PREVALENCE AND PERSISTENCE OF SLEEP COMPLAINTS IN A RURAL OLDER COMMUNITY SAMPLE - THE MOVIES PROJECT

OBJECTIVES: To determine the prevalence and 2-year persistence of subj ective sleep complaints in a rural older population. DESIGN: A prospec tive epidemiological study of an age-stratified random community sampl e. SETTING: The mid-Monongahela Valley, a rural area of Southwestern P ennsylvania. PARTICIPANTS: A total of 1050 individuals with a mean age of 74.4 years (range, 66-97; SD=;5.5); 57.2% were women. MEASUREMENTS : Subjective responses to questions about sleep complaints, classified as ''never'' experienced versus ''sometimes'' Or ''usually''; these q uestions reflected difficulty falling asleep (DFA), sleep continuity d isturbance (SCD), early morning awakening (EMA), and uncontrollable da y-time somnolence (DaSom). Subjects were also asked about snoring. Fre quencies of these complaints were used to calculate their prevalence; those who remained in the study 2 years later were asked the same ques tions again to determine the persistence of sleep complaints. On the f irst occasion, subjects were also asked for ''usual'' estimates of how long they took to fall asleep, how many times they wakened during the night, and how many hours of sleep they obtained per night. RESULTS: With regard to prevalence, 385 (36.7%) subjects reported DFA, 301 (28. 7%) reported SCD, 201 (19.1%) reported EMA, and 198 individuals (18.9% ) reported DaSom. Of those who knew whether they snored, 334 (40.0%) r eported snoring loudly during sleep, Within the age range of this grou p, age was not associated with complaints of insomnia or somnolence; h owever, older age was associated with a significantly lower prevalence of snoring (P <.001). All three insomnia complaints were significantl y more common among women (P <.001). Snoring was significantly more co mmon among men (P <.005), but there was no gender difference in DaSom. With regard to subjective estimates, of those reporting DFA, 49.2% re ported that sleep latency exceeded an hour; of those reporting SCD, 26 .2% reported waking three or more times per night; and of the entire s ample, 11.8% reported 5 hours or less, whereas 12.7% reported 9 to 12 hours, of sleep pet night. Approximately 2 years later, among those wh o had reported insomnia previously and participated in the follow-up w ave, the persistence of DFA was 74.9%, that of SCD 68.9%, that of EMA 47.3%, and that of known snoring was 59.6%. The persistence of DaSom, however, was only 5.7%; only DaSom was significantly (P=.049) associat ed with mortality. CONCLUSIONS: Sleep complaints were common among the se older individuals. Because these data were collected prospectively, they also provide objective evidence that insomnia is relatively pers istent or chronic among older adults. This finding has implications fo r the diagnosis and long-term management of sleep disorders in older p eople. Derivation from a random community-based sample rather than fro m samples of patients or volunteers makes these data more generalizabl e to the general older population. Finally, these data describe a rura l older population, a group which, in general, is medically underserve d and understudied.