Poor Sleep Quality of Hospitalized Geriatric Patients in General Hospital in Karawaci , Tangerang , Banten Province , Indonesia

Background: In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health. Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulation Objective: To study the epidemiological (gender, age group) and health status (co-morbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia. Materials and Methods: A hospital based cross sectional study was conducted from January to June 2014. A total of 92 subjects aged 60 years and above were selected consecutively from hospitalized geriatric patients for this study. The data was analyzed by means and proportions. Results: The male and female subjects were 51.1% and 48.9%. Mean age was 66.79 + 5.448 years. The age group of 60 – 75 years and above 75 years was 92.4% and 7.6% consecutively. Subjects with diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were 30.4%, 62.0%, 18.5%, 21.7%, 21.7%, 20.7% consecutively and 63.0% with more than 2 comorbidities. According to PSQI 72.8% subjects have poor sleep quality. Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes (RR= 3.208 [95% CI: 1.045 – 9.848], p = 0.022) and chronic kidney disease (RR= 6.247 [95% CI: 0.902 – 43.279], p = 0.017) Conclusions: Seventy two percents of subjects have poor sleep quality, and associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.


Introduction
In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. 1 There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health.In geriatric populations, sleep disturbances is associated with greater risk of adverse health-related outcomes, such as poor health status, 2 disability, 3 poorer physical functioning, 4,5 falls and fractures. 6Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulation.
Geriatric population with multiple comorbidities that was also related to more poor sleep. 7These co-morbidities were also related to dysregulation of inflammatory responses.
This study aimed to study the epidemiological (gender, age group) and health status (comorbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia.

Participants
The study was conducted in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia from January to June 2014.Subjects were patients aged 60 years and above, selected consecutively from hospitalized geriatric patients.
Data collected were demographic data including age and gender, co-morbidities data (diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease), and sleep quality.Data on cancer were not collected.Co-morbidities was coded only for subjects who has a confirmed history of diagnosis and treatment for one of the above comorbidities.

Sleep quality
Sleep quality were investigated using specific questions and items obtained from the Pittsburgh Sleep Quality Index (PSQI).The cutoff for PSQI-defined poor sleep quality was a score > 5.

Statistical analysis
Statiscal analysis was done using the SPSS version 20.0.The minimum statistical significance level for all analyses was p < 0.05.Categorical datas were presented as frequency and percentage, while numerical datas were presented as mean + standar deviation.Association between sleep quality and epidemiologicalhealth status including age and gender, co-morbidities such as diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were analyzed using Chi-square test and Fisher exact test to obtain 95% confidence interval of the risk ratio (RR) and p value.

Discussion
8][9] Studies have shown that older adults with poor sleep-related inflammation is transposed onto immunosenescence and may contribute additively or synergistically to inflammatory-related mental and physical morbidity. 5riatric patients were associated with multiple health conditions, including chronic diseases and chronic pain the diseases caused.
Multiple conditions in geriatric patients was related to more sleep disturbances. 61][12][13][14][15] Sleep disturbances were associated with mortality, frailty and death.Studies have shown that sleep quality in geriatric patients has prognostic value in assessing risk of frailty and mortality.
Sleep disturbances might be a sign of many conditions in geriatric patients including poor health condition, intermediate stage of frailty and comorbidities which impair sleep and increase the possibility for frailty or death.Sleep disturbances were related to other condition including low endogenous level of testosterone 16 , renal dysfunction 17 and increased level of chronic inflammation markers. 18Any one or a combination of condition mentioned above might increase the risk of frailty or death in geriatric patients with sleep disturbance.Sleep disturbance might also be affected by the frailty that was frequently experienced by geriatric patients with chronic condition such as diabetes or cardiac failure. 19is study results showed that majority of geriatric patients admitted to hospital experienced sleep disturbance, as the PSQI score > 5.The explanation could be that the geriatric patients included in this study was being admitted, thus their health condition was in poor condition.The worsening condition that leads to hospitalization also increases the inflammatory markers and also the frailty, resulting sleep disturbance.
In spite of the conditions of these geriatric patients that lower sleep quality, diabetes was shown to have impacted more on sleep quality.Other epidemiologicalhealth status of these geriatric patients did not seemed to have enough on sleep quality.

Conclusions
Seventy two percent of subjects have poor sleep quality.Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.

Table 1 .
Demography and epidemiology profile of geriatric patients

Table 2 .
Associations between sleep quality and epidemiologicalhealth status of geriatric patients