Table 1:
Characteristics of Included Studies
| Authors | Design | Study Name, Country | Sample Size | Sleep Measure | Demographics | Results | Quality Score Rating |
|---|---|---|---|---|---|---|---|
| Abell et al., (2015) | Prospective cohort, Longitudinal | The Whitehall II Cohort, United Kingdom | 4491 | Jenkins Sleep Problem Scale | Age range: 55–79 Female: 25.2% | The percentage of those participants who reported high levels of insomnia symptoms at each of the three time points was 8.2% (n=368). Chronic insomnia symptoms were associated with poorer overall well-being (difference between insomnia at 3 assessments vs none −7.0 (SE=0.4) p<0.001), mental well-being (difference −6.9 (SE=0.4), p<0.001) and physical well-being (difference −2.8 (SE=0.4), p<0.001). | 29 |
| Adams et al., (2017) | Cross-sectional, Online survey | Australia | 175 | International Classification of Sleep Disorder s −3 criteria, ESS | Not Reported | 17.7% of older adults experienced insomnia. Sleep problems: 32% had difficulty falling asleep, 52% waking a lot during the night, 40% waking up too early and can’t get back to sleep, 34.3% waking feeling unrefreshed. 60.6% report getting adequate sleep. Daytime symptoms: 15.4% daytime sleepiness, 24% fatigue/exhaustion, 13.1% irritable/moody, 13.1 average ESS score. 61.1% reported at least 1 sleep problem, and 39.4% reported at least 2 sleep problems. | 30 |
| Alcantara et al., (2016) | Prospective cohort | Multi-Ethnic Study of Atherosclerosis Sleep Study | 1784 | WHIIRS, ESS, PSG, Actigraphy, Sleep diary | Age range: 54–93 Female: 54% White: 36.8% Black: 28% Hispanic: 23.7% Chinese: 11.5% | 29.3% had insomnia (WHIIRS ≥ 10), 14.1% had excessive daytime sleepiness. Depression was associated with insomnia (PR = 1.83, 95% CI = 1.39, 2.40) and excessive daytime sleepiness (PR = 1.61, 95% CI = 1.19, 2.18). Insomnia was more strongly associated with depression among men than women. | 32 |
| Alessi et al., (2016) | Randomized Controlled Trial | USA | 60 (≥ 60) | ISI, Sleep diary, PSQI, Actigraphy | Mean age: 72.2 (7.7) Age range: 60–91 Female: 3.1% Hispanic: 6.3% Black: 4.4%, White: 78.6%, Other: 7.6% | More than 90% of subjects reported that their sleep problems had been present for longer than 12 months. Compared to participants in the control group, participants who received CBTi (5 sessions) had greater improvements at the post-treatment, 6-month assessments, and 12-month assessments: sleep diary-sleep onset latency (−23.4, −15.8, and −17.3 minutes, respectively), sleep efficiency (10.5%, 6.7%, and 5.4%, respectively), PSQI (−3.4, −2.4, and −2.1 in total score, respectively), and ISI (−4.5, −3.9, and −2.8 in total score, respectively) (all P < .05). | 32 |
| Altintas et al., (2018) | Cross-sectional | Turkey | 291 (≥ 60) | ISI | Mean age: 76.18 (8.06) Age range: 60–96 Female: 33.7% | 14.1% had moderate insomnia, 2.7% had severe insomnia. 16.8% experienced insomnia at a clinical level. | 29 |
| Baron et al., (2017) | Pilot Intervention study | USA | 17 (≥55) | Insomnia diagnosed by sleep clinician, PSQI, Actigraphy | Mean Age: 61.6 (4.3) Female: 94.1% | Participants had an average wake after sleep onset of 57 min per night at baseline. Greater variability in objective sleep measures were associated with poorer subjective sleep quality on the global scale of PSQI for wake after sleep onset (p<0.01), sleep efficiency (p < 0.05), and fragmentation index (p < 0.01). Greater variability in sleep onset time (actigraphy) was associated with higher body mass index (p< 0.05). Sleep efficiency and wake after sleep onset variability decreased with 16 weeks of sleep intervention (sleep hygiene and aerobic exercise activity or nonphysical activity-social, educational activity) (p < 0.05). |
30 |
| Brenes et al., (2016) | Randomized Controlled Trial | USA | 141 (≥60) | ISI | Mean Age: 66.8 (6.2) Age Range: 60–87 Black:5.7% White:90.8% Other:3.5% | Symptoms of insomnia (ISI) declined among participants who received both CBT-T (telephone) and telephone-delivered nondirective supportive therapy on sleep in patients with generalized anxiety at the 4-month visit, but participants in the CBT-T intervention experienced significantly greater improvement (F=10.21; df=1,136; p=0.002). Improvements in insomnia were maintained at the 15-month assessment. | 28 |
| Cao et al., (2016) | Prospective, cohort | China | 1168 (≥60) | Self-report insomnia symptoms | Mean age: 70.70 (7.07) Age range: 60–94 Female:52.4% | 31.8% had self-reported insomnia. Self-reported insomnia (p<0.05) was significantly associated with depression. | 30 |
| Caroll et al., (2016) | Cross-sectional | USA | 126 | DSM-4 and ICSD-2 criteria for primary insomnia | Mean age: 70.7 (6.6) Age range: 60–88 Female: 54.7% | Age (60–69 years vs. 70–88 years) and insomnia diagnosis interacted to predict shorter telomere length. In the oldest age group (70–88), telomere length was significantly shorter in those with insomnia compared to controls with no insomnia. In the adults aged 60–69, telomere length was not different between insomnia cases and controls. | 31 |
| Castello-Domenech et al., (2016) | Descriptive cross-sectional | Spain | 99 | Athens insomnia scale, Oviedo sleep questionnaire | Mean age: 82.5 (0.8) Age range: 65–99 Female: 80.8% | 67.9% of the participants had insomnia based on the Oviedo questionnaire. The average “insomnia” score based on the Oviedo questionnaire was 19.1 ± 1 (range 9–39). The mean Athens score was 4.4 ± 0.4 (range 0–16). There was no significant correlation between cognitive function (measured by the MMSE) and the Athens scale or the Oviedo questionnaire in persons living in nursing homes without a diagnosis of dementia. There was a significant correlation between cortisol and Oviedo questionnaire subscale for evaluating insomnia-related adverse events.” |
29 |
| Chan et al., (2017) | Randomized Controlled Trial | USA | 62 | Sleep diaries, actigraphy | Mean age: 69.45 (7.71) Female: 68% White: 82.26% Hispanic: 6.45%, Black: 3.23%, Asian: 3.23%, Multiracial: 4.84% | Variabilities in sleep-diary assessed sleep onset latency significantly decreased in brief behavioral therapy for insomnia compared to self-monitoring attention control (Pseudo R2 = .12; P=0.018). These effects were mediated by reductions in bedtime and wake time variability and time in bed. Their actigraphy-assessed sleep onset latency and sleep efficiency also improved (Pseudo R2 = .15 to .66; P < .001 to .044).” | 31 |
| Chen et al., (2017) | Longitudinal | USA-Health and Retirement Study (2006–2014) | 6882 | 4 questions on insomnia symptoms | Mean age: 74.5 (6.6) Female: 57.4% White: 85.7% Non-White: 14.3% | 6.6% used non-physician recommended sleep medications and 11.8% used physician-recommended sleep medications. Mean number of insomnia symptoms (0–4): 1.90. Older adults who fell reported a greater number of insomnia symptoms compared with those who did not fall. A greater burden of insomnia symptoms at baseline independently predicted falling after adjusting for known risk factors of falling. Older adults who reported one additional insomnia symptom at baseline were 5% more likely to fall at follow-up. Insomnia symptoms and using physician-recommended sleep medications at baseline were significant predictors of any fall at follow-up. Compared with participants who did not take any sleep medications, the probability of falling was consistently higher for all levels of insomnia symptoms among older adults who took physician-recommended sleep medications at baseline. | 27 |
| Chiou et al., (2016) | Cross-sectional | Taiwan-The Shih-Pai Sleep Study | 4047 | PSQI, DSM-4 criteria of insomnia | Female: 44.2% | 5.8% had insomnia, with 67.2% of those having insomnia for ≥6 months. The prevalence of insomnia disorder for 1 to 6 months and ≥6 months was 1.9% and 3.9 %, respectively. Women (p <0.001) and single individuals (p = 0.005) had a higher prevalence of insomnia disorder. Women had a higher prevalence of insomnia disorder for both duration quantifiers (1 to 6 months: 2.7 % of women vs. 1.3 % of men; and ≥6 months: 5.0 % of women vs. 3.0 % of men). Compared with married participants, single older adults had a higher prevalence of insomnia disorder for both duration quantifiers (1 to 6 months: 3.0 % of single individuals vs. 1.6 % of married individuals; ≥6 months: 4.6 % of single individuals vs. 3.6 % of married individuals). Insomnia disorder was significantly associated with heart disease (p <0.001), stroke (p = 0.002), pulmonary diseases (p = 0.001), depression (p < 0.001), excessive daytime sleepiness (p =0.01), pain (p < 0.001), and falling (p = 0.001). Insomnia disorder between 1 to 6 months was associated with being a woman (OR: 2.16, 95 % CI:1.33–3.51), having pulmonary diseases (OR: 2.57, 95 % CI: 1.46–4.52), having depression (OR: 2.81, 95 % CI: 1.59–4.96) and moderate pain (OR:2.56, 95 % CI:1.23–5.32). Insomnia disorder for more than 6 months was associated with being a woman (OR: 1.50, 95 % CI: 1.07–2.10) and having heart disease (OR: 1.73, 95 % CI: 1.21–2.49), depression (OR: 4.68, 95 % CI: 3.24–6.75), or moderate and severe pain (OR: 2.23, 95 % CI: 1.26–3.93 and OR: 2.34, 95 % CI:1.14–4.40) respectively. |
29 |
| Culver et al., (2016) | Cross-sectional survey | USA | N (60–69 years):257 N (≥70 years):145 Total N: 1538 | Insomnia Treatment Acceptability Scale, PSQI, ICSD-3 criteria, ISI,, STOP Questionnaire | Mean age: 51.8 (14.6) Female: 100% White: 66.3% Black: 26.5%, Hispanic: 6.5% American Indian/Alaska Native: 2.9%, Asian/Asian American: 1.7% | 60–69 group: 28.6% reported insomnia medication treatment as very acceptable, 51% reported non-medication treatment very acceptable. ≥70y group: 16.9% reported insomnia medication treatment as very acceptable, 37.1% reported non-medication treatment very acceptable. | 31 |
| Devkota et al., (2017) | Cross-sectional | Nepal | 253 (≥60) | Self-reported physical and mental well-being | Female: 68% Janajati: 82.5% Khas/Arya: 15.5% Dalit: 2.4% | 37.8% of the male pensioners reported insomnia, 53.8% of the female pensioners reported insomnia. Insomnia was associated with increased frailty in univariate models. | 30 |
| DiNapoli et al., (2016) | Cross-sectional | USA | 879 (≥65) | International Classification of Diseases (9th ed) | Mean age: 76.5 (6.39) Female: 1.9% White: 85.4% Black: 11.9% Other:1.5% Unknown:1.2% | 23.2% of the sample had insomnia. 41.7% of them used any sedative hypnotics, 14.7% used Z-drugs (selective benzodiazepine receptor agonists i.e. eszopiclone, zaleplon, zolpidem), 14.7% used Trazadone, 11.8% used on-label benzos, 3.9% used off-label benzos, 1% used hydroxyzine, 2.5% used diphenhydramine. Older veterans with newly reported insomnia (41.7%) were most likely to receive a sedative hypnotic. Trazodone (6.7%) and on-label benzodiazepines (5.9%) were the most commonly prescribed sedative hypnotics to older veterans. | 27 |
| Dragioti et al., (2018) | Cross-sectional | Sweden | 2790 (≥65) | ISI | Median age: 76 Age range: 70–82 Female: 52% | Participants with clinical insomnia was 24.6%. Lower overall wellbeing and quality of life were reported in severe clinical insomnia (i.e. ISI ≥ 22). Higher pain intensity, frequency and total comorbidities were reported in severe clinical insomnia compared to the other subcategories of insomnia. The total annual healthcare costs were more than doubled in severe clinical insomnia compared with no clinically significant insomnia. | 31 |
| Endeshaw & Yoo (2016) | Cross-sectional | USA - National Health Aging Trends Study | 7162 (≥65) | 2 questions about insomnia symptoms | Female: 56% White: 80% Black: 8% Hispanic:7% Other: 5% | 28% of study participants reported 1 or both insomnia symptoms. Difficulty falling asleep, trouble staying asleep, and both insomnia symptoms were reported by 12%, 5%, and 11% of the participants, respectively. The proportion of study participants with insomnia symptoms was higher among women, Black and Hispanic participants, participants with lower education level, lower income, who reside in “not desirable” neighborhood, and who had poor health status and lower physical performance test scores. Participants engaging in organized social activity and/or walking exercise were significantly less likely to report insomnia symptoms. The risk of insomnia symptoms was lower in those who engaged in both activities versus those who engaged in one activity, suggesting the additive beneficial effect of two activities. Participants engagingin both activities were 40% less likely to report both insomnia symptoms while participants who reported engaging in organized social activity and walking exercise were 30% and 22% less likely to report both insomnia symptoms, respectively. |
29 |
| Endeshaw et al. (2016) | Prospective cohort | USA - Healthy Aging Body Composition Study | 1478 | questions about insomnia, self-reported sleep duration | Mean age: 73.8 (2.9) Age range: 70–79 Female: 0% White: 62.9% Black: 37.1% | 23.2% of the participants reported at least 1 insomnia symptom. The proportion of participants who reported insomnia symptoms was higher among those with increased frequency of nocturia episodes. Overall, 19%, 25%, and 33% of participants with 0–1, 2, and ≥ 3 nocturia episodes, respectively, reported one or more insomnia symptoms (p < 0.001). | 28 |
| Hartescu et al., (2016) | Cohort | United Kingdom - Nottingham Longudinal Study of Activity and Aging | 926 (≥65) | Questions about insomnia symptoms | Female: 60.2% | 21.6% of the baseline sample reported insomnia symptoms, with women reporting a significantly greater prevalence of insomnia symptoms than men. The higher level of walking was significantly and independently associated with a lower likelihood of reporting insomnia symptoms (OR = 0.67, 95% CI = 0.45–0.91, p < .05). Higher level of walking at baseline significantly predicted a lower likelihood of problems getting to sleep (OR = 0.64, 95% CI = 0.42–0.97, p < .05) and staying asleep (OR = 0.63,95% CI = 0.41–0.95, p < .05), but not early morning awakening (OR = 0.63, ns) at the four-year follow-up. |
26 |
| Helbig et al., (2017) | Cross-sectional | Germany - KORA Age Study | 3833 (≥65) | Questions about insomnia symptoms | Mean age: 73 (5.8) Range: 65–93 Female: 51.3% | 8.2% of the sample were classified as having insomnia. The prevalence of difficulty staying asleep was the highest in the whole sample (40.7%), followed by trouble falling asleep (16.6%). In comparison to respondents without insomnia, there was a higher proportion of women among those suffering from insomnia, and participants with insomnia were, on average, significantly older than those without insomnia. Many of the participants with insomnia reported chronic conditions including hypertension (71.4%), eye diseases (53.7%) and heart diseases (43.2%). The frequency of individual chronic conditions was higher in participants with insomnia versus those without insomnia. Participants with insomnia were more likely to suffer from 2 or more chronic conditions (83.5%), compared to those without insomnia (56.5%). The most frequent co-occurring pairs of chronic conditions among individuals with insomnia were hypertension/eye diseases (37.5%) and hypertension/heart diseases (33.3%). Although insomnia and all its unique symptoms were associated with multimorbidity among women, in the multivariable models, trouble falling asleep was not significant after adjusting for all covariables among men. Among common pairs of conditions, associations were observed between insomnia with joint diseases/eye diseases in men and joint diseases/heart diseases in women. |
31 |
| Hishikawa et al., (2017) | Cross-sectional | Japan | 142 | AIS | Mean age: 70.5 (9.7) Female: 50% | Subjective insomnia (AIS ≥4) was reported by 36.2% of participants and was more frequent in females than males. For both sexes, depressive symptoms were significantly higher in the AIS ≥4 subgroup than the AIS ≤3 subgroup. Apathy Scale scores were significantly higher in males in the AIS ≥4 subgroup. Of the AIS subscales, ‘sleepiness during the day’ was significantly higher in females than males (p < 0.01), especially in those aged ≥75 years (p < 0.01). This group of older females also performed poorer on the Trail Making Test score (p < 0.05). | 25 |
| Huang et al., (2016) | Randomized Controlled Trial (crossover) | Taiwan | 38 (≥50) | Actigraph with electroencepalogram, Visual analog scale, PSQI | Mean age: 56.42 (6.35) Age range: 50–75 Female: 78.9% Chinese: 5.3% Taiwanese: 86.8% Hakka: 7.9% | Listening to soothing music for 30 minutes before bedtime significantly shortened the wake time after sleep onset measured by electroencephalogram, compared with brisk walking on the treadmill with music for 30 minutes in the evening. Music was effective in reducing sleep onset latency (P=.02) and wake after sleep onset (p<.001), as measured using electroencephalogram. | 36 |
| Hung et al., (2018) | Case-control | Taiwan-Longitudinal Health Insurance Database of Taiwan’s National Health Institute Research Database | 12025 (≥60) | Diagnosis based on International Classification of Disease, 9 th edition, Clinical Modification | Not Reported | Patients with primary insomnia were more likely to have diabetes, dyslipidemia, hypertension, coronary artery disease, chronic liver disease, and chronic kidney disease. During the 3-year follow up period, 1316 pts with primary insomnia (2.54% of the study cohort) compared to 3742 patients with non-primary insomnia (1.34% of the comparison cohort) developed dementia. For relative risk of dementia, the hazard ratio was 2.21 for 60–74 age group and 1.96 for 75+ years. Patients with primary insomnia have a higher longitudinal risk of developing dementia. | 33 |
| Ibanez-del Valle et al., (2018) | Cross-sectional | Spain | 62 (≥60) | AIS, Oviedo questionnaire, actigraphy | Mean age: 82.8 (8.7) | 20% of participants had insomnia based on the AIS. The average insomnia subscale (Oviedo subscale 2) score was 20.5 ± 6.9. Patients classified as patients with insomnia according to AIS score (score of ≥6) had higher blood plasma cortisol concentrations compared to the remaining group of individuals (p<0.01). | 29 |
| Jackowska & Poole (2017) | Prospective cohort | United Kingdom - English Longitudinal Study of Ageing | Total: 4545 (≥50), 3200 (≥60) | Insomnia questions from Jenkins Sleep Problems Scale | Not reported | Insomnia was more prevalent in women (P < 0.001), respondents who were neither married nor cohabiting (P < 0.001), were from lower wealth quintiles (P < 0.001), current smokers (P = 0.04), consumed alcohol less frequently (P < 0.001), engaged in moderate or vigorous physical activity less than once a week (P < 0.001), had higher body mass index (BMI) (P < 0.001), reported having a limiting long-standing illness (P < 0.001), had elevated depressive symptoms (P < 0.001), and were undergoing treatment for depression (P < 0.001). Insomnia symptoms were associated with increased odds of elevated depressive symptoms 6 years later (OR = 1.36, 95% CI = 1.19–1.56, P < 0.001), independent of covariates. Difficulty falling asleep less than once a week, when compared with no difficulty during the past month, was predictive of higher odds of depressive symptoms (OR=1.49, 95% CI=1.06–2.11, P=0.023). Waking in the morning feeling tired once or twice a week (OR = 1.43, 95% CI = 1.00–2.03, P = 0.049) and three or more times a week (OR = 1.71, 95% CI = 1.24–2.37, P = 0.001) also predicted depressive symptoms at follow-up. | 28 |
| Kaufmann et al., (2016) | Cohort study | USA - Health and Retirement Study (2002–2010) | 22,252 (≥50) | Questions about insomnia symptoms | Mean age: 63.96 (10.47) Female: 53.7% White: 74% Black: 14.4% Hispanic: 9.8% Other: 1.8% | Across all participants, the mean insomnia score increased modestly by 0.19 points (95% CI=0.14–0.24; t=7.52; p<0.001) between 2002 and 2010 after controlling for baseline age, race/ethnicity, gender, and education. There were statistically significant increases for Whites, Blacks, and Hispanics. Hispanics experienced a greater increase in insomnia severity over time compared to Whites. After adjusting for multiple accumulated health conditions and BMI, the association between insomnia severity and time decreased substantially and changed direction (B=−0.24; 95% CI=−0.29, −0.19; t=−9.22; design df=56; p<0.001), suggesting that the observed worsening in insomnia severity was attributable to the accumulation of health conditions. Hispanics saw significantly greater increases in insomnia severity even after controlling for all variables. By race/ethnicity group, Hispanics had a statistically significant increase in insomnia score for “no health conditions” stratum, but no statistically significant change in insomnia for 1, 2 or 3+ health conditions. Among non-Hispanic whites, there was no statistically significant change in the insomnia score for the no health conditions stratum, but a statistically significant decline in insomnia severity for the other three strata. |
30 |
| Kay et al., (2016) | Case-control | USA | 135 (≥40) | Insomnia symptoms from Hamilton Rating Scale for Depression | Mean age: 66 Female: 47% White: 86.9% | The suicide attempt group had significantly more severe insomnia than the suicidal ideation (p = .010) and non-suicidal depressed (p = .006) groups. Individuals with a suicide attempt had on average one more symptom of insomnia (29% greater insomnia severity) than the non-attempt groups. The suicide attempt group had more severe insomnia symptoms of a particular type (onset, maintenance, or early morning awakening) and on average had at least two different symptoms of insomnia. | 31 |
| Kim et al., (2017) | Cross-sectional | South Korea - Osan Mental Health Survey | 881 (≥60) | Athens Insomnia Scale, ICSD-2, DSM-4 interview, PSQI, ESS | Mean age: 70.6 (7) Female: 59% | The prevalence of insomnia was estimated to be 32.7% (95% CI = 29.6–35.8%). Insomnia was more prevalent in women than in men (37.9% vs. 25.2%; p < 0.001). Insomnia was less prevalent in the old-old group aged 80 years or older than in the young-old group aged 60–77 (22.4%, 95% CI = 14.7%–30.0% vs. 34.2%, 95% CI = 30.9% –37.6%, p = 0.014). The prevalence of insomnia subtypes was: psychophysiological insomnia, 20.5%; insomnia due to mental disorder 7.2%; insomnia due to general medical conditions 2.9%; insomnia in other sleep disorders 2.2%, and insomnia due to substance use 0.2%. Female gender was associated with the risk of insomnia (OR=2.40, 95% CI=1.30–4.44, p=0.005). | 33 |
| Kuok et al., (2017) | Cross-sectional | China | 451 (≥50) | Questions about insomnia symptoms | Mean age: 72 (10.5) Female: 78.7% | 38.1% of the sample had insomnia. In the community, 13.7% had insomnia. In nursing homes, 44.4% had insomnia. Insomnia significantly predicted poor physical quality of life (p=0.02). | 29 |
| Laredo-Aguilera et al., (2018) | Randomized Controlled Trial | Spain | 38 (≥65) | Oviedo Sleep Questionnaire | Mean age: experimental group: 75.44 (5.31), control group: 76.35 (6.45) Female: 84.2% | Following the 10-week functional training program, the experimental group’s insomnia scores decreased, but did not reach statistical significance (22.05 ± 12.51 to 16.45 ± 10.42; p=0.065). | 31 |
| Larsson et al., (2017) | Cross-sectional | Sweden | 2415 (≥65) | ISI | Mean age: 75.9 (7.4) % female: 60.1 | The average ISI scores were highest among Subgroup 1 (moderate pain and high psychological symptoms, 14.4 ± 5.2, p<0.001). Subgroups 1 (moderate pain and high psychological symptoms, OR = 1.23, 95% CI:1.17–1.28), 2 (high pain and moderate psychological symptoms, OR = 1.13, 95% CI: 1.08–1.17), and 3 (low pain and moderate psychological symptoms, OR = 1.10, 95% CI: 1.07–1.14) were also associated with increased levels of insomnia. | 36 |
| Li et al., (2018) | Secondary data analysis | USA | 49 (≥55) | AIS, PSQI | Mean age: 66.3 Age Range: 55–80 Female: 67% Non-White: 16% | Insomnia score decreased with time (10 weeks, change in the mean = −1.8, SD = 3.4) regardless of the intervention (mindfulness intervention or sleep hygiene intervention). Change in insomnia scores was associated with change in depressive symptoms (β = 0.38, p < 0.01). | 25 |
| Lin et al., (2018) | Retrospective cohort study | Taiwan - National Health Insurance Research Database (2000–2013) | 192,358 (≥ 65) | International Classification of Diseases-9 criteria | Not Reported | 33.3% had insomnia. The risk of suicide attempts among insomnia patients aged 65 years and older was 1.595 fold (p < 0.001). | 34 |
| Ling et al., (2016) | Cross-sectional | Singapore-Longitudinal Ageing Studies | 859 | 9 sleep questions: 3 regarding nocturnal sleep pattern, 3 insomnia, and 3 from Hamilton Depression Rating Scale | Mean age: 71.9 Age range: 65–94 Female: 59.4% | Insomnia complaints were present in 18.0% (n = 155) of the participants. Of these, 14.8% reported experiencing difficulty initiating sleep, 13.1% reported difficulty maintaining sleep, and 10.7% reported early morning awakening in the past month. Participants experiencing at least one type of insomnia complaint were generally older than those who reported no insomnia (p ≤ 0.030). They were more likely to report a history of medical conditions, such as gastro-intestinal disorders (p ≤ 0.043). A higher percentage of those with difficulty initiating sleep reported a history of arthritis (p = 0.016) compared to those with no difficulty initiating sleep, while those with difficulty maintaining sleep consumed more medications (2.6 vs. 3.2; p = 0.038) and were more likely to report a history of kidney failure (p = 0.046) and thyroid problems (p = 0.002). Those with early morning awakening were more likely to report a history of stroke (p = 0.048) and atrial fibrillation (p = 0.040). Participants with any insomnia complaint reported greater depressive symptoms (p ≤ 0.012), but only those with experiencing difficulty initiating sleep had a significantly higher percentage of depressive symptoms (Geriatric Depression Scale ≥ 5, 1.7% vs. 6.0%; p = 0.025). |
33 |
| Ma et al., (2018) | Cross-sectional | China | 3045 (≥60) | AIS | Mean age: 69.7 (7.4) Age range: 60–95 Female: 45% Han: 97% | 24% had insomnia and 9% had suspected insomnia. Having no fixed income (p=0.04); living alone (p=0.007), being socially less connected with children (p<0.001), neighbors or friends (p<0.001), disagreeing about having spiritual or financial support during difficulty (p<0.001), and lack of trustworthy relationship with children (p=0.02), neighbors or friends (p=0.004, p=0.05, respectively), were all significantly associated with higher likelihood of suffering from severe insomnia. | 34 |
| Manjavong et al., (2016) | Cross-sectional | Thailand: Healthy Ageing Khon Kaen Univeresity Campus Project | 491 (≥50), 95 (≥65) | International Classification of Diseases-10 criteria | Female: 65.8% | 60% of the participants had insomnia. The significant consequences related to insomnia were feeling unrefreshed (p<0.001), daytime sleepiness (p=0.002), need for a sedative drug (p<0.001), depression (p=0.002), and impaired attention (p<0.001). | 32 |
| Moreno-Vecino et al., (2017) | Cross-sectional | Spain: Research Network in Exercise and Health for Special Populations | 463 (≥65) | Jenkins Sleep Scale | Age range: 66 – 91 Female: 100% | Participants with insomnia had significantly greater values of body mass index (30.0 ± 4.4 kg/m2 vs. 28.9 ± 4.2 kg/m2, p < 0.05, with and without sleep disorders, respectively), and waist circumference (94.1 ± 11.5 cm vs. 91.3 ± 10.3 cm, p < 0.01, with and without sleep disorders, respectively) than those with proper sleep. Women without sleep disturbance had greater lower body strength (13.9 ± 4.0 vs. 14.7 ± 3.5 repetitions, p < 0.05), upper body strength (18.5 ± 4.1 vs. 17.2 ± 4.0 repetitions, p < 0.001), agility (6.4 ± 2.4 vs. 6.1 ± 2.0 s, p < 0.01) and walking speed (19.0 ± 5.5 vs. 17.2 ± 4.0 s, p < 0.05), compared to women with sleep disturbances (with and without sleep disturbance, respectively). Women without sleep disturbance reported better health related quality of life as compared to those with it (73.3 ± 1.7 vs. 65.7 ± 1.9, p < 0.05, respectively). Women with better physical condition had lower risk of suffering from sleep disturbance by 92% (odds ratio, OR = 0.52, 95%CI 0.251–1.083) compared to women with lower physical condition (p = 0.08). | 35 |
| Morita et al., (2017) | Longitudinal (Repeated measures non-randomized crossover) | Japan | 43 (≥55) | AIS, PSG | Mean age: 58.9 (3.6), 57.7 (2.9) Age range: 55–65 Female: 58.1% | 69.7% of the participants had primary insomnia (34.8% difficulty initiating sleep, 34.8% early morning awakening). No significant effect of the morning and evening exercise on the insomnia symptoms. | 32 |
| Nowicki et al., (2016) | Cross-sectional | Poland: NATPOL study | 590 (≥60) | 3 questions about sleep | Age range: 60–79 Female: 27.6% | 74.8% of the female participants aged 60–79 had subjective insomnia. 55.6% reported difficulty falling asleep, 52.5% reported difficulty with sleep maintenance, and 20.1% reported early morning awakening. Among male participants aged 60–79, 52.9% had subjective insomnia. 50.2% reported difficulty falling asleep, 37.2% reported difficulty with sleep maintenance, and 33.2% reported early morning awakening. Age and gender were the most important factors for prevalence of self-reported insomnia. There was no correlation between self-reported insomnia and body mass index, level of education or place of residence. | 25 |
| Sakamoto et al., (2017) | Cross-sectional | India | 112 (≥60) | ISI | Mean age: Males: 71.3 (7) Females: 67.9 (6.5) Female: 58% | The mean score of ISI was 2.8 (3.6) among males and 4.1 (4.4) among females. The prevalence of ISI (8 or more) was 15.2%. The prevalence of ISI (8 or more) among older adults living at the altitudes of 2800–3000 m, 3000–3500 m, and 3500–4200 m was 0%, 10.5%, and 28.9%, respectively (p=0.002). Altitude of residence was significantly related to ISI (R =0.350, p < 0.001). Living at higher altitude (odds ratio [OR] 1.003, 95% confidence interval [95% CI] 1.000–1.005, p=0.020) was an independent risk factor for insomnia. | 32 |
| Tang et al., (2017) | Cross-sectional | Randomized Controlled Trial | 367 (≥60) | ISI, PSQI | Mean age: 72.9 (8.2) Female: 78.5% White: 90.1%, Non-White: 9.9% | All participants had clinically significant insomnia (ISI 12.8 ± 4.8). Sex, education, and fatigue predicted ISI nighttime sleep complaints [R2 = .187; F = 11.458 (p < .001)]. Fatigue, depression, and pain predicted daytime sleep-related consequences for ISI [R2 = .418; F = 33.742 (p < .000)]. When measures of sleep and pain beliefs/attitudes were added, depression was no longer a significant predictor of ISI daytime consequences. Education, fatigue, sleep beliefs and pain beliefs predicted ISI nighttime sleep complaints [R2 = .222; F = 21.334 (p < .001), R2 change .030; F change 7.023 (p < .001)]. Fatigue and sleep beliefs predicted ISI daytime sleep-related consequences [R2 = .458; F = 61.113 (p < .001), R2 change .045; F change 15.114 (p < .001)]. | 28 |
| Uchmanowicz et al., (2019) | Cross-sectional | Poland | 100 | ESS, AIS | Mean age: 65.5 (15.6) Female: 41% | 59% of the participants had insomnia based on the AIS scale. Insomnia was more common in participants who were elderly (P=0.001); non-working (P=0.005); overweight (P=0.042); clinically diagnosed with hypertension (P=0.014), comorbid hypercholesterolemia (P=0.007) or ischemic heart disease (P=0.036); characterized by a lack of knowledge about the symptoms of hypertension (P=0.028) or complications of hypertension (P=0.003); and patients who were more frequently hospitalized due to complications of hypertension (P<0.001). There was a negative correlation between AIS score and all domains of quality of life. Insomnia had most effect on physical (r=−0.582, P=0.001) and psychological domain of quality of life (r=−0.520, P<0.001). | 35 |
| Wang et al., (2016) | Cross-sectional | China | 3716 (≥60) | Questions about insomnia | Mean age: 69.4 (6.8) Female: 59.3% | 37.8% of the participants had insomnia. The overall proportion of insomnia in women was significantly higher than in men (41.5% vs 32.3%, p < 0.05). The most common type of sleep disturbance was difficulty maintaining sleep (25.2%; 21.8% in men vs 27.4% in women; p < 0.05), followed by difficulty initiating sleep (16.6%; 10.3% in men vs 20.9% in women; p < 0.05) and early morning awakening (12.2%; 11.2% in men vs 12.9% in women; p > 0.05). The prevalence of sleep disturbances significantly increased with age (p < 0.05). Among the subjects with insomnia, only 21.9% were taking sleep medications. Never smoking (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.06–2.06), experiencing the loss of a parent (OR = 1.60, 95% CI = 1.25–2.05), and depression symptoms (OR = 2.72, 95% CI = 1.61–4.59) were independent risk factors for risk factors for insomnia in men. Occasional drinking (OR = 0.59, 95% CI = 0.40–0.86) was an independent protective factor against insomnia in men. Older age (OR = 1.48, 95% CI = 1.10–1.99), depression symptoms (OR = 3.11, 95% CI = 2.22–4.35), a history of cerebral hemorrhage (OR = 4.39, 95% CI = 1.68–11.45), a history of hyperlipidemia (OR = 1.35, 95% CI = 1.08–1.68), living without a spouse (OR = 1.68, 95% CI = 1.08–2.61), and having mild cognitive impairment (OR = 1.38, 95% CI = 1.08– 1.76) were independent risk factors for insomnia in women. | 34 |
| Wilckens et al., (2016) | Randomized Controlled Trial | USA: AgeWise program project | 77 (≥60) | PSQI, PSG | Mean Age: 71.67 Age range: 60–87 Female: 68.4% White: 93.5% | Lower wake after sleep onset was associated with higher delayed recall performance. Participants in the brief behavioral therapy for insomnia group exhibited significantly greater improvements in WASO relative to those in the control condition. | 30 |
| Wilckens et al. (2017) | Uncontrolled experimental trial | USA: AgeWise program project | 48 (≥60) | PSG, insomnia based on DSM-IV/ICS D-2 criteria and ISI score ≥ 10 | Mean age 69.26 (7.87) Age range: 60–93 Female: 60.4% White: 87.5% | Mean ISI for insomnia group was 14.67(4.56) pre-intervention and 5.58(4.48) post-intervention. 75% had wake after sleep onset latency complaints and 70.8% had sleep onset latency complaints. Wake after sleep onset showed a significant main effect of time point, indicating improvement following CBTi (t(37) = 6.30, p < 0.001). Reductions in wake after sleep onset were significantly associated with improvements in repetition trial accuracy, R2 change = 0.13, β = 0.372, t = 2.51, p = 0.017. | 34 |
| Yeung et al., (2018) | Secondary analysis of Randomized Controlled Trial | USA | 106 (≥60) | Actigraphy, sleep diaries, PSQI, ISI | Mean age: 72.1 (79) Female: 3.8% White: 78.3% Hispanic: 6.6% Black: 5.7% | The ISI for the group was 11.7 (5.3). There was no difference among the CBTi with low physical activity group (N = 46) and CBTi with high physical activity group (N = 60) on the ISI score (p=.1) at baseline, post-treatment, 6-months and 1 year follow-up. All participants (older veterans) experienced an improvement in ISI score. | 34 |
| Zhang et al., (2017) | Cross-sectional | USA: Boston Puerto Rican Health Study and Boston Puerto Rican Osteoporosis Study | 439 (≥60) | Insomnia questions | Age range: 60–79 | Among participants ≥ 60 years, 11% had insomnia disorder. Participants aged 60 years and older reported fewer insomnia symptoms (Chi-square = 13.1, p<0.01) than those younger than 60 years. Insomnia was associated with 49% greater risk of falls in adults 60 years or older (p<0.05), and in women, but not in those younger than 60 years, or in men. Insomnia was not associated with recurrent falls or fractures. | 36 |
Key: AIS - Athens Insomnia Scale, CBT- Cognitive Behavioral Therapy, CBTi- Cognitive Behavioral Therapy for insomnia, DSM - Diagnostic and Statistical Manual for Mental Disorders, ESS- Epworth Sleepiness Scale, ICSD-International Classification of Sleep Disorders, ISI- Insomnia Severity Index, MMSE-Mini Mental State Examination, PSG- Polysomnography, PSQI- Pittsburgh Sleep Quality Index, USA- United States of America, WHIIRS - Women’s Health Initiative Insomnia Rating Scale