DOI QR코드

DOI QR Code

The Influence of Health Behaviors and Sleep related Factors on Cognitive Function in the Elderly Hypertensive Patients

노인 고혈압 환자의 건강행태 및 수면 관련 요인이 인지기능에 미치는 영향

  • Kim, Ahrin (Department of Nursing, Cheongju University) ;
  • Jeon, Hae Ok (Department of Nursing, Cheongju University)
  • Received : 2015.08.26
  • Accepted : 2015.10.08
  • Published : 2015.10.31

Abstract

This study examined effects of health behaviors and sleep related factor on cognitive function in the elderly hypertensive patients. Data were collected through a face to face interview survey with structured questionnaire form 140 elderly with hypertension ($age{\geq}65years$) from February 5 to May 1, 2013. Research instruments included Pittsburgh Sleep Quality Index(PSQI), Epworth Sleepiness Scale(ESS) and Korean version the Mini-Mental State Examination(MMSE-K). Cognitive function was negatively related to degradation in quality of sleep(r=-.29, p<.001). Sleep duration were negatively related to body mass index(r=-.18, p=.032) and degradation in quality of sleep(r=-.59, p<.001). Sleep duration was positively related to daytime sleepiness(r=.22, p=.008). Hierarchical multiple regression showed that age, education levels and living arrangement were associated with cognitive function(F=8.56, p<.001, Adjusted $R^2=.14$). After controlling for demographic characteristics and health behaviors, degradation in quality of sleep(${\beta}=-.27$, p=.008) was identified as significant predictors of cognitive function. This final model explained 17.0% of the cognitive function in the elderly hypertensive patients(F=4.09, p<.001). Therefore, as a strategy improving cognitive function of the elderly with hypertension, therapeutic intervention should be developed to improve quality of sleep considering age, education levels and living arrangement.

본 연구의 목적은 노인 고혈압 환자의 건강행태, 수면 관련 요인이 인지기능에 미치는 영향을 파악하는 것이다. 연구대상은 지역사회에 거주하는 65세 이상 노인 중 고혈압을 진단 받은 140명이었다. 자료 수집은 2013년 2월 5일부터 5월 1일까지로 일대일면접 설문조사로 시행되었다. 연구도구는 Pittsburgh Sleep Quality Index(PSQI), Epworth Sleepiness Scale(ESS)와 한국어판 노인용 간이정신상태 검사 도구를 사용하여 측정하였다. 연구결과, 노인고혈압 환자의 인지기능은 수면의 질 저하와 유의한 음의 상관관계를 나타냈다(r=-.29, p<.001). 수면시간은 체질량지수(r=-.18, p=.032) 및 수면의 질 저하(r=-.59, p<.001)와 유의한 음의 상관관계가 있었고, 주간졸음과는 유의한 양의 상관관계가 있었다(r=.22, p=.008). 위계적 회귀분석 결과, 노인 고혈압 환자의 연령, 교육수준, 거주유형은 인지기능과 유의한 관련성이 있으며(F=8.56, p<.001, Adjusted $R^2=.14$), 인구사회학적 특성과 건강행태를 통제한 상태에서 수면의 질 저하(${\beta}=-.27$, p=.008)는 인지기능에 유의한 영향을 미치며, 최종 모형의 설명력은 17%였다(F=4.09, p<.001). 그러므로 노인 고혈압 환자의 인지기능 향상전략은 연령, 교육수준, 거주유형을 고려하고, 낮은 수면의 질을 향상 시킬 수 있는 치료적인 중재가 도움이 될 것으로 사료된다.

Keywords

References

  1. Statistics Korea, World and Korea's Population Prospects, 2015.
  2. Ministry of Health and Welfare, Korea Centers for Disease Control & Prevention, 2013 Health Behavior and Chronic Disease Statistics, 2014.
  3. W. C. Cuchmaman, "Alcohol Consumption and Hypertension", Journal of Clinical Hypertension, Vol.3, No.3, pp.166-170, 2001. DOI: http://dx.doi.org/10.1111/j.1524-6175.2001.00443.x
  4. J. M. Halimi, B. Giraudeau, S. Vol, E. Caces, H. Nivet, J. Tichet, "The risk of hypertension in men: Direct and indirect effects of chronic smoking", Journal of Hypertension, Vol.20, No.2, pp.187-193, 2002. DOI: http://dx.doi.org/10.1097/00004872-200202000-00007
  5. K. D. Wald, D. Sparrow, L. Landsberg, J. B. Yonung, S. T. Weiss, "Influence of Insulin, Sympathetic Nervous System Activity, and Obesity on Blood Pressure: The Normative Aging Study", Journal of Hypertension, Vol.14, No.3, pp.301-308, 1996. DOI: http://dx.doi.org/10.1097/00004872-199603000-00005
  6. E. Park, "Sleep Duration and the Related Factors of Hypertension among Korean Middle-aged Adults", Korean Journal of Adult Nursing, Vol.26, No.3, pp. 372-381, 2014. DOI: http://dx.doi.org/10.7475/kjan.2014.26.3.372
  7. K. Horvath, K. Jeitler, U. Siering, A. K. Stich, G. Skipka, T. W. Gratzer, A. Siebenhofer, "Long-term Effects of Weight-reducing Interventions in Hypertensive Patients: Systematic Review and Meta-analysis", Archives of Internal Medicine, Vol.168, Vo.6, pp.571-580, 2008. https://doi.org/10.1001/archinte.168.6.571
  8. M. A. R. Martires, M. A. M. Costa, C. S. Vilaca Santos, "Obesity in Aged Hypertension Patients", Texto Contexto-enferm, Vol.22 No.3 Florianopolis Jul. 2013.
  9. X. Xiang, R. An, "Body Weight Status and Onset of Cognitive Impairment among U.S. Middle-aged and Older adults", Archives of Gerontology and Geriatrics, Vol.60, No.3, pp.394-400, 2015. DOI: http://dx.doi.org/10.1016/j.archger.2015.02.008
  10. http://www.doopedia.co.kr/
  11. D. J. Foley, A. A. Monjan, S. L. Brown, E. M. Simonsick, R. B. Wallace, D. G. Blazer, "Sleep Complaints among Elderly Persons: An Epidemiologic Study of Three Communities", Sleep, Vol.18, pp. 425-432, 1995. https://doi.org/10.1093/sleep/18.6.425
  12. I. Jaussent, J. Bouyer, M. L. Ancelin, T. Akbaraly, K. Peres, K. Ritchie, A. Besset, Y. Dauvilliers, "Insomnia and Daytime Sleepiness are Risk Factors for Depressive Symptoms in the Elderly", Sleep, Vol.34, No.8, pp.1103-1110, 2011. DOI: http://dx.doi.org/10.5665/sleep.1170
  13. K. W. Yao, S. Yu, S. Cheng, I. Chung, "Relationships between Personal, Depression, Social Network Factors and Sleep Quality in Community-dwelling Older Adults", Journal of Nursing Research, Vol.16, No.2, pp.131-139, 2008. DOI: http://dx.doi.org/10.1097/01.JNR.0000387298.37419.ff
  14. Z. Ismail, C. Fischer, W. V. McCall, "What Characterizes Late-life Depression?", Psychiatric Clinics of North America, Vol.36, pp.483-496, 2013. DOI: http://dx.doi.org/10.1016/j.psc.2013.08.010
  15. P. E. Peppard, T. Young, M. Palta, J. Skatrud, "Prospective Study of the Association between Sleep-disordered Breathing and Hypertension", The New England Journal of Medicine, Vol.342, pp. 1378-1384, 2000. DOI: http://dx.doi.org/10.1056/NEJM200005113421901
  16. S. H. Kim, K. H. Ji, C. H. Yun, C. K. Ha, "Association Between Obstructive Sleep Apnea and Cardiovascular Diseases", Journal of the Korean Neurological Association, Vol.27, No.3, pp. 223-228, 2009.
  17. Ministry of Health and Welfare, 2012 Nationwide Study on the Prevalence of Dementia in Korean Elders, 2013.
  18. J. C. de la Torre, "Critically Attained Threshold of Cerebral Hypoperfusion: The CATCH Hypothesis of Alzheimer's Pathogenesis", Neurobiology of Aging, Vol.21, pp. 331-342, 2000. DOI: http://dx.doi.org/10.1016/S0197-4580(00)00111-1
  19. R. N. Kalaria, "The Role of Cerebra Ischemia in Alzheimer's Disease", Neurobiology of Aging, Vol.21, pp.321-330, 2000. DOI: http://dx.doi.org/10.1016/S0197-4580(00)00125-1
  20. H. J. Lee, J. S. Lee, T. Kim, I. Y. Yoon, "Relationship between Sleep Disturbances and Cognitive Impairments in Older Adults with Depression", Sleep Medicine and Psychophysiology, Vol.21, No.1, pp.5-13, 2014. DOI: http://dx.doi.org/10.14401/KASMED.2014.21.1.5
  21. H. A. Keage, S. Banks, K. L. Yang, K. Morgan, C. Brayne, F. E. Matthews, "What Sleep Characteristics Predict Cognitive Decline in the Elderly?", Sleep Medicine, Vol.13, No.7, pp.886-892, 2012. DOI: http://dx.doi.org/10.1016/j.sleep.2012.02.003
  22. R. D. Nebes, D. J. Buysse, E. M. Halligan, P. R. Houck, T. H. Monk, "Self-reported Sleep Quality Predicts Poor Cognitive Performance in Healthy Older Adults", Journals of Gerontology Series B: Psychological Sciences & Social Sciences, Vol.64B, No.2, pp.180-187, 2009. DOI: http://dx.doi.org/10.1093/geronb/gbn037
  23. J. H. Lee, S. J. Kim, D. Y. Lee, I. H. Chou, K. W. Kim, J. C. Youn, J. I. Woo, "Relationship of Sleep Factors with Neurocognitive Function in Normal Elderly", Journal of Korean Neuropsychiatric Association, Vol.46, No.1, pp.41-49, 2007.
  24. W. Moraes, D. Poyares, I. Zalcman, M. T. de Mello, L. R. Bittencourt, R. Santos-Silva, S. Tufik, "Association between Body Mass Index and Sleep Duration Assessed by Objective Methods in a Representative Sample of the Adult Population", Sleep Medicine. Vol.14, No.4, pp.312-318, 2013. DOI: http://dx.doi.org/10.1016/j.sleep.2012.11.010
  25. Q. Xiao, S. K. Keadle, A. R. Hollenbeck, C. E. Matthews, "Sleep Duration and Total and Cause-specific Mortality in a Large US Cohort: Interrelationships with Physical Activity, Sedentary Behavior, and Body Mass Index", American Journal of Epidemiology, Vol.180, No.10, pp.997-1006, 2014. DOI: http://dx.doi.org/10.1093/aje/kwu222
  26. F. Faul, E. Erdfelder, A. G. Lang, A. Buchner, "G*POWER 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences", Behavior Research Methods, Vol.39, pp.175-191, 2007. DOI: http://dx.doi.org/10.3758/BF03193146
  27. D. Buysse, C. Reynolds, T. Monk, S. Berman, D. Kuper, "The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research", Psychiatry Research, Vol.28, pp.193-213, 1998. DOI: http://dx.doi.org/10.1016/0165-1781(89)90047-4
  28. M. Johns, "A New Method for Measuring Daytime Sleepiness : The Epworth Sleepiness Scale", Sleep, Vol.14, No.6, pp.540-545, 1991. https://doi.org/10.1093/sleep/14.6.540
  29. M. Folstein, S. Folstein, P. McHugh, "Mini-mental State. A Practical Method for Grading the Cognitive State of Patients for the Clinician", Journal of Psychiatric Research, Vol.12, No.3, pp.189-198, 1975. DOI: http://dx.doi.org/10.1016/0022-3956(75)90026-6
  30. Y. C. Kwon, J. H. Park, "Part 1: Development of the Test for the Elderly: Korean version of Mini-Mental State Examination (MMSE-KC).", The Korean Neuropsychiatirc Association, Vol.28, No.1, pp.125-135, 1989.
  31. World Health Organization, Global Database on Body Mass Index, 2010.
  32. K. D. Wald, D. Sparrow, L. Landsberg, J. B. Yonung, S. T. Weiss, "Influence of Insulin, Sympathetic Nervous System Activity, and Obesity on Blood Pressure: The Normative Aging Study", Journal of Hypertension, Vol.14, No.3, pp.301-308, 1996. DOI: http://dx.doi.org/10.1097/00004872-199603000-00005
  33. M. Kivipelto, T. Ngandu, L. Fratiglioni, M. Viitanen, I. Kareholt, B. Winblad, E. L. Helkala, J. Tuomilehto, H. Soininen, A. Nissinen, "Obesity and Vascular Risk Factors at Midlife and the Risk of Dementia and Alzheimer Disease", Archives of Neurology, Vol.62, pp.1556-1560, 2005. DOI: http://dx.doi.org/10.1001/archneur.62.10.1556
  34. Ministry of Health and Welfare, Korea Institute for Health and Social Affairs, 2011 Korean National Survey on the Elderly, 2012.
  35. W. A. Rocca, R. C. Petersen, D. S. Knopman, L. E. Hebert, D. A. Evans, K. S. Hall, F. W. Unverzagt, K. M. Langa, E. B. Larson, L. R. White, "Trends in the Incidence and Prevalence of Alzheimer's Disease, Dementia, and Cognitive Impairment in the United States", Alzheimer's & Dementia, Vol.7, pp. 80-93, 2011. DOI: http://dx.doi.org/10.1016/j.jalz.2010.11.002
  36. A. Cherubini, D. T. Lowenthal, E. Paran, P. Mecocci, L. S. Williams, U. Senin, "Hypertension and Cognitive Function in the Elderly", American Journal of Therapeutics, Vol.14, No.6, pp. 533-554, 2007. DOI: http://dx.doi.org/10.1097/MJT.0b013e3180ed6b8f
  37. H. S. Jeon, "An Exploratory Study on the Predictors of Cognitive Improvement among Older Adults: Using Korean Longitudinal Study of Aging(KLoSA)", Health and Social Welfare Review, Vol.33, No.3, pp.461-488, 2013. DOI: http://dx.doi.org/10.15709/hswr.2013.33.2.461
  38. J. H. Son, D. H. Han, B. S. Kee, "The Effect of Living with Spouse on Cognitive Decline and Depressive Symptom in Elderly People", Journal of Korean Geriatric Psychiatry, Vol.17, No.1, pp.14-19, 2013.
  39. M. A. Miller, H. Wright, C. Ji, F. P. Cappuccio, "Cross-sectional Study of Sleep Quantity and Quality and Amnestic and Non-amnestic Cognitive Function in an Ageing Population: The English Longitudinal Study of Ageing(ELSA)", PLoS ONE, Vol.9, No.6, e100991, 2014. DOI: http://dx.doi.org/10.1371/journal.pone.0100991
  40. J. E. Gangwisch, S. B. Heymsfield, B. Boden-Albala, R. M. Buijs, F. Kreier, M. G. Opler, T. G. Pickering, A. G. Rundle, G. K. Zammit, D. Malaspina. "Sleep Duration Associated with Mortality in Elderly, but not Middle-aged, Adults in a Large US Sample", Sleep, Vol.31, No.8, pp.1087-1096, 2008.