Sleep-wake disturbances and frailty in community-living older persons.
OBJECTIVE
To evaluate the association between sleep-wake disturbances and frailty.


METHODS
Cross-sectional.


METHODS
New Haven, Connecticut.


METHODS
Three hundred seventy-four community-living persons aged 78 and older.


METHODS
Frailty was based on the Fried phenotype, and sleep-wake disturbances were defined as daytime drowsiness, based on an Epworth Sleepiness Scale (ESS) score of 10 or greater, and as subthreshold and clinical insomnia, based on Insomnia Severity Index (ISI) scores of 8 to 14 and greater than 14, respectively.


RESULTS
Mean age was 84.3; 87 (23.8%) participants were drowsy, 122 (32.8%) had subthreshold insomnia, 38 (10.2%) had clinical insomnia, and 154 (41.2%) were frail. There was a significant association between drowsiness and frailty, with unadjusted and adjusted odds ratios (ORs) of 3.79 (95% confidence interval (CI)=2.29-6.29) and 3.67 (95% CI=2.03-6.61), respectively. In contrast, clinical insomnia was significantly associated with frailty in the unadjusted analysis (OR=2.77, 95% CI=1.36-5.67) but not the adjusted analysis (OR=1.93, 95% CI=0.81-4.61)), and subthreshold insomnia was not associated with frailty in the unadjusted or adjusted analysis.


CONCLUSIONS
In older persons, sleep-wake disturbances that present with daytime drowsiness, but not insomnia, are independently associated with frailty. Because drowsiness is potentially remediable, future studies should determine whether there is a temporal relationship between drowsiness and frailty, with the ultimate goal of informing interventions to reverse or prevent the progression of frailty.
Vaz Fragoso
Carlos A
CA
Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA. carlos.fragoso@yale.edu
Gahbauer
Evelyne A
EA
Van Ness
Peter H
PH
Gill
Thomas M
TM
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005684:Gait; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D051346:Mobility Limitation; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013223:Statistics as Topic