More daytime sleeping predicts less functional recovery among older people undergoing inpatient post-acute rehabilitation.
OBJECTIVE
To study the association between sleep/wake patterns among older adults during inpatient post-acute rehabilitation and their immediate and long-term functional recovery


METHODS
Prospective, observational cohort study.


METHODS
Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration).


METHODS
Older patients (aged > or = 65 years, N = 245) admitted for inpatient post-acute rehabilitation.


METHODS
None.


RESULTS
Based on 7-day wrist actigraphy during the rehabilitation stay, mean nighttime percent sleep was only 52.2% and mean daytime percent sleep was 15.8% (16.3% based on structured behavioral observations). Using the Pittsburgh Sleep Quality Index (PSQI), participants reported their sleep was worse during rehabilitation compared to their premorbid sleep. Functional recovery between admission and discharge from rehabilitation (measured by the motor component of the Functional Independence Measure) was not significantly associated with reported sleep quality (PSQI scores) or actigraphically measured nighttime sleep. However, more daytime percent sleep (estimated by actigraphy and observations) during the rehabilitation stay was associated with less functional recovery from admission to discharge, even after adjusting for other significant predictors of functional recovery (mental status, hours of rehabilitation therapy received, rehospitalization, and reason for admission; adjusted R2= 0.267, P < 0.0001). More daytime sleeping during rehabilitation remained a significant predictor of less functional recovery in adjusted analyses at 3-month follow-up.


CONCLUSIONS
Sleep disturbance is common among older people undergoing inpatient post-acute rehabilitation. These data suggest that more daytime sleeping during the rehabilitation stay is associated with less functional recovery for up to three months after admission for rehabilitation.
Alessi
Cathy A
CA
Geriatric Research, Education and Clinical Center, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA, USA. cathy.alessi@va.gov
Martin
Jennifer L
JL
Webber
Adam P
AP
Alam
Tarannum
T
Littner
Michael R
MR
Harker
Judith O
JO
Josephson
Karen R
KR
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000534:rehabilitation*; D002940:Circadian Rhythm; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory; D009735:Nursing Homes; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012890:Sleep; D014851:Wakefulness
Am J Geriatr Psychiatry. 2006 Feb;14(2):121-9
16473976
Psychiatry Res. 1989 May;28(2):193-213
2748771
Stroke. 1996 Feb;27(2):252-9
8571419
Arch Phys Med Rehabil. 1995 Jun;76(6):495-500
7763146
Nurs Res. 2004 May-Jun;53(3):154-62
15167503
Health Qual Life Outcomes. 2004 Mar 24;2:17
15040803
J Adv Nurs. 2005 Feb;49(3):245-53
15660548
J Am Geriatr Soc. 1995 Feb;43(2):130-7
7836636
Clin Orthop Relat Res. 1980 Oct;(152):173-84
7438601
Arch Phys Med Rehabil. 1993 Feb;74(2):133-8
8431095
Sleep. 2005 Aug 1;28(8):981-9
16218081
J Am Geriatr Soc. 2005 May;53(5):803-10
15877555
J Am Geriatr Soc. 2000 Nov;48(11):1389-97
11083313
J Gerontol. 1990 May;45(3):M101-7
2335719
JAMA. 1997 Feb 5;277(5):396-404
9010172
J Am Geriatr Soc. 1988 Sep;36(9):801-6
3411063
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
Stroke. 1992 Jul;23(7):978-82
1615548
Sleep. 2001 Feb 1;24(1):96-105
11204058
J Neurol. 2000 Jan;247(1):41-7
10701896
Sleep Med Rev. 2004 Jun;8(3):159-74
15144959
J Psychosom Res. 2004 May;56(5):497-502
15172205
Sleep. 1997 Jan;20(1):18-23
9130329
Sleep. 2006 Jul;29(7):881-9
16895254
J Clin Nurs. 2007 Jan;16(1):46-57
17181666
Clin Geriatr Med. 1993 Nov;9(4):705-16
8281500
Psychiatry Res. 1992 Mar;41(3):237-48
1594710
Psychol Aging. 1990 Mar;5(1):16-24
2317297
Sleep. 1995 Jul;18(6):425-32
7481413
Nurs Res. 1994 May-Jun;43(3):168-73
8183659
Psychosom Med. 2003 Jan-Feb;65(1):63-73
12554816
J Am Geriatr Soc. 2000 Dec;48(12):1669-73
11129760
J Am Geriatr Soc. 1990 Oct;38(10):1139-44
2172352
J Am Geriatr Soc. 1994 Jul;42(7):757-62
8014352
Sleep. 1996 Jan;19(1):59-64
8650465
Psychosom Med. 2006 May-Jun;68(3):427-36
16738075
Sleep. 2003 May 1;26(3):293-7
12749548
J Gerontol A Biol Sci Med Sci. 2000 Jul;55(7):M406-11
10898258
J Am Geriatr Soc. 1983 Mar;31(3):166-70
6338093