Protecting Sleep, Promoting Health in Later Life: A Randomized Clinical Trial

Psychosomatic Medicine
Q1
Feb 2010
Citations:29
Influential Citations:1
Interventional (Human) Studies
84
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Enhanced Details

Methods
Single-blind, randomized clinical trial conducted at a university-based sleep center; 64 healthy elderly adults aged ≥75 years (mean age 79; 34 men, 30 women) without sleep/wake complaints or psychiatric or sleep disorder; eligible with Hamilton Depression Rating Scale ≤7 and Mini-Mental State Examination ≥24; randomly assigned to SLEEP or NUTRITION for 18 months, followed by 12 months of posttreatment follow-up; SLEEP involved delaying bedtime by 30 minutes nightly with education in healthy sleep practices; NUTRITION involved education in healthy dietary practices; 24 sessions conducted over 18 months (weekly for 8 weeks, then monthly).
Results
SLEEP did not improve sleep continuity or depth and reduced total sleep time by about 30 minutes per night over 18 months. Compared with NUTRITION, SLEEP was associated with a decline in physical health-related quality of life and an increase in medical burden (cardiovascular illness); inflammation markers, BMI, and exercise did not explain these changes. Authors conclude that in healthy adults aged ≥75 without sleep complaints, modest time-in-bed restriction may be detrimental; allowing about 7.5 hours of sleep nightly was associated with better maintenance of physical health-related quality of life and stability of medical illness burden over 30 months. Education in nutrition could have a positive effect, but evidence is not definitive.
Limitations
Absence of a noninterventional control group limits causal interpretation of nutrition versus sleep restriction effects; lipid profiles were not measured; CIRS-G data were not collected at 30 months; CPAP use in a subset of participants; results unchanged when excluding those participants; participants were healthy older adults without sleep complaints, limiting generalizability to those with sleep disorders; single-blind design with relatively small sample size and power aimed at large effects; about 9% dropout before intervention and 10% did not complete all assessments; seven SLEEP participants restricted time in bed by 15 minutes instead of 30 minutes, indicating adherence variability.

Abstract

Objectives: To determine in healthy people aged ≥75 years 1) if restricting time in bed and education in health sleep practices are superior to an attention-only control condition (i.e., education in healthy dietary practices) for maintaining or enha...