Psychosomatic Medicine
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Published online before print December 22, 2009, 10.1097/PSY.0b013e3181c870a5
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Psychosomatic Medicine 72:178-186 (2010)
© 2010 American Psychosomatic Society

ORIGINAL ARTICLES

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

Charles F. Reynolds, III, MD, Linda Serody, MSW, Michele L. Okun, PhD, Martica Hall, PhD, Patricia R. Houck, MSH, Susan Patrick, BS, Jennifer Maurer, MLIS, Salem Bensasi, BS, Sati Mazumdar, PhD, Bethany Bell, BS, Robert D. Nebes, PhD, Mark D. Miller, MD, Mary Amanda Dew, PhD and Eric A. Nofzinger, MD

From the Sleep and Chronobiology Program (C.F.R., L.S., M.L.O., M.H., P.R.H., S.P., J.M., S.B., S.M., B.B., R.D.N., M.D.M., M.A.D., E.A.N.), Department of Psychiatry, University of Pittsburgh School of Medicine; University of Pittsburgh Graduate School of Public Health (C.F.R.); the Advanced Center for Interventions and Services Research for Late-Life Mood Disorders (C.F.R., P.R.H., S.B., M.D.M., M.A.D.); and the John A. Hartford Foundation Center of Excellence in Geriatric Psychiatry (C.F.R.), Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Charles F. Reynolds III, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213. E-mail: Reynoldscf{at}upmc.edu

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 enhancing sleep continuity and depth over 2.5 years; and 2) if maintenance or enhancement of sleep continuity and depth promotes the maintenance or enhancement of health-related quality of life.

Methods: Single-blind, randomized, clinical trial in a university-based sleep center, enrolling 64 adults (n = 30 women, 34 men; mean age = 79 years) without sleep/wake complaints (e.g., insomnia or daytime sleepiness), followed by randomized assignment to either: 1) restriction of time in bed by delaying bedtime 30 minutes nightly for 18 months, together with education in healthy sleep practices (SLEEP); or 2) attention-only control condition with education in health dietary practices (NUTRITION).

Results: SLEEP did not enhance sleep continuity or depth; however, compared with NUTRITION, SLEEP was associated with decreased time spent asleep (about 30 minutes nightly over 18 months). Contrary to hypothesis, participants in SLEEP reported a decrement in physical health-related quality of life and an increase in medical burden (cardiovascular illness), relative to NUTRITION. Neither markers of inflammation, body mass index, or exercise explained treatment-related changes in medical burden.

Conclusions: Although we cannot exclude a positive effect of education in healthy nutrition, for healthy elderly >75 years of age without sleep complaints, reducing sleep time may be detrimental, whereas allowing more time to sleep (about 7.5 hours nightly) is associated with better maintenance of physical health-related quality of life and stability of medical illness burden over 30 months.

Key Words: sleep • aging • quality of life • physical health • inflammation

Abbreviations: IL-6 = interleukin-6; TNF-{alpha} = tumor necrosis factor-{alpha}.






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