Evaluation of Sleep Quality and Sleepiness in Alzheimer 's Patients

Abstract

Sleep disorders are common in neurodegenerative diseases such as Alzheimer's type of Dementia (ATD). It has been reported that sleep disorders are especially prominent in moderate- severe stages of the disease. Sleep disorders may reduce quality of life, cognitive functions and may negatively affect the mood of the patients as well as the caregiver burden. The aim of this study was to evaluate the quality of sleep, sleepiness and related factors in 50 outpatients whom were admitted to the outpatient Geriatric Psychiatry Unit and were received a diagnosis of Alzheimer’s Type of Dementia according to the DSM-IV-TR criteria. A sociodemographic form, the Mini Mental State Examination (MMSE), Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Zarit Caregiver Burden Interview (ZBI), Functional Activities Questionnaire (FAQ) were applied to the participants and\or their caregivers. Most of the patients (62%) had sleep disturbances. The total ESS scores of the sample were significantly correlated with the FAQ scoresand age, but there was no association between EUS or PSQI scores and other scales as well as the duration of dementia. There was no difference between femaleand male patients in terms of the total PSQI and the total ESS scores. The results of the present study emphasized that sleep disturbances were associated with low level of functionality in patients with ATD, but there was no relation between the sleep disturbance and the caregiver burden. In future studies,developing specific assessment instruments for this group of patients and studying sleep disordersin comparison with healthy elderly people in larger samples are recommended.

Keywords

• Sleep Disturbances,Caregiver Burden,Functionality,Alzheimer type Dementia,Geriatric Psychiatry

Alzheimer Hastalarında Uyku Kalitesi ve Uykululuk Halinin Değerlendirilmesi

Öz

Uyku bozuklukları Alzheimer tipi Demans (ATD) gibi nörodejeneratif hastalıklarda sık görülmektedir. Özellikle hastalığın orta-ileri evresinde uyku bozukluklarının arttığı bildirilmektedir. Bu hastalarda uyku bozuklukları bireyin yaşam kalitesini, bilişsel işlevlerini düşürebilir, duygudurumunu ve bakım verenin yükünü olumsuz etkileyebilir. Bu çalışmada Geriatrik Psikiyatri Birimi polikliniğine ayaktan başvuran ve DSM-IV tanı ölçütlerine göre ATD tanısı alan 50 hastada uyku kalitesi ve uykululuk hali ile bunlarla ilişkili faktörlerin değerlendirilmesi amaçlanmıştır. Hastalara ve/veya yakınlarına sosyodemografik veri formu, Standardize Mini-Mental Test (SMMT), Pittsburgh Uyku Kalitesi İndeksi (PUKİ), Epworth Uykululuk Ölçeği (EUÖ), Zarit Bakıcı Yükü Ölçeği (ZBYÖ) ile İşlevsel Faaliyetler Anketi (İFA) uygulanmıştır. Hastaların çoğunun (%62) uyku sorunu yaşadığı görülmüştür. Hastaların sadece EUÖ puanları ile İFA puanları ve yaş arasında anlamlı pozitif korelasyon bulunmuş, ancak diğer ölçek puanları ve demans süresi ile EUÖ ve PUKİ puanları arasında anlamlı korelasyon saptanmamıştır. Kadın ve erkek hastalar arasında PUKİ ve EUÖ toplam puanları açısından anlamlı fark saptanmamıştır. Sonuç olarak, bu çalışma ATD hastalarında uyku bozukluklarının düşük işlevsellikle ilişkili olduğunu, ancak bakım veren yükünü etkilemediğini göstermiştir. İleride yapılacak çalışmalarda daha büyük örneklemlerde sağlıklı yaşlılarla kıyaslanarak çalışılması ve uyku bozuklukları için bu hasta grubuna özgü ölçüm araçlarının geliştirilmesi önerilir.

Anahtar Kelimeler

• Uyku bozuklukları,Bakım veren Yükü,İşlevsellik,Alzheimer tipi Demans

References

1. 1. Ağargün M.Y., Kara H., Anlar Ö. (1996) Pittsburgh Uyku Kalitesi İndeksi'nin geçerliği ve güvenirliği. Turk Psikiyatri Derg,7(2),107-115.
2. 2. Ancoli-Israel S., Ayalon L. (2006)Diagnosis and treatment of sleep disorders in older adults. Am J. Geriatr Psychiatry; 14, 95–103.
3. 3. Anderson K.N., Hatfield C., Kipps C., Hastings M., Hodges J.R. (2009 Mar).Disrupted sleep and circadian patterns in frontotemporal dementiaEur J Neurol. 16(3):317-23.
4. 4. Beaulieu-Bonneau S., Hudon C. (2009) Sleep disturbances in older adults with mild cognitive impairment. Int Psychogeriatr, 21, 654–66.
5. 5. Bedrosian T.A., Nelson R.J. (2012). Pro: Alzheimer’s disease and circadian dysfunction: chicken or egg? Alzheimers Res Ther, 4(4), 25.
6. 6. Berry R.B. (2012). Fundamentals of Sleep Medicine. Chapter 31: Sleep and neurologic disorders, Philedelphia PA: Elsevier Saunders. S.631-645
7. 7. Bonanni E., Maestri M., Tognoni G., Fabbrini M., Nucciarone B., Manca M.L., Gori S., Iudice A., Murri L.(2005). Daytime sleepiness in mild and moderate Alzheimer’s disease and its relationship with cognitive impairment. J Sleep Res., 14:311–317
8. 8. Buysse D.J., Reynolds C.F., Monk T.H., Berman S.R., Kupfer D.J.(1989 May). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.Psychiatry Res, 28(2):193-213.

9. 9. Chokroverty S.(2009). Sleep and neurodegenerative diseases. Semin Neurol.,29, 446–467
10. 10. Cole C., Richards K. (2007). Sleep disruption in older adults. Harmful and by no means in evitable, it should be assessed for and treated, Am J Nurs, 107(5), 40-9.
11. 11. Creese J., Bedard M., Brazil K., Chmbers L.(2008 Feb). Sleep disturbances in spousal caregivers of individuals with Alzheimer’s disease. Int Psychogeriatr, 20,149–161
12. 12. Deschenes C.L., McCurry S.M.(2009 Feb). Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep., 11, 20–26.
13. 13. Emek-Savaş D., Baklan B., Yener G.G. (2014). Sleep Disturbances in Patients With Alzheimer Disease and Dementia With Lewy Bodies. Journal of Neurological Sciences, 31(1), 144-154
14. 14. Fetveit A. (2009). Late-life insomnia: a review. Geriatr Gerontol Int, 9(3), 220–34.
15. 15. Fernández-Martínez M., Castro J., Molano A., Zarranz J.J., Rodrigo R.M., Ortega R (2008). Prevalence of neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. Curr Alzheimer Res, 5, 61-9.
16. 16. Garcia-Alberca J.M., Lara J.P., Cruz B., Garrido V., Gris E., Barbancho M.Á. (2013). Sleep disturbances in Alzheimer’s disease are associated with neuropsychiatric symptoms and antidementia treatment. J Nerv Ment Dis, 201, 251–257.
17. 17. Jones B. E. (2000) Principles and practice of sleep Medicine . WB Saunders, Philadelphia, 134–154
18. 18. Gaugler J.E., Edwards A.B., Femia E.E., Zarit S.H., Stephens M.A., Townsend A., Greene R.(2000 Jul) Predictors of institutionalization of cognitively impaired elders: Family help and the timing of placement. J Gerontol B Psychol Sci Soc Sci, 55, 247-255.
19. 19. Grace J.B., Walker M.P., McKeith I.G.(2000 Now.). A comparison of sleep profiles in patients with dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry 15, 1028–1033.
20. 20. Güngen C. , Ertan T. ,Eker E. , Yaşar R. ,Engin F. (2002 Jan) Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population, Turkish Journal of Psychiatry 13 (4),273-281]
21. 21. Harper D.G., Stopa E.G., McKee A.C., Satlin A., Harlan P.C., Goldstein R., Volicer L.(2001 Apr.), Differential circadian rhythm disturbances in men with Alzheimer’s disease and frontotemporal degeneration. Arch Gen Psychiatry,58(4), 353–360.
22. 22. İzci B., Ardic S., Firat H., Sahin A., Altinors M., Karacan I. (2008). Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath,12, 161-8.
23. 23. Johns M.W. (1992). Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15(4),376–381
24. 24. Lee, J. H., Bliwise, D. L., Ansari, F. P., Goldstein, F. C., Cellar, J. S., Lah, J. J., & Levey, A. I. (2007). Daytime sleepiness and functional impairment in Alzheimer disease. The American journal of geriatric psychiatry, 15(7), 620-626.
25. 25. Malhotra R.K. (2018) NeurodegenerativevDisorders and Sleep, Sleep Med Clin, 13, 63–70
26. 26. Mishima K., Tozawa T., Satoh K. Matsumoto Y, Hishikawa Y, Okawa M. (1999). Melatonin secretion rhythm disorders in patients with senile dementia of Alzheimer’s type with disturbed sleepwaking. Biol Psychiatry, 45(4), 417–21.
27. 27. Moe KE., Prinz P.N., Vitiello M.V., Marks A.L., Larsen H.L. (1991) Healthy elderly women and men have different entrained circadian temperature rhythms. J Am Geriatr Soc, 39, 383-7
28. 28. Mortimer J.A., Ebbitt B., Jun S.P.,Finch M.D.(1992). Predictors of cognitive and functional progression in patients with probable Alzheimer’s disease. Neurology, 42, 1689–1696
29. 29. Orhan F.O., Tuncel D., Taş F., Demirci N., Ozer A., Karaaslan M.F.(2012). Relationship between sleep quality and depression among elderly nursing home residents in Turkey. Sleep Breath, 16(4), 1059-67
30. 30. Özlü A., Yıldız M., Aker T. (2009). Zarit Bakıcı Yük Ölçeğinin Şizofreni Hasta Yakınlarında Geçerlilik ve Güvenilirlik Çalışması, Archives of Neuropsychiatry, 46 Supplement: 38-42
31. 31. Peter-Derex L., Yammine P., Bastuji H., Croisile B. (2015). Sleep and Alzheimer’s Disease. Sleep Medicine Reviews, 19, 29-38
32. 32. Pfeffer R.I., Kurosaki T.T., Harrah C.H. Jr, Chance J.M., Filos S.(1982). Meajurement functional activities of older adults in community. J Geront, 37, 3234- 329.
33. 33. Redline S., Kirchner H.L., Quan S.F., Gottlieb D.J., Kapur V., Newman A. (2004). The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Arch Intern Med 164, 406–18.
34. 34. Selekler,K., Cangöz, B., Karakoç, E.(2004) İşlevsel faaliyetler anketi’nin 50 yaş ve üzeri grupta Türk kültürü için uyarlama ve norm belirleme çalışması. Türk Nöroloji Dergisi, 10 (2), 102-107
35. 35. Stepnowsky C., Ancoli-Israel S.(2008) Sleep and its disorders in seniors. Sleep Med Clin, 3, 281–293.
36. 36. Vitiello M.V., Borson S.(2001) Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs, 15, 777–796.
37. 37. Zarit S., Reever K., Bach-Peterson J.(1980). Relatives of the impaired elderly: Correlates of feeling of burden. Gerontologist, 20, 649-55
38. 38. Zhao Q.F., Tan L., Wang H.F., Jiang T., Tan M.S, Tan L., Xu W., Li J.Q., Wang J., Lai T.J, Yu J.T. (2016). The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis. Journal ofAffective Disorders, 190, 264–271