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Daytime Sleepiness and Cognitive Impairment in the Elderly Population
Maurice M. Ohayon, MD, DSc, PhD;
Marie-Françoise Vecchierini, MD
Arch Intern Med. 2002;162:201-208.
Background Recent findings suggest that there may be a relationship between excessive
daytime sleepiness (EDS) and cognitive deficits. This study aims to determine
to what extent EDS is predictive of cognitive impairment in an elderly population.
Methods A total of 1026 individuals 60 years or older representative of the
general population living in the metropolitan area of Paris, France, were
interviewed by telephone using the Sleep-EVAL expert system. To find these
individuals, 7010 randomly selected households were called: 1269 had at least
1 household member in this age range (participation rate, 80.9%). In addition
to Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, and International Classification
of Sleep Disorders diagnoses, the system administered to participants
the Psychological General Well-being Schedule, the Cognitive Difficulties
Scale (MacNair-R), and an independent living scale.
Results Excessive daytime sleepiness was reported by 13.6% of the sample, with
no significant difference among age groups. Compared with nonsleepy participants,
those with EDS were at increased risk of cognitive impairment on all the dimensions
of the MacNair-R scale after controlling for age, sex, physical activity,
occupation, organic diseases, use of sleep or anxiety medication, sleep duration,
and psychological well-being. The odd ratios were 2.1 for attention-concentration
deficits, 1.7 for praxis, 2.0 for delayed recall, 2.5 for difficulties in
orientation for persons, 2.2 for difficulties in temporal orientation, and
1.8 for prospective memory.
Conclusions Among elderly individuals in the general population, EDS is an important
risk factor for cognitive impairment. A complaint of EDS by an elderly patient
should signal the possibility of an underlying cognitive impairment in need
of evaluation.
From the Stanford Sleep Epidemiology Research Center, Stanford University
School of Medicine, Stanford, Calif (Dr Ohayon); and the Laboratoire d'Exploration
Fonctionnelle, Hôpital Bichat, Paris, France (Dr Vecchierini).
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