Sleep-wake cycle disturbances in elderly acute general medical inpatients: longitudinal relationship to delirium and dementia

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Date
2017
Authors
FitzGerald, James M.
O'Regan, Niamh
Adamis, Dimitrios
Timmons, Suzanne
Dunne, Colum P.
Trzepacz, Paula T.
Meagher, David J.
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Elsevier Inc. on behalf of the Alzheimer’s Association
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Abstract
Introduction: Sleep disturbances in elderly medical inpatients are common, but their relationship to delirium and dementia has not been studied. Methods: Sleep and delirium status were assessed daily for a week in 145 consecutive newly admitted elderly acute general hospital patients using the Delirium Rating Scale-Revised-98 (DRS-R98), Diagnostic and Statistical Manual 5, and Richards-Campbell Sleep Quality Scale measures. The longitudinal relationship between DRS-R98 and Richards-Campbell Sleep Quality Scale sleep scores and delirium, also with dementia as a covariate, was evaluated using generalized estimating equation logistic regression. Results: The cohort was divided into delirium only, dementia only, comorbid delirium-dementia, and no-delirium/no-dementia subgroups. Mean age of total group was 80 ± 6.3, 48% were female, and 31 (21%) had dementia, 29 had delirium at admission (20%), and 27 (18.5%) experienced incident delirium. Mild sleep disturbance (DRS-R98 sleep item score ≥1) occurred for at least 1 day in all groups, whereas moderate sleep disturbance (score ≥2) occurred in significantly more of the prevalent delirium-only (81%; n = 17) cases than incident delirium-only (46%; n = 13) cases (P < .001). There were more cases with DRS-R98 sleep item scores ≥2 (P < .001) in the delirium-only group compared with the other subgroups. Severity of sleep-wake cycle disturbance over time was significantly associated with Diagnostic and Statistical Manual 5 delirium status but not with age, sex, or dementia (P < .001). Conclusions: Observer-rated more severe sleep-wake cycle disturbances are highly associated with delirium irrespective of dementia status, consistent with being a core feature of delirium. Monitoring for altered sleep-wake cycle patterns may be a simple way to improve delirium detection.
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Keywords
Dementia , Delirium , Sleep disturbance detection , Elder care medicine
Citation
Fitzgerald, J. M., O'Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T. and Meagher, D. J. (2017) ‘Sleep-wake cycle disturbances in elderly acute general medical inpatients: longitudinal relationship to delirium and dementia’, Alzheimer's and Dementia: Diagnosis, Assessment & Disease Monitoring, 7, pp. 61-68. doi: 10.1016/j.dadm.2016.12.013