title: Balance and Mobility in Community-Dwelling Older Adults: Effect of Daytime Sleepiness.
abstract: OBJECTIVE
  To examine the effect of self-reported daytime sleepiness on performance-based balance measures and self-reported balance confidence in community-dwelling older adults.
  
  
  METHODS
  Cross-sectional secondary analysis of an observational cohort study designed to develop and refine measures of balance and mobility in community-dwelling older adults.
  
  
  METHODS
  Community.
  
  
  METHODS
  Older adults (aged 78.2 ± 5.9) (n = 120).
  
  
  METHODS
  The performance-based gait and balance measures included gait speed, double support time, and step width. Narrow walk, obstacle walk, and timed standing balance were also assessed. The Activities-Specific Balance Confidence Scale was included as a self-reported measure. Daytime sleepiness was defined as an Epworth Sleepiness Scale score of 9 or greater. Body mass index, fall-related comorbidities, and use of central nervous system (CNS) medications were considered as covariates.
  
  
  RESULTS
  Forty-five percent of participants reported daytime sleepiness. Participants reporting daytime sleepiness differed significantly from those without in gait speed (adjusted difference (standard error (SE)) -0.09 (0.04) m/s, P = .03), step width (adjusted difference (SE) 0.02 (0.01), P = .03), and self-reported balance confidence (adjusted difference (SE) -1.02 (0.38), P = .01) even after adjusting for covariates. Two-way analysis of variance of CNS medication use and daytime sleepiness showed no significant interaction effects.
  
  
  CONCLUSIONS
  Self-reported daytime sleepiness is associated with slower gait speed and poor balance confidence in community-dwelling older adults. Subjective sleep assessment should be considered when assessing balance and implementing interventions for improving balance in older adults. Further study is needed to examine the role of CNS medication use.
authors.affiliation: Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Shachi
authors.initials: S
authors.lastname: Tyagi
authors.affiliation: Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.affiliation: Department of Physical Therapy, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Brach
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D004856:Postural Balance; D057566:Self Report; D011795:Surveys and Questionnaires; D016138:Walking / Q000706:statistics & numerical data*
keywords: balance; daytime sleepiness; elderly; mobility