Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults.

OBJECTIVE To examine the association of subjective and objective sleep quality with subsequent peptic ulcer rebleeding among older patients. METHODS Of 1,196 older patients with peptic ulcer bleeding (PUB) recruited from twelve Grade-A hospitals in the People's Republic of China, 1,106 achieved full recovery from PUB, and they were followed for up to 30 days. Using multiple measures at one-week intervals, patients who presented PUB symptoms were invited to have an esophagogastroduodenoscopy (EGD) examination. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep-onset latency, sleep efficiency, total sleep time, and the number of awakenings. RESULTS This study documented a 30-day cumulative ulcer rebleeding rate of 15.3%. Multivariate analyses showed that longer sleep onset latency (hazard ratio HR 2.136 (1.336, 2.558)) and more nighttime awakenings (HR 1.698 (1.169, 2.666)) increased the risk of ulcer rebleeding. However, a longer total sleep time (HR 0.768 (0.698, 0.887)) and better sleep efficiency (HR 0.795 (0.682, 0.975)) protected against ulcer rebleeding. Older patients who perceived poorer sleep quality were also more likely to experience ulcer rebleeding (HR 2.295 (1.352, 3.925)). CONCLUSION The present results highlight the importance of proper treatment and prevention of sleep problems in older adults after successful PUB treatment. Our results, if replicable in future studies with more rigorous design and representative samples, might shed light on the etiology of ulcer rebleeding and suggest new pathways for preventing this disease.