title: Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study.
abstract: OBJECTIVE
  To test the hypothesis that subjective and objective sleep disturbances are associated with risk of incident falls in older men.
  
  
  METHODS
  The prospective observational MrOS Sleep Study.
  
  
  METHODS
  Six academic clinical centers in the United States.
  
  
  METHODS
  Community-dwelling men aged 67 and older (mean 76) (n = 3,101).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Subjective and objective sleep disturbances were associated with risk of falls in older men, independent of confounders.
authors.affiliation: Research Institute, California Pacific Medical Center, San Francisco, California.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
authors.forename: Terri L
authors.initials: TL
authors.lastname: Blackwell
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Marshall
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D017286:Polysomnography; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000453:epidemiology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology
keywords: falls; hypoxemia; sleep; sleep disordered breathing