Relationship between Sleep Disturbance and Polypharmacy among Hospitailzed Elderly

Background Aging induces many changes in sleep architecture, many studies suggests that older adults are particularly vulnerable (1) . Although changes in sleep architecture are to be expected with increasing age, age itself does not result in disturbed sleep. But it is the ability to sleep that decreases with age, which may be due to other associated factors with aging (2) . Sleep disturbance is common in older adults because aging is associated with an increasing prevalence of multiple morbidities and polypharmacy (3) . Medication use is another factor that may increase risk for sleep disturbances in older adults. Polypharmacy may also contribute to heightened risk for sleep disturbance in older adults (3) . Polypharmacy is associated with adverse outcomes including mortality, falls, adverse drug reactions, increased length of stay in hospital and readmission to hospital soon after discharge (4) . The risk of adverse effects and harm increases with increasing numbers of medications (5) . The use of multiple drugs more than 5 drugs is defined by many authors as polypharmacy (6) . Polypharmacy is really common as age-related morbidities increase, putting the elderly at risk for drug-drug and drugdisease interactions (7) .

Males and females, 60 years and older hospitalized in Demerdash Hospital. Exclusion Criteria: Those who refused to participate in the study and Demented elderly. Study Procedures: 1-Full Medical History Detailed history of chronic diseases e.g multi morbidities is 2 or more chronic conitions (9) . Drug history if more than 5 medication in one month consider polypharmacy (6) .

2-Physical Examination
General and local examination with special concern to cardiovascular, neurological and musculoskeletal systems.

3-The Pittsburgh Sleep Quality Index (PSQI)
is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval (10) . Statistical Analysis: Data were collected, revised, coded and entered to the Statistical Package for Social Science (IBM SPSS) version 20. The quantitative data were presented as mean, standard deviations and ranges when their distribution found parametric while non-parametric data were presented as median with interquartile range (IQR) and qualitative data were presented as number and percentages. The comparison between groups regarding qualitative data was done by using Chi-square test and/or Fisher exact test only when the expected count in any cell was less than 5. The comparison between two independent groups with quantitative data and parametric distribution was done using Independent t-test while data with non-parametric distribution was compared using Mann-Whitney test. Generalized linear regression was done to assess predictors, among the assessment tools, of frailty domains. The confidence interval was set to 95% and the margin of error accepted was set to 5%. The p-value was considered significant as the following: P > 0.05: Non-significant P < 0.05: Significant P < 0.01: Highly significant.

Results
The study was conducted on 100 hospitalized patients, 51 were females and 49 were males. According to age, 19 patients were in 60-69 years age group,40 patients were 70-79,and 49 patients over 80. By asking the patient we found that 79 out of 100 patients were taking more than 4 drugs. This table shows that there's a highly significant relationship between increasing age and sleep disturbance, 48% of the patient over 80 have sleep problems while only 12.5% of patient between 60-61 have sleep problems, with p value <0.001.
This table shows a highly significant relationships between sleep problems and polypharmacy, 87% of elderly who take more than 5 medication in one month has sleep problems with pvalue <0.001. Table 4 showed significant relationship between component 2 (sleep duration) where most of the patients showed moderate difficulty, with p value 0.03, and it also shows a significant relationship between component 3 (sleep latency) and polypharmacy where most patients had severe difficulty with p value 0.002.

Discussion
Polypharmacy and sleep disturbance are common in elderly because aging is associated with an increasing prevalence of multiple morbidities, Medication use is another factor that may increase risk for sleep disturbances in older adults (3) . In elderly, there are changes in sleep architecture, increased risk for sleep disorders, circadian rhythm shifts, multiple mental & physical morbidities, polypharmacy, institutionalization and likely a combination of these factors are possible factors contributing to older adult sleep disturbance (11) . The current study is a cross-sectional study to determine relationship between sleep disturbance and polypharmacy in hospitalized elderly in El Demerdash Hospital.