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Sleep-Disordered Breathing and Agitation in Institutionalized Adults With Alzheimer Disease

Received November 18, 2001; revised February 11, 2002; accepted February 20, 2002. From the San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology (PRG,JLM), Brown University Department of Psychiatry and Human Behavior (JLM), Department of Psychiatry, University of California, San Diego (TS,SN,SA-I), Department of Neurology, University of California, San Diego (JC-B), and the Veterans Affairs San Diego Healthcare System (TS,JC-B,SA-I). Address correspondence to Sonia Ancoli-Israel, Ph.D., Department of Psychiatry 116A, Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, Ca 92161. email: sancoliisrael{at}ucsd.edu

Objective: The authors examined the relationship between sleep-disordered breathing (SDB) and agitation in patients with Alzheimer disease (AD). Methods: Thirty-eight AD patients (29 women, 9 men) in nursing homes in San Diego, CA participated. The mean age was 82.3 years, with a range of 61 to 95 years. Mean Mini-Mental State Exam score was 6.5 (range: 0–16). Sleep was recorded for one night, and agitation was measured with behavioral observations and ratings by nursing staff. Results: SDB was very prevalent in this sample and was related to some types of agitation during the day but not in the evening or night. Aggressive Agitation on the Cohen-Mansfield Agitation Inventory and Manual Manipulation on the Agitated Behavior Rating Scale were greater with more severe SDB. Searching and wandering agitation decreased with more severe SDB. Conclusion: This study supports the hypothesis that SDB is related to agitation in AD, although the results are specific to certain types of agitation. Treatment of SDB may decrease agitation, easing the burden of caregiving and prolonging the time that patients are able to remain at home.

Key Words: Sleep Disorder • Agitation • Alzheimer Disease

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