Research Review
(1) New studies in the journal Sleep examine sleep problems in older adults
Sleep is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. Sleep reports sleep-related issues that affect the health and quality of life of older adults.
The following findings of three new studies appear in the August 2005 issue of the journal.
Insomnia does not lead to an increased risk of death
In a study of 13,564 adults from 45 to 69 years of age, the results showed that insomnia is not associated with an increased risk of death during an average follow-up period of 6.3 years.
While 23 percent of participants reported having insomnia, the study indicates that these complaints did not predict a higher likelihood of death in the 709 members of the study group who died during follow-up.
Sleep problems in elderly women related to a reduction in quality of life
A survey of 1,001 elderly Australian women shows that higher scores for sleeping difficulty are associated with a greater reduction in health-related quality of life. While not pointing to a causal relationship, the statistical analysis shows a significant association between sleep problems and quality of life even when other factors such as underlying medical conditions and depression are considered. These results underscore the importance of strategies to assist women to find safe methods to deal with sleeping difficulty and to recognise sleeping difficulty as a valid symptom, not just a normal part of ageing.
Getting more or less sleep than normal is associated with health risks in elderly
A study of 1,026 Parisians between the ages of 60 and 101 shows that health risk factors increase in those getting the most and the least amounts of sleep. Poor health is significantly related to a short average nightly sleep duration of 4.5 hours or less, while the presence of a physical disease is associated with very long sleep of 9.5 hours or more.
The researchers suggest that such self-reported sleep-wake data can help physicians identify elderly patients at risk of having sleep problems.
(2) Impaired performance in commercial drivers: Role of sleep apnea and short sleep duration
According to a major new study by Penn researchers (University of Pennsylvania School of Medicine) truck drivers who routinely get too little sleep or suffer from sleep apnoea show signs of fatigue and impaired performance that can make them a hazard on the road.
This study, published in the 15 August 2006 on-line issue of the American Journal of Respiratory and Critical Care Medicine, is among the largest and most comprehensive studies of truck drivers and fatigue ever done. The study examined 406 truck drivers and found that those who routinely slept less than five hours a night were likely to fare poorly on tests designed to measure sleepiness, attention and reaction time, and steering ability. Drivers with severe sleep apnoea, a medical condition that causes a poor quality of sleep, also were sleepy and had performance impairment.
Allan Pack, a sleep expert directing Penn's Centre for Sleep and Respiratory Neurobiology, said that
“… Tired truck drivers had impaired performance similar to that of drivers who are legally drunk. We identified some very impaired people.
”Nearly five percent of the truckers had severe sleep apnoea (a condition in which someone stops breathing often during sleep), and about 13 percent of the drivers got fewer than five hours of sleep a night on a regular basis. There are daytime neurobehavioral performance impairments that are found commonly in commercial drivers, and these are more likely among those who get an average of five or less hours of sleep a night and those who suffer from severe obstructive sleep apnoea."
To measure the impact of fatigue on driver performance and safety, the Penn researchers sent questionnaires to 4,826 truck drivers who had commercial licenses and lived within 50 miles of the Penn sleep centres. After getting complete responses from 1,329 drivers, they focused on 247 drivers at high risk for sleep apnoea and 159 drivers at low risk.
The truck drivers, almost all men and on average 45 years old, were given wrist motion detection devices to measure how much they slept during a week. They then were put through a battery of tests at the sleep centre. The drivers were monitored in the sleep lab while they slept to see if they had sleep apnoea. About 28 percent of the drivers were found to have some degree of sleep apnoea, with nearly five percent of them having a severe case.
Three tests were then given to measure daytime sleepiness and performance. The drivers were put in a dark room and observed to see how long it took them to doze off. Drivers who logged less than five hours of sleep dozed-off more quickly than those who got seven to eight hours of sleep. Drivers with severe sleep apnoea also dozed-off more rapidly. A lab test to analyse attention and reaction time and another to gauge "lane tracking ability" also turned up performance impairment among the sleep-deprived.
When the results were compiled, investigators discovered:
* Just over five percent of drivers showed impairment on all three performance-related tests.
* Nearly 60 percent did not fare well by at least one measure.
* About half of the drivers who got less than five hours of sleep had two or three impairments. That is compared to 10 percent of driver who got more than eight hours of sleep regularly.
* Likewise, about 60 percent of the drivers with severe sleep apnoea had two or three impairments.
According to the journal article, about 5,600 people are killed each year in the US in crashes involving commercial trucks. Many of the crashes happen when the driver falls asleep at the wheel. Penn researchers are now suggesting specific steps for the Federal Motor Carrier Safety Administration to take to improve safety for everyone on our roads:
* Develop strategies to identify impaired drivers through objective testing.
* Implement programs to identify and test drivers with severe sleep apnoea and monitor that they stick to their treatment.
* And introduce programs to assess and promote longer durations of sleep among commercial drivers.
References
Redline S and Pack AI, 2006. Rising to meet an unmet Public Health need: Sleep medicine and the pulmonary community. American Journal of Respiratory and Critical Care Medicine; 174: 487-488. Published on-line, 15 August 2006.
Division of Sleep Medicine or Centre for Sleep and Respiratory Neurobiology, http://www.uphs.upenn.edu/sleepctr/
Allan Pack http://www.uphs.upenn.edu/sleepctr/faculty/Pack.html
Medical News Today http://www.medicalnewstoday.com/medicalnews.php?newsid=49787
Monika
Monika Bhatia
Project Manager and Editor, Quality4life
28 August 2006
