[Most of the eye problems can be managed in primary health care. Simple check lists and "languages skills" are often the correct way].
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Communication↗
Biomedical subjects
R Asplund
Publications and source records attributed to R Asplund.
Sleep and cardiac symptoms amongst women aged 40-64 years.
OBJECTIVES: To determine whether the occurrence of cardiac symptoms is related to sleep disturbances. DESIGN: An epidemiological survey by means of a questionnaire. SETTING: The county of Jämtland in northern Sweden. SUBJECTS: Randomly selected women (6000) aged 40-64 years, with a similar number of women in each 5-year age group. A total of 3669 responded. MAIN OUTCOME MEASURES: Sleep disturbances and cardiac symptoms. RESULTS: In total, 81.9% of the women reported a good night's sleep. Amongst them, 0.4% stated that they were troubled by both spasmodic chest pain and a sensation of irregular heart beat, 0.8% spasmodic chest pain alone, 5.8% irregular heart beat and 93.0% neither of these conditions. The corresponding frequencies amongst the women who slept poorly were 1.5, 1.8, 15.0 and 81.7%, respectively (P < 0.0001). Amongst the subjects with reported sleep complaints, there was an increase in heart symptoms, both in those with trouble falling asleep, frequent awakenings and difficulty in getting to sleep again, and in those who awoke too early in the morning. Spasmodic chest pain was 8.8 (1.9-40.3) times and irregular heart beat 7.7 (3.3-18.1) times more common in women with nightmares almost every night than in those who never experienced nightmares. Daytime sleepiness was also associated with increased heart symptoms. CONCLUSION: Poor sleep was associated with an increase in spasmodic chest pain and irregular heart beat.
Adult↗
Desmopressin for the treatment of nocturnal polyuria in the elderly: a dose titration study.
OBJECTIVE: To evaluate the decrease in nocturnal polyuria and the tolerability of three different doses of oral desmopressin in elderly subjects. SUBJECTS AND METHODS: Subjects were included in the study if they; (i) were healthy and free from medication with possible influence on their diuresis or voiding pattern: (ii) had an increased nocturnal frequency (> or = 2 nocturnal voids, as reported in the pre-screening period); and (iii) had a nocturnal urinary output of > or = 0.9 mL/min. Seventeen men and six women (mean age 68.1, SD 4.7 years) met these criteria and were treated with 0.1, 0.2 and 0.4 mg oral desmopressin given at bedtime, each dose taken for one week on three consecutive weeks. RESULTS: The mean (SD) nocturnal diuresis before treatment was 1.6 (0.7) mL/min, which decreased significantly to 1.1 (0.4) mL/min when 0.1 mg desmopressin was given. A dose of 0.2 mg desmopressin resulted in a further small decrease in the nocturnal diuresis to 0.9 (0.4) mL/min, whereas the 0.4 mg dose produced no additional effect. The reduction in nocturnal diuresis occurred almost exclusively in the group with a nocturnal urinary output of > or =1.3 mL/min. After treatment, diuresis returned to pretreatment levels. There was no change in body weight or in ankle circumference during desmopressin treatment and no serious adverse effects were observed. CONCLUSION: Desmopressin reduces nocturnal diuresis in polyuric elderly subjects and this reduction, occurring with doses of 0.1 mg given at bedtime, does not increase in a dose-dependent way.
Administration, Oral↗
Daytime sleepiness in 40-64 year-old women in relation to somatic health and medical treatment.
OBJECTIVE: To investigate daytime sleepiness and napping in relation to nocturnal sleep, health, and medication. DESIGN: An epidemiological survey using a questionnaire. SETTING: The county of Jämtland in northern Sweden. SUBJECTS: 3669 randomly selected women aged 40-64 years, with a similar number of women in each 5-year age group. MAIN OUTCOME MEASURES: Daytime sleepiness (DS), health, night sleep, somatic diseases, and medication. RESULTS: DS was more common in subjects suffering from asthma, cardiac diseases, hypertension, muscular pain, and frequent nocturnal micturition. In a logistic regression analysis with DS as the dependent variable and age, health, nocturnal sleep, frequent awakenings, inability to fall asleep again after nocturnal awakening, and hypnotic medication as explanatory variables there was an increase in DS by age in each 5-year class from 40-44 years, but a decrease in DS beyond 60 years. General health, health development during the last 5 years, and sleep characteristics were associated with increased DS. There was no increase in DS related to the use of hypnotics. CONCLUSIONS: Poor health, a poor night's sleep, and different somatic diseases, but not use of hypnotics, are associated with DS in women aged 40-64.
Adult↗
The seasonal interrelationship between melatonin, vasopressin, and serum osmolality in elderly subjects.
Plasma concentration of arginine vasopressin (AVP) and melatonin and serum osmolality were measured at noon and at midnight in individuals living in the northern hemisphere on March 22-23, June 13-14, September 26-27, and December 12-13 in 35 healthy volunteers (15 men and 20 women) aged 60-74 years. The nocturnal increase in melatonin was highest in the autumn and lowest in the winter in both sexes. The midnight serum osmolality level was lower in the autumn than in any other time of the year. In both the men and the women the AVP level was higher in winter than in any other season (P < 0.01 and P < 0.0001, respectively). In men, the AVP level was higher at noon than at midnight in 49% of the investigated 24 hr periods, at the same level in 15% and lower in 36% (NS). The corresponding figures for women were 55%, 25%, and 20%, respectively (P < 0.05). This study suggests a possible relationship between melatonin and serum osmolality.
Aged↗
Nocturnal micturition, sleep and well-being in women of ages 40-64 years.
OBJECTIVE: To study the relationship between sleep and nocturnal micturition in women 40-64 years old. METHODS: A questionnaire study was carried out in 3669 (6000 invited) randomly selected women in the County of Jämtland in Sweden. Questions were asked about the general state of health, nocturnal micturition, sleep, menstruation and menopausal symptoms, and also about visits to doctors and the use of sleeping pills and hormone preparations. RESULTS: The subjective evaluation of the general state of health and of a feeling of contentedness and of confidence in the future worsened with increasing numbers of nocturnal voiding episodes. Sleep was more strongly correlated to the number of nocturnal voiding episodes (R2 = 0.099; P < 0.0001) than to age (R2 = 0.021; P < 0.0001) or the menopause (R2 = 0.017; P < 0.0001). Daytime sleepiness was three times more common among women with three or more nocturnal voiding episodes than among those with no nocturnal micturition. Women who voided three or more times in the night consulted a doctor twice as frequently as those without nocturnal micturition and were treated with drugs 2.5 times as often. The corresponding figures for sick-listing were 75 and 15 days per year, respectively. CONCLUSION: Frequent nocturnal micturition is common in 40-64-year-old women and impair sleep with subsequent decrease in daytime performance and general well-being.
Activities of Daily Living↗
Daytime sleepiness and napping amongst the elderly in relation to somatic health and medical treatment.
OBJECTIVES: To investigate daytime sleepiness and napping in relation to age, health and nocturnal sleep. DESIGN: An epidemiological survey by means of a questionnaire. SETTING: The counties of Västerbotten and Norrbotten in northern Sweden. SUBJECTS: All 10,216 members of the pensioners' association SPF. MAIN OUTCOME MEASURES: Daytime sleep, daytime sleepiness, health, night sleep, somatic diseases and medication. RESULTS: Daytime sleepiness was 4.9 (3.7-6.4) and 5.1 (4.2-6.1) times more common in men and women, respectively, in poor health than in those in good health. It was also more common in subjects suffering from cardiac diseases, diabetes and musculo-skeletal diseases, urological symptoms, and diseases with sensory and neurological impairments, compared with symptomless subjects. Stepwise regression analysis showed an increase in daytime sleepiness in men in association with impaired general health (r2 = 0.067), frequent awakenings (r2 = 0.098), higher age (r2 = 0.109) and difficulty in falling asleep again after nocturnal awakening (r2 = 0.115), and in the women, in association with impaired health (r2 = 0.118), difficulty in falling asleep again (r2 = 0.149), frequent awakenings (r2 = 0.160) and higher age (r2 = 0.171). There was no further increase in r2 = either for men or women in relation to use of hypnotics. CONCLUSION: Age, poor health and different somatic diseases, but not hypnotics, are associated with daytime sleepiness in elderly persons.
Aged↗
The nocturnal polyuria syndrome (NPS).
1. The nocturnal polyuria syndrome (NPS) is characterized by an increased nocturnal urine output. The diurnal rhythm in the antidiuretic hormone (ADH) system is absent, and often there is no detectable ADH in the plasma at all during the night. The 24-hr urine output is normal or only moderately increased. Men without nocturnal micturition, normally have a substantial increase in their nocturnal plasma ADH, while those with a need to micturate during the night have the same ADH level at night as in the daytime. Women have lower ADH levels than men, and no nocturnal increase in ADH irrespective of nocturnal voiding. Subjects with an increased nocturnal voiding frequency due to increased nocturnal urine output have an increased thirst, most markedly at night. They often avoid drinking in the evening, but they are unable to resist the impulse to drink during the night. People with polyuria at night wake up often because of the need to void, and accordingly are often tired during the day. 2. An increased nocturnal urine output can be reduced by administration of desmopressin at night. In a short-term study of elderly sufferers from NPS, treated with 20 micrograms desmopressin as nose drops in the evening the nocturnal urine output was reduced from 65 +/- 8% of the 24-hr urine output before treatment to 50 +/- 15% during treatment. In another study elderly with NPS were treated with 40 micrograms desmopressin as an intranasal aerosol in the evening.(ABSTRACT TRUNCATED AT 250 WORDS)
Atrial Natriuretic Factor↗
Body mass index and sleep in women aged 40 to 64 years.
A questionnaire study was carried out in 6000 randomly selected women in the County of Jämtland in Sweden. The response rate was 61.2%. Questions were asked about general health, height and body weight, sleep, menstruation and menopausal complaints. There were also questions about visits to doctors and the use of sleeping pills and hormone preparations. A deterioration of the night's sleep after the age of 60 years was associated especially with a low body mass index (BMI). In the subgroup with a BMI below 20 (kg m-2), frequent awakenings were reported 4 times more often in women 60-64 years old than in those aged 40-44 years. No such difference was found with a BMI > or = 30. In the age group 60-64 years twice as many women with BMI > or = 30 as women with BMI < 20 slept without waking up at night. BMI was similar in women with and without oestrogen therapy before the menopause. After the menopause the BMI in these two groups was 25.0 +/- 3.1 (mean +/- S.D.) and 25.6 +/- 3.8, respectively (P < 0.05). Oestrogen-treated women had fewer sleep disorders than other women of the same age. Of the premenopausal women, 3.4% used sleeping pills, compared with 8.0% after the menopause. Before the menopause the use of sleeping pills was not related to BMI, but after the menopause this use was twice as common among women with BMI < 20 kg m-2 than among those with BMI > or = 30kg m-2.
Adult↗
Sleep and hypnotics among the elderly in relation to body weight and somatic disease.
OBJECTIVES: To investigate the interrelationship between sleep complaints and hypnotics in relation to general health and somatic diseases. DESIGN: An epidemiological survey conducted by means of a questionnaire. SETTING: The counties of Västerbotten and Norrbotten in northern Sweden. SUBJECTS: All 10,216 members of the Swedish Pensioners' Association. MAIN OUTCOME MEASURES: Sleep disturbances, health, somatic diseases and hypnotic medication. RESULTS: General ill health, cardiovascular diseases, different painful diseases and increased nocturnal voiding frequency were all associated with poor sleep and increased treatment with hypnotics. Hypnotics were used by 13.5% of the men and 22.3% of the women. Of the men aged < 70 years, 7.9% were receiving such treatment, of those aged 70-80 years 14.4% were using hypnotics, and of those aged > or = 80 years 21.8% were taking hypnotics (P < 0.0001). The corresponding frequencies among women were 15.0%, 23.0% and 34.9%, respectively (P < 0.0001). Half of all men and women treated with hypnotics in all age groups reported a good night's sleep. Among these both angina pectoris and cardiac arrhythmia were twice as common as among elderly subjects who experienced poor sleep and were receiving treatment with hypnotics. CONCLUSIONS: Poor health and different somatic diseases are over-represented in elderly persons treated with hypnotics.
Aged↗
Seasonal changes in the levels of antidiuretic hormone and melatonin in the elderly.
Antidiuretic hormone (ADH) and melatonin in plasma were measured every 4 hr during a 24-hr period in 69 elderly volunteers (42 males and 27 females) aged 75.6 +/- 8.8 years (+/- SD) and 73.5 +/- 9.5 years, respectively. The population was divided into three groups, which were examined February 27-28, April 25-26, and November 14-15. For the males, the mean ADH level during 24 hr was lowest in April and highest in November with a level five times higher than in April. The ADH level in February was about three times higher that in April. Females did not show any seasonal variation in the ADH system. The melatonin levels were lowest in November, higher in February, and even higher in April in both male and female volunteers. The ADH increased with age in males (R2 = 0.13; P < 0.05) but not in females (R2 = 0.07; NS). The melatonin concentration decreased with age for the whole group, aged 60-98 years.
Aged↗
Sleep and cardiac diseases amongst elderly people.
OBJECTIVES: To investigate the interrelationship between sleep complaints and cardiac symptoms. DESIGN: An epidemiological survey by means of questionnaire. SETTING: Västerbotten and Norrbotten in northern Sweden. SUBJECTS: All 10,216 members of the Swedish Pensioners' Association (SPF). MAIN OUTCOME MEASURES: Sleep disturbances and cardiac diseases. RESULTS: Of the men who slept well, 3.0% stated they were troubled by both spasmodic chest pain ('angina pectoris') and a sensation of irregular heart beats ('cardiac arrhythmia'), 9.9% had angina pectoris alone, 7.9% suffered from cardiac arrhythmia, and 79.2% had neither of these disorders. Amongst the men who slept poorly, the corresponding frequencies were 7.0%, 8.7%, 12.3% and 72.0% (P < 0.001). Amongst the women who slept well these frequencies were 2.3%, 7.0%, 8.2% and 82.5%, and among those who slept poorly 5.9%, 10.2%, 15.0% and 68.9% (P < 0.0001). Amongst those with reported sleep complaints, there was an increased occurrence of both angina pectoris and cardiac arrhythmia. This increase in cardiac disease was found in men and women; both in those with trouble falling asleep, those who frequently awoke during the night and those who had difficulty regaining sleep; and also in those with too early final awakening in the morning. Daytime sleepiness was also associated with increased cardiac symptoms. CONCLUSION: Poor sleep was associated with both an increase in angina pectoris and cardiac arrhythmias.
Aged↗
Desmopressin in elderly women with increased nocturnal diuresis. A short-term study.
We report the changes in the pattern of diuresis in 20 women (average age 71 years) with increased nocturnal diuresis who were treated with 20 micrograms desmopressin (Minirin). Before treatment, antidiuretic hormone levels were measured every 4 h over a 24-h period and 75% of the levels were found to be beneath the lowest detectable limit (< 0.4 pmol/l). Nocturnal diuresis decreased by 355 +/- 208 ml and in 8 cases the decrease exceeded 400 ml. Diurnal diuresis, on the other hand, increased by 226 +/- 331 ml. Side effects were mild and occurred in only 2 women.
Aged↗
Desmopressin in elderly subjects with increased nocturnal diuresis. A two-month treatment study.
This study describes changes in diuresis during a two-month treatment with 40 micrograms desmopressin (Minirin) in a group of elderly persons with increased nocturnal diuresis and decreased ADH secretion. The average age of the men (n = 7) was 72 +/- 4 years and of the women (n = 14) 73 +/- 6 years. Nocturnal diuresis decreased after one and two months by 21% and 20% in the men and by 36% and 34% in the women, respectively. Half of the change persisted among the women but not among the men one month after the treatment. The decrease in nocturnal diuresis was greatest among those who, before the treatment, had a large part of their diuresis during the night. Diuresis during the day changed only insignificantly. Body weight did not change during treatment, nor did blood pressure, osmolality, sodium or potassium in serum. Sleep improved during treatment. In one case, side-effects were observed, with a feeling of swelling in the body and decreased diuresis in the morning.
Administration, Intranasal↗
Micturition habits of older people. Voiding frequency and urine volumes.
A questionnaire study was carried out among elderly subjects (mean age 73.6 +/- 6.1 years (SD)) with a response rate of 74% (n = 1,115). It covered various aspects of health, symptoms and disease. 26% (n = 287) stated that they had two or more micturitions per night. A subgroup consisting of healthy older people, 39 men and 56 women with an average age of 73.9 +/- 4.9 years and 70.8 +/- 5.3 years, respectively, was studied concerning the distribution of diuresis and the frequency of voiding. The combined 24-hour diuresis (average for three 24-hour periods) was 1,400-1,600 ml, with a quotient between day and night of about 1, except the group with only one micturition at night (12 hours), where it was 1.8. The micturition volume between 08-20 h was less than between 20-08 h. The micturition volumes during both periods were significantly less with an increase in the number of voidings between 20-08 h. The quotient between the micturition volume 08-20 h and 20-08 h was strikingly constant (about 0.7). The finding of equally large urine volumes both day and night differs from that among younger adults in whom the diuresis is twice as large in the day as in the night.
Aged↗
Health of the elderly with regard to sleep and nocturnal micturition.
A questionnaire study was carried out among pensioners in Jämtland County, Sweden. The questionnaire was answered by 1,115 persons, representing a response rate of 74%. It covered various aspects of health, with emphasis on sleep, fatigue, thirst, and other symptoms that may interfere with night-time sleep. The data were analysed with regard to the stated number of night-time disturbances due to urination. Nocturnal micturition was often associated with increased sleep disorders, a poorer quality of sleep, increased thirst, particularly at night, and increased fatigue in the daytime. All the relationships were clearer in women than in men. There was no relationship between reported enuresis in childhood and an increased frequency of voiding when the subject became older.
Aged↗
Stimulus-specific mechanisms of visual short-term memory.
The retention of spatial information in visual short-term memory was assessed by measuring spatial frequency discrimination thresholds with a two-interval forced-choice task varying the time interval between the two gratings to be compared. The memory of spatial frequency information was perfect across 10-sec interstimulus intervals. Presentation of a "memory masker" grating during the interstimulus interval may interfere with short-term memory. This interference depends on the relative spatial frequency of the test and masker gratings, with maximum interference at spatial frequency differences of 1-1.5 octaves and beyond. This range of interference with short-term memory is comparable to the bandwidth of sensory masking or adaptation. A change of the relative orientation of test and masker gratings does not produce interference with spatial frequency discrimination thresholds. These results suggest stimulus-specific interactions at higher-level representations of visual form.
Discrimination, Psychological↗
Diurnal variation in the levels of antidiuretic hormone in the elderly.
The secretion of antidiuretic hormone (ADH) and the serum osmolality were measured at 4-h intervals throughout a 24-h period in 69 healthy elderly volunteers. In male subjects the concentrations of plasma ADH were always twofold higher than in female subjects. The normal diurnal rhythm, with increased ADH secretion during the night, was not seen in this group of elderly subjects, with the exception of elderly men who did not urinate during the night, in whom a substantial increase in plasma ADH levels occurred. In as many as 25% of all the ADH measurements performed (n = 455) ADH was not detectable by the method used. The lack of a definite diurnal rhythm in most of the elderly subjects could to some extent explain the increased diuresis during the night in the elderly.
Aged↗