Abstract
Introduction:
Sleep disturbance in older adults is associated with age-related health outcomes. However, little is known about sleep characteristics and their consequences during ...hospitalization among older adults. We initiated a pilot study among inpatients in an acute-care hospital to describe objective and subjective sleep characteristics. The goal is to evaluate associations between sleep disruption and hospital-related outcomes such as length of stay, discharge to long-term care, delirium and re-admissions. These data may also be utilized to inform potential future interventions to improve sleep and quality of care for older adults in the hospital setting.
Methods:
The study setting is an 81-bed community acute-care hospital, in rural Tracy, California. Initial inclusion criteria were age 60+ years and expected duration of stay 2+ days (later relaxed to 1+ day). Exclusion criteria include severe cognitive impairment (MoCA score lt 18) and examiner determination of patient’s inability to complete the study. Sleep data are collected using 24-hour actigraphy, sleep diaries, and self-reported pre-hospitalization sleep habits derived from the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Additional data are obtained from electronic health records and chart abstraction.
Results:
Thus far, 44 (of a projected 100) patients have been enrolled with a mean age of 69 years. Approximately 55% are female, and 73% scored mild-moderate cognitive impairment at study entry (MoCA score 18–26). Self-reported sleep disturbance was common in the month prior to admission: 83% reported PSQI scores gt 5, 25% night-time sleep duration lt 5 hours, and 30% reported using sleep medications 3+ times per week. Daily napping and excessive daytime sleepiness were reported by 58% and 20% of participants, respectively.
Conclusion:
Characterizing sleep and related outcomes among hospitalized older adults is a critical first step towards improving quality of care, and potentially reducing adverse health outcomes in this vulnerable population. Our preliminary data suggest substantial self-reported sleep disturbance and use of sleep medications prior to hospitalization. We expected to complete recruitment by May, 2017, and additional results including objective sleep data are forthcoming.
Support (If Any):
Supported by the Tracy Hospital Foundation, Sutter Tracy Community Hospital.
The editing and scoring of actigraphy data are important for calculating variables that describe sleep. Scoring is dependent on marking time points for when a participant got in and out of bed, plus ...time when the actigraph was removed. This placement of time points is subject to error. We examined interscorer reliability to determine if files scored by 2 different people were comparable.
Observational study.
Community-based.
A subset of 36 women taken from the latest biannual visit of the Study of Osteoporotic Fractures. All women had actigraphy data scored by 1 scorer for the Study of Osteoporotic Fractures staff, plus a blinded rescoring by an expert scorer at a different site.
N/A.
The outcomes of interest from actigraphy are duration of in-bed interval, total sleep time, sleep latency, sleep efficiency, wake after sleep onset, total nap time, and total daytime minutes of watch removal. Clearly documented actigraphy scoring procedures were used. There were no significant differences between the expert scorer and the study scorer in sleep outcomes (all P values >.16 from a paired t test). There was a small but statistically significant difference between scorers for watch removal times (mean absolute difference 3.4 minutes +/- 5.4, P=.02). The intraclass correlation coefficients showed a high level of agreement (range, 0.84-0.99).
Even in a large study with 2 scorers, it is possible to use actigraphy as a measure of sleep without introducing interscorer measurement error. Using well-documented scoring and data-gathering procedures are essential for data quality control.
RT-PCR methods have been applied to the detection and sequencing of the glycoprotein gene of putative spring viraemia of carp viruses (SVCV) and pike fry rhabdoviruses (PFRV), including isolates from ...tench, grass carp, roach, bream and false harlequin, sheatfish and orfe. Phylogenetic analysis of a 550 nucleotide (nt) region of the glycoprotein gene identified 4 groups, I to IV. Significantly, the majority of viruses previously identified as PFRV formed a distinct cluster (Genogroup IV) which shared <80% nucleotide identity with the PFRV reference strain (Genogroup III). The similarity between another PFRV-like virus isolated from grass carp and representatives of Genogroups III and IV was also <80%, indicating that this virus belonged to a third group (Genogroup II). All of the putative SVC viruses were assigned to a 4th group (Genogroup I), sharing <61% nucleotide identity with viruses in Genogroups II to IV.
The potential for chemistry occurring in cloud droplets to impact atmospheric composition has been known for some time. However, the lack of direct observations and uncertainty in the magnitude of ...these reactions led to this area being overlooked in most chemistry transport models. Here we present observations from Mt Schmücke, Germany, of the HO2 radical made alongside a suite of cloud measurements. HO2 concentrations were depleted in-cloud by up to 90% with the rate of heterogeneous loss of HO2 to clouds necessary to bring model and measurements into agreement, demonstrating a dependence on droplet surface area and pH. This provides the first observationally derived assessment for the uptake coefficient of HO2 to cloud droplets and was found to be in good agreement with theoretically derived parameterisations. Global model simulations, including this cloud uptake, showed impacts on the oxidising capacity of the troposphere that depended critically on whether the HO2 uptake leads to production of H2O2 or H2O.
Background. Reported fatigue has been identified as a component of frailty. The contribution of nighttime sleep quality (duration and complaints) to fatigue symptoms in community-dwelling older ...adults has not been evaluated. Methods. We studied 2264 men and women, aged 75–84 years (mean 77.5 years; standard deviation SD 2.9), participating in the Year 5 (2001–2002) clinic visit of the Health, Aging, and Body Composition (Health ABC) study. Fatigue was determined using a subscale of the Modified Piper Fatigue Scale (0–50; higher score indicating higher fatigue). Hours of sleep per night, trouble falling asleep, waking up during the night, and waking up too early in the morning were assessed using interviewer-administered questionnaires. Results. The average fatigue score was 17.7 (SD 8.4). In multivariate models, women had a 3.8% higher fatigue score than men did. Individuals who slept ≤6 hours/night had a 4.3% higher fatigue score than did those who slept 7 hours/night. Individuals with complaints of awakening too early in the morning had a 5.5% higher fatigue score than did those without these complaints. These associations remained significant after multivariate adjustment for multiple medical conditions. Conclusion. The association between self-reported short sleep duration (≤6 hours), and waking up too early and fatigue symptoms suggests that better and more effective management of sleep behaviors may help reduce fatigue in older adults.
Abstract
Introduction:
Periodic limb movements during sleep (PLMS) and arousals are associated with sympathetic nervous system activation. We hypothesize a temporal relationship of individual PLMS, ...particularly those with arousal, and non-sustained ventricular tachycardia (NSVT) events.
Methods:
A bidirectional case-crossover design (characterized by inherently perfect subject characteristic matching) was used to assess temporal PLMS and NSVT associations in 41 Osteoporotic Fractures in Men Sleep Study participants with in-home polysomnography-identified NSVT events during sleep. Arrhythmias were annotated blinded to other data. Sleep time was divided into ~30-minute segments. A priori, for each NSVT event (n=96), we selected a preceding 30-second hazard period and three randomly-chosen 30-second control periods from sleep at ~5-minute intervals from the NSVT within the same 30-minute segment and evaluated for PLMS, respiratory events, and arousals. Odds ratios and 95% confidence intervals - OR(95%CI) - were determined by conditional logistic regression; covariates included arousals and respiratory events in the same hazard/control period. Interactions of PLMS and both respiratory event and arousal were examined.
Results:
Male participants were 79.8 ± 6.0 years with a PLMS index of 40.6(IQR:21.6,67.1) and apnea-hypopnea index of 17.1(IQR:8.6,26.1). PLMS were not significantly associated with NSVT (OR=1.49, 95%CI 0.70–3.17). PLMS with arousal were associated with NSVT in unadjusted analyses (OR=3.31, 95%CI 1.32–8.30) and after respiratory event adjustment (OR=3.36, 95%CI 1.34–8.46). Arousals were associated with NSVT in unadjusted analyses (OR=2.15, 95%CI 1.22–3.79), but not after PLMS-related arousals were excluded (OR=1.60, 95%CI 0.83–3.07). There were no significant interactions of PLMS and respiratory events or arousals (p=0.69 and p=0.13, respectively). Analysis of one NSVT event per participant yielded similar results.
Conclusion:
PLMS with (but not without) arousals are associated with >3-fold higher odds of subsequent NSVT episodes. These findings suggest PLMS-related arousals are physiologically important ventricular arrhythmia triggers. Investigation targeting PLMS with arousals to reduce ventricular arrhythmogenesis is needed.
Support (If Any):
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, R01 HL070839, and R21HL108226.
To determine whether longitudinal cognitive decline is associated with increased risk of sleep disturbance in older, nondemented, community-dwelling women.
We studied 2,474 women (mean age 68.9 ...years) who were part of a prospective study started in 1986; women with baseline or follow-up evidence of possible dementia were excluded. Cognitive data were gathered over 15 years for modified Mini-Mental State Examination (mMMSE) and 13 years for Trails B; cognitive decline was defined as declining >1.5 SDs on the mMMSE (> or =3 points) or Trails B (>92 seconds). Sleep disturbance was measured objectively using actigraphy (Sleepwatch-O, Ambulatory Monitoring) at the 15-year follow-up visit; measures included total sleep hours, sleep efficiency, sleep latency, napping, and time awake after sleep onset (WASO).
During follow-up, 11% of women declined on mMMSE and 15% on Trails B. Cognitive decliners were more likely than non-decliners to experience sleep disturbance at follow-up on most measures. For women who declined on mMMSE, adjusted ORs (aOR) (95% CI) were 1.71 (1.24, 2.37) for sleep efficiency <70%, 1.57 (1.12, 2.21) for sleep latency > or =1 hour, and 1.43 (1.07, 1.92) for WASO > or =90 minutes. Results were similar for women who declined on Trails B; in addition, these women were more likely to nap >2 hours per day (aOR: 1.73; 95% CI: 1.28, 2.33). Cognitive decline on either test was not associated with total sleep time.
Cognitive decline is associated with sleep disturbance in nondemented community-dwelling elderly women.
Neuregulins and their erbB receptors are essential for cardiac development and postulated to be cardioprotective in the presence of injury in the postnatal heart. We tested the hypothesis that the ...development of doxorubicin-induced cardiotoxicity in vivo is more severe in mice with heterozygous knockout of the neuregulin-1 gene (NRG-1(+/-)) compared with wild-type mice (WT). Three-month old NRG-1(+/-) and WT mice were injected with a single dose of doxorubicin (20 mg/kg ip). Survival was analyzed by the Kaplan-Meier approach. Left ventricular (LV) function and signaling pathways were analyzed 4 days after treatment. Fifteen days after treatment, survival was significantly lower in doxorubicin-treated NRG-1(+/-) mice (NRG-1(+/-)-Dox) compared with doxorubicin-treated WT mice (WT-Dox) (15% vs. 33%, P < 0.01). LV mass was significantly lower in NRG-1(+/-)-Dox but not in WT-Dox compared with nontreated animals. LV systolic pressure and LV midwall fractional shortening were significantly lower in NRG-1(+/-)-Dox compared with WT-Dox mice. LV protein levels of NRG-1, erbB2, and erbB4 receptors were similar in WT-Dox and NRG-1(+/-)-Dox mice. However, levels of phosphorylated erbB2, Akt, and ERK-1/2 were significantly decreased in NRG-1(+/-)-Dox compared with WT-Dox mice. A significant decrease in phosphorylated P70S6K levels was also observed in NRG-1(+/-)-Dox compared with nontreated NRG-1(+/-) mice. These results demonstrate that heterozygous knockout of the neuregulin-1 gene worsens survival and LV function in the presence of doxorubicin-induced cardiac injury in vivo. This is associated with the depression of activation of the erbB2 receptor as well as Akt, p70S6K, and ERK-1/2 pathways.
Corn (Zea mays L.) grain yields are known to vary from plant to plant, but the extent of this variability across a range of environments has not been evaluated. This study was initiated to evaluate ...by-plant corn grain yield variability over a range of production environments and to establish the relationships among mean grain yield, standard deviation, coefficient of variation, and yield range. A total of forty-six 8- to 30-m corn transects were harvested by plant in Argentina, Mexico, Iowa, Nebraska, Ohio, Virginia, and Oklahoma from 2002 to 2004. By-plant corn grain yields were determined, and the average individual plant yields were calculated. Over all sites in all countries and states, plant-to-plant variation in corn grain yield averaged 2765 kg ha(-1) (44.1 bu ac(-1)). At the sites with the highest average corn grain yield (11 478 and 14 383 kg ha(-1), Parana Argentina, and Phillips, NE), average plant-to-plant variation in yield was 4211 kg ha(-1) (67 bu ac(-1)) and 2926 kg ha(-1) (47 bu ac(-1)), respectively. As average grain yields increased, so did the standard deviation of the yields obtained within each row. Furthermore, the yield range (maximum corn grain yield minus the minimum corn grain yield per row) was found to increase with increasing yield level. Regardless of yield level, plant-to-plant variability in corn grain yield can be expected and averaged more than 2765 kg ha(-1) over sites and years. Averaging yield over distances >0.5 m removed the extreme by-plant variability, and thus, the scale for treating other factors affecting yield should be less than 0.5 m. Methods that homogenize corn plant stands and emergence may decrease plant-to-plant variation and could lead to increased grain yields.
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