Abstract
Objectives
Both excessive daytime sleepiness (EDS) and nutritional deficiencies are common and
can cause similar negative consequences, such as falls, and cognitive impairment in
older adults, but there is no study investigating the relationship between the two.
The aim of this study is to investigate the relationship between malnutrition/micronutrient
deficiency and EDS in patients with and without dementia.
Design
Cross-sectional study.
Setting and Participants
A total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included.
Methods
All patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment
(MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition
risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted
as dysphagia. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale
score of ≥11 points indicated EDS.
Results
The mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with
dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia
(P < .05). In patients without dementia, those with EDS have lower MNA scores than those
without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic
heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association
between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20],
dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55)
persisted.
Conclusions and Implications
There is a significant relationship between EDS and malnutrition risk, dysphagia,
and vitamin D deficiency in older adults. Therefore, when examining an older patient
with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS
should be investigated in an older patient with malnutrition, dysphagia, and vitamin
D deficiency. Thus, it will be possible to manage all these conditions more effectively.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Functional Outcomes of Excessive Daytime Sleepiness in Older Adults.J Am Geriatr Soc. 2003; 51: 642-649
- Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test.Sleep. 2005; 28: 113-121
- Sleep disorders and aging.Curr Opini Psychiatry. 1996; 9: 284-289
- Daytime sleepiness and cognitive impairment in the elderly population.Arch Intern Med. 2002; 162: 201-208
- Prevalence of excessive daytime sleepiness in a sample of the Australian adult population.Sleep Med Netherlands. 2014; 15: 348-354
- Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years.J Am Geriatr Soc. 2000; 48: 1234-1240
- Excessive daytime sleepiness in the elderly: Association with cardiovascular risk, obesity and depression.Rev Bras Epidemiol. 2013; 16: 872-879
- Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia.Exp Gerontol. 2021; 150: 111364
- Excessive daytime sleepiness and fatigue in neurological disorders.Sleep Breath. 2020; 24: 413-424
- Trajectories of daytime sleepiness and their associations with dementia incidence.J Sleep Res. 2020; 29: e12952
- Malnutrition is associated with increased mortality in older adults regardless of the cause of death.Br J Nutr. 2017; 117: 532-540
- Malnutrition and malnutrition risk can be associated with systolic orthostatic hypotension in older adults.J Nutr Heal Aging. 2018; 22: 928-933
- Relationship between nutritional status and insomnia severity in older adults.J Am Med Dir Assoc. 2019; 20: 1593-1598
- The association of sleep quality and sleep duration with nutritional status in older adults: Findings from the WCHAT study.Maturitas. 2021; 145: 1-5
- Baseline vitamin D status, sleep patterns, and the risk of incident type 2 diabetes in data from the uk biobank study.Diabetes Care. 2020; 43: 2776-2784
- Excessive daytime sleepiness is associated to the development of swallowing impairment in a cohort of early stage drug naïve Parkinson’s disease patients.J Neurol Sci. 2020; 410: 116626
- The relationship between dementia subtypes and nutritional parameters in older adults.J Am Med Dir Assoc. 2020; 21: 1430-1435
- ESPEN guidelines on nutrition in dementia.Clin Nutr. 2015; 34: 1052-1073
- Costs of medication in older patients: Before and after comprehensive geriatric assessment.Clin Interv Aging. 2018; 13: 607-613
- Frequency and coincidence of geriatric syndromes according to age groups: Single-center experience in Turkey between 2013 and 2017.Clin Interv Aging. 2018; 13: 1899-1905
- Validity and reliability of the eating assessment tool (EAT-10).Ann Otol Rhinol Laryngol. 2008; 117: 919-924
- Utility of the Eating Assessment Tool-10 (EAT-10) in evaluating self-reported dysphagia associated with oral frailty in Japanese community-dwelling older people.J Nutr Heal Aging. 2020; 24: 3-8
- The effects of early vitamin B12 replacement therapy on the cognitive and functional status of elderly subjects.Klin Psikofarmakol Bul. 2010; 20: 120-124
- Vitamin B12 and folate deficiencies are not associated with nutritional or weight status in older adults.Exp Gerontol. 2019; 116: 1-6
- IOF position statement: Vitamin D recommendations for older adults.Osteoporos Int. 2010; 21: 1151-1154
- Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: Failure of the MSLT as a gold standard.J Sleep Res. 2000; 9: 5-11
- Prevalence, risk factors, and impact of excessive daytime sleepiness in an elderly Korean population.Sleep Med Res. 2014; 5: 54-61
- Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study.Rev Bras Epidemiol. 2015; 18: 607-617
- Excessive daytime sleepiness among the Japanese general population.J Epidemiol. 2005; 15: 1-8
- Gender differences in the sleep variables contributing to excessive daytimesleepiness among patients with obstructive sleep apnea.Sleep Breath. 2021 Jan 19.; ([Epub ahead of print])
- Malnutrition in the elderly and its relationship with other geriatric syndromes.Clin Nutr. 2010; 29: 745-748
- Screening of malnutrition and its correlates among a sample of rural elderly in Qalyobeya Governorate, Egypt.J Egypt Public Health Assoc. 2017; 92: 156-166
- Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women.Sleep Med. 2019; 53: 94-100
- Low white-matter integrity between the left thalamus and inferior frontal gyrus in patients with insomnia disorder.J Psychiatry Neurosci. 2018; 43: 366-374
- Sleepiness, inflammation and oxidative stress markers in middle-aged males with obstructive sleep apnea without metabolic syndrome: A cross-sectional study.Respir Res. 2015; 16: 3
- Malnutrition and inflammation—"burning down the house": Inflammation as an adaptive physiologic response versus self-destruction?.J Parenter Enter Nutr. 2015; 39: 56-62
- Sleep pattern is associated with adipokine levels and nutritional markers in resident physicians.Chronobiol Int. 2014; 31: 1130-1138
- New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation.Br J Pharmacol. 2018; 175: 3190-3199
- Serum vitamin D levels in office workers in a subtropical climate.Photochem Photobiol. 2011; 87: 714-720
- Serum tumor necrosis factor-alpha concentrations are negatively correlated with serum 25(OH)D concentrations in healthy women.J Inflamm. 2008; 5: 10
- Nuclear factor-κB-like activity increases in murine cerebral cortex after sleep deprivation.Am J Physiol Integr Comp Physiol. 1999; 276: R1812-R1818
- Vitamin D, race, and excessive daytime sleepiness.J Clin Sleep Med. 2012; 8: 693-697
Article info
Publication history
Published online: June 25, 2021
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
