Decrease in Daytime Sleeping Is Associated with Improvement in Cognition After Hospital Discharge in Older Adults

Abstract

Background/Objectives: The longitudinal association between sleep and cognitive functioning is not well understood in late-life. Examination of the association between a potentially modifiable risk factor such as sleep, and cognitive change in at-risk older adults is of both theoretical and practical importance. We examined the relationship between changes in objectively-assessed sleep and global cognitive functioning from inpatient post-acute rehabilitation to 6-months follow-up. Design: Secondary analysis of two prospective, longitudinal studies. Setting: Inpatient rehabilitation units at a VA Medical Center. Participants: 192 older patients (mean age=73.8±9.4 years) undergoing inpatient rehabilitation. Measurements: All participants completed 7 nights/days of ambulatory sleep monitoring via wrist actigraphy (yielding an estimate of nighttime wakefulness and daytime sleep) and the Mini-Mental State Examination (MMSE; global cognitive functioning) during a post-acute inpatient rehabilitation stay and 6-months following discharge. The 5-item Geriatric Depression Scale (GDS5), Geriatric Pain Measure (GPM), and Cumulative Illness Rating Scale for Geriatrics were completed during inpatient rehabilitation. Results: Growth curve modeling (controlling for baseline age, education, gender, BMI, depression, pain, and comorbidity burden) revealed that individuals whose amount of daytime sleep decreased from inpatient post-acute rehabilitation to 6-month follow-up also experienced improvements in MMSE (β = −0.01, t(80) = β3.22, p<0.01). Change in nighttime wakefulness was not a significant predictor of change in MMSE. Conclusion: Older adults whose daytime sleeping decreased following hospital discharge also experienced improvements in cognitive functioning at 6-months follow-up. As such, daytime sleep may represent a promising candidate for targeted interventions aimed at promoting cognitive recovery following hospital discharge.

Self-reported sleep duration mitigates the association between inflammation and cognitive functioning in hospitalized older men

“…Still other researchers observed relationships between long sleep duration, but not short sleep duration, and general cognitive functioning (Faubel et al, 2009 ). Beyond our recent work demonstrating that when sleep improves following hospital discharge, so too does cognitive functioning (Dzierzewski et al, 2014 ), there is a dearth of research examining the relationship between sleep and cognitive functioning in hospitalized older adults. Such research is important, given the increased risk for negative cognitive changes associated with hospitalization in late-life (Wilson et al, 2012 ) and the relative ease of assessing self-reported sleep duration.…”

Patterns and Predictors of Sleep Quality Before, During, and After Hospitalization in Older Adults

“…and decreased cognitive functioning following discharge. [12][13][14] While these fi ndings suggest that disturbed sleep represents an important independent risk factor for poor outcomes among older adults recovering from acute health events and hospitalizations, questions remain concerning (1) how sleep quality may change throughout the course of an acute health event and/ or hospitalization, and (2) the optimal methods to assess sleep disturbances in older adults during this process so interventions can be effectively targeted.…”

“…4,5 In addition, long-term changes in health status, pain symptoms, and cognitive impairment are factors with known negative associations with sleep disturbances in older adults. [6][7][8][9][10][11][12] This paper aims to extend previous work and examine patterns and predictors of sleep quality throughout the hospitalization process (i.e., from pre-admission through 1 year post-discharge follow-up).…”

An exploratory investigation of the effect of naturalistic light on fatigue and subjective sleep quality in stroke patients admitted for rehabilitation: A randomized controlled trial

“…Disrupted sleep, characterized by shorter sleep duration during the night and greater daytime sleepiness has been related to reduced physical and cognitive performance (Goldman et al, 2007). Sleep itself and decreased daytime sleeping may however improve motor consolidation after physical training (Siengsukon & Boyd, 2009) and the cognitive function after discharge (Dzierzewski et al, 2014). Prevention of sleep disturbances and improvement in sleep quality may therefore be necessary to achieve optimal rehabilitation outcome after stroke.…”