Journal OF MILITARY PHARMACO MEDICINE N05 2021 170 ASSOCIATION BETWEEN SLEEP DISTURBANCE AND SARCOPENIA AMONG OLDER ADULTS Nguyen Trung Anh1,2, Bui Thi Thu Trang2 Dang Thi Xuan3, Nguyen Xuan Thanh1,2[.]
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 ASSOCIATION BETWEEN SLEEP DISTURBANCE AND SARCOPENIA AMONG OLDER ADULTS Nguyen Trung Anh1,2, Bui Thi Thu Trang2 Dang Thi Xuan3, Nguyen Xuan Thanh1,2 SUMMARY Objectives: To investigate the association between sleep disturbances and sarcopenia among older adults Subjects and methods: A cross-sectional study on 522 patients aged 60 years old and over treated at the National Geriatric Hospital Patients were interviewed according to a uniform questionnaire; sleep disturbances were assessed by using the PSQI instrument The definition of the Asian Working Group for Sarcopenia 2019 was used for diagnosis of sarcopenia Results: The mean age of the patients was 70.91 ± 8.67 years The ratio of female/male was 1.45 The prevalence of sleep disturbances in older adults was 85.8% There was an association between sleep disturbance and sarcopenia among older adults with statistical significance after using both unilabiate and multivariable model logistic Conclusion: The prevalence of sleep disturbance was high and was associated with sarcopenia among older people Sleep disorders are very common in older adults and there was an association between sleep disturbance and sarcopenia The sleep disturbance among patients in general, those with sarcopenia in particular, should be paid much attention * Keywords: Sleep disturbance; The elderly; Sarcopenia INTRODUCTION Aging is a worldwide phenomenon with significant social, economic, and health implications Sleep disturbance is a group of conditions that affect the ability to sleep well on a regular basis and a decline in the quality of life, and it is considered to be a serious health problem Approximately 50% of older adults have complaints of sleep problems in their daily life [1] Sleep disturbance is associated with a decline in activities of daily living, cognitive function, falling and slows down basic metabolism The above factors are attributed to a reduction in skeletal muscle mass, strength, and function A combination of these changes has been called sarcopenia Sarcopenia is a common clinical problem in people over 50 years of age, which leads to severe adverse outcomes, including loss of function, disability, and frailty Degenerative changes in muscle tissue, unrelated to sarcopenia, were diagnosed in 14% of the male population and 13% of the female population in the age group 65 - 75 years, and 56% of men and 53% of women in the age group 80 years or older [2] National Geriatric Hospital Hanoi Medical University Vietnam Poison Control Center Corresponding author: Nguyen Trung Anh (trunganhvlk@gmail.com) Date received: 22/3/2021 Date accepted: 26/4/2021 170 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Nonetheless, the medical literature shows a gap between the role of sleep quality and its effects on the prevalence of sarcopenia [3] Vietnam will soon move to an aging population pyramid, so earlier understanding of the relationship between sleep disturbance and sarcopenia is important for providing potential targets for preventing and treating sarcopenia Besides, prevention is an advantage for improving people’s health status and decreasing the cost burden We conduct this study: To investigate the association between sleep disturbances and sarcopenia among older adults SUBJECTS AND METHODS Subjects The study was performed on 522 elderly patients at the National Geriatrics Hospital from June 1st to October 1st 2020 * Inclusion criteria: - Patients aged 60 years and older were examined and treated in National Geriatric Hospital from June 1st to October 1st 2020 - The patients had the physical and cognitive abilities to a face-to-face interview * Exclusion criteria: - Patients or families refused to participate in the study - Patients with inability to communicate Methods The study was a cross-sectional study The sample was selected according to the entire sampling method The estimated sample size was 380 elderly patients The number of elderly patients in our study was 522 Data were collected by using a unified research record * Variables: - Demographic information includes: full name, age, sex, residual place, marital status, educational level - Sleep disturbance was assessed by using the PSQI instrument Total score PSQI is calculated by the sum of components Evaluation results: Good sleep (< points), poor sleep (≥ points) - Sarcopenia diagnosis was performed by the standards of the Asian Working Group for Sarcopenia (AWGS) Based on the AWGS, sarcopenia is diagnosed with (1) low muscle mass and (2) low HGS [4] * Evaluation of results: Table 1: Evaluation of results AWGS Men (1) Low muscle mass (ASM/ht2) < 7.0 kg/m (2) Low HGS < 28 kg Women < 5.4 kg/m < 18 kg * Data processing and data analysis: Descriptive statistics were adopted to examine characteristic data: frequency, percentage, mean Inferential statistics was done to perform comparisons between groups: Chi-square, multivariable regression Statistical significance was accepted at the 95% confidence level (p < 0.05) * Ethical consideration: Study subjects were explained clearly about the purpose of the study, and they were willing to participate in the study Collected data was used for research The results of the study were proposed for improving health of the community, not for other purposes 171 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 RESULTS Demographic characteristic Table 2: Description of demographic characteristics (n = 522) Total Variables n = 522 (%) Yes n = 327 (%) No n = 195 (%) 70.91 ± 8.67 73.32 ± 9.02 66.85 ± 6.22 60 - 69 265 (50.8) 128 (43.8) 137 (51.7) 70 - 79 156 (29.9) 105 (67.3) 51 (32.7) ≥ 80 101 (19.3) 94 (93.1) (6.9) Male 213 (40.8) 150 (70.4) 63 (29.6) Female 309 (59.2) 177 (57.3) 132 (42.7) Primary school or below 191 (50.3) 183 (69.3) 81 (30.7) Secondary school 107 (28.2) 79 (56.4) 61 (43.6) High school 46 (12.1) 18 (36.1) 39 (68.4) College/university and above 37 (9.5) 47 (77.1) 14 (22.9) Married 411 (78.7) 233 (56.) 178 (43.3) Other 111 (21.3) 94 (84.7) 17 (15.3) With family 496 (95.0) 305 (61.5) 191 (38.5) With caregiver (0.6) (100.0) (0.0) Alone 21 (4.0) 17 (81.0) (19.0) Others (0.4) (100.0) (0.0) Rural 249 (47.7) 174 (69.9) 75 (30.1) Urban 73 (52.3) 153 (56) 120 (44.0) ( Age Sarcopenia ± SD) Gender Educational level < 0.001 0.002 Marital status < 0.001 < 0.001 Living status Current living place p 0.099 0.007 A total of 522 participants, the age ranged from 60 to 98, with the mean age being 70.91 ± 8.67 years old The greatest distribution was generated by people aged from 60 to 69, with the percentage of 50.8%, of which the highest percentage of sarcopenia in the older adults aged 80 and above was 93.1% Female accounted for 59.2% (n = 309), higher than the male (40.8%) (n = 213) The ratio of female/male was 1.45 More than half of the participants (78.7%) got married The majority lived with family (95.8%) Among participants living in rural, the prevalence of sarcopenia was higher compared to people living in urban (69.9% and 56.0%) These differences were statistically significant with p = 0.001, respectively 172 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 THE PREVALENCE OF SLEEP DISTURBANCES (N=522) 14.20% Good sleep Poor sleep 85.80% Figure 2: Prevalence of sleep disturbances among older adults (n = 522) Fig presented sleep disturbances among older people The prevalence of poor sleep was 85.80% (448 people), the prevalence of good sleepers was 14.2% (74 people) Table 2: Characteristics of some components of sleep disturbances by PSQI questionnaire (n = 522) Component of PSQI Sleep latency Sleep efficiency Sleep quality Sleep disturbance Sleep medication Daytime function Classification n (%) Can sleep within 30 minutes 354 (67.8) Cannot sleep within 30 minutes 168 (32.2) ≥ 85% 136 (26.1) < 85% 384 (73.9) Very good 46 (8.8) Fairly good 476 (59.8) Fairly bad 136 (26.1) Very bad 340 (5.4) Getting up at midnight or early morning 433 (83.0) Getting up to use the bathroom 89 (67.6) Feeling difficult to breath 274(52.5) Coughing or snoring 302 (58.0) Feeling cold 119 (22.8) Feeling hot 124 (23.8) Having bad dreams 177 (33.9) Having pain 293 (56.1) Other 15 (2.9) Non-users 412 (78.9) Taking sleeping pills 110 (21.1) Difficult in staying awake 217 (41.6) Difficult in enthusiasm 277 (53.1) No suffering from difficult in acting in daytime 268 (51.3) Difficult in acting in daytime 254 (48.7) 173 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Almost all patients cannot sleep within 30 minutes occupying 32.2% The prevalence of people having sleep efficiency of more than 85% was 26.1% and less than 85% was 73.9% Sleep quality showed that the highest prevalence of older adults having fairly good sleep was 59.8% and the lowest prevalence of older adults having very bad sleep was 5.40% Only 8.80% of people had a good sleep Regarding sleep disturbance, the majority of people had to get up at midnight or early morning (83.0%) 67.6% of patients must get up to use the bathroom like notarial The percentage of patients feeling pain when sleeping was 56.1% The rates of patients coughing or snoring and feeling difficult to breathe were 58.0% and 52.5%, respectively 33.9% of patients had bad dreams The proportion of patients feeling cold and hot were 22.8% and 23.8%, respectively The majority of the elderly people did not use sleeping pills (78.9%) The proportion of patients no having difficulty in daytime activities and having difficulty in daytime activities were 48.7% and 51.3%, respectively * Association between sleep disturbance and sarcopenia: Table 3: Univariate regression association between sleep disturbance and sarcopenia 95%CI Characteristic OR p Lower Upper Long sleep latency 1.017 1.006 1.028 0.002 Sleep duration 0.863 0.759 0.983 0.027 High sleep efficiency 0.988 0.977 0.999 0.026 Low sleep quality 2.434 1.801 3.288 < 0.001 Use sleep medication 1.550 1.160 2.071 0.003 Impair daytime function 2.007 1.501 2.683 < 0.001 Sleep disturbance 2.086 1.270 3.425 0.004 Table demonstrated sleep disturbance factors related to sarcopenia Among sarcopenia older adults, the people had long sleep latency more than the ones getting short sleep latency with OR = 1.017, 95%CI: 1.006 - 1.028 This rate was significant (p = 0.002) Patients with long sleep duration (OR = 0.759, 95%CI: 1.047 - 10.041, p = 0.027) and best sleep efficiency (OR = 0.988, 95%CI: 0.977 - 0.999, p = 0.026) had lower odds in sarcopenia Patients with bad sleep quality (OR = 2.434, 95%CI: 1.801 - 3.288, p < 0.001) had higher odds in sarcopenia Patients with sleep medication (OR = 1.550, 95%CI: 1.160 - 2.071, p = 0.003) had higher odds in sarcopenia 174 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Regarding physical function in poor sleepers, the rate of impaired people higher 2.007 times than the rate of normal ones (95%CI: 1.501 - 2.683) It was statistic significant (p < 0.001) Patients with sleep disturbances 2.086 (95%CI: 1.270 - 3.425) had higher odds in sarcopenia This rate was significant (p = 0.004) Table 3: Logistic regression of sleep disturbances and sarcopenia (n = 522) Adjust odds ratios for being sarcopenia p Model 1.700 (1.006 - 2.872) 0.047 Model 1.715 (1.004 - 2.929) 0.048 Model 2.090 (1.224 - 3.568) 0.007 * Model adjustment age * Model adjustment age, low education level * Model adjustment age, low education level, malnutrition, depression After adjustment for age, low education level, malnutrition, depression was associated with increased odds of greater sarcopenia remain significant (multivariable odds ratio (MOR) 2.090, 95%CI (1.224 - 3.568) higher than before adjustment OR = 2.086, 95%CI: 1.270 - 3.425) for sleep disturbances DISCUSSION The majority of the elderly getting poor sleep was 448 people (85.80%) with the score of PSQI ranging from to 23, mean score of 9.39 (SD = 4.37) In Malaysia’s study, the PSQI score ranged from to 16 with a mean score of 7.1 (SD 3.4) and the majority of poor sleep (76.8%, n = 116) [5] The result was higher than a study in Japan (2019), the prevalence of sleep disorder was 44.8% There was a statistically significant association between sleep disturbance and sarcopenia (p = 0.004) Patients with sleep disturbances (OR = 2.086, 95%CI: 1.270 - 3.425) had high odds in sarcopenia After adjustment for age, education level, nutrition status, and depression were associated with increased odds of greater sarcopenia remain significant (multivariable odds ratio (MOR) 2.090, 95%CI (1.224 3.568), p = 0.007) This result similar to a systematic review research [7] showed that the prevalence of sarcopenia appears to be associated with sleep quality, with higher prevalence values in older adults who have an inadequate sleep In addition, this prevalence seems to be higher in men than in women This result lower with a study in Japan in 2019 with 318 patients Adjusted odds ratios of sarcopenia and sleep disorder were 6.04 in men (95%CI: 1.71 - 21.36, p= 0.005) and 6.33 in women 175 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 (95%CI: 1.91 - 20.97, p = 0.003) found a statistically significant association between sarcopenia and sleep disorder in older patients with diabetes using SARC‐F questionnaire [6] This difference between this study and research can be explained by the fact that the sample size (n = 522 > 318) and the prevalence of sarcopenia between each research were different Among sarcopenia older adults, the people had long sleep latency more than the ones getting short sleep latency with OR = 1.017, 95%CI: 1.006 - 1.028 This rate was significant (p = 0.002) In the sarcopenia group, the prevalence of sleep disturbance was higher than in this study [8] A research in 2019 reported lowest category of sleep duration (under 6h) versus the reference category (6 - 8h) was significantly related to the increased risk of sarcopenia (OR = 1.71; 95%CI: 1.11 - 2.64) This meta-analysis indicates that the public should be aware of the negative consequences of long and short sleep for sarcopenia, especially among women [9] A cross-sectional study of 607 participants aged 60 years and older living in China In women, the prevalence of sarcopenia was significantly higher in the short sleep duration group (< hours - 27.5%) and long sleep duration group (> 8 hours - 22.2%) compared with women in the normal sleep duration group (6 - hours - 13.9%) (respectively; p = 0.014) Similar results were found in men; however, the differences between groups were not statistically significant 176 (18.5%, 20.6%, and 13.0%, respectively; p = 0 .356) A U-shape relationship between self-reported sleep duration and sarcopenia was identified in a population of Chinese community-dwelling older adults, especially in women These results could have a practical application for public health since they can help us to consider sleep quality as a risk factor, as well as the need to incorporate therapies in order to improve the sleep quality and to reduce the negative effects of ageassociated sarcopenia CONCLUSION The prevalence of sleep disturbance was high and was associated with sarcopenia among older people Sleep disorders are very common in older adults and there was an association between sleep disturbance and sarcopenia Medical staffs should concern more about the patient’s sleep disturbance, especially in patients with sarcopenia REFERENCES Neikrug AB, Ancoli-Israel S Sleep disorders in the older adult - a mini-review Gerontology 2010; 56(2):181-189 Baumgartner Richard N, Koehler Kathleen M, Gallagher Dympna, et al Epidemiology of sarcopenia among the elderly in New Mexico American Journal of Epidemiology 1998; 147(8):755-763 Chien MY, Wang LY, Chen HC The Relationship of sleep duration with obesity and sarcopenia in community-dwelling older adults Gerontology 2015; 61(5):399-406 ... of sleep disturbance was high and was associated with sarcopenia among older people Sleep disorders are very common in older adults and there was an association between sleep disturbance and sarcopenia. .. activities were 48.7% and 51.3%, respectively * Association between sleep disturbance and sarcopenia: Table 3: Univariate regression association between sleep disturbance and sarcopenia 95%CI Characteristic... PREVALENCE OF SLEEP DISTURBANCES (N=522) 14.20% Good sleep Poor sleep 85.80% Figure 2: Prevalence of sleep disturbances among older adults (n = 522) Fig presented sleep disturbances among older people