title: Underperception of Naps in Older Adults Referred for a Sleep Assessment: An Insomnia Trait and a Cognitive Problem?
abstract: OBJECTIVE
  To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Outpatient geriatric sleep clinic.
  
  
  METHODS
  Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135).
  
  
  METHODS
  Tests included clinical interview, sleepiness scale, anxiety and depression scale, Insomnia Severity Index (ISI), Mini-Mental State Examination (MMSE), and overnight polysomnography, followed by multiple sleep latency tests. At the end of each of four nap opportunities, participants answered whether they had slept during the test. Nap underperception was defined as two or more unperceived naps.
  
  
  RESULTS
  Of the 105 participants who napped at least twice, 42 (40%) did not perceive at least two naps. These participants had lower MMSE scores (P = .01) and were more likely to be taking benzodiazepines (P = .008) than the 63 participants who did not underperceive their naps but had similar demographic characteristics, sleep diagnoses, depression and anxiety scores, and polysomnography measures. Both groups had similarly short mean daytime sleep latencies (9.7 ± 4.5 minutes and 9.8 ± 3.7 minutes), but participants who underperceived their naps scored lower on the Epworth Sleepiness Scale (5.6 ± 4.0, vs 9.6 ± 4.8, P < .001). An ISI of 11 or greater, a MMSE score of 26 or less, and a sleepiness score of 8 or less were each independently associated with underperception of naps. The combination of these three factors yielded a positive predictive value of 93% and a negative predictive value of 71% for nap underperception.
  
  
  CONCLUSIONS
  Older adults referred for sleep consultation with cognitive impairment and greater insomnia symptoms frequently underperceive naps, leading them to underestimate their level of sleepiness. In such cases, objective measures of daytime sleepiness would be better than the Epworth Sleepiness Scale.
authors.affiliation: Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France.|Geriatric Department, Consultation and Investigation Center for the Elderly, Paris, France.
authors.forename: Vi-Huong
authors.initials: VH
authors.lastname: Nguyen-Michel
authors.affiliation: Public Health Department, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de l'Est Parisien, Paris, France.|Epidemiology of Allergic and Respiratory Diseases Team, Unité Mixte de Recherche en Santé 1136, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.|Epidemiology of Allergic and Respiratory Diseases Team, Inserm U 1136, Paris, France.
authors.forename: Pierre-P
authors.initials: PP
authors.lastname: Lévy
authors.affiliation: Department of Clinical Neurophysiology, Insomnia Investigation Center, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pallanca
authors.affiliation: Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France.|Geriatric Department, Consultation and Investigation Center for the Elderly, Paris, France.|Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.|Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Centre National de la Recherche Scientifique, Paris, France.
authors.forename: Kiyoka
authors.initials: K
authors.lastname: Kinugawa
authors.affiliation: Department of Neurology, Louis Pasteur Hospital, Le Coudray, France.
authors.forename: Raluca
authors.initials: R
authors.lastname: Banica-Wolters
authors.affiliation: Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Sebban
authors.affiliation: Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France.|Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.|Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Centre National de la Recherche Scientifique, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Mariani
authors.affiliation: Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France.|Department of Clinical Neurophysiology, Insomnia Investigation Center, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.|Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Fournier
authors.affiliation: Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.|Sleep Disorders Unit, National Reference Center for Narcolepsy, Hypersomnia and Kleine-Levin Syndrome, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
mesh_terms: D000368:Aged; D001364:Awareness; D003072:Cognition Disorders / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017286:Polysomnography; D011446:Prospective Studies; D012017:Referral and Consultation; D012720:Severity of Illness Index; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: aged; cognition; daytime sleepiness; insomnia; sleep perception