Circadian sleep-wake rhythm of older adults with intellectual disabilities.
Older adults with ID have frail, fragmented sleep-wake cycles—check for medical and sensory causes and push daytime activity.
01Research in Context
What this study did
Maaskant et al. (2013) strapped wrist-watch actigraphs on older adults with intellectual disability.
The team tracked sleep-wake patterns for several days to see how steady the rhythms were.
They also checked medical charts for vision loss, hearing loss, depression, and dementia.
What they found
The sleep rhythms were weak and broken.
People woke often and napped more, so the day-night signal was blurry.
Medical and sensory problems made the rhythms even worse.
How this fits with other research
van Schrojenstein Lantman-de Valk et al. (2006) saw the same broken rhythms in younger adults with ID, but they said ASD added no extra damage.
Marijke’s 2013 study shows the damage grows larger after age 50, so age matters more than ASD label.
Mikulovic et al. (2014) and Tassé et al. (2013) found that early wake-up times link to lower weight and more steps in both adults and teens with ID.
Together the papers say: weak rhythms start early, get worse with age, and fixing daytime activity may help both sleep and weight.
Why it matters
If you support older adults with ID, expect poor sleep and treat it.
Screen for dementia, depression, vision or hearing loss, and add daytime walks or light exposure.
Small fixes can tighten the day-night signal and lift overall health.
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02At a glance
03Original abstract
The circadian sleep-wake rhythm changes with aging, resulting in a more fragmented sleep-wake pattern. In individuals with intellectual disabilities (ID), brain structures regulating the sleep-wake rhythm might be affected. The aims of this study were to compare the sleep-wake rhythm of older adults with ID to that of older adults in the general population, and to investigate which factors are associated with the sleep-wake rhythm in older adults with ID. This study is part of the 'Healthy Aging and Intellectual Disabilities' study (HA-ID). We applied actigraphy in 551 persons with ID and 58 persons in the general population, aged 50 years and over. Outcome measures were stability (interdaily stability), fragmentation (intradaily variability) and amplitude (relative amplitude) of the sleep-wake rhythm. Compared to older adults in the general population, the sleep-wake rhythm of older adults with ID was significantly less stable (p=0.03), more fragmented (p<0.001) and had a lower relative amplitude (p<0.001). Multivariate regression analysis revealed that higher age, dementia, depression, visual impairment, severe hearing impairment, epilepsy and spasticity are independently associated with a more disturbed sleep-wake rhythm in this group. The sleep-wake rhythm is more stable in females and those living at a setting for more intensive care. Higher physical activity levels are strongly associated with both a less fragmented (p<0.001) and a more stable (p<0.001) sleep-wake rhythm. Higher age, dementia and depression are also associated with the sleep-wake rhythm in the general population. Neurological and sensory impairments that were associated with the sleep-wake rhythm in older adults with ID, are frequent known conditions in the ID population. Further research should focus on which factors specifically influence the sleep-wake rhythm in older adults with ID, and on the effects of more physical daytime activity on the sleep-wake rhythm in this population.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2012.12.009