年龄与失眠或嗜睡主诉无关；然而，年龄较大者打鼾的患病率显著较低（P < 0.001）。所有三种失眠主诉在女性中显著更常见（P < 0.001）。打鼾在男性中显著更常见（P < 0.005），但白天嗜睡在性别上无差异。关于主观估计，在报告入睡困难的人群中，49.2%报告睡眠潜伏期超过1小时；在报告睡眠连续性紊乱的人群中，26.2%报告每晚醒来三次或更多次；在整个样本中，11.8%报告每晚睡眠时间为5小时或更少，而12.7%报告为9至12小时。大约2年后，在之前报告有失眠且参与随访的人群中，入睡困难的持续率为74.9%，睡眠连续性紊乱为68.9%，早醒为47.3%，已知打鼾的持续率为59.6%。然而，白天嗜睡的持续率仅为5.7%；只有白天嗜睡与死亡率显著相关（P = 0.049）。
这些老年个体中睡眠问题很常见。由于这些数据是前瞻性收集的，它们也提供了客观证据表明失眠在老年人中相对持续或为慢性。这一发现对老年人睡眠障碍的诊断和长期管理具有重要意义。源自基于社区的随机样本而非患者或志愿者样本使得这些数据更能推广至一般老年人群。最后，这些数据描述的是农村老年人群，总体而言，这是一个医疗服务不足且研究较少的群体。
