Self-reported and actigraphic short sleep duration in older adults

J Clin Sleep Med. 2021 Aug 2. doi: 10.5664/jcsm.9584. Online ahead of print.


Study objectives: Persons > 65 years with short sleep duration (≤ 6 hours) are at risk for adverse outcomes, but the accuracy of self-reported sleep duration may be affected by reduced symptom awareness. We evaluated the performance characteristics of self-reported versus objectively-measured sleep duration in this age group.

Methods: In 2,980 men from the Osteoporotic Fractures in Men Sleep Study (MrOS) and 2,855 women from the Study of Osteoporotic Fractures (SOF), we examined the agreement and accuracy of self-reported versus actigraphy-measured short and normal (> 6 but < 9 hours) sleep duration. We evaluated associations of select factors (demographics, medical, physical, and neuropsychiatric conditions, medication and substance use, and sleep-related measures) with risk of false-negative (normal sleep duration by self-report but short sleep duration by actigraphy) and false-positive (short sleep duration by self-report and normal sleep duration by actigraphy) designations, respectively, using logistic regression.

Results: Average ages were 76.3 ± 5.5 and 83.5 ± 3.7 years in men and women, respectively. There was poor agreement between self-reported and actigraphic sleep duration (Kappa ≤ 0.24). False-negatives occurred in nearly half and false-positives in over a quarter of older persons. In multivariable models in men and women, false-negatives were independently associated with obesity, daytime sleepiness, and napping, while false-positives were significantly lower with obesity.

Conclusions: Under- and over-reporting of short sleep is common among older persons. Reliance on self-report may lead to missed opportunities to prevent adverse outcomes or unnecessary interventions. Self-reported sleep duration should be objectively confirmed when evaluating the effect of sleep duration on health outcomes.

Keywords: actigraphy; aging; sleep disorders; sleep duration.