Sleep disorders and acute nocturnal delirium in the elderly

A comorbidity not to be overlooked

Michele Terzaghi, Ivana Sartori, Valter Rustioni, Raffaele Manni

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours.

Original languageEnglish
Pages (from-to)350-355
Number of pages6
JournalEuropean Journal of Internal Medicine
Volume25
Issue number4
DOIs
Publication statusPublished - 2014

Fingerprint

Delirium
Comorbidity
Sleep
Arousal
Confusion
Obstructive Sleep Apnea
Sleep Wake Disorders
Wakefulness
Consciousness
Cognition

Keywords

  • Arousal
  • Confusional arousal
  • Delirium
  • Elderly
  • Sleep
  • Sleep apnoea

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Sleep disorders and acute nocturnal delirium in the elderly : A comorbidity not to be overlooked. / Terzaghi, Michele; Sartori, Ivana; Rustioni, Valter; Manni, Raffaele.

In: European Journal of Internal Medicine, Vol. 25, No. 4, 2014, p. 350-355.

Research output: Contribution to journalArticle

@article{dd62b753035e4e88aae29b2f35e5d780,
title = "Sleep disorders and acute nocturnal delirium in the elderly: A comorbidity not to be overlooked",
abstract = "Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours.",
keywords = "Arousal, Confusional arousal, Delirium, Elderly, Sleep, Sleep apnoea",
author = "Michele Terzaghi and Ivana Sartori and Valter Rustioni and Raffaele Manni",
year = "2014",
doi = "10.1016/j.ejim.2014.02.008",
language = "English",
volume = "25",
pages = "350--355",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier B.V.",
number = "4",

}

TY - JOUR

T1 - Sleep disorders and acute nocturnal delirium in the elderly

T2 - A comorbidity not to be overlooked

AU - Terzaghi, Michele

AU - Sartori, Ivana

AU - Rustioni, Valter

AU - Manni, Raffaele

PY - 2014

Y1 - 2014

N2 - Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours.

AB - Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours.

KW - Arousal

KW - Confusional arousal

KW - Delirium

KW - Elderly

KW - Sleep

KW - Sleep apnoea

UR - http://www.scopus.com/inward/record.url?scp=84899962791&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899962791&partnerID=8YFLogxK

U2 - 10.1016/j.ejim.2014.02.008

DO - 10.1016/j.ejim.2014.02.008

M3 - Article

VL - 25

SP - 350

EP - 355

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

IS - 4

ER -