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Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults.

STUDY OBJECTIVE
To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival.


DESIGN
Prospective, observational cohort study.


SETTING
Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration).


PARTICIPANTS
Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation.


INTERVENTIONS
None.


MEASUREMENTS AND RESULTS
Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk.


CONCLUSIONS
Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored.