Long Sleep Duration Is Associated With Increased Frailty Risk in Older Community-Dwelling Adults

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Sex differences in the association between sleep duration and frailty in older adults: evidence from the KNHANES study

BACKGROUND

Frailty is a pervasive clinical syndrome among the older population. It is associated with an increased risk of diverse adverse health outcomes including death. The association between sleep duration and frailty remains unclear. Therefore, the aim of this study was to investigate the relationship between sleep duration and frailty in community-dwelling Korean older adults and to determine whether this relationship is sex-dependent.

METHODS

Data on 3,953 older adults aged ≥ 65 years were obtained from the 7th (2016-2018) Korea National Health and Nutrition Examination Survey (KNHANES). Frailty was defined using the Fried phenotype with criteria customized for the KNHANES dataset. Self-reported sleep duration was classified as short sleep duration (≤ 6 h), middle sleep duration (6.1-8.9 h), and long sleep duration (≥ 9 h). Complex samples multivariate logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The percentage of male participants with short, middle, and long sleep durations was 34.9%, 62.1%, and 16.8%, respectively, while that of female participants was 26.1%, 59.2%, and 14.7%. The prevalence of frailty in the middle sleep duration group was lower than that in the short and long sleep duration groups in both men (short, 14.7%; middle, 14.2%; long, 24.5%; p < 0.001) and women (short, 42.9%; middle, 27.6%; long, 48.6%; p < 0.001). Both short (OR = 2.61, 95% CI = 1.91 - 4.83) and long (OR = 2.57, 95% CI = 1.36 - 3.88) sleep duration groups had a significantly higher OR for frailty than the middle sleep duration group even after adjusting for confounding variables among women, but not among men.

CONCLUSION

Short and long sleep durations were independently associated with frailty in community-dwelling Korean older adult women. Managing sleep problems among women should be prioritized, and effective interventions to prevent frailty should be developed accordingly.

Association of two novel systemic inflammatory biomarkers and frailty based on NHANES 2007-2018

Background

Frailty is a significant concern in the field of public health. However, currently, there is a lack of widely recognized and reliable biological markers for frailty. This study aims to investigate the association between systemic inflammatory biomarkers and frailty in the older adult population in the United States.

Methods

This study employed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2018 and conducted a rigorous cross-sectional analysis. We constructed weighted logistic regression models to explore the correlation between the Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and frailty in the population aged 40 to 80 years. Using restricted cubic spline (RCS), we successfully visualized the relationship between SII, SIRI, and frailty. Finally, we presented stratified analyses and interaction tests of covariates in a forest plot.

Results

This study involved 11,234 participants, 45.95% male and 54.05% female, with an average age of 64.75 ± 0.13 years. After adjusting for relevant covariates, the weighted logistic regression model indicated an odds ratio (OR) and 95% confidence interval(CI) for the correlation between frailty and the natural logarithm (ln) transformed lnSII and lnSIRI as 1.38 (1.24-1.54) and 1.69 (1.53-1.88), respectively. Subsequently, we assessed different levels of lnSII and lnSIRI, finding consistent results. In the lnSII group model, the likelihood of frailty significantly increased in the fourth quartile (OR = 1.82, 95% CI: 1.55-2.12) compared to the second quartile. In the lnSIRI group model, the likelihood of frailty significantly increased in the third quartile (OR = 1.30, 95% CI: 1.10-1.53) and fourth quartile (OR = 2.29, 95% CI: 1.95-2.70) compared to the second quartile. The interaction results indicate that age and income-to-poverty ratio influence the association between lnSIRI and frailty. RCS demonstrated a nonlinear relationship between lnSII, lnSIRI, and frailty.

Conclusion

The results of this cross-sectional study indicate a positive correlation between systemic inflammatory biomarkers (SII, SIRI) and frailty.

Trajectories of sleep duration and quality and their association with mild cognitive impairment, frailty, and all-cause mortality

OBJECTIVES

To identify longitudinal trajectories of sleep duration and quality and estimate their association with mild cognitive impairment, frailty, and all-cause mortality.

METHODS

We used data from three waves (2009, 2014, 2017) of the WHO Study on Global Aging and Adult Health in Mexico. The sample consisted of 2722 adults aged 50 and over. Sleep duration and quality were assessed by self-report. Sleep trajectories were determined by applying growth mixture models. Mixed-effects logistic (mild cognitive impairment) and ordinal logistic (frailty), and Cox proportional hazards (all-cause mortality) models were fitted.

RESULTS

Three classes for sleep duration ("optimal-stable," "long-increasing," and "short-decreasing") and quality ("very good-increasing," "very good-decreasing," and "moderate/poor stable") were identified. Compared to the optimal-stable group, the long-increasing trajectory had greater odds for mild cognitive impairment (odds ratio=1.68, 95% CI: 1.01-2.78) and frailty (odds ratio=1.66, 95% CI: 1.13-2.46), and higher risk for all-cause mortality (hazard ratio=1.91, 95% CI: 1.14-3.19); and the short-decreasing class had a higher probability of frailty (odds ratio=1.83, 95% CI: 1.26-2.64). Regarding the sleep quality, the moderate/poor stable trajectory had higher odds of frailty (odds ratio=1.71, 95% CI: 1.18-2.47) than very good-increasing group.

CONCLUSIONS

These results have important implications for clinical practice and public health policies, given that the evaluation and treatment of sleep disorders need more attention in primary care settings. Interventions to detect and treat sleep disorders should be integrated into clinical practice to prevent or delay the appearance of alterations in older adults' physical and cognitive function. Further research on sleep quality and duration is warranted to understand their contribution to healthy aging.

The causal relationship between sleep disturbances and the risk of frailty: a two-sample Mendelian randomization study

OBJECTIVE

Adequate sleep is closely related to people's health. However, with increasing age, the quality of sleep worsens. At the same time, among elderly individuals, frailty is also a disturbing factor, which makes elderly individuals more vulnerable to negative factors. To explore the relationship between the two, we conducted this study.

METHODS

In this paper, independent genetic variations related to insomnia, sleep duration and daytime sleepiness were selected as IVs, and related genetic tools were used to search published genome-wide association studies for a two-sample Mendelian randomization (TSMR) analysis. The inverse-variance weighted (IVW) method was used as the main Mendelian randomization analysis method. Cochran's Q test was used to test heterogeneity, MR‒Egger was used to test horizontal pleiotropy, and the MR-PRESSO test was used to remove outliers.

RESULTS

According to our research, insomnia (OR = 1.10, 95% CI 1.03-1.17, P = 2.59e-97), long sleep duration (OR = 0.66, 95% CI 0.37-1.17, P = 0.02), short sleep duration (OR = 1.30, 95% CI 1.22-1.38, P = 2.23e-17) and daytime sleepiness (OR = 1.49, 95% CI 1.25-1.77, P = 0.96e-4) had a bidirectional causal relationship with frailty.

CONCLUSIONS

Our research showed that there is a causal relationship between sleep disturbances and frailty. This result was obtained by a TSMR analysis, which involves the use of genetic variation as an IV to determine causal relationships between exposure and outcome. Future TSMR studies should include a larger sample for analysis.

Association between poor sleep quality and locomotive syndrome in middle-aged and older women: A community-based, cross-sectional study

OBJECTIVE

Poor sleep quality, such as nocturnal arousal and sleep inefficiency, is associated with frailty and sarcopenia. Herein, we evaluated the relationship between poor sleep quality and locomotive syndrome (LS), a motor organ dysfunction common among community-dwelling middle-aged and older women.

METHODS

Participants comprised 2246 Japanese middle-aged and older women. LS was classified into stages LS-1, LS-2, and LS-3 (from least to most severe) according to the results of the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. Sleep quality was assessed using the Pittsburgh Sleep Quality Index.

RESULTS

The Pittsburgh Sleep Quality Index scores were significantly higher in the LS group than that in the non-LS group (P < .001). Multivariate logistic regression analyses adjusted for potential confounders identified poor sleep quality as an independent factor of LS (odds ratio 1.59 [95% confidence interval 1.30-1.93], P < .001). Similar results were observed in the sensitivity analysis in postmenopausal women. LS and trouble sleeping because of pain showed stepwise association in all LS stages.

CONCLUSIONS

Poor sleep quality was independently associated with LS among community-dwelling middle-aged and older women. As the stage of LS progressed, the proportion of women with poor sleep quality increased significantly.

Does testosterone influence the association between sleep and frailty in men: results from the European Male Aging Study

BACKGROUND

Previous studies have suggested an association between sleep disturbance and frailty. The mechanism is unknown, although it has been suggested that hormonal factors may play a role.

METHODS

The aim was to determine the association between sleep duration, sleep quality and frailty, and to determine whether testosterone influenced this association. Males aged 40-79 years were recruited from eight European centres to the European Male Aging Study (EMAS). Subjects completed an interviewer-assisted questionnaire including questions regarding sleep quality and duration. Sleep quality was scored 0-20 and categorised as 0-4, 5-9, 10-14, and 15-20, with higher scores indicating poorer quality. A 39-component frailty index (FI) was constructed. Total testosterone levels were measured. The association between sleep duration, sleep quality and the FI was assessed using negative binomial regression, with adjustment for putative confounders including testosterone level.

RESULTS

Two thousand three hundred ninety-three participants contributed data to the analysis. The mean age was 63.3 years and mean sleep duration was 7.01 h. The mean frailty index was 0.15. Mean testosterone levels declined with decreasing sleep quality. After adjustment, compared to those with a sleep score of 0-4, the FI was 57% (95% CI 38%, 78%) higher among those with a sleep score of 15-20. After adjustment compared to those with normal sleep duration (6-9 h), those with a short (< 6 h) and long (≥ 9 h) sleep duration had a 16% (95% CI 6%, 28%) and 11% (95% CI 0%, 23%) higher FI, respectively. Adjustment for testosterone did not influence the strength of either association.

CONCLUSION

Frailty is associated with impaired sleep quality and sleep duration. The association cannot, however, be explained by variation in testosterone levels.

Association of Insomnia, Sleep Quality, and Sleep Duration With Risk of Physical Frailty in Middle-aged and Older People With HIV

Background

Frailty is one of the major concerns among aging people with HIV (PWH). Evidence regarding the association between sleep disorders and physical frailty in PWH is limited.

Methods

PWH and HIV-negative individuals aged ≥40 years were included and frequency-matched in a 1:2 ratio by sex and age. Logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs of the association between sleep disorders and physical frailty, and restricted cubic splines were used to describe the dose-response association. The contribution of depression to the association was estimated by mediation analysis.

Results

A total of 1526 PWH and 3052 HIV-negative individuals were included. Logistic regression indicated that insomnia (OR, 3.05; 95% CI, 1.63-5.72) and poor sleep quality (OR, 2.32; 95% CI, 1.21-4.45) were significantly associated with physical frailty in middle-aged and older PWH, especially in those with current CD4+ T-cell counts <350 cells/µL, but not in HIV-negative participants. A U-shaped and J-shaped dose-response relation between sleep duration and physical frailty was observed in PWH and HIV-negative participants, respectively. Shorter and longer sleep duration was associated with an increased risk of physical frailty in PWH. However, in HIV-negative participants, only longer sleep duration was associated with physical frailty. Mediation analysis revealed that depression mediated the relation between sleep disorders and frailty among PWH.

Conclusions

Sleep disorders including insomnia, poor sleep quality, and short and long sleep duration were significantly associated with physical frailty among middle-aged and older PWH. Depression may play a mediating role in the sleep-frailty association.

Racial and Ethnic Differences in Sleep Duration Life Expectancies among Men and Women in Mid-to-Late Life

This analysis documents U.S. racial/ethnic and gender differences in life expectancies with different self-reported sleep durations among adults aged 50 and older. We used self-reported sleep duration and linked mortality information from the 2004-2015 National Health Interview Survey (n = 145,015) to calculate Sullivan Method Lifetables for life expectancies with different self-reported sleep duration states: short (≤6 hours), optimal (seven to 8 hours), and long (≥9 hours) sleep duration per-day by race/ethnicity and gender. Non-Hispanic Black men (35.8%, 95% CI: 34.8%-36.8%) and women (36.5%, 95% CI: 35.7%-37.1%) exhibited the highest proportion of years lived with short sleep duration followed by Hispanic men (31.1%, 95% CI: 29.9%-32.3%) and women (34.1%, 95% CI: 33.1%-35.1%) and Non-Hispanic White men (25.8%, 95% CI: 25.4%-26.2%) and women (27.4%, 95% CI: 27.0%-27.7%). These results highlight how race/ethnic inequality in sleep duration and life expectancy are intertwined among older adults in the U.S.

Dual trajectory of sleep and frail in elderly people

The high incidence of dual sleep and frail disorders in the elderly people, often occurring together, seriously affects the physical and mental health of the older people, effective research on the dynamics of dual sleep and frail disorders is important for improving the quality of life for the older people and responding to global ageing trend. While trajectory studies provide a unique practical scientific perspective to grasp the dynamics of development, dual trajectories unite dual barriers provide an opportunity to study the dynamic dependence of both sleep and frailty simultaneously sleep trajectories and frailty trajectories in older people are interrelated and interacted through deeper mechanisms. Therefore, it is necessary for the study not only focus on the ongoing development of health problems, but also needs to consider multiple aspects and propose targeted intervention program.

Effects of different sleep disorders on frailty in the elderly: a systematic review and meta-analysis of observational studies

STUDY OBJECTIVES

Frailty is frequently reported following sleep disorders; however, the extent to which sleep disorders influence frailty remains unclear. In the current study, we performed a meta-analysis to evaluate the quantitative effects of different sleep disorders on frailty in the elderly.

METHODS

We conducted a systematic search of several databases, including PubMed, Web of Science, Embase, and Scopus, to retrieve articles published from May 2009 to June 2021. The data outcomes are expressed as the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Eighteen studies were included, with 39669 participants. Older adults with sleep disorders were found to have a higher risk of frailty (pooled OR = 1.49, 95%CI = 1.35-1.64, p < 0.01). Specifically, daytime sleepiness (pooled OR = 1.69, 95%CI = 1.09-2.61, p < 0.01), short sleep duration (pooled OR = 1.36, 95%CI = 1.20-1.54, p = 0.45), long sleep duration (pooled OR = 1.99, 95%CI = 1.39-2.85, p = 0.02), sleep latency extension (pooled OR = 1.38, 95%CI = 1.19-1.60, p = 0.72), and sleep disordered breathing (pooled OR = 1.30, 95%CI = 1.11-1.53, p = 0.37) were correlated with frailty.

CONCLUSIONS

The risk of frailty differs between older adults with sleep disorders and controls, suggesting that the relationships between different sleep disorders and frailty vary. These results highlight the need to monitor sleep disorders of the elderly and conduct intervention to prevent or delay the frailty process.

Interactions of Insomnia and Sedative-Hypnotic Drug Use Associated with Frailty Over Time Among Older Adults

BACKGROUND

Insomnia and frailty are prevalent in older adults. This study aimed to elucidate the impact of insomnia and sedative-hypnotic use on the frailty rate over time.

METHODS

We used data from community-dwelling older adults (mean ± SD age = 69.4 ± 8.2 years) from the Healthy Aging Longitudinal Study in Taiwan (HALST). A total of 4,744 participants were included in the study and were followed up for an average of 3.2 years. Frailty was assessed using the Fried criteria. Self-reported sleep problems, sedative-hypnotic use, and claims records from the National Health Insurance database were used. The generalized equation estimation (GEE) approach was applied to account for correlations between repeated measures. The average impact of insomnia and drug use on frailty over time was estimated by adjusting for potential confounding factors using the logic link in the GEE approach.

RESULTS

The adjusted odds ratio (OR) of frailty was 1.41 (95% CI: [1.16, 1.72], Z-test statistics Z = 3.39, p <0.001) for insomnia and 1.52 ([1.16, 2.00], Z = 3.00, p = 0.0027) for sedative-hypnotic use. Interactions between insomnia and sedative-hypnotic use with frailty were not statistically significant. Long sleep duration > 8 hours, daytime sleepiness, and sleep apnea was also associated with an increased likelihood of developing frailty. Notably, a dose-response relationship between sedative-hypnotic drug use and frailty was observed.

CONCLUSIONS

Insomnia and sedative-hypnotic use were independently associated with increased frailty. The implementation of nonpharmacological treatments to attenuate insomnia may reduce frailty rates.

Frailty is associated with worse cognitive functioning in older adults

INTRODUCTION

Frailty and impaired cognitive functioning often co-occur in older adults and are associated with adverse health outcomes. However, their relationship is unclear. This study sought to examine the association of frailty status with cognitive functioning in older adults.

METHOD

The study population consisted of 2,296 older adults aged ≥60 from the National Health and Nutrition Examination Survey 2011-2014. Frailty status was measured based on the Fried Phenotype and the participants were categorized into three groups- robust, pre-frailty, and frailty. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) immediate and delayed recall tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated. Multinomial linear regression models were constructed to examine the association between frailty status (reference: robust) and test-specific and global cognition z-scores. Multiple linear regression models were used to examine the relationship between the number of frailty dimensions and test-specific and global cognition z-scores. All models controlled for age, race/ethnicity, education, total cholesterol level, and systolic blood pressure.

RESULTS

About half of the participants (median age 68 years) were female (49.9%) and non-Hispanic White (48.7%). A quarter (23.3%) of the participants completed some college and above. Multinominal linear regression showed that compared with participants who were robust, those with frailty had worse DSST [β = -0.234, 95% confidence interval (CI): -0.391, -0.078, P = 0.003] and global cognition z scores (β = -0.129, 95% CI -0.233, -0.025, P = 0.02). Multiple linear regression model showed that the number of frailty dimensions was significantly associated with decreased the DSST (β = -0.065, 95% CI -0.103, -0.026, P = 0.001) and global cognition z-scores (β= -0.034, 95% CI -0.06, -0.009, P = 0.009).

CONCLUSION

Frailty is associated with worse processing speed, sustained attention, working memory, and global cognition in older adults. Prevention and treatment of frailty in older adults may help protect their cognitive functioning. Further, clinicians should consider assessing cognitive functioning, especially processing speed, sustained attention, and working memory, among frail older patients, which may allow early identification and interventions of cognitive impairment.

How did trends in sleep duration in 2020 compare to previous years and how did they vary by sex, race/ethnicity, and educational attainment?

Recent evidence utilizing online samples indicates that sleep patterns were significantly altered during the initial months of the SARS-CoV-2 (COVID-19) pandemic/lockdown. However, it remains less clear how sleep duration changed in population-based samples, in the later months of 2020, and across subpopulations. Here we used a population-based sample to document sleep duration trends for the entire year of 2020, compared these trends to the previous years of 2013, 2014, 2016, and 2018, and systematically analyzed whether self-reported sleep duration patterns in 2020 varied by sex, race/ethnicity, and educational attainment. Data were from the Behavioral Risk Factor Surveillance System (n = 2,203,861) and focused on Americans aged 18 years and older. Respondents self-reported the hours of sleep they got in a 24-h period. We fit multinomial and linear regression models to predict the category of sleep duration (six or fewer hours, seven to eight h (base), and nine or more hours) and the raw reports of sleep duration, net of demographic, socioeconomic, and behavioral health covariates. Results revealed significant increases in sleep duration during the months directly after the COVID-19 lockdown (March and April in particular). However, these increases were short lived; reports of sleep duration reverted to historical levels by the Fall of 2020. We also found that the changes in sleep duration trends in 2020 were similar by sex, race/ethnicity, and educational attainment, cumulatively leading to little impact to disparities in sleep duration. In a dramatic, but brief, alteration of population-level sleep duration patterns, disparities in self-reported sleep duration remained intractable.

Long Sleep Duration Increases the Risk of All-Cause Mortality Among Community-Dwelling Older Adults With Frailty: Evidence From NHANES 2009-2014

Objectives: The aim of this study was to determine the effect of sleep duration on all-cause mortality among older adults with frailty. Methods: The prospective cohort study included 5705 community participants aged 60 or above in the National Health and Nutrition Examination Survey (NHANES). Health indicators were selected in the NHANES to obtain the frailty index and sleep duration. The risk of all-cause mortality was estimated by a Cox proportional hazard model. Results: During the follow-up, long sleep duration was associated with higher all-cause mortality (adjusted HR = 1.28, 95% CI 1.03-1.59). The hazard of all-cause mortality was the lowest from the beginning of sleep until sleep duration reached 5.8 hours among older adults with frailty. Discussion: Long sleep duration was associated with higher all-cause mortality among older adults with frailty. There was a U-shaped relationship between sleep duration and all-cause mortality.

Relationship of hearing impairment, social participation and depressive symptoms to the incidence of frailty in a community cohort

BACKGROUND

The mediating effect of social participation and depressive symptoms on the relationship between hearing impairment and frailty remains unclear.

METHODS

A total of 3981 participants from three waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. The outcome was incidental frailty. Hearing impairment, social participation, and depressive symptoms were the main variables. Cox regression models and structural equation models were adopted to examine the relationship between hearing impairment, social participation, depressive symptoms, and the incidence of frailty, with adjustments for demographic characteristics and lifestyle variables at baseline.

RESULTS

Hearing impairment (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.12, 1.74), social participation (HR 0.72, 95% CI 0.55, 0.94), and depressive symptoms (HR 1.78, 95% CI 1.37, 2.30) were associated with the incidence of frailty. Hearing impairment was associated with frailty not only through social participation (β = 0.015, 95% CI 0.003, 0.037) and depressive symptoms (β = 0.070, 95% CI 0.037, 0.116) separately but also through social participation and depressive symptoms sequentially (β = 0.002, 95% CI 0.001, 0.004). Furthermore, the effect of social participation on frailty occurred in participants with hearing impairment, while the effect of depressive symptoms on frailty occurred in participants with normal hearing status.

CONCLUSIONS

Hearing impairment is associated with frailty, in which social participation and depressive symptoms partly mediate the association. The effect of social participation and depressive symptoms on frailty varies across hearing statuses. Integrated and comprehensive intervention measures, including hearing screenings, promoting social participation, and improving depressive symptoms, are suggested to prevent frailty.

Maintaining healthy sleep patterns and frailty transitions: a prospective Chinese study

BACKGROUND

Little is known about the effects of maintaining healthy sleep patterns on frailty transitions.

METHODS

Based on 23,847 Chinese adults aged 30-79 in a prospective cohort study, we examined the associations between sleep patterns and frailty transitions. Healthy sleep patterns included sleep duration at 7 or 8 h/d, without insomnia disorder, and no snoring. Participants who persisted with a healthy sleep pattern in both surveys were defined as maintaining a healthy sleep pattern and scored one point. We used 27 phenotypes to construct a frailty index and defined three statuses: robust, prefrail, and frail. Frailty transitions were defined as the change of frailty status between the 2 surveys: improved, worsened, and remained. Log-binomial regression was used to calculate the prevalence ratio (PR) to assess the effect of sleep patterns on frailty transitions.

RESULTS

During a median follow-up of 8.0 years among 23,847 adults, 45.5% of robust participants, and 10.8% of prefrail participants worsened their frailty status, while 18.6% of prefrail participants improved. Among robust participants at baseline, individuals who maintained sleep duration of 7 or 8 h/ds, without insomnia disorder, and no-snoring were less likely to worsen their frailty status; the corresponding PRs (95% CIs) were 0.92 (0.89-0.96), 0.76 (0.74-0.77), and 0.85 (0.82-0.88), respectively. Similar results were observed among prefrail participants maintaining healthy sleep patterns. Maintaining healthy sleep duration and without snoring, also raised the probability of improving the frailty status; the corresponding PRs were 1.09 (1.00-1.18) and 1.42 (1.31-1.54), respectively. Besides, a dose-response relationship was observed between constantly healthy sleep scores and the risk of frailty transitions (P for trend < 0.001).

CONCLUSIONS

Maintaining a comprehensive healthy sleep pattern was positively associated with a lower risk of worsening frailty status and a higher probability of improving frailty status among Chinese adults.

Prevalence of Frailty and Associated Factors Among Hospitalized Older Adults: A Cross-Sectional Study

This study aimed to estimate the prevalence of frailty and associated factors among hospitalized older adults. It consisted of 184 hospitalized older adults recruited between October 2019 to January 2020. We used the FRAIL scale, Geriatric Depression Scale-15, and the Pittsburg Sleep Quality Index to collect data. Descriptive statistics, independent group t-test, Chi-square (χ²) tests, and logistic regression were applied to statistical analysis. It found that the prevalence of frailty among hospitalized older adults was 39.7%. Depression (Mild: OR = 5.312, 95% CI [2.384-11.833]; Moderate: OR = 6.630, 95% CI [2.077-21.160]) and low activities of daily living (ADL) (Slight dependence: OR = 5.667, 95% CI [1.308-24.557]; Moderate dependence: OR = 15.188, 95% CI [3.342-69.016]; Severe dependence: OR = 5.872, 95% CI [2.645-13.038]) were independent predictors of frailty. Future studies on the interventions to reduce depression, improve ADL and delay the progression of frailty are encouraged. We should focus more on ADL, emotional and psychological state of hospitalized older adults to prevent frailty.

Nonlinear associations between sleep patterns and sarcopenia risks in older adults

STUDY OBJECTIVES

Despite considering it as a common geriatric condition, sarcopenia is linked to various behavioral factors that may be changeable. As sleep is one of the important routines in physiological homeostasis, further investigating the underlying relationships of sleep behavior with sarcopenia is urgently needed. We examined the association between sleep parameters (ie, sleep duration, bedtime, wake time, or midsleep time) and sarcopenia risks in older adults, in the total sample and age group subsamples.

METHODS

A total of 1,068 older adults in Taiwan were included. Data on bedtime, wake time, and sleep duration were collected through telephone interview. Midsleep time was calculated by the midpoint of bedtime and wake time. Sarcopenia was screened by the SARC-F questionnaire composed of 5 questions (the strength, assistance in walking, rising from a chair, climbing stairs, and falls) as well as higher scores was related to greater risks. Generalized additive models were conducted to examine the nonlinear relationships between sleep parameters and sarcopenia risks.

RESULTS

The covariate-adjusted analysis showed that a reverse J-shaped relationship for sleep duration and sarcopenia risk (P < .001) and a significant association for wake time and the SARC-F score (P = .009) in total sample, with considering age-related interaction. No associations were found in the other sleep parameters (bedtime and midsleep time) and sarcopenia in older adults. Similar associations were observed between wake time and the SARC-F score across age groups, while diverse associations of sleep duration with the SARC-F score were found in different age groups.

CONCLUSIONS

The sleep pattern is significantly associated with sarcopenia risks in aging adults. Improving inappropriate sleep behaviors in older adults is suggested to prevent a decline in muscle function and promote healthy aging.

CITATION

Huang W-C, Lin C-Y, Togo F, et al. Nonlinear associations between sleep patterns and sarcopenia risks in older adults. J Clin Sleep Med. 2022;18(3):731-738.

Secondhand smoke is positively associated with pre-frailty and frailty in non-smoking older adults

INTRODUCTION

Either exposure to secondhand smoke (SHS) or frailty has been linked to adverse health outcomes in nonsmoking adults. However, their relationship is rarely studied. The purpose of this study is to examine the association between serum cotinine level and frailty status among non-smoking older adults.

METHOD

The study population consisted of 2,703 older adults aged ≥60 from the National Health and Nutrition Examination Survey 2011-2014. Non-smokers were included based on (1) a serum cotinine level ≤ 10 ng/mL and 2) a response of "no" to the question, "Do you currently smoke?" Frailty status was measured based on the Fried Phenotype and had three groups- robust, pre-frailty, and frailty. Multinomial logistic regression models were constructed to examine the association between serum cotinine level quartile and frailty status, controlling for age, sex, race/ethnicity, education, depressive symptoms, alcohol use, and systolic blood pressure.

RESULTS

About half of the participants (median age 70.0 years, range 64-78) were female (53.6%), non-Hispanic White (48.3%), and completed some college and above (50.1%). Multinomial logistic regression with a reference group being those in the 1^st quantile (the lowest) of serum cotinine level showed that participants in the 4^th quartile (the highest) of serum cotinine level had increased odds of pre-frailty vs. robust (OR 1.522, 95% confidence interval [CI] 1.060, 2.185, P = 0.023) as well as increased odds of frailty vs. robust (OR 2.349, 95% CI 1.081, 5.107, P = 0.031).

CONCLUSIONS

Higher serum cotinine level is associated with increased risk of pre-frailty and frailty versus robust in non-smoking older adults. Prevention and reduction of SHS in older adults may help protect them from developing pre-frailty or frailty.

Sleep Duration and Frailty Risk among Older Adults: Evidence from a Retrospective, Population-Based Cohort Study

OBJECTIVES

Frailty and sleep duration complaints are both prevalent and often coexist among older adults. The purpose of this study was to examine the prospective association between sleep duration and frailty risk in a nationally representative cohort study.

DESIGN

Prospective cohort study, ten-year follow-up.

SETTING

Community-based setting in 23 provinces of China.

PARTICIPANTS

A total of 7623 older adults age 65 and over without frailty at baseline were included in the analysis.

MEASUREMENTS

The participants were divided into three groups according to self-reported sleep duration: short (≤6 hours per day), middle (>6 but <10 hours per day) and long (≥10 hours per day). Frailty was measured according to the accumulation of health deficits by the construction of a frailty index of 38 items with 0.25 as the cutoff. A Cox proportional hazard model, a competing risk model and a generalized estimating equation (GEE) model with multiple adjustments were performed to evaluate the association between sleep duration and frailty risk.

RESULTS

During a median follow-up period of 4.4 years (IQR 2.9-9.0), 2531 (33.2%) individuals developed frailty. Compared with participants with middle sleep duration, the risk of frailty was increased among participants with long sleep duration (HR 1.26, 95% CI 1.14-1.38) in the fully adjusted Cox proportional hazard model. However, short sleep duration was insignificantly associated with frailty risk. The competing risk model and the GEE model yielded similar results.

CONCLUSION

Long sleep duration is significantly associated with frailty incidence among older adults even after adjustment for confounding factors. This study provides reinforcing longitudinal evidence for the need to design sleep quality improvement interventions in health care programs to prevent frailty among older adults.

Long sleep duration is associated with cognitive frailty among older community-dwelling adults: results from West China Health and Aging Trend study

OBJECTIVE

To investigate the association between sleep duration and cognitive frailty among older adults dwelling in western China.

METHODS

We used the baseline data from West China Health and Aging Trend (WCHAT) study. Sleep duration was classified as short sleep duration (< 6 h), normal sleep duration (6-8 h) and long sleep duration (≥ 9 h). Fried frailty criteria and Short Portable Mental Status Questionnaire were used to measure cognitive frailty. Multinomial logistic regression was conducted to estimate odds ratio (OR) and 95% confidence interval (CI).

RESULTS

A total of 4093 older adults (age = 67.8 ± 5.9 years, 1708 males and 2385 females) were included in the analysis. The prevalence of cognitive frailty was 11.8% among older adults in western China. Approximately 11.9% participants had short sleep duration (< 6 h); 22.2% had a long sleep duration (≥ 9 h). After adjusting for covariates, only long sleep duration was significantly associated with high risk of cognitive frailty (OR = 2.07, 95%CI = 1.60-2.68, P <  0.001) in western China older adults compared to normal sleep duration.

CONCLUSIONS

Long sleep duration was significantly related to cognitive frailty in older adults. Intervention for long sleep duration may be helpful to prevent cognitive frailty.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR1800018895 .

Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults

STUDY OBJECTIVES

To determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults.

METHODS

We used data from Waves 2 (W2) and 3 (W3) (2010-2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase.

RESULTS

After controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02-2.84) and mortality (OR = 2.12, 95% CI: 1.09-4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02-1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17-0.97) were associated with mortality.

CONCLUSIONS

Among community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.

Sleep duration and incident frailty: The Rural Frailty Study

Background

The association between sleep duration and frailty remains unconclusive since most of the studies have been cross-sectional. Therefore, this study aimed to analyze the association between sleep duration, sleep complaints, and incident frailty.

Methods

A community-based cohort study from rural areas in Mexico with 309 older adults aged 70 and over. Data from waves two and three of the Rural Frailty Study were used. We operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive waves. Sleep duration was classified as: ≤ 5 h, 6 h, 7–8 h, and ≥ 9 h; and the self-reported sleep complaints as a dichotomous variable. Analyses were performed using Poison regression models.

Results

The average age was 76.2 years and 55.3% were women; the incidence of frailty was 30.4%; 13.3% slept ≤5 h, and 38.5% ≥ 9 h. Compared with the group that slept 7–8 h, the risk of frailty at 4.4 years of follow-up was significantly higher among those who slept ≤5 h (adjusted RR 1.80, 95% CI: 1.04–3.11) and among those who slept ≥9 h (adjusted RR 1.69, 95% CI: 1.10–2.58). Sleep complaints were not associated with incident frailty (adjusted RR 1.41, 95% CI: 0.94–2.12).

Conclusions

Our results show that short and long sleep duration are associated with the incidence of frailty. Studies that objectively evaluate sleep duration are needed to clarify whether meeting the recommended hours of sleep decreases frailty incidence.

Frailty is associated with poor sleep quality in the oldest old

Background/aim

Sleep disorders and frailty increase with advancing age, along with physical disabilities, cognitive dysfunction, mood disorders, and social vulnerability. Thus, the study objective was to evaluate the relationship between frailty and sleep quality in the oldest old patients.

Materials and methods

In this study, 100 patients aged ≥80 years were assessed using comprehensive geriatric assessment (CGA) including basic activities of daily living (ADL), instrumental ADL, handgrip strength, the Geriatric Depression Scale-15, the Mini-Mental State Examination, and the Mini-Nutritional Assessment-Short Form. The sleep quality and frailty status of the patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Fried Frailty Index, respectively.

Results

The median age of the participants was 84 years (80–92), 55% of them were women, and 41% of them were frail. There was no statistically significant difference between the frail and nonfrail groups in terms of age, sex, and comorbidities (P > 0.050). The frail patients scored poorly according to the CGA tests when compared to the nonfrail ones (P < 0.050). The median score for the PSQI was significantly higher in the frail group, 12 points (3–19) versus 6 points (1–19) in the nonfrail patients (P < 0.001). The PSQI score (odds ratio [OR] of 1.308, 95% confidence interval [CI]: 1.092–1.566, P = 0.004), female sex (OR of 5.489, 95% CI: 1.063–28.337; P = 0.042), and the basic ADL score (OR of 0.383; 95% CI: 0.207–0.706; P = 0.002) were found to be independently associated with frailty using multivariate analysis.

Conclusion

Sleep quality was significantly decreased in the oldest old frail patients compared to the nonfrail ones, and poor sleep quality was independently associated with frailty. Evaluating the sleep patterns of the oldest old patients with CGA in daily geriatric practice might help to improve the quality of life of frail patients.

Sleep patterns and physical function in older adults attending primary health care

BACKGROUND

Sleep disturbances may contribute to physical function impairment among older adults.

OBJECTIVE

To examine the associations between sleep quality and duration and impaired physical function among older adults.

METHODS

Cross-sectional study involving 392 non-institutionalized adults aged ≥65 years, who were recruited from primary health care centres in Spain. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index (PSQI). The FRAIL scale was used to identify physical frailty, the short physical performance battery to assess lower extremity functional impairment (LEFI) and grip strength was measured using a hand-held dynamometer to assess muscle weakness. Statistical analyses were performed with logistic regression models adjusted for potential confounders.

RESULTS

Participants with poor sleep quality (PSQI global score ≥10) were more likely to have functional limitations; the odds ratio (95% confidence interval) was 2.90 (1.10-7.64) for physical frailty, 2.73 (1.34-5.58) for LEFI and 2.32 (1.14-4.75) for muscle weakness. Sleep quality components associated with frailty were sleep disturbances, use of sleeping medication and daytime dysfunction. The only quality component associated with LEFI was poor sleep efficiency, while subjective poor sleep quality and daytime dysfunction were linked to muscle weakness. No associations were observed between night-time sleep duration and physical function indicators.

CONCLUSIONS

Poor self-reported sleep quality, but not sleep duration, was associated with an increased frequency of physical frailty, LEFI and muscle weakness. Interventions to improve sleep quality could contribute to healthy ageing.

Longitudinal Impact of Frailty States and Sleep Duration on Subsequent Depressive Symptoms of Older Adults

OBJECTIVES

To determine the effects of baseline and changes in frailty states on subsequent depressive symptoms, and whether sleep duration would modify these effects.

DESIGN

Prospective, cohort study.

SETTING

The 2011 baseline and 2013 follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS).

PARTICIPANTS

Community-dwelling old adults who were aged 60 or above at baseline and participated in the 2011 and 2013 waves of the CHARLS (N = 5,026).

MEASUREMENTS

Frailty was measured using the physical frailty phenotype (PFP) scale. Levels of depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Using the generalized estimating equations (GEE), the effects of baseline and transitions in frailty states were examined on subsequent depressive symptoms, adjusting for a range of confounding variables.

RESULTS

Baseline prefrail (b = 0.97, P < .05) and frail states (b = 0.35, P < .05) were associated with higher subsequent level of depressive symptoms 2 years later. Within individuals who were robust at baseline, transitioning into prefrail/frail (b = 3.04, P < .001) was associated with a higher subsequent level of depressive symptoms, and this association was accelerated by short sleep duration. Within individuals who were prefrail at baseline, transitioning into frail (b = 1.76, P < .001) was associated with higher subsequent levels of depressive symptoms, and this association was stronger among those who reported short sleep duration.

CONCLUSION

Baseline and transitions in frailty states were significantly related with higher subsequent levels of subsequent depressive symptoms. Short sleep duration significantly moderated the effects of baseline or transitions of frailty on subsequent depressive symptoms. Targeted interventions could be implemented to improve sleep quality for prefrail and frail older adults.

Sex Differences in the Association Between Risk of Obstructive Sleep Apnea, Insomnia, and Frailty in Older Adults

PURPOSE

To analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults.

PATIENTS AND METHODS

Cross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex.

RESULTS

This study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty.

CONCLUSION

In community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.

Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress

Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19-1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.

Insomnia, low sleep quality, and sleeping little are associated with frailty in Mexican women

OBJECTIVE

To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults.

SUBJECTS & METHODS

Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty.

RESULTS

Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men.

CONCLUSION

In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.

Associations of sleep quality and sleep duration with frailty and pre-frailty in an elderly population Rugao longevity and ageing study

BACKGROUND

Previous studies suggest that poor sleep quality or abnormal sleep duration may be associated with frailty. Here we test the associations of sleep disturbances with both frailty and pre-frailty in an elderly population.

METHODS

Participants included 1726 community-dwelling elders aged 70-87 years. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disturbances. Frailty was defined using phenotype criteria. Logistic regression models were used to estimate odds ratio of the associations.

RESULTS

The average PSQI score was 5.4 (SD, 3.1). Overall 43.6% of the participants had poor sleep quality (PSQI> 5), 8.2% had night sleep time ≤ 5 h, and 27.8% had night sleep time ≥ 9 h. The prevalence of frailty and pre-frailty was 9.2 and 52.8%, respectively. The proportions of PSQI> 5 increased with the severity of frailty status (robust: pre-frail: frail, 34.5%: 48%: 56.1%, P < 0.001). After adjustment for multiple potential confounders, poor sleep quality (PSQI> 5) was associated with higher odds of frailty (OR = 1.78, 95% CI 1.19-2.66) and pre-frailty (OR = 1.51, 95% CI 1.20-1.90). Sleep latency, sleep disturbance, and daytime dysfunction components of PSQI measurements were also associated with frailty and pre-frailty. In addition, sleep time 9 h/night was associated with higher odds of frailty and pre-frailty.

CONCLUSIONS

We provided preliminary evidences that poor sleep quality and prolonged sleep duration were associated with being frailty and pre-frailty in an elderly population aged 70-87 years. The associations need to be validated in other elderly populations.