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Nocturnal Awakenings, Sleep Dissatisfaction and the Risk of Falls in Older Adults

Katie Stone, PhD
California Pacific Medical Center-Research Institute
San Francisco, CA, USA

Data are coming from two large observational cohorts of older adults: the Study of Osteoporotic Fractures (SOF) Sleep Ancillary which is comprised of approximately 3000 older women; and the MrOS Sleep Study of approximately 3000 older men. In both of these multi-center cohorts, objective measures of sleep based on actigraphy will be utilized to characterize nocturnal awakenings, and to explore the prevalence and relationship to sleep dissatisfaction. Gender differences will be described. We will also present data on the relationship of nocturnal awakenings (with and without self-reported sleep dissatisfaction) and risk of falls and other age-related outcomes.

Subjective Reports of Sleep Quality: Clinical Utility

Edward O Bixler, PhD
Pennsylvania State University
Hershey, PA, USA

"Non-Restorative Sleep" and "Global Sleep Dissatisfaction" are subjective reports reflecting sleep quality and as such are primary clinical indicators. The available data suggests that the association between subjective reports of sleep and objectively derived sleep data is weak. In order to develop the clinical utility of these subjective sleep reports it is critical to understand what factors may have an influence on these subjective reports.

Further, to refine the development of an appropriate clinical treatment it is critical to understand how these subjective sleep reports are associated with health-related outcomes.

Polysomnographic Correlates of Self-Reported Awakenings and Sleep Restoration

Andrew Krystal, MD
Duke University
Durham, NC, USA

Lack of restoration from sleep is one of the three types of sleep difficulty that define insomnia. Yet, we lack objective correlates of sleep restoration in insomnia patients. One factor that limits research on sleep restoration is that this aspect of sleep has not been operationalized.

This paper focuses on sleep restoration as a single self-rating such as might be found on a sleep diary. The goal is to examine physiologic correlates of these ratings. Potential measures include:

1. indices derived from traditional scoring of the polysomnogram (PSG) (total sleep time, sleep onset latency, wake time after sleep onset, sleep stage distribution and percentage, etc);
2. non-REM EEG spectral power; and
3. cyclic alternating pattern (CAP). Here we will discuss potential traditional PSG and non-REM EEG spectral measures.

We hypothesize that, due to the global and non-standardized nature of restedness ratings, the best physiologic correlate of these ratings is likely to differ among people and may well differ in the same individual over time.

In order to explore these issues we discuss data from two studies. In one of these studies a single night of PSG data was collected in 30 primary insomnia patients. In the other up to 6 nights of PSG data were collected in 64 primary insomnia patients and 60 controls.

The findings of these studies support the hypothesis that sleep restoration ratings are not unitary phenomena. The best physiologic correlate appears to differ in sub-groups of the population and depends on the number of nights of objective data studied.