Difficulty staying wakeful during the day is a prevalent problem among nursing facility residents. In a new investigation, researchers have found that excessive daytime sleepiness predicts both mortality and the presence of age-related comorbidities in this population.
Excessive daytime sleepiness (EDS) is often associated with other sleep disorders, according to researchers from University of Adelaide in Australia. It also can be due to a failure of mechanisms that control the sleep-wake cycle, particularly in older adults who have other chronic conditions and low levels of social interaction, they said.
To further examine the effects of this problem, researchers followed outcomes in 550 long-stay residents of 12 nursing homes from South Australia. Almost one-third of residents (30.4%) were found to have EDS based on Epworth Sleepiness Scale (ESS) scores.
EDS in these residents was linked to malnutrition, myocardial infarction, heart failure, Parkinson’s disease and severe dementia. In addition, EDS was an independent risk factor for 12-month mortality, the investigators found. Mortality risk appeared to increase alongside residents’ ESS scores and EDS severity, a finding that was particularly notable after six months of follow-up and in residents with severe EDS, further analysis showed.
Identifying EDS in residents
EDS is frequently under-recognized and undermanaged in nursing homes, according to lead author Ronaldo D. Piovezan, PhD, and colleagues. Nursing home clinicians should make an effort to identify EDS in residents so as not to miss opportunities for better care, they recommended. This could include monitoring sleep-wake disturbances in order to pinpoint which residents are more susceptible to diminished quality of life and reduced survival related to their wakefulness problems.
“Measuring EDS levels as a general health indicator can sustain improved care practices by triggering the assessment and management of potentially treatable EDS risk factors and reducing the impact of reversible EDS consequences,” Piovezan and colleagues explained. “In the context of nonreversible associated conditions, such as advanced dementia, increasing EDS can precipitate discussions and considerations about end-of-life care,”
The study was published April 13 in JAMDA.
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