title: Risk factors for sleep disturbances in older adults: Evidence from prospective studies.
abstract: No systematic review of epidemiological evidence has examined risk factors for sleep disturbances among older adults. We searched the PubMed database combining search terms targeting the following domains 1) prospective, 2) sleep, and 3) aging, and identified 21 relevant population-based studies with prospective sleep outcome data. Only two studies utilized objective measures of sleep disturbance, while six used the Pittsburgh sleep quality index (PSQI) and thirteen used insomnia symptoms or other sleep complaints as the outcome measure. Female gender, depressed mood, and physical illness were most consistently identified as risks for future sleep disturbances. Less robust evidence implicated the following as potentially relevant predictors: lower physical activity levels, African-American race, lower economic status, previous manual occupation, widowhood, marital quality, loneliness and perceived stress, preclinical dementia, long-term benzodiazepine and sedative use, low testosterone levels, and inflammatory markers. Chronological age was not identified as a consistent, independent predictor of future sleep disturbances. In conclusion, prospective studies have identified female gender, depressed mood, and physical illness as general risk factors for future sleep disturbances in later life, although specific physiological pathways have not yet been established. Research is needed to determine the precise mechanisms through which these factors influence sleep over time.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Smagula
authors.affiliation: Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
authors.affiliation: Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: jcauley@edc.pitt.edu.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012893:Sleep Wake Disorders
keywords: Aging; Insomnia; Prospective research; Risk factors; Sleep disturbance; Sleep quality