title: The Effect of Age in the Association between Frailty and Poor Sleep Quality: A Population-Based Study in Community-Dwellers (The Atahualpa Project).
abstract: OBJECTIVE
  To assess the effect of age in the association between poor sleep quality and frailty status.
  
  
  METHODS
  Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador.
  
  
  METHODS
  Out of 351 Atahualpa residents aged ≥ 60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association.
  
  
  RESULTS
  Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11-0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores.
  
  
  CONCLUSIONS
  This study shows the strong effect of age in the association between poor sleep quality and frailty status.
authors.affiliation: School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador. Electronic address: oscardelbrutto@hotmail.com.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.affiliation: School of Medicine, Stony Brook University, New York, NY.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sedler
authors.affiliation: Community Center, Atahualpa, Ecuador.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.affiliation: School of Medicine, Stony Brook University, New York, NY.
authors.forename: Johnathan L
authors.initials: JL
authors.lastname: Nieves
authors.affiliation: School of Medicine, Stony Brook University, New York, NY.
authors.forename: Kristen
authors.initials: K
authors.lastname: Cagino
authors.affiliation: School of Medicine, Stony Brook University, New York, NY.
authors.forename: Kathryn D
authors.initials: KD
authors.lastname: Fanning
authors.affiliation: School of Medicine, Stony Brook University, New York, NY.
authors.forename: Marleni F
authors.initials: MF
authors.lastname: Milla-Martinez
authors.affiliation: Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL.
authors.forename: Pablo R
authors.initials: PR
authors.lastname: Castillo
mesh_terms: D000328:Adult; D000367:Age Factors; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D012424:Rural Population; D012893:Sleep Wake Disorders / Q000453:epidemiology*
keywords: Age; Atahualpa Project; Edmonton Frail Scale; Pittsburgh Sleep Quality Index; frailty; population-based study; sleep quality