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Feasibility of self-administered sleep assessment in older women in the Women’s Health Initiative (WHI)

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Abstract

Purpose

Laboratory-based polysomnography (PSG) is the gold standard assessment of sleep disordered breathing (SDB). In large cohort studies and clinical trials, however, these overnight procedures can be expensive and burdensome to participants, especially older adults. In preparation for a large observational study, we determined the feasibility of self-administering two devices mailed to participants’ homes that estimate indices of SDB.

Methods

In two separate studies, older women enrolled in the Women’s Health Initiative (WHI) Memory Study extension aged mean (SD) 85.77 (2.98) years who were not using supplemental oxygen and consented to being in the feasibility study completed either an in-home, self-administered overnight sleep assessment using a multi-sensor device that measured oximetry, nasal pressure, chest effort, and snoring (ApneaLinkTM) (N = 58), or a wrist-worn oximeter (NoninWristOx2TM) (N = 33). A follow-up questionnaire assessed the devices’ acceptability and important sleep-related exposures.

Results

Although the multi-sensor device was assessed only in older women with no cognitive impairment, the proportion of completed interpretable sleep studies was low (54 %) and participants reported needing help to administer the device successfully. In contrast, the wrist-worn device was used in women with either no or mild cognitive impairment (MCI), completion rates were higher (100 %), and women reported being able to administer the device independently.

Conclusions

These studies demonstrated that home-based self-administered assessments of SDB are feasible in older adults with and without cognitive impairment using wrist-worn oximetry. These data support the feasibility of using simple oximetry measurements to provide indices of overnight intermittent hypoxemia in large observational studies and clinical trials.

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Acknowledgments

WHIMS was funded by the National Heart, Lung and Blood Institute, Contract No. HHSN-268-2004-6-4221C through the initial follow-up period, WHIMS-ECHO is funded by the National Institute on Aging, Contract No. HHSN-271-2011-00004C, and the WHI program is funded by the National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services.

Funding

WHIMS was funded by the National Heart, Lung and Blood Institute, Contract No. HHSN-268-2004-6-4221C through the initial follow-up period, WHIMS-ECHO is funded by the National Institute on Aging, Contract No. HHSN-271-2011-00004C, and the WHI program is funded by the National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Leslie Vaughan, Heather Dailey & Sally A. Shumaker

  2. Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Susan Redline, Julianne Ulanski & Michael Rueschman

  3. California Pacific Medical Center Research Institute, University of California, San Francisco, CA, 94158, USA

    Katie Stone

  4. Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Stephen R. Rapp

  5. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Beverly M. Snively

  6. Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Laura D. Baker

Authors
  1. Leslie Vaughan
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  2. Susan Redline
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  3. Katie Stone
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  4. Julianne Ulanski
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  5. Michael Rueschman
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  6. Heather Dailey
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  7. Stephen R. Rapp
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  8. Beverly M. Snively
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  9. Laura D. Baker
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  10. Sally A. Shumaker
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Corresponding author

Correspondence to Leslie Vaughan.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix 1: Sleep Questionnaire (wrist-worn device)

Appendix 1: Sleep Questionnaire (wrist-worn device)

Sleep Study Questionnaire

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Vaughan, L., Redline, S., Stone, K. et al. Feasibility of self-administered sleep assessment in older women in the Women’s Health Initiative (WHI). Sleep Breath 20, 1079–1091 (2016). https://doi.org/10.1007/s11325-016-1314-3

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  • DOI: https://doi.org/10.1007/s11325-016-1314-3

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