Abstract
Population aging has materialized as an innovative demographic inclination with imperative insinuation for government programs, public health and education, and family restructuring. Among such changes, insomnia, snoring and sleep apnea, in conjunction with sleep hygiene have been usually ignored. Changes in sleep are part of the ageing process. Nocturnal total sleep time can become more fragmented with age, with an increase in awaking early in the morning and nighttime awakenings.
Body mass Index (BMI) and body weight have important health and educational implications across the lifespan. Most recent attention has been focused on the issue of obesity, an epidemic that occurs in most parts of the world. Yet the older Filipinos have prevalence of underweight, approximately thirty per cent of the population, while that of overweight close to ten percent. By comparison, in Taiwan, the prevalence of underweight is less than ten percent, while approximately thirty percent of Taiwanese elderly are overweight.
The main purpose of this article is to signify the economic and cultural impacts on healthy weight and BMI maintenance in potentially decreasing the prevalence of sleep disturbance and improving quality of the elderly life in two Asian societies.
With advancing age, age-related changes have been described for sleep-wakefulness and additional behavioral cycles. Trends in the relationship between elderly sleep disturbance and BMI in the observed two societies merit our serious attention. Further study is necessary to investigate whether the differences between two societies are caused the limitation of hospital-based study or by differences in ethnicity.
Keywords: Asian, Body weight, Body Mass Index, Sleep Disturbance, Older adults
Selected Abbreviations ad Acronyms
Apnea-Hyperpnoea-Index (AHI),
Body Mass Index (BMI)
Coronary heart disease (CHD)
National Cholesterol Education Program (NCEP)
National Heart Lung and Blood Institute’s (NHLBI’s) guidelines for body weight Spearman’s rank correlation coefficient (rs)
Introduction
Sleep Disturbance in the elderly population is not uncommon. One of the most common complaints of sleep disturbance is insomnia.. Whether it is a solitary disorder or merely a symptom is still unclear. In the Philippines, it is noted that, for exa,ple, insomnia has its prevalence in non-governmental community dwelling elderly individuals in a dwelling facility in Quezon City was 43%, and they were mostly females (Kamble 1979): Philippines poverty assessment). The prevalence of chronic insomniac (>4 weeks) in that facility was enormous female predominance, which was accredited to the much larger proportion of females in the dwelling association, about 92% of 2,200 members.
Table 1. The relationship of BMI in the elderly people in the Philippines and Taiwan
|
Country |
The Philippines |
Taiwan |
|
Age (y) |
69.3 (7.2) |
69.9 (7.2) |
|
The year of survey |
1996 |
1999 |
|
Prevalence |
||
|
Underweight, BMI< 14.8 |
29.9 % |
6.4% |
|
Overweight, BMI > = 30 |
12.2% |
29.3% |
As per Jenkins et al (Jenkins et al 2007), the data from two nationally-representative surveys of older adults (aged 60 and older) in the Philippines (1996) and Taiwan (1999) to assess the prevalence of underweight and overweight and examine associations between body weight and demographic, socioeconomic, and health characteristics in these populations.
Table 2. Comparison of Different Sleep Studies between two Societies in three hospitals
|
Setting |
St. Luke’s Medical Center, |
The Medical City |
Changhua Christian |
|
Quezon City, Philippines |
Hospital A tertiary hospital in Metro Manila, The Philippines |
Hospital Medical Center, Taiwan |
|
|
Number of participants |
223 |
126 |
124 |
|
Age range (yr) |
18 – 65 |
65 – 88.5 |
|
|
Gender F/M |
1/3.76 |
1/1.07 |
1/1.17 |
|
Mean age |
47.40 (13.06) |
60.30 (13.70) |
71.69 (4.4) |
|
Exclusion criteria |
COPD, heart failure, asthma, other respiratory disease, and taking respiratory medications |
COPD, heart failure, and age < 65 years |
|
|
Health insurance coverage |
National health insurance of Taiwan |
||
|
Height cm |
169.5 (7.61) |
160.83 (15.4) |
159.76 |
|
Weight kg [[190.5, 46.31 |
86.39 (21.00) |
59.26 (13.70) |
65.5 |
|
BMI kg/m2 |
29.10 (7.61) |
23.59 |
25.68 (4.54) |
|
Neck circumference cm |
44.45 (13.92) |
36.7, among which for females is 34.79+_2.85, whereas for males is 37.89+ 3.16 |
|
|
AHI events/hr |
37.80 (24.73) |
AHI 2.3+_1.64, i.e. |
|
 |
95% C I (26.22 – 34.99) n=21 (21/124 = 16.94%) |
||
 |
AHI 30.62+ 22.20, i.e. 95% C I (1.59 – 3.00) n=103 (103/124 = 83.06%) |
||
 |
53.17 % of 126 46.83% of 126 |
||
|
Prevalence of snoring |
66.67% |
Taichung area |
|
|
Total No. of snorers |
53.17% of 126 |
110 |
|
|
Total No. of non-snorers |
46.83% of 126 |
14 |
|
|
Total sleep time for entire subjects n=mean+SD |
 |
||
|
the median TST of insomniacs n = |
 |
||
|
For those above median vs. those below median |
 |
||
|
Mean+_SD Polysomnography |
Yes |
Noticeably, during the decade from 1979 to 1989, most of East and South-East Asian countries have undergone a period of swift, communal, financial and demographic modifications. Population aging has materialized as an innovative demographic inclination with imperative insinuation for government programs, public health and education, and family restructuring. Changes that are usually ignored include sleep disturbance, sleep apnea, associated with sleep hygiene. Changes in sleep are part of the aging process. Nocturnal total sleep time can become more fragmented with age, with an increase in awaking early in the morning and nighttime awakenings (Bliwise, 1999). Since nocturnal total sleep time is affected, daytime sleep may be prolonged. Sleep hygiene, beyond nocturnal and day time cycles may be warped. Daytime sleepiness and frequent sleep apnea and increases in nighttime awakenings, along with decreases in both slow-wave sleep and REM sleep have been reported. (Prinz, Peskind et al. 1982; Prinz PN, Vitaliano PP et al, 1982; Vitiello and Borson 2001) According to Sawit et al (2006), Filipino physicians seldom inquire about snoring during their clinical encounter with patients. Both doctors and patients consider snoring to be a normal sleeping characteristic, without health implications. Thus, a closer study on snoring is warranted. (Sawit et al, 2006) Snoring is a common phenomenon seen in approximately 20% of the adult population and in about 60% of men over 40 years of age. One of the objects of this article is to explore the role of snoring on the above health issues. One of the other aims of this article was to examine the prevalence of abnormal body weight among elderly Filipino and Taiwanese adults and investigate the factors that are correlated with body weight in these populations with emphases on sleep disturbance vs. good sleep quality.
A Strong Contrast of the Elderly Populations Exists Between Two Societies
The socioeconomic status and age distribution of the subjects in these two societies may explain the different distribution of BMI of the two societies. (Table 1) These cross-cultural distinctions are consistent with the greater economic development in Taiwan than in the Philippines (Tables 2 to 5). One of the aims is to compare the implications related with healthy weight and BMI the prevalence of sleep disturbance and improving quality of the elderly life.
Body mass Index and body weight have important health implications across the lifespan. Recent attention has focused on the issue of obesity that is prevalent in most parts of the world. Older Filipinos are more likely to be underweight. Approximately 30% of the population, while overweight Filipinos is close to 10%. In Taiwan, less than 10% of the population is underweight and approximately 30% are heavier than normal. (Table 1) The aforementioned situation contrasts starkly with each other between these two societies.
This article evaluates the trend in the Association of the Elderly Sleep Disturbance and Body Mass Index in the Philippines and Taiwan two Asian societies.
The Necessity of a Cross-Cultural Evaluation
Few studies deal with cross-cultural evaluation regarding the Elderly Sleep Disturbance and the Body Mass Index. There is little emphasis on society and patient interaction as well as cultural factors. Few works are devoted to the sleep quality and sleep hygiene in the elderly population, and its research. This article includes a qualitative approach to the understanding of sleep disturbance in two Asian societies.
Materials and Methods
Data
The Taiwanese data in the present article have been described in detail somewhere else mainly for total nocturnal sleep time (TST) and sleep study 2.
From 1 January 2002 to 31 January 2003 the Sleep Medicine Laboratory, Changhua Christian Hospital Medical Center, Taiwan, admitted no subjects with heart failure and chronic obstructive lung disease, as there was no physician at night in the Sleep Laboratory. The 124 participants aged from 65 to 88.5 years were studied. No pair of participants was related. No participant had more than one PSG. Among the 124 individuals, there were 117 subjects with available BMI data. Written informed consents including personal and clinical data in the research database of all participants. The research protocol was approved by the Review Board of the Medical Center, and conformed to the Declaration of Helsinki.
Apnea/hypopnea Index (AHI) is defined as the number of apneic episodes (obstructive, central, and mixed) plus hypopnea per hour of sleep as determined by all-night PSG. AHI is synonymous with respiratory disturbance index. AHI was measured for all the subjects. All AHI values were classified as first, second and third degrees of sleep-apnea severity. The gold standard for diagnosis of sleep disturbance is in-laboratory nocturnal PSG. Participants were required to have in-laboratory nocturnal PSG at sleep medicine laboratory.
PSG was used not only to measure AHI, but also to evaluate sleep efficiency and snoring.
Obstructive sleep apnea/ hypopnea (OSAP) was defined as AHI >=15 per hour. A computerized PSG system (Alice 4 Sleep Diagnostic System, Respironics) was used in this study. As previously mentioned, no second PSG study was conducted after the single-night PSG. Mean, standard deviation, student t-test and correlation were measured with SPSS version 10. A two tailed p value of < 0.05 was accepted as statistically significant. The mean age of male subjects was 71.6 +_4.47 years, while that of females was 72.3 5.47 years. All 124 subjects had chief complaints of sleeping disturbance. The ratio of female to male subjects was 1: 1.7 (the total number of subjects was 124) (Tang, 2007).
Control Subjects
A second data set consisting of 1,014 (aged 65 and over) control subjects came from 15,798 subjects who had participated in the Nutrition and Health Survey in Taiwan (NSC 93WFD2000205), between 1993 and 1996. The data of age and blood pressure of those 1,014 subjects were cited and analyzed. Among them, merely 665 subjects had complete data consisting of their age, blood pressure, weight, height, and BMI, while 95.79% (15,133/15,798) of the control subjects lacked one or more of the above listed information.
In this article, the author compares data from national surveys.
