Archives of Gerontology and Geriatrics
Volume 36, Issue 1 , Pages 93-99, January 2003

Sleepiness and sleep in elderly subjects with hearing complaints

  • R Asplund

      Affiliations

    • Family Medicine Stockholm, Karolinska Institute, SE-141 57 Huddinge, Sweden
    • The Research and Development Unit, Jämtland County Council, SE-831 25 Östersund, Sweden
    • Corresponding Author InformationPresent address: Tallvägen 3, S-833 34 Strömsund, Sweden. Tel.: +46-670-10007; fax: +46-631-65626

Received 18 March 2002; received in revised form 31 July 2002; accepted 6 August 2002.

Article Outline

Abstract 

The aim of this study was to evaluate the relation of hearing complaints to daytime sleepiness and sleep in a group of elderly men and women. A questionnaire survey was undertaken among 10 216 elderly subjects in northern Sweden. The mean (±S.D.) ages of the men and women were 73.0±6.0 and 72.6±6.7 years, respectively. Poor hearing was reported by 43.1% of the men and 22.8% of the women. The relative numbers with hearing complaints increased with age. Daytime sleepiness (DS) was reported by 32.9% of the men and 23.2% of the women. In a multiple logistic regression analysis significant independent correlates of daytime sleepiness in men were: hearing, good versus poor (odds ratio [OR] 1.5; confidence interval [CI] 1.2–1.8), health, good versus poor (3.3; 2.6–4.4), sleep, good versus poor (2.1; 1.6–2.8) and age, ≥80 years versus <70 years (1.5; 1.1–2.1). The corresponding correlates in women were: hearing (1.4; 1.1–1.8), health (4.3; 3.4–5.4), sleep (2.2; 1.6–2.8) and age (1.6; 1.3–2.2). Thus, poor hearing was associated with increased daytime sleepiness independently of health, sleep status and age. Also subjects with hearing complaints more often slept poorly, woke up more often and had more difficulty in falling asleep after waking.

Keywords:  Health, Hypnotics, Poor hearing, Sleep, Sleepiness

 

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1. Introduction 

Daytime sleepiness (DS) is a common problem in the elderly and has a profound influence on the quality of life (Asplund, 1996, Barbar et al., 2000). The occurrence of DS increases with increasing age and with a poor night's sleep and is associated with many diseases and symptoms that are prevalent among the elderly (Asplund, 1996).

Presbyacusis, or age-related hearing loss, is also common in the elderly, with an age-related increase, and is more pronounced in men than in women at all ages (Shah and Prabhakar, 1997). It negatively influences the quality of life by making communication more difficult, a problem which has become of increasing social importance with the rising proportion of elderly persons in the population (Megighian et al., 2000, Tsuruoka et al., 2001). Hearing loss influences psychological well-being and reduces the opportunities for mental stimulation, which may have a negative impact on alertness and daytime activity (Tsuruoka et al., 2001).

Although DS, sleep deterioration and hearing impairment are all common phenomena, the possible interaction between these problems does not seem to have attracted much attention. Sparse reports have been published on the relationship between sleep and hearing in tinnitus sufferers (Hallam, 1996). In such a group of patients it was found that absence of self-reported sleep disturbance was associated with essentially normal objectively assessed hearing (Hallam, 1996).

The aim of the present study was to investigate more closely the possible relationship between hearing complaints and DS.

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2. Subjects and methods 

2.1. Current study group 

All 10 216 members of the pensioners’ association SPF in the Swedish counties of Västerbotten and Norrbotten were asked to participate in a questionnaire survey. A further questionnaire was sent to those who did not respond within 1 month.

2.2. The questionnaire 

The questionnaire has been described previously (Asplund, 1995). Health was evaluated from response to the statement ‘I have a good health’, and hearing from response to the statement ‘I have good hearing’, DS and napping with the statements ‘I am often sleepy in the daytime’ and ‘I usually sleep for a while at daytime’. Night sleep was evaluate by three statements: ‘I have a good night's sleep’, ‘I often wake up at night’ and ‘I easily fall asleep again after a nocturnal awakening’. All statements allowed the alternative answers ‘yes’ or ‘no’. The questionnaire also included questions on age, civil status, the general state of health, diseases and medication.

2.3. Statistical methods 

Standard methods were used for calculating mean values and standard deviations. Group comparisons of non-numerical data were made with the χ2 test. For comparing frequencies, odds ratios (ORs) with a 95% confidence interval (CI) were calculated. For simultaneous evaluation of the influence of more than one independent variable on hearing complaints, logistic regression analysis (statview 5.0 for Macintosh) was performed.

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3. Results 

3.1. General 

The questionnaire was completed initially by 4544 persons. After a reminder, a further 1559 answers were received. Thus, there were 6143 evaluable questionnaires, of which 39.5% were from men. The response rate was 61.3%.

The ages (mean±S.D.) of the male and female participants were 73.0±6.0 and 72.6±6.7 years, respectively. About 26% of the men and 57% of the women were living alone. Hearing complaints were 1.3 (OR) (95% CI 1.1–1.6) times more common in women living alone than in married or cohabiting women. No such difference was observed in men.

Poor hearing was reported by 43.1% of the men and 22.8% of the women. The relative number of subjects with hearing complaints increased with age, especially among women, and such complaints were more common in men in all age groups (Table 1).

Table 1. The percentage proportions of elderly men and women of different ages in poor health and suffering from hearing complaints
Age (years)Poor healthHearing complaints
MenWomenMenWomen
<7014.618.240.318.2
70–7917.617.443.926.2
≥8018.623.248.541.2

Poor health was reported by 16.8% of the men and 18.7% of the women. Health deteriorated with age (Table 1). Among subjects with hearing complaints, poor health was 1.4 (1.1–1.7) times more common in men and 1.9 (1.5–2.3) times more common in women, compared with men and women with no hearing complaints, respectively.

3.2. Daytime sleepiness and napping 

Frequent daytime sleepiness was reported by 32.9% of the men and 23.2% of the women. DS and napping were more common in subjects with hearing complaints, both men and women (Fig. 1).

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  • Fig. 1. 

    The occurrence of daytime sleepiness (left group of bars), and of daytime napping (right group of bars) in men and women with good hearing (white bars) and poor hearing (black bars). DS: good vs. poor hearing, men P<0.0001, women P<0.0001. Daytime napping: P<0.001 and P<0.001, respectively.

A logistic regression analysis was performed with the occurrence of daytime sleepiness as the dependent variable and poor hearing, age, health and night's sleep as explanatory variables (Table 2). The analyses revealed that poor hearing, poor health and poor sleep were all associated with more daytime sleepiness. Increasing age was associated with daytime sleepiness only among men and women ≥80 years versus <70 years.

Table 2. The occurrence of daytime sleepiness in relation to hearing complaints, age, health and night's sleep
DS
OR (CI)OR (CI)
MenWomen
Hearing (good=1.0)
Poor1.5 (1.2–1.8)1.4 (1.1–1.8)
Age (<70 years=1.0)
70–79 years1.1 (0.9–1.4)1.1 (0.9–1.4)
≥80 years1.5 (1.1–2.1)1.6 (1.3–2.2)
Health (good=1.0)
Poor3.3 (2.6–4.4)4.3 (3.4–5.4)
Night's sleep (good=1.0)
Poor2.1 (1.6–2.8)2.2 (1.8–2.7)

ORs and 95% CI for each of the variables included in the logistic model.

3.3. Hearing complaints and sleep 

Poor sleep occurred in 14.4% of the men and 27.9% of the women. Among the subjects with impaired hearing, poor sleep was more common in both sexes, while frequent awakenings and difficulties in falling asleep after waking at night were more common in women (Fig. 2). No differences in sleep was found between subjects living in urban and rural areas, irrespective of the hearing status.

  • View full-size image.
  • Fig. 2. 

    The occurrence of poor sleep (left group of bars), frequent awakenings (middle group of bars) and difficulty in falling asleep again after nocturnal awakening (right group of bars) in men and women with good hearing (white bars) and poor hearing (black bars). Poor sleep: good vs. poor hearing, men P<0.01, women P<0.001. Frequent awakenings: men NS, women P<0.001. Difficulty in falling asleep again: men NS, women P<0.0001.

In a multiple logistic regression analysis with hearing complaints, health and age as independent variables, significant independent correlates of poor night's sleep among the men were: hearing complaints (1.4; 1.0–1.8) and poor health (2.6; 1.9–3.5). The corresponding ORs in women were 1.3 (1.1–1.6) and 3.0 (1.4–3.7), respectively. Age was deleted by the statistical model in both sexes.

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4. Discussion 

In this study it was found that among elderly persons with hearing complaints the frequency of daytime sleepiness was increased by 50% in men and by 40% in women, compared with persons with good hearing, after the influence of health, night's sleep and age had been taken into account (Table 2).

One important question in the interpretation of these data is whether or not there is correspondence between perceived hearing status and objectively found hearing impairment. In an evaluation by comparison with pure-tone audiometer, it has been shown that self-reports on trouble with hearing are reliable (Nondahl et al., 1998). Another question in the interpretation of the findings concerns the validity of sleep data from a questionnaire. However, consistent correspondence has been found between reports on poor sleep and different sleep measurements (Morgan et al., 1989).

Hearing complaints were more common in men than in women, a finding in accordance with previous reports. In a study of elderly men and women it was found that both self-reported and audiometrically determined hearing impairment were significantly less frequent in women at all ages (Nondahl et al., 1998).

The elderly subjects with hearing impairment in the present study were more troubled by daytime sleepiness, and the habit of taking naps was almost twice as common in this group as in the group with good hearing (Fig. 1). One common cause of DS is a poor night's sleep (Asplund, 1996, Alapin et al., 2000). Compared with the subjects who considered their hearing to be good, those with impaired hearing in this study more often reported poor sleep (Fig. 2). As a result of the more frequent sleep problems there was a more frequent use of sleep medication in persons with hearing complaints than in the group as a whole. The use of hypnotics reflects the extent of sleep deterioration and is increased in parallel with decreasing somatic and mental health (Asplund, 2000b).

Elderly persons with poor hearing more often suffer from psychosocial problems due to boredom and isolation than contemporaries with good hearing (Chen, 1994). One out of four men and more than half of the women in this study were living alone. The women with hearing complaints, in contrast to the men, were also married or cohabiting to a lower extent than women with good hearing.

The quality of the night's sleep is improved by daytime stimulation and an active way of life (Hashimoto and Kobayashi, 1998). DS is increased by poor sleep (Asplund, 1996, Alapin et al., 2000). Hence, elderly persons with hearing impairment may be at risk of sleep impairment and, in turn, of DS as a consequences of their communication problems which may lead to reduced activity and lack of mental stimulation (Asplund, 1996, Hashimoto and Kobayashi, 1998, Alapin et al., 2000).

Thus, elderly persons who suffer impaired hearing seem to share the proneness to DS, poor sleep and increased use of sleep medication with blind and visually impaired persons, who also have difficulties in their social contacts and, thus, suffer from lack of stimulation (Leger et al., 1996, Asplund, 2000a).

It was expected that sleep might have been worse among good-hearing persons living in cities, with probably more traffic noise than in rural areas. Environmental noise, e.g. from traffic or aircrafts, is a common cause of sleep deterioration and there is a noise level-dependent relationship between sleep deterioration and traffic noise (Kageyama et al., 1997, Schnelle et al., 1998). There is an age-related decline in auditory awakening thresholds in adults from 18 to 71 years (Zepelin et al., 1984). From this aspect hearing impairment might be sleep-protective by reducing the influence of environmental noise, and more so among elderly who lived in densely populated areas. However, no difference in sleep was found in the present study in relation to place of residence in elderly persons with good hearing, and this hypothesis could not, therefore, be confirmed.

To summarize, in these elderly subjects poor hearing was associated with an increased frequency of daytime sleepiness, independently of the influence of health, sleep status and age. Elderly persons with impaired hearing were also more troubled by poor sleep, more frequent awakenings and more difficulty in falling asleep after waking.

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References 

  1. Alapin I, Fichten CS, Libman E, Creti L, Bailes S, Wright J. How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate. J. Psychosom Res. 2000;49:381–390
  2. Asplund R. Are sleep disorders hereditary? A questionnaire survey of elderly persons about themselves and their parents. Arch. Gerontol. Geriatr. 1995;21:221–231
  3. Asplund R. Daytime sleepiness and napping among the elderly in relation to somatic health and medical treatment. J. Int. Med. 1996;239:261–267
  4. Asplund R. Sleep, health and visual impairment in the elderly. Arch. Gerontol. Geriatr. 2000;30:7–15
  5. Asplund R. Sleep and hypnotics use in relation to perceived somatic and mental health among the elderly. Arch. Gerontol. Geriatr. 2000;31:199–205
  6. Barbar SI, Enright PL, Boyle P, Foley D, Sharp DS, Petrovitch H, et al. Sleep disturbances and their correlates in elderly Japanese American men residing in Hawaii. J. Gerontol. A. Biol. Sci. Med. Sci. 2000;55:M406–411
  7. Chen HL. Hearing in the elderly. Relation of hearing loss, loneliness, and self-esteem. J. Gerontol. Nurs. 1994;20:22–81
  8. Hallam RS. Correlates of sleep disturbance in chronic distressing tinnitus. Scand. Audiol. 1996;25:263–266
  9. Hashimoto T, Kobayashi T. Correlation between daytime activities and night sleep of aged individuals estimated by wrist activity and sleep log. Psychiatry Clin. Neurosci. 1998;52:187–189
  10. Kageyama T, Kabuto M, Nitta H, Kurokawa Y, Taira K, Suzuki S, et al. A population study on risk factors for insomnia among adult Japanese women: a possible effect of road traffic volume. Sleep. 1997;20:963–971
  11. Leger D, Guilleminault C, Defrance R, Domont A, Paillard M. Blindness and sleep patterns. Lancet. 1996;348:830–831
  12. Megighian D, Savastano M, Salvador L, Frigo A, Bolzan M. Audiometric and epidemiological analysis of elderly in the Veneto region. Gerontology. 2000;46:199–204
  13. Morgan K, Healey DW, Healey PJ. Factors influencing persistent subjective insomnia in old age: a follow up study of good and poor sleepers aged 65–74. Age Ageing. 1989;2:117–122
  14. Nondahl DM, Cruickshanks KJ, Wiley TL, Tweed TS, Klein R, Klein BE. Accuracy of self-reported hearing loss. Audiology. 1998;37:295–301
  15. Shah B, Prabhakar AK. Chronic morbidity profile among elderly. Indian J. Med. Res. 1997;106:265–272
  16. Schnelle JF, Cruise PA, Alessi CA, Ludlow K, al-Samarrai NR, Ouslander JG. Sleep hygiene in physically dependent nursing home residents: behavioral and environmental intervention implications. Sleep. 1998;21:515–523
  17. Tsuruoka H, Masuda S, Ukai K, Sakakura Y, Harada T, Majima Y. Hearing impairment and quality of life for the elderly in nursing homes. Auris Nasus Larynx. 2001;28:45–54
  18. Zepelin H, McDonald CS, Zammit GK. Effects of age on auditory awakening thresholds. J. Gerontol. 1984;39:294–300

PII: S0167-4943(02)00062-6

Archives of Gerontology and Geriatrics
Volume 36, Issue 1 , Pages 93-99, January 2003

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