Sleep, Falls and Fractures in men and women: Role of nocturnal hypoxia

1/3的女性和1/5的男性在≥50岁时会经历骨质疏松性骨折 一辈子。跌倒很常见，25%的老年人报告每年≥1摔倒，12-15%的老年人报告≥2摔倒 2015年，联邦医疗保险的成本为310亿美元。最近，美国的秋季死亡率稳步上升。 因此，确定跌倒和骨折的可改变的危险因素是至关重要的。睡眠障碍是 在美国很常见，高达60%的老年人符合睡眠呼吸障碍(SDB)的标准。 间歇性低氧血症(IH)是阻塞性睡眠呼吸暂停的标志。该项目的长期目标是 描述睡眠障碍之间的前瞻性联系，包括IH、SDB、 睡眠时间、睡眠效率和扰乱的昼夜休息-活动节律以及发生的骨折和 老年女性和男性反复跌倒。科学的前提是睡眠不好会增加摔倒的风险 并通过包括IH和SDB在内的多种机制发生骨折。这项提议建立在两口大油井的基础上- 招募老年男性和女性的特色研究：窃窃私语：女性健康倡议(WHI)睡眠 低氧对老年男性恢复力的影响和睡眠障碍的结果研究(MROS睡眠研究)。 Whisper是一项关于睡眠障碍及其与心血管疾病和癌症的关系的观察性研究 和认知障碍。Whisper招募了4959名WHI参与者进行家庭睡眠测试(包括 血氧饱和度和SDB评估)和6天腕部活动描记。我们建议将密语扩展到包括 反复跌倒和骨折的重要临床和老年结局。我们还建议利用 根据MROS睡眠研究的现有数据，提供男性的可比数据，以测试 睡眠不佳与跌倒和骨折的风险之间的关联因性别而异。在MROS睡眠研究中，2865人 男性参与了一项睡眠评估，包括手腕动作图和居家多导睡眠图， 夜间血氧测定仪。我们证明夜间低氧血症与更大的复发风险有关。 老年男性的跌倒和非脊柱骨折。然而，目前还没有关于全面睡眠措施的研究 包括IH以及老年女性的跌倒和骨折，尽管在睡眠障碍和 骨折。我们将检验以睡眠时间血氧饱和度(SaO2)和lt；90%来衡量IH的假设 SDB与复发跌倒(目标1)和骨折(目标2)无关的风险增加相关 睡眠碎片化。次级目标将检验以下假设：睡眠时间短或长，睡眠 效率、碎片化和打乱的昼夜节律(都来自活动记录)也与 反复跌倒(目标1)和骨折(目标2)，这些关联与间歇性高血压无关。最后，我们会 对男性进行平行分析，以探索性别差异(目标3)。将耳语扩展到包括瀑布和 骨折是一个极具成本效益的机会，可以大幅增加我们对睡眠对 老年人的健康。

One in three women and one in five men age ≥50 years will experience an osteoporotic fracture in their lifetime. Falls are common with 25% of older adults reporting ≥1 fall and 12-15% reporting ≥2 falls annually with costs to Medicare in 2015 of $31 billion. More recently, fall death rates in the US have steadily increased. Therefore, identifying modifiable risk factors for falls and fractures is essential. Sleep disturbances are common in the US with up to 60% of older adults meeting criteria for sleep-disordered breathing (SDB). Intermittent hypoxemia (IH) is the hallmark of obstructive sleep apnea. The long-term goal of the project is to describe the prospective association between sleep disturbances including objective measures of IH, SDB, sleep duration, sleep efficiency and disrupted circadian rest-activity rhythms and incident fractures and recurrent falls in older women and men. The scientific premise is that poor sleep increases the risk of falls and fractures through several mechanisms including IH and SDB. This proposal builds on two large well- characterized studies that enrolled older men and women: WHISPER: Women’s Health Initiative (WHI) Sleep Hypoxia Effect on Resilience, and the Outcomes of Sleep Disorders in Older Men Study (MrOS Sleep Study). WHISPER is an observational study of sleep disorders and their relationship to cardiovascular disease, cancer and cognitive impairment. WHISPER recruited 4959 WHI participants for in home sleep testing (including oximetry and SDB assessment) and 6-day wrist actigraphy. We propose to extend WHISPER to include the important clinical and geriatric outcomes of recurrent falls and fractures. We also propose to capitalize on the existing data from the MrOS Sleep Study to provide comparable data on men to test whether the associations between poor sleep and risk of falls and fractures differ by sex. In the MrOS Sleep Study, 2865 men participated in a sleep assessment including wrist actigraphy and in-home polysomnography with overnight oximetry. We demonstrated that nocturnal hypoxemia is associated with greater risk of recurrent falls and non-spine fractures in older men. However, there are no studies of comprehensive sleep measures including IH and falls and fractures in older women despite established sex differences in sleep disorders and fractures. We will test the hypotheses that IH as measured by % sleep time oxygen saturation (SaO2) <90% and SDB will be associated with an increased risk of recurrent falls (Aim 1) and fractures (Aim 2) independent of sleep fragmentation. Secondary aims will test the hypotheses that short or long sleep duration, sleep efficiency and fragmentation and disrupted circadian rhythms, (all from actigraphy) are also associated with recurrent falls (Aim 1) and fractures (Aim 2) and these associations are independent of IH. Finally, we will perform parallel analyses in men to explore sex differences (Aim 3). Extending WHISPER to include falls and fractures is a cost-efficient opportunity to substantially increase our understating of the impact of sleep on the health of older adults.