Multidimensional sleep disturbances in hospitalized older adults: associated factors and modifiable exacerbating factors

Abstract

Sleep disturbances are highly prevalent among hospitalized older adults; however, data simultaneously evaluating insomnia, sleep quality, excessive daytime sleepiness (EDS), and obstructive sleep apnea (OSA) risk, particularly in Türkiye, remain scarce. This study evaluated the prevalence of insomnia, poor sleep quality, EDS, and OSA risk and identified factors associated with each outcome, with emphasis on potentially modifiable exacerbating factors. In this cross-sectional study, 400 patients aged ≥ 65 years hospitalized for ≥ 48 h in internal medicine and affiliated wards were enrolled. Insomnia was diagnosed according to ICSD-3 criteria. Sleep quality was assessed with the PSQI, EDS with the ESS, and OSA risk with the Berlin Questionnaire. Univariate and multivariable logistic regression analyses were used to identify factors independently associated with each outcome; multicollinearity was assessed with the variance inflation factor (VIF). Insomnia was present in 74.3% of participants, 93.6% of whom had chronic insomnia. Poor sleep quality was identified in 66.3%, high OSA risk in 57.3%, and EDS in 12.5%. Females had significantly higher global PSQI scores and OSA risk than males (66.7% vs. 45.9%). In multivariable models entering all candidate variables simultaneously, poor sleep quality was independently associated with pain (aOR 1.85), and insomnia with extreme room temperature (aOR 4.22); other environmental items were attenuated after adjustment. High OSA risk was independently associated with hypertension (aOR 4.82) and higher body mass index (aOR 1.07). No variable was independently associated with EDS; female sex showed the strongest trend (aOR 0.55; p  = 0.056). Because the four outcomes were only weakly to moderately inter-correlated, they were treated as related but distinct dimensions. Sleep disturbances in hospitalized older adults are highly prevalent and are associated with modifiable environmental and clinical factors. Because these disturbances frequently pre-date admission, addressing such factors is more likely to limit their exacerbation than to prevent the underlying disorder. Routine sleep screening and targeted environmental interventions should nonetheless be integrated into geriatric inpatient care. Because the recall periods of the instruments (past month for the PSQI; at least three months for chronic insomnia) exceed the hospitalization duration, the design cannot attribute the disturbances to the hospital stay or separate pre-existing from hospital-acquired problems.