Sleep-wake Disturbances and Frailty in Community-living Older Persons

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2009 Oct 2

PMID 19793356

Citations 38

Authors

Carlos A Vaz Fragoso

Evelyne A Gahbauer

Peter H Van Ness

Thomas M Gill

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the association between sleep-wake disturbances and frailty.

Design: Cross-sectional.

Setting: New Haven, Connecticut.

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

Measurements: 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.

Conclusion: 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.

Citing Articles

Sleep quality and duration and frailty in older adults: a systematic review.

de Souza A, Fernandes D, Castro I, Grola F, Ribeiro A Front Public Health. 2025; 13:1539849.

PMID: 40078770 PMC: 11898741. DOI: 10.3389/fpubh.2025.1539849.

Sleep Health and Falls Risk for Older Adults Living in Residential Aged Care and in Community Dwelling Settings: A Longitudinal Observation Study.

Fien S, Bennett N, Owen P, Alley S, Vandelanotte C, Sprajcer M Inquiry. 2024; 61:469580241306274.

PMID: 39688004 PMC: 11650497. DOI: 10.1177/00469580241306274.

Insomnia Severity and Daytime Sleepiness in Caregivers of Advanced Age.

Webster L, Ali T, Sharninghausen J, Hajduk A, Gill T, Miner B Front Sleep. 2024; 3.

PMID: 39544482 PMC: 11563192. DOI: 10.3389/frsle.2024.1404684.

Nocturia and frailty in older adults: a scoping review.

Komleva Y, Gollasch M, Konig M BMC Geriatr. 2024; 24(1):498.

PMID: 38844878 PMC: 11155172. DOI: 10.1186/s12877-024-05049-3.

The effects of nonpharmacological sleep hygiene on sleep quality in nonelderly individuals: A systematic review and network meta-analysis of randomized controlled trials.

Hirohama K, Imura T, Hori T, Deguchi N, Mitsutake T, Tanaka R PLoS One. 2024; 19(6):e0301616.

PMID: 38837997 PMC: 11152306. DOI: 10.1371/journal.pone.0301616.

References

Wright J, Johns R, Watt I, Melville A, Sheldon T . Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ. 1997; 314(7084):851-60. PMC: 2126251. DOI: 10.1136/bmj.314.7084.851. View

Kohout F, Berkman L, Evans D . Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993; 5(2):179-93. DOI: 10.1177/089826439300500202. View

Gehrman P, Marler M, Martin J, Shochat T, Corey-Bloom J, Ancoli-Israel S . The timing of activity rhythms in patients with dementia is related to survival. J Gerontol A Biol Sci Med Sci. 2004; 59(10):1050-5. DOI: 10.1093/gerona/59.10.m1050. View

Pereira M, FitzerGerald S, Gregg E, Joswiak M, Ryan W, Suminski R . A collection of Physical Activity Questionnaires for health-related research. Med Sci Sports Exerc. 1997; 29(6 Suppl):S1-205. View

Unruh M, Redline S, An M, Buysse D, Nieto F, Yeh J . Subjective and objective sleep quality and aging in the sleep heart health study. J Am Geriatr Soc. 2008; 56(7):1218-27. DOI: 10.1111/j.1532-5415.2008.01755.x. View

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328(17):1230-5. DOI: 10.1056/NEJM199304293281704. View

Dam T, Ewing S, Ancoli-Israel S, Ensrud K, Redline S, Stone K . Association between sleep and physical function in older men: the osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2008; 56(9):1665-73. PMC: 2631084. DOI: 10.1111/j.1532-5415.2008.01846.x. View

Pack A . Advances in sleep-disordered breathing. Am J Respir Crit Care Med. 2005; 173(1):7-15. DOI: 10.1164/rccm.200509-1478OE. View

Goldstein I, Ancoli-Israel S, Shapiro D . Relationship between daytime sleepiness and blood pressure in healthy older adults. Am J Hypertens. 2004; 17(9):787-92. DOI: 10.1016/j.amjhyper.2004.05.009. View

10.

Kim S, Cairns N, Fountoulakisc M, Lubec G . Decreased brain histamine-releasing factor protein in patients with Down syndrome and Alzheimer's disease. Neurosci Lett. 2001; 300(1):41-4. DOI: 10.1016/s0304-3940(01)01545-2. View

11.

Vaz Fragoso C, Gill T . Sleep complaints in community-living older persons: a multifactorial geriatric syndrome. J Am Geriatr Soc. 2007; 55(11):1853-66. PMC: 2785709. DOI: 10.1111/j.1532-5415.2007.01399.x. View

12.

Desarnaud F, Murillo-Rodriguez E, Lin L, Xu M, Gerashchenko D, Shiromani S . The diurnal rhythm of hypocretin in young and old F344 rats. Sleep. 2004; 27(5):851-6. PMC: 1201560. DOI: 10.1093/sleep/27.5.851. View

13.

Whitney C, Enright P, Newman A, Bonekat W, Foley D, Quan S . Correlates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study. Sleep. 1998; 21(1):27-36. DOI: 10.1093/sleep/21.1.27. View

14.

Gill T, Williams C, Tinetti M . Assessing risk for the onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc. 1995; 43(6):603-9. DOI: 10.1111/j.1532-5415.1995.tb07192.x. View

15.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

16.

Rothman M, Leo-Summers L, Gill T . Prognostic significance of potential frailty criteria. J Am Geriatr Soc. 2008; 56(12):2211-16. PMC: 2782664. DOI: 10.1111/j.1532-5415.2008.02008.x. View

17.

Espana R, Scammell T . Sleep neurobiology for the clinician. Sleep. 2004; 27(4):811-20. View

18.

Gill T, Richardson E, Tinetti M . Evaluating the risk of dependence in activities of daily living among community-living older adults with mild to moderate cognitive impairment. J Gerontol A Biol Sci Med Sci. 1995; 50(5):M235-41. DOI: 10.1093/gerona/50a.5.m235. View

19.

Vaz Fragoso C, Araujo K, Van Ness P, Marottoli R . Prevalence of sleep disturbances in a cohort of older drivers. J Gerontol A Biol Sci Med Sci. 2008; 63(7):715-23. PMC: 3719852. DOI: 10.1093/gerona/63.7.715. View

20.

Gill T, Desai M, Gahbauer E, Holford T, Williams C . Restricted activity among community-living older persons: incidence, precipitants, and health care utilization. Ann Intern Med. 2001; 135(5):313-21. DOI: 10.7326/0003-4819-135-5-200109040-00007. View