A. Cotroneo, P. Gareri, S. Cabodi

Quality of sleep is one of the main quality indexes of life and is a remarkable dimension of lived life in elderly population, especially in frail elders having comorbidities and therefore, polytherapy. Sleep is often underevaluated even if it is closely related to individual well-being. This is more marked in the elderly and is often the cause of worsening in quality of life; in particular, sleep is more light, is characterized by several awakenings and is associated to a diurnal somnolence.

Poor quality of sleep is at the third place after headache and gastrointestinal disorders among all causes and/or symptoms referred to doctor from elderly patients.

The aim of the present study was to evaluate quality of sleep in a group of elderly patients visited in our geriatric ambulatory. A sleep questionnaire was administered to all the patients visited in our ambulatory, even if insomnia was not among reported symptoms; this has let us know their quality of sleep. Insomnia was classified according to American Sleep Disorders ( A.S.D.) and Associated Professional Sleep Societies ( A.P.S.S.) criteria and the following scales were admnistered: IADL, ADL, GDS, CIRS, SPMSQ, MNA, DMI, Sleep Questionnaire, social and environmental status. An accurate history let us point out clinical causes such as anxiety, panic attacks, depression, alcohol abuse and administered drugs, working activity carried out in the past potentially cause of insomnia. In the first two months 50 subjects with a history of insomnia were evaluated, mean age 78.9 years old, 35 women and 15 men. Moreover, 30 subjects (20 women and 10 men) with similar characteristics, but onset of insomnia since the last three weeks, were studied. The first group was further divided into three subgroups (diabetic, hypertensive and healthy patients), the same distinction was also made for the second group. Doctor-patient dialogue was essential and contributed to an appropriate educational and behavioural intervention; a sleep diary was effective and well accepted from patients and their family. Patients who needed a pharmacologic treatment were treated with zolpidem, 10 mg at bedtime. This drug presents a short half-life, a low muscle relaxant action, significantly contributed to modify 3 and 4 stages of sleep and was also well-tolerated.

Results were quite positive: a high satisfaction was registered in the treated subjects, expressed as number of hours and quality of sleep. An only case of morning fall was reported; however, it occurred in a diabetic and hypertensive patient presenting a hypertensive peak, as shown by arterial pressure measurement. A remarkable improvement of IADL and ADL in patients with high comorbidities and a good recovery in non-diabetic and normotensive patients were obtained too. No cases of rebound insomnia was shown.

We have also to point out that in a subgroup of patients with IPH (Isolated Postchallenge Hyperglycemia) a clear sleep disorder, with repeated and precocious morning awakenings vs. overt diabetic patients was shown; this occurred even without any differences in the evening sleeping hour, but it needs further controls.

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