Study On Sleep Quality And Health-related Quality Of Life In The Elderly With Different Status Of Cognitive Decline

With the decline of cognitive function,the elderly will have symptoms such as anxiety,depression,sleep disorders,memory loss,impaired orientation,and ataxia.The relationship between sleep quality and cognitive function has been deeply concerned by researchers.And the relationship between the two is not clear.Sleep disorders not only occur frequently in elderly people with Alzheimer’s disease,but also frequently in the preclinical stage of Alzheimer’s disease,which has a negative impact on the health-related quality of life of the elderly.There is currently no research on sleep quality and health-related quality of life in the elderly with different status of cognitive decline.Objective:The purpose of this study is to investigate the sleep quality and health-related quality of life in older people with different states of cognitive decline and to explore the correlation between them,so as to provide reference for the development of targeted nursing intervention for the elderly with normal cognitive function and in the preclinical stage of Alzheimer’s disease,and prevent the progressive decline of cognitive function and improve the HRQOL of the elderly.Methods:The questionnaire survey was conducted among the elderly in the Chaoyang District of Changchun City from June 2018 to September 2018 by using convenient sampling method.The elderly who met the inclusion criteria were divided into five groups according to the cognitive function assessment: the normal control group(NC),subjective cognitive decline without worrying group(SCD-0),subjective cognitive decline with worrying group(SCD-1),mild cognitive impairment group(MCI),and Alzheimer’s disease group(AD).The research tool consists of four parts:(1)General information questionnaire;(2)Cognitive function assessment related scale,including Mini-mental State Examination(MMSE),Montreal Cognition Assessment(MoCA),Activity Daily Living Scale(ADL),Clinical Dementia Rating Scale(CDR),Hachinki Ischemic Index Scale(HIS);(3)Pittsburgh Sleep Quality Index(PSQI);(4)36-Item Short-Form Health Survey(SF-36).Epidata 3.1 software was used to establish the database.Statistical analysis was carried out in SPSS 22.0.The demographic characteristics of the subjects were described by median and quartiles(skewed distribution),mean and standard deviation(normal distribution),frequency and percentage;The PSQI and SF-36 scores between the 5 groups were compared using a nonparametric rank-sum test;The multinomial logistic regression analysis was used to investigate the risk of cognitive decline in the elderly with good or poor sleep quality;Kruskal-Wallis test with post hoc tests were used to analyze the influence of sleep status on the HRQOL of the elderly with different states of cognitive decline;Spearman rank correlation coefficient method was used to analyze the correlation between sleep quality and HRQOL.Results:1.A total of 221 valid subjects were enrolled in this study,including 46 in the NC group,53 in the SCD-0 group,38 in the SCD-1 group,67 in the MCI group,and 17 in the AD group.In the demographic data,the differences in age,education level,exercise,smoking,hypertension,and diabetes were statistically significant among older people with different states of cognitive decline(p<0.05).2.The results of nonparametric rank-sum test showed that the total score of PSQI and the score of sleep latency,sleep duration,habitual sleep efficiency,sleep disturbance,and daytime dysfunction dimension among the five groups increased gradually with the increase of cognitive decline,and the differences were statistically significant(p<0.05).There was no statistically significant difference in subjective sleep quality dimension(p=0.223).The total score of SF-36 and the score of Physiological Field,Psychological Field,physical functioning dimension,general health dimension,vitality dimension,social functioning dimension,role-emotional dimension and mental health dimension among the five groups increased gradually with the increase of cognitive decline,and the differences were statistically significant(p<0.05).There was no statistical difference in role-physical dimension and bodily pain dimension(p>0.05).3.Model 1 had not been adjusted for any confounding variables.Participants with poor sleep quality had an increased risk of cognitive impairment compared with participants with good sleep quality.The ORs were 7.810,11.030,and 14.848 for SCD-1,MCI and AD,respectively.Then we used a multiple adjustment model(Model 2)adjusted for age,education level,exercise,smoking,hypertension,and diabetes mellitus.Compared with participants with good sleep quality,the participants with poor sleep quality had an increased risk of SCD-1(OR=5.293)and MCI(OR=6.822).4.Kruskal-Wallis test with post hoc tests showed that SF-36 total score,Physiological Field score and Psychological Field score of the elderly with poor sleep quality were generally lower than those with good sleep quality.For the elderly with good sleep quality,the scores of SF-36,Physiological Field and Psychological Field among the 5 groups were statistically significant(p<0.05).For the total score of SF-36,the differences between NC group and SCD-1 group,NC group and AD group were also statistically significant.There was no statistical difference between any two groups in the Physiological Field.In the Psychological Field,the differences between NC group and SCD-1 group,NC group and AD group,SCD-0 group and SCD-1 group were statistically significant.For the elderly with poor sleep quality,the scores of SF-36,Physiological Field and Psychological Field among the 5 groups were statistically significant(p<0.05).For the total score of SF-36,the differences between NC group and MCI group,NC group and AD group,SCD-0 group and MCI group,SCD-0 group and AD group,SCD-1 group and AD group,MCI group and AD group were statistically significant.In the Physiological Field,the difference between SCD-0 group and MCI group,SCD-0 group and AD group was statistically significant.In the Psychological Field,the differences between NC group and MCI group,NC group and AD group,SCD-0 group and MCI group,SCD-0 group and AD group,SCD-1 group and AD group,MCI group and AD group were statistically significant.5.The correlation analysis showed that there was a significant positive correlation between sleep quality and health-related quality of life in the total sample,that is,the better the sleep quality,the higher the HRQOL level.For the five cognitive groups,there was a different degree of correlation between sleep quality and HRQOL,and the AD group showed a weaker correlation compared with other groups.Conclusion:1.The severity of cognitive decline in the elderly is affected by age,education,exercise,smoking,hypertension,and diabetes.2.Compared with the NC group,the total sleep quality and HRQOL in the SCD-0 group,SCD-1 group,MCI group,and AD group decreased,and the more severe the cognitive decline,the lower the total sleep quality and HRQOL.3.Older people with poor sleep quality have an increased risk of cognitive decline compared with older adults with good sleep quality.4.For the elderly with different states of cognitive decline,the total sleep quality has a significant impact on their HRQOL.The better the total sleep quality,the higher the HRQOL.5.There was a significant positive correlation between sleep quality and health-related quality of life in the total sample.For the five cognitive subgroups,the correlation between sleep quality and health-related quality of life was gradually enhanced with the aggravation of cognitive decline in the NC group,SCD group and MCI group.6.Nursing staff should pay attention to the influence of sleep quality on the HRQOL of the elderly.It is of great importance for nursing staff to perform sleep assessment in older people with normal cognitive function and in the preclinical stage of AD.