Sleep Disturbances and Risk of Falls in Older Men
Sleep Disturbances and Risk of Falls in Older Men
Objectives: To test the hypothesis that subjective and objective sleep disturbances are associated with risk of incident falls in older men.
Design: The prospective observational MrOS Sleep Study.
Setting: Six academic clinical centers in the United States.
Participants: Community-dwelling men aged 67 and older (mean 76) (n = 3,101).
Measurements: Subjective sleep measurements included daytime sleepiness (Epworth Sleepiness Scale (ESS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), and total sleep time (TST). Objective sleep measurements included actigraphic TST and sleep efficiency (an index of fragmentation) and sleep disordered breathing (measured using in-home polysomnography). Fall frequency during the subsequent year was ascertained three times per year using questionnaires. Recurrent falling was defined as having two or more falls in the subsequent year.
Results: In multivariable-adjusted models, participants with excessive daytime sleepiness (ESS > 10) but not poor subjective sleep quality (PSQI > 5) had greater odds of experiencing two or more falls in the subsequent year (odds ratio (OR) = 1.52 95% confidence interval (CI) = 1.14–2.03). Based on actigraphic recordings, the odds of having recurrent falls was higher for men who slept 5 hours or less (OR = 1.79, 95% CI = 1.22–2.60) than for those who slept 7 to 8 hours. Actigraphically measured sleep efficiency was also associated with greater risk of falls, as was nocturnal hypoxemia (≥10% of sleep time with arterial oxygen saturation <90%; OR = 1.62, 95% CI = 1.17–2.24) but not apnea hypopnea index.
Conclusion: Subjective and objective sleep disturbances were associated with risk of falls in older men, independent of confounders.
Falls pose a major health risk for older adults and are a leading cause of mortality, morbidity, and premature nursing home placement, placing a significant burden on the healthcare system. It is estimated that falls occur yearly in one-third of persons aged 65 and older.
As many as 50% of older adults report sleep problems. A few studies have examined the relationship between falls and sleep problems. All but one have focused on subjective sleep data. Most studies have had limitations, including retrospective assessment of falls and incomplete collection of covariate information.
To the knowledge of the authors of the current study there is only one previous study of sleep apnea and falls. No studies have examined the association between less-severe levels of sleep disordered breathing (SDB) and falls.
To test the hypothesis that subjective and objective sleep disturbances are associated with falls risk in older men, sleep parameters were measured in the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study, and information about incident falls was collected. This study provides a unique opportunity to examine this question in a large cohort of community-dwelling older men. Comprehensive sleep measurements allow for assessment of the independent contributions of sleep duration, sleep fragmentation, daytime sleepiness, and SDB to risk of falls.
Abstract and Introduction
Abstract
Objectives: To test the hypothesis that subjective and objective sleep disturbances are associated with risk of incident falls in older men.
Design: The prospective observational MrOS Sleep Study.
Setting: Six academic clinical centers in the United States.
Participants: Community-dwelling men aged 67 and older (mean 76) (n = 3,101).
Measurements: Subjective sleep measurements included daytime sleepiness (Epworth Sleepiness Scale (ESS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), and total sleep time (TST). Objective sleep measurements included actigraphic TST and sleep efficiency (an index of fragmentation) and sleep disordered breathing (measured using in-home polysomnography). Fall frequency during the subsequent year was ascertained three times per year using questionnaires. Recurrent falling was defined as having two or more falls in the subsequent year.
Results: In multivariable-adjusted models, participants with excessive daytime sleepiness (ESS > 10) but not poor subjective sleep quality (PSQI > 5) had greater odds of experiencing two or more falls in the subsequent year (odds ratio (OR) = 1.52 95% confidence interval (CI) = 1.14–2.03). Based on actigraphic recordings, the odds of having recurrent falls was higher for men who slept 5 hours or less (OR = 1.79, 95% CI = 1.22–2.60) than for those who slept 7 to 8 hours. Actigraphically measured sleep efficiency was also associated with greater risk of falls, as was nocturnal hypoxemia (≥10% of sleep time with arterial oxygen saturation <90%; OR = 1.62, 95% CI = 1.17–2.24) but not apnea hypopnea index.
Conclusion: Subjective and objective sleep disturbances were associated with risk of falls in older men, independent of confounders.
Introduction
Falls pose a major health risk for older adults and are a leading cause of mortality, morbidity, and premature nursing home placement, placing a significant burden on the healthcare system. It is estimated that falls occur yearly in one-third of persons aged 65 and older.
As many as 50% of older adults report sleep problems. A few studies have examined the relationship between falls and sleep problems. All but one have focused on subjective sleep data. Most studies have had limitations, including retrospective assessment of falls and incomplete collection of covariate information.
To the knowledge of the authors of the current study there is only one previous study of sleep apnea and falls. No studies have examined the association between less-severe levels of sleep disordered breathing (SDB) and falls.
To test the hypothesis that subjective and objective sleep disturbances are associated with falls risk in older men, sleep parameters were measured in the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study, and information about incident falls was collected. This study provides a unique opportunity to examine this question in a large cohort of community-dwelling older men. Comprehensive sleep measurements allow for assessment of the independent contributions of sleep duration, sleep fragmentation, daytime sleepiness, and SDB to risk of falls.