Sleep and Aging. Frankie Roman MD JD. Focus Spring Orlando, Florida. May 6 th, 2017

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1 Sleep and Aging Frankie Roman MD JD Focus Spring 2017 Orlando, Florida May 6 th, 2017

2 NaConal Sleep FoundaCon Sleep Time RecommendaCons Newborns (0-3 months): Sleep range narrowed to hours each day (previously hours). Infants (4-11 months): Sleep range widened two hours to hours (before 14-15). Toddlers (1-2 years): Sleep range widened by one hour to hours ( before 12-14). Preschoolers (3-5): Sleep range widened by one hour to hours (before 11-13)

3 NSF Sleep Time RecommendaCons School age children (6-13): Sleep range widened by one hour to 9-11 hours (10-11). Teenager (14-17): Sleep range widened by one hour to 8-10 hours ( ). Younger Adults (18-25): Sleep range is 7-9 hours (new age category). Adults (26-64): Sleep range did not change and remains 7-9 hours. Older Adults (65+): Sleep range is 7-8 hours (new age category).

4 The Sleep Heart Health Study : Sleep and reported DayCme Sleepiness in Normal Subjects. 470 subjects enrolled in SHHS (n= 6440) selected as a normacve group. Home based PSG and heath related data obtained Sleep efficiency decreased by 1.6% for each 10 years of increased age. Sleep Cme decreased by 0.1 hours (6 minutes) for each 10 year age increase and was longer in women.

5 SHHP: Sleep and reported DayCme Sleepiness (cont) Arousal index increased by 0.8 for each 10 year increase in age and was lower by 1.4 in women. Women had a lower mean percentage of Stage 1 and Stage 2 sleep. Mean percentage of slow wave sleep was higher in women (by 6.7%) Percentage of SWS decreased with increased age for men only by 1.9% for each 10 year age change.

6 The Cross- SecConal and Longitudinal Aging Study (CALAS) MulCdimensional survey of random sample of older Jewish populacon in Israel. StraCfied by age group in year (75-79, 80-84,85-89,90-94), sex, and place of birth. Data colleccon ,166 self respondent, community dwelling parccipants ages

7 CALAS DuraCon of nighcme sleep of more than 9 hr was significantly related to increased mortality in comparison with sleeping 7-9 hr. Short nighcme sleep of fewer than 7 hr mortality did not from that of 7-9 hr of sleep. For those that nap, sleeping more than 9 hr per night significantly increased mortality risk. For those who do not or somecmes nap short amount of sleep appears to be harmful up toage 84 and may be proteccve thereader.

8 Recommended Amount of Sleep For A Healthy Adult Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Part of CDC grant NaConal Healthy Sleep Awareness Project. Effort to address the four sleep health objeccves from Healthy People ObjecCve four increase the proporcon of adults who get sufficient sleep.

9 Recommended Amount of Sleep Sleep duracon. Sleep Cming. Self reported sleep quality. Day to day variability in sleep duracon. Napping. Sleep Disorders. ALL of the above influence health outcomes in cross secconal and/or longitudinal studies.

10 Recommended Amount of Sleep Summary of Literature General Health - young adults who slept less than 7 hours were more likely to report poor general health, both low overall health and mental health related quality of life (HRQOL) than those sleeping 7 or more hours. Specific disease many studies but not all, indicate increase risk or presence of disease with sleep less than 7 hrs compared to 7-8 hours. Few studies demonstracng an associacon of poorer general health or increase risk/presence of disease with 9 or more hours of sleep.

11 Recommended Amount of Sleep Cardiovascular Health Elevated risk for both overall cardiovascular disease and hypertension is associated with sleep duracons less than 6 hours and possibly 6-7 hours compared to sleep duracons of 7-8 hours. Evidence for increased risk of CV disease and hypertension less compelling for sleep duracons greater than 8 hours.

12 Recommended Amount of Sleep Metabolic Health Significant associacon between short sleep duracon and incidence of type 2 diabetes. Experimental sleep restriccon reduces insulin sensicvity, lowers glucose tolerance, and raises adernoon/evening corcsol levels. Experimental sleep restriccon affects levels of hunger regulacng hormones lepcn and ghrelin increasing hunger and appecte. Results of meta analysis relacng long sleep duracon to metabolic outcomes are mixed.

13 Recommended Amount of Sleep Mental Health No published meta analysis has specifically addressed the relaconship between sleep duracon and depression, anxiety or other psychiatric disorders. Short self reported sleep duracon is associated with increase risk for depression. Some data suggests increase risk for depression with sleep duracon longer than 8-9 hours. Short sleep duracon also associated with suicidal ideacon and psychological distress.

14 Recommended Amount of Sleep Immunologic Health AssociaCon between short sleep duracon and decrease natural killer cell funccon and mobilizacon. Shorter sleep associated with decreased vaccine immune response. Other studies suggest increase risk of pneumonia if self reported sleep less than 5 or greater than 9 hours.

15 Recommended Amount of Sleep Human Performance CogniCve performance vigilance amencon, cognicve processing speed, working memory- as well as physiological sleep propensity are all sensicve to sleep duracon below 7 hours. No clear evidence that sleep duracon greater than 8 hours has an impact on these domains

16 Recommended Amount of Sleep - Cancer Large prospeccve cohort studies including 12, ,011 subjects. Five large prospeccve cohort studies looking at Breast Cancer in more than 250,000 women Four studies showed no associacon between sleep duracon and Breast Cancer, while one showed an increase risk if sleep duracon less than 6 hours. Three large prospeccve cohort studies assessed sleep duracon and general cancer mortality no associacon for either short or long sleep duracon.

17 Recommended Amount of Sleep - Pain Sleep duracons below 5 hours were associated with increased pain in all studies. Sleep duracons of 7-8 or 8-9 hours were consistently associated with reduced pain symptoms. Results less consistent for sleep duracons of 6-7 hours and more than 9 hours (small number of studies).

18 Recommended Amount of Sleep - Mortality Two independent meta analyses found increased mortality associated with short sleep and long sleep duracons. Short and long sleep were defined differently across studies. Self reported sleep duracon of 7-8 hours was generally associated with the lowest mortality risk. Increased mortality risk associated with long sleep may be parcally explained by age.

The Effect of the HealthyKids Program on Childhood Obesity and Long- term BMI Maintenance

The Effect of the HealthyKids Program on Childhood Obesity and Long- term BMI Maintenance Jamie Jeffrey, MD, FAAP Adele P. Schweller, DO Stephanie Thompson, PhD Background Overweight and obesity becoming