Abstract
Objective: To test the hypothesis that non-frail older men with poorer sleep at baseline are at increased risk of frailty and death at follow-up. Methods: In this prospective cohort study, subjective (questionnaires) and objective sleep parameters (actigraphy, in-home overnight polysomnography) were measured at baseline in 2505 non-frail men aged 67. years. Repeat frailty status assessment performed an average of 3.4. years later; vital status assessed every four. months. Sleep parameters expressed as dichotomized predictors using clinical cut-points. Status at follow-up exam classified as robust, intermediate (pre-frail) stage, frail, or died in interim. Results: None of the sleep disturbances were associated with the odds of being intermediate/frail/dead (vs. robust) at follow-up. Poor subjective sleep quality (multivariable odds ratio [MOR] 1.26, 95% CI 1.01-1.58), greater nighttime wakefulness (MOR 1.31, 95% CI 1.04-1.66), and greater nocturnal hypoxemia (MOR 1.47, 95% CI 1.02-2.10) were associated with a higher odds of frailty/death at follow-up (vs. robust/intermediate). Excessive daytime sleepiness (MOR 1.60, 95% CI 1.03-2.47), greater nighttime wakefulness (MOR 1.57, 95% CI 1.12-2.20), severe sleep apnea (MOR 1.74, 95% CI 1.04-2.89), and nocturnal hypoxemia (MOR 2.28, 95% CI 1.45-3.58) were associated with higher odds of death (vs. robust/intermediate/frail at follow-up). The association between poor sleep efficiency and mortality nearly reached significance (MOR 1.48, 95% CI 0.99-2.22). Short sleep duration and prolonged sleep latency were not associated with frailty/death or death at follow-up. Conclusions: Among non-frail older men, poor subjective sleep quality, greater nighttime wakefulness, and greater nocturnal hypoxemia were independently associated with higher odds of frailty or death at follow-up, while excessive daytime sleepiness, greater nighttime wakefulness, severe sleep apnea and greater nocturnal hypoxemia were independently associated with an increased risk of mortality.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1217-1225 |
| Number of pages | 9 |
| Journal | Sleep Medicine |
| Volume | 13 |
| Issue number | 10 |
| DOIs | |
| State | Published - Dec 2012 |
Bibliographical note
Funding Information:Source of Funding: The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) , the National Institute on Aging (NIA) , the National Cancer Institute (NCI) , the National Center for Research Resources (NCRR) , and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580 , U01 AR45614 , U01 AR45632 , U01 AR45647 , U01 AR45654 , U01 AR45583 , U01 AG18197 , U01-AG027810 , UL1 RR024140 , and AG08415 . The National Heart, Lung, and Blood Institute (NHLBI) provided funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194 , R01 HL070848 , R01 HL070847 , R01 HL070842 , R01 HL070841 , R01 HL070837 , R01 HL070838 , and R01 HL070839 . The funding agencies had no direct role in the conduct of the study; the collection, management, analyses and interpretation of the data; or preparation or approval of the manuscript. Disclosures: Drs. Ensrud and Stone have received grant support from the NIH (and supporting agencies) grant as listed above. Dr. Ancoli-Israel has received consultant fees or served on scientific advisory boards for Ferring Pharmaceuticals Inc., GlaxoSmithKline, Johnson & Johnson, Merck, NeuroVigil, Inc., Pfizer, Philips, Purdue Pharma LP, Sanofi-Aventis, and Somaxon. All other authors have nothing to report. Other Acknowledgments: We would like to thank Mr. Kyle A. Moen for his assistance with the manuscript and preparation and formatting of the tables.
Keywords
- Elderly
- Frailty
- Men
- Mortality
- Sleep disturbances