Geriatric Sleep Research Program
Functional Outcomes of Excessive Daytime Sleepiness in the Elderly
Manuscript accepted for publication, Journal of the American Geriatrics Society
Objective: To describe the impact of self-reported excessive daytime sleepiness (EDS) on functional outcomes.
Design: Case-control study of daytime sleepiness in 114 non-depressed, non-demented adults, age 65 and older, designed to examine differences in functional status between cases (with daytime sleepiness) and controls (no daytime sleepiness) with regards to demographic factors, general health, sleep history, and medications.
Participants: Subjects were recruited from 26 retirement communities.
Measurements: Standardized questionnaires to assess disease-specific functional status [Functional Outcomes of Sleepiness Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS)], depression (Geriatric Depression Scale-Short Form and the Center for Epidemiologic Studies-Depression screen), dementia (Short Blessed Test), demographic factors, current medical history and sleep complaints.
Results: There was a significant difference in functional status between sleepy cases versus non-sleepy controls. Sleepiness had moderate to large negative impact effect (effect size range from 0.59 to 0.83, p<0.005) on the following functional domains of the FOSQ: social outcome, general productivity, vigilance and activity level as well as global assessment of functional status. Correlation between ESS and FOSQ subscales were -0.31 to -0.67, p<0.05. Examination of cases with daytime sleepiness revealed increased functional impairment in individuals with more than three medical conditions or those taking more than four medications (p<0.001 and p=0.03 respectively).
Conclusions: Daytime sleepiness is associated with functional impairments in a broad range of activities. The decrease in daily functioning noted in the sleepy subjects has implications for deconditioning and related co-morbidity. These findings suggest that exploration of daytime sleepiness should be part of the ongoing assessment of the elderly, particularly those with multiple medical conditions.
Nalaka S. Gooneratne
Terri E. Weaver
Jacqueline R. Cater
Frances M. Pack
Heidi M. Arner
Andra S. Greenberg
Allan I. Pack