Underperception of Naps in Older Adults Referred for a Sleep Assessment: An Insomnia Trait and a Cognitive Problem?. Issue 10 (29th September 2015)

• Record Type: Journal Article
• Authors: Nguyen‐Michel, Vi‐Huong; Lévy, Pierre‐P; Pallanca, Olivier; Kinugawa, Kiyoka; Banica‐Wolters, Raluca; Sebban, Claude; Mariani, Jean; Fournier, Emmanuel; Arnulf, Isabelle
• Is Part Of: Journal of the American Geriatrics Society. Volume 63:Issue 10(2015:Oct.)
• Page Start: 2001
• Page End: 2007
• Publication Date: 2015-09-29
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.13660
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs13660-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs13660-sec-0001" sec-type="section"> <title>Objectives</title> <p>To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment.</p> </sec> <sec id="jgs13660-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective study.</p> </sec> <sec id="jgs13660-sec-0003" sec-type="section"> <title>Setting</title> <p>Outpatient geriatric sleep clinic.</p> </sec> <sec id="jgs13660-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135).</p> </sec> <sec id="jgs13660-sec-0005" sec-type="section"> <title>Measurements</title> <p>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.</p> </sec> <sec id="jgs13660-sec-0006" sec-type="section"> <title>Results</title> <p>Of the 105 participants who napped at least twice, 42 (40%) did not perceive at least two naps. These participants had lower MMSE scores (<italic>P</italic> = .01) and were more likely to be taking benzodiazepines (<italic>P</italic> = .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, <italic>P</italic> < .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.</p> </sec> <sec id="jgs13660-sec-0007" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>