Sleep Disturbances and Risk of Hospitalization and Inpatient Days Among Older Women.
Determine the associations of sleep disturbances with hospitalization risk among older women.



One thousand eight hundred and twenty-seven women (mean age 83.6 years) participating in Study of Osteoporotic Fractures Year 16 (Y16) examination (2002-2004) linked with Medicare and/or HMO claims. At Y16 examination, sleep/wake parameters were measured by actigraphy (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], and wake after sleep onset [WASO]) and subjective sleep measures (sleep quality [Pittsburgh Sleep Quality Index] and daytime sleepiness [Epworth Sleepiness Scale]) were assessed by questionnaire. Measures except TST were dichotomized based on clinical thresholds. Incident hospitalizations were determined from claims data.



Nine hundred and seventy-six women (53%) had ≥1 hospitalization in the 3 years after the Year 16 examination. Reduced SE (odds ratio [OR] = 2.39, 95% confidence interval [CI] 1.69-3.39), prolonged SL (OR = 1.41, 95% CI 1.11-1.78), greater WASO (OR = 1.57, 95% CI 1.28-1.93), shorter TST (OR = 1.98, 95% CI 1.42-2.77) and poorer sleep quality (OR = 1.33, 95% CI 1.07-1.65) were each associated with a higher age and site-adjusted odds of hospitalization; associations were attenuated after multivariable adjustment for traditional prognostic factors with the OR for reduced SE (OR = 1.60, 95% CI 1.08-2.38) and shorter TST (OR = 1.63, 95% CI 1.12-2.37) remaining significant. Among women who were hospitalized, greater WASO (rate ratio [RR] = 1.20, 95% CI 1.04-1.37) and poorer sleep quality (RR = 1.18, 95% CI 1.02-1.35) were each associated with a greater age and site-adjusted RR of inpatient days, but associations did not persist after multivariate adjustment.



Older women with sleep disturbances have an increased risk of hospitalization partially attributable to demographics, poorer health status, and comorbidities.
Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN.
Misti L
ML
Paudel
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.|Department of Medicine, University of Minnesota, Minneapolis, MN.|Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN.
Brent C
BC
Taylor
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
Tien N
TN
Vo
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
Allyson M
AM
Kats
Park Nicollet Clinic, St. Louis Park, MN.|Division of Health Policy and Management, University of Minnesota, Minneapolis, MN.
John T
JT
Schousboe
California Pacific Medical Center Research Institute, San Francisco, CA.
Li-Yung
LY
Lui
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
Charles E
CE
McCulloch
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
Lisa
L
Langsetmo
Departments of Psychiatry and Medicine, University of California-San Diego, La Jolla, CA.
Sonia
S
Ancoli-Israel
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Susan
S
Redline
Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, CA.
Kristine
K
Yaffe
California Pacific Medical Center Research Institute, San Francisco, CA.
Katie L
KL
Stone
Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, OR.
Teresa A
TA
Hillier
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.|Department of Medicine, University of Minnesota, Minneapolis, MN.|Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN.
Kristine E
KE
Ensrud
D056044:Actigraphy; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012306:Risk; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
Medicare; aging; hospitalization; sleep disturbances; sleep quality.