Underperception of Naps in Older Adults Referred for a Sleep Assessment: An Insomnia Trait and a Cognitive Problem?

Authors

  • Vi-Huong Nguyen-Michel MD,

    Corresponding author
    1. Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France
    2. Geriatric Department, Consultation and Investigation Center for the Elderly, Paris, France
    • Address correspondence to Dr. Vi-Huong Nguyen-Michel, Unité d'explorations fonctionnelles du sujet âgé, Hôpital Charles Foix, 7 avenue de la République, 94205 Ivry-sur-Seine, France. E-mail: vhnguyen.michel@gmail.com

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  • Pierre-P Lévy MD,

    1. Public Health Department, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier de l'Est Parisien, Paris, France
    2. Epidemiology of Allergic and Respiratory Diseases Team, Unité Mixte de Recherche en Santé 1136, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
    3. Epidemiology of Allergic and Respiratory Diseases Team, Inserm U 1136, Paris, France
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  • Olivier Pallanca MD,

    1. Department of Clinical Neurophysiology, Insomnia Investigation Center, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
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  • Kiyoka Kinugawa MD, PhD,

    1. Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France
    2. Geriatric Department, Consultation and Investigation Center for the Elderly, Paris, France
    3. Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
    4. Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Centre National de la Recherche Scientifique, Paris, France
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  • Raluca Banica-Wolters MD,

    1. Department of Neurology, Louis Pasteur Hospital, Le Coudray, France
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  • Claude Sebban MD,

    1. Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France
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  • Jean Mariani MD, PhD,

    1. Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France
    2. Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
    3. Biological Adaptation and Ageing Team Brain Development, Repair and Aging, Unité Mixte de Recherche 8256, Centre National de la Recherche Scientifique, Paris, France
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  • Emmanuel Fournier MD, PhD,

    1. Functional Explorations Unit for the Elderly, Département Hospitalo Universitaire, Fight Against Ageing and Stress, Paris, France
    2. Department of Clinical Neurophysiology, Insomnia Investigation Center, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
    3. Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
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  • Isabelle Arnulf MD, PhD

    1. Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
    2. 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
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Abstract

Objectives

To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment.

Design

Prospective study.

Setting

Outpatient geriatric sleep clinic.

Participants

Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135).

Measurements

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.

Conclusion

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.

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