title: A longitudinal study of poor sleep after inpatient post-acute rehabilitation:  the role of depression and pre-illness sleep quality.
abstract: OBJECTIVE
  To explore the unique impact of poor sleep and symptoms of depression on sleep quality for up to 1 year after inpatient post-acute rehabilitation among older adults.
  
  
  METHODS
  Prospective longitudinal cohort study.
  
  
  METHODS
  Two inpatient post-acute rehabilitation facilities.
  
  
  METHODS
  A total of 245 individuals older than 65 years (mean age = 80 years, 38% women).
  
  
  METHODS
  None.
  
  
  METHODS
  Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) during the post-acute care stay twice to evaluate pre-illness sleep quality and sleep quality during the post-acute care stay, and again at 3-, 6-, 9-, and 12-month follow-up. Demographics, symptoms of depression, cognitive functioning, and comorbidities were also assessed.
  
  
  RESULTS
  Across time points, sleep was significantly disturbed for many individuals. Nested regression models predicting PSQI total score at 3, 6, 9, and 12 months showed that variables entered in Block 1 (age, gender, cognitive functioning, and comorbidities) were significant predictors of poor sleep at 6-month follow-up but not at 3-, 9-, or 12-month follow-up. Depression (Block 2) and pre-illness PSQI total score (Block 3) were significant predictors of PSQI total score at all follow-up time points. PSQI total score during post-acute care (Block 4) explained a significant proportion of variance only at the 3-month follow-up.
  
  
  CONCLUSIONS
  This study confirms that chronic poor sleep is common among older adults during post-acute rehabilitation and resolution of sleep disturbance after acute health events may be a lengthy process. Our findings expand understanding of the role of depressive symptoms and preexisting sleep complaints in predicting poor sleep over time among these vulnerable older adults.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. jennifer.martin@va.gov
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
authors.forename: Stella
authors.initials: S
authors.lastname: Jouldjian
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mitchell
authors.forename: Karen R
authors.initials: KR
authors.lastname: Josephson
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Alessi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D012046:Rehabilitation; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires