Sleep Quality in Assisted Living Residents and Its Associations with Cognitive Functioning and Functional Capacity

Abstract

Study Objectives: Sleep and its associations with cognition, functional capacity, and quality of life have been examined in community-dwelling and long-term care populations, but remain poorly characterized in assisted living (AL) residents. Methods: We assessed sleep, cognition, functional capacity and quality of life in 26 AL residents and 52 propensity-matched community-dwelling residents. Sleep was measured with polysomnography (PSG), actigraphy, and subjective questionnaires. Functional capacity was measured with the timed up and go and the short physical performance battery. Agreement of sleep recording techniques was evaluated with Bland-Altman statistics. Group differences were examined using general linear models, controlled for age and sleep disordered breathing. Associations between sleep and cognition were assessed with stepwise regression and interaction models. Associations between sleep, functional capacityand quality of life were assessed with linear regression. Results: AL residents had greater sleep fragmentation (events/hour; mean difference (MD) = 12.19), lower sleep efficiency (%, MD = 13.44), greater wake after sleep onset (WASO) (minutes; MD = 20.23), more periodic limb movements (events/hour; MD = 10.02), and lower average oxygen saturation (%; MD = 1.58) than community-dwelling residents. Bland–Altman analyses showed actigraphy significantly overestimated sleep efficiency in AL residents (bias = 6.9%). Regression models indicated stronger negative associations between poor sleep and cognition in AL (e.g., WASO × group and Hopkins Verbal Learning Test-Revised delayed recall: β = –0.016, p =0.029). TST <90% was associated with timed up and go (β = 0.071), and the Pittsburgh Sleep Quality Index was associated with Short Physical Performance Battery Score (β = -0.814). Conclusions: AL residents experience more disrupted sleep and poorer cognition than community-dwelling residents. Sleep disturbance has stronger cognitive relationships in AL. Measurement bias highlights challenges in applying common sleep measures to this population. Finally, both sleep disordered breathing and subjective sleep are associated with functional capacity.