Sleep state misperception in the elderly. A community study of objective and subjective sleep problems and their presentation in general practice.
Projectomschrijving
Slaapproblemen zijn een veelvoorkomend klacht in de eerstelijnszorg.
Werkwijze
Er is bij 2.076 deelnemers aan de Rotterdam Study van 46-97 jaar uitgebreide informatie verzameld over het slaapgedrag. Deelnemers kregen een slaapkwaliteitsvragenlijst, hielden een slaapdagboek bij en droegen een week een actimeter waarmee hun 24-uurs bewegingspatroon in kaart is gebracht
Resultaten
- Er lijkt geen rol voor actimetrie in de diagnostiek van slaapstoornissen door de huisarts.
- Actimetrie kan wel goed worden gebruikt voor onderzoek naar slaap in de algemene bevolking.
- De met actimetrie gemeten slaap kan sterk verschillen van zelfgerapporteerde slaap. Dit is interessant voor huisartsen. Bovendien heeft het gevolgen voor ander onderzoek. Bevolkingsonderzoek naar slaapduur wordt namelijk vaak alleen gedaan met zelfrapportage-methoden. Studies met alleen zelfrapportage-methoden kunnen een vertekend beeld geven.
Verslagen
Eindverslag
Samenvatting van de aanvraag
BACKGROUND Sleep problems are very common in the general population as well as in primary care. General practitioners can manage sleep problems by giving information, education about sleep hygiene, stress management and use of hypnotic agents.[1, 2] Particularly in the elderly, however, it is unclear whom to target for these interventions. On the one hand, some patients with compelling sleep complaints have no objective sleep difficulties. Among the range of insomnia subtypes "sleep state misperception" (subjective insomnia) is perhaps the most difficult for the general practitioner to identify.[3] On the other hand, many non-complaining individuals sleep rather poorly, and still others report and show objective evidence of poor sleep. OBJECTIVE The aim of this study is to objectify sleep complaints and problems in the elderly. This will enable us to study the prevalence, the presentation in general practice and patient characteristics associated with subjective and objective insomnia in community-dwelling elderly. We will examine how social factors, physical health, and psychiatric disorders determine the perception and presentation of sleep complaints. Our overall objective is to provide practitioners with a method and information on how to manage sleep problems and insomnia in general practice. The results will be incorporated in a diagnostic algorithm for sleep complaints in primary care. METHOD The proposed study is conducted in the framework of the population-based Rotterdam Study.[4] From May 2004 onwards 2800 participants aged 57 and above will be re-examined. All participants undergo an extensive health assessment including several cardiologic, loco-motor, neurological and psychiatric examinations. Objective information about sleep-wake schedule and sleep quality will be obtained with actigraphy. An actimeter records accelerations associated with movements. The type used in this study is also equipped with a button which enables the wearer to mark e.g. awakenings during sleep time and and wake up time. In this project, an actimeter is worn around the wrist for five to seven consecutive nights. The movements are highly correlated with frequency and duration of awakenings and total sleep time.[5] Subjective sleep quality and complaints are assessed with the Pittsburgh Sleep Quality Index and a sleep log. The questionnaire discriminates between "good" and "poor" sleepers and elicits information on a variety of sleep disturbances that might affect sleep quality.[6] The sleep log is used to document the sleep perception in the nights with actigraphy. Furthermore, there is a computerised linkage with general practitioner records to extract all relevant health events and complaints. RELEVANCE: Adequate management of sleep problems in primary care may require more sophisticated and objective measures of sleep in selected patients. The boundaries of normal and abnormal age-related sleep changes as well as the guidelines for the choice of intervention are not clear. For example, if individuals with sleep state misperception can be identified, the use of hypnotics may be reduced and patient communication improved.