Vi-Huong Nguyen-Michel1,2, Pierre-P Lévy3,4,5, Olivier Pallanca6, Kiyoka Kinugawa1,2,7,8, Raluca Banica-Wolters9, Claude Sebban1, Jean Mariani1,7,8, Emmanuel Fournier1,6,10, Isabelle Arnulf10,11. 1. Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France. 2. Geriatric Department, Consultation and Investigation Center for the Elderly, Paris, France. 3. Public Health Department, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de l'Est Parisien, Paris, France. 4. Epidemiology of Allergic and Respiratory Diseases Team, Unité Mixte de Recherche en Santé 1136, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France. 5. Epidemiology of Allergic and Respiratory Diseases Team, Inserm U 1136, Paris, France. 6. Department of Clinical Neurophysiology, Insomnia Investigation Center, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France. 7. Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France. 8. Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Centre National de la Recherche Scientifique, Paris, France. 9. Department of Neurology, Louis Pasteur Hospital, Le Coudray, France. 10. Sorbonne Universités, Université Pierre et Marie Curie, Paris, France. 11. Sleep Disorders Unit, National Reference Center for Narcolepsy, Hypersomnia and Kleine-Levin Syndrome, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
Abstract
OBJECTIVES: To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment. DESIGN: Prospective study. SETTING: Outpatient geriatric sleep clinic. PARTICIPANTS: Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135). MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVES: To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment. DESIGN: Prospective study. SETTING:Outpatient geriatric sleep clinic. PARTICIPANTS: Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135). MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Brittany Rohl; Kathleen Collins; Sarah Morgan; Stephanie Cosentino; Edward D Huey; Elan D Louis Journal: J Neurol Sci Date: 2016-10-08 Impact factor: 3.181
Authors: Miranda V McPhillips; Junxin Li; Nancy A Hodgson; Pamela Z Cacchione; Victoria V Dickson; Nalaka S Gooneratne; Barbara Riegel Journal: Gerontol Geriatr Med Date: 2020-11-03