Evaluation of sleep quality status, associated factors and its effects on geriatric syndromes in hospitalized geriatric patients

With aging, sleep rythm shifts, waking up early and increased sleep latency are seen. Time spent in bed is increased, night awakening and napping are frequent. Total sleep time, non REM and REM sleep are decreased.Older people with sleep problems have increased risk of heart failure, diabetes mellitus, depression, falls, dementia, delirium, impaired cognition and low quality of life. Sleep problems is a predictor of high morbidity and mortality. In this research our aim was to diagnose sleep disorders and their associated factors in older patients who are hospitalized at internal medicine wards by using practical methods and evaluate poor health outcomes. One hundred and one patients aged 65 years and over (54 female and 47 male) were included between August 2017 and September 2018. Seventy three patients were included at the second interview 1 week later. Sleep quality and insomnia were assessed by Pittsburgh Sleep Quality Index (PSQ) and Insomnia Severity Index (ISI). Comprehensive geriatric assesment tests and Charlson Comorbidity Index were performed. Comorbidities, medications and laboratory results were recorded. Patients were divided into two different groups according to PSQ and ISI scores, as insomnia present and absent. After comprehensive geriatric assesment, lower score of Katz (p:0,045) and lower score of MNA-sf (p:0,025) were found to be related to insomnia significantly. Patients using diuretics (p:0,044) and inhalers (p:0,017) had significantly higher scores on PSQ that means insomnia. At PSQ scale presence of asthma (p:0,016) within the chronic diseases were related to insomnia. Factors causing disruption in sleep according to both scales were cough (p:0,013), pain (p<0,001) and restless leg syndrome (p<0,001). These were significantly related to insomnia. According to ISI scale dyspnea was also related to sleep disturbance significantly (p:0,006). According to PSQ scale the total sleep duration was decresead significantly after one week (p <0,001) and the other components of PSQ were not significantly effected. Median score of the ISI scale was lower than the insomnia cut-off and there was no significant difference between the baseline and first week ISI scores. In regression analysis, presence of restless leg syndrome, pain, lower score of Katz and younger age were associated factors with insomnia according to PSQ scale. However lower score of Katz Scale, higher score of Yesavage Geriatric Depression Scale, presence of restless leg syndrome and diuretic usage were associated factors with insomnia according to USI scale. Number of medications (p:0,025; r:0,223) and Charlson Comorbidity Scores (p:0,014; r:0,245) were correlated with PSQ scores on the first interview. Yesevage Geriatric Depresion Scale score was positively correlated with insomnia (p:0,005; r:0,283) but MNA-sf score (p:0,006; r:-0,173), Lawton Brody score (p:0,006; r:-0,271) and Katz score (p<0,001; r:-0,377 had negatively weak correlation with insomnia. Results of this study revealed association between sleep problems and geriatric syndromes. Furthermore, sleep duration decreases after 1 week of hospitalization. Assessment of sleep should be a routine part of geriatric assessment in hospitalized patients. Key Words: Pittsburgh Sleep Index, Insomnia Severity Index, Charlson Comorbity Score, geriatric patient with insomnia