Sleep Disturbances Recorded in Care Home Residents with Dementia

Lucy Webster, PhD

A new investigation from London found that approximately one-third of care home residents suffering from dementia have or will develop sleep disturbances over 1 year. These disturbances were associated with lower quality of life and sedative prescriptions.

Consistent quantitative evidence of sleep disturbance in this population has been associated with staff distress, resident agitation, and prescription of psychotropic medications.

However, little is known about incidence and importance of these disturbances.

Using data from the Managing Agitation and Raising Quality of Life (MARQUE) longitudinal cohort study, investigators led by Lucy Webster, PhD, Division of Psychology at UCL, London, aimed to describe the prevalence of sleep disturbances in residents with dementia in a 16-month timeframe as well as the prevalence of difference manifestations of sleep disturbance.

The Methods

The secondary analysis of the data from the MARQUE study was comprised of residents with dementia from 97 English care homes between 2014 and 2015.

Data was collected from residents on 5 occasions every 4 months from baselines until 16 months, and patients were recruited into the study via the Noticeable Problems Checklist.

Neuropsychiatric symptoms including sleep disturbances were collected through the Neuropsychiatric Inventory Nursing Home Version (NPI-NH) ,which measured the presence, severity, and frequency of 12 neuropsychiatric symptoms.

Overall quality of life was measured via the Dementia Quality of Life Instrument (DEMQOL)m while dementia severity was acquired through the Clinical Dementia Rating (CDR).

Furthermore, agitation was measured through the Cohen-Mansfield Agitation Inventory, and data were also collected on resident medication that was prescribed in the 2 weeks prior to the study.

The Findings

A total of 1483 patients from 97 care homes were interviewed for the study. Of the 1483 residents, 1462 (98.6%) had data collected on the NPI sleep disturbance item on at least one timepoint in the study.

The point prevalence of clinically significant sleep disturbances was 13.7% (n = 200) at baseline and remained similar across the five timepoints up to 16 months (range: 12.9% to 16.0%).

Approximately 31.3% of all residents had clinically significant sleep disturbance on at least 1 timepoint.

The point prevalence of experiencing any symptom of sleep disturbance was 24.7% (n = 360) at baseline and remained stable across the five timepoints (range: 24.3 to 26.6; Table), and half of the residents (n = 696; 47.6%) had symptoms of sleep disturbances of any severity on at least 1 of the timepoints.

Among the 1260 residents who did not have clinically significant sleep disturbances at baseline, 257 developed them over the following 16 months. Of the 1100 residents who did not have symptoms of sleep disturbance at baseline, 336 residents developed symptoms over the 16-month follow-up.

At baseline, residents with sleep disturbance had lower quality of life (mean difference –4.84; 95% confidence interval [CI] –6.53 to –3.16) and were more frequently prescribed medications (odds ratio 1.75; CI 1.17 to 2.61) than other residents.

“Further research is needed to investigate the course of sleep disturbances in residents and delineate in whom they persist, fluctuate, or resolve over time, which would also indicate if these sleep disturbances need active treatment or management, or if they resolve without it,”the team wrote. “Additionally, longitudinal studies may further inform us about the direction of causation of between sleep disturbance, depression, and agitation, as well as quality of life and medication.”

The study, "Care home residents with dementia: Prevalence, incidence, and associations with sleep disturbance in an English cohort study," was published online in Alzheimer’s & Dementia.