Sleep disturbance and functional recovery among older people undergoing post-acute rehabilitation

Alessi CA, Martin JL, Webber AP, Alam T, Josephson KR, Harker JO. Sleep disturbance and functional recovery among older people undergoing post-acute rehabilitation. Paper presented at: VA HSR&D National Meeting; 2006 Feb 1; Arlington, VA.

Related HSR&D Project(s)

• IIR 04-321 – Non-Pharmacological Interventions on Sleep in Post-Acute Rehabilitation

Objectives:Rehabilitation of older people is often provided after acute hospitalization to facilitate functional recovery. Although other factors have been studied, the potential role of sleep disturbance during rehabilitation in predicting functional recovery has not been addressed. The purpose of this study was to test for an association between sleep disturbance among older people during post-acute rehabilitation and their immediate and long-term functional recovery. Methods:This was a prospective, descriptive study of older adults (aged > 65 years) admitted to one VA and one community rehabilitation site. Sleep assessments included self-reported sleep (Pittsburgh Sleep Quality Index, PSQI), one week of wrist actigraphy, and timed, structured daytime observations of sleep versus wake. Functional status was assessed by the motor component of the Functional Independence Measure (mFIM) administered on admission and discharge from rehabilitation and at 2, 6, and 9 months after enrollment.Results:We enrolled 245 people (n = 87 at VA, n = 158 at non-VA site; mean age 80.6 years, 38% female, 80% non-Hispanic white). Average length of stay in post-acute rehabilitation was 21.0 days. PSQI scores were worse in rehabilitation compared to pre-morbid sleep quality. During their rehabilitation stay participants slept 16% of daytime hours (8am-8pm) and only 52% of nighttime hours (10pm-6am). Even after adjusting for other significant predictors of mFIM change (e.g., more hours of therapy received, better mental status, lack of hospitalization during rehabilitation stay), less daytime sleeping (but not nighttime percent sleep) during post-acute rehabilitation was associated with greater mFIM change (i.e., greater functional recovery) between admission and discharge (p = .005), and at 2-month (p = .004) and 6-month (p = .004) follow-up (6-month adjusted R-square .234, model p < .0001). By 9 months, the relationship between daytime sleep during rehabilitation and functional recovery was no longer statistically significant in adjusted analysis.Implications:Abnormal sleep/wake patterns are common among older people undergoing post-acute rehabilitation, and certain sleep problems (particularly excessive daytime sleeping) are associated with less immediate and long-term functional recovery up to six months after admission. Impacts:Further study is needed to determine whether interventions to improve abnormal sleep/wake patterns can improve immediate and long-term functional recovery among older veterans undergoing post-acute rehabilitation.