title: Feasibility of self-administered sleep assessment in older women in the Women's Health Initiative (WHI).
abstract: OBJECTIVE
  Laboratory-based polysomnography (PSG) is the gold standard assessment of sleep disordered breathing (SDB). In large cohort studies and clinical trials, however, these overnight procedures can be expensive and burdensome to participants, especially older adults. In preparation for a large observational study, we determined the feasibility of self-administering two devices mailed to participants' homes that estimate indices of SDB.
  
  
  METHODS
  In two separate studies, older women enrolled in the Women's Health Initiative (WHI) Memory Study extension aged mean (SD) 85.77 (2.98) years who were not using supplemental oxygen and consented to being in the feasibility study completed either an in-home, self-administered overnight sleep assessment using a multi-sensor device that measured oximetry, nasal pressure, chest effort, and snoring (ApneaLink(TM)) (N = 58), or a wrist-worn oximeter (NoninWristOx2(TM)) (N = 33). A follow-up questionnaire assessed the devices' acceptability and important sleep-related exposures.
  
  
  RESULTS
  Although the multi-sensor device was assessed only in older women with no cognitive impairment, the proportion of completed interpretable sleep studies was low (54 %) and participants reported needing help to administer the device successfully. In contrast, the wrist-worn device was used in women with either no or mild cognitive impairment (MCI), completion rates were higher (100 %), and women reported being able to administer the device independently.
  
  
  CONCLUSIONS
  These studies demonstrated that home-based self-administered assessments of SDB are feasible in older adults with and without cognitive impairment using wrist-worn oximetry. These data support the feasibility of using simple oximetry measurements to provide indices of overnight intermittent hypoxemia in large observational studies and clinical trials.
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA. alvaugha@wakehealth.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Vaughan
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: California Pacific Medical Center Research Institute, University of California, San Francisco, CA, 94158, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Stone
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Ulanski
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rueschman
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Dailey
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Rapp
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
authors.forename: Beverly M
authors.initials: BM
authors.lastname: Snively
authors.affiliation: Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Baker
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Shumaker
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D059026:Diagnostic Self Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000523:psychology; D010092:Oximetry / Q000295:instrumentation; D017286:Polysomnography / Q000295:instrumentation* / Q000523:psychology; D012648:Self Care / Q000295:instrumentation / Q000523:psychology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: Aging; Feasibility study; Hypoxia; Sleep disordered breathing; Wrist-worn oximetry
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