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

年龄≥50岁的三分之一女性和五分之一男性将在其 辈子福尔斯很常见，25%的老年人报告每年跌倒≥1次，12-15%的老年人报告每年跌倒≥2次福尔斯 2015年医疗保险的成本为310亿美元。最近，美国的跌倒死亡率稳步上升。 因此，识别福尔斯和骨折的可改变的风险因素是至关重要的。睡眠障碍是 在美国常见，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 描述了睡眠障碍之间的前瞻性关联，包括IH，SDB， 睡眠持续时间、睡眠效率和昼夜休息-活动节律紊乱以及意外骨折， 老年妇女和男子经常性的福尔斯。科学的前提是睡眠不好会增加福尔斯的风险 通过包括IH和SDB在内的多种机制进行骨折。这一计划建立在两个大的基础上-- 招募老年男性和女性的特征研究：WHISPER：妇女健康倡议（WHI）睡眠 低氧对恢复力的影响，以及老年男性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、癌症 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 血氧测定和SDB评估）和6天腕关节活动记录仪。我们建议扩展WHISPER以包括 复发性福尔斯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 睡眠不足与福尔斯和骨折风险之间的关系因性别而异。在MrOS睡眠研究中， 男性参与了一项睡眠评估，包括腕关节活动记录仪和家庭多导睡眠记录仪， 过夜血氧测定。我们证明夜间低氧血症与复发性高血压的风险相关。 老年男性的福尔斯和非脊柱骨折。然而，目前还没有关于全面睡眠测量的研究。 包括IH和老年妇女的福尔斯和骨折，尽管睡眠障碍存在性别差异， 骨折我们将检验如下假设，即通过%睡眠时间氧饱和度（SaO 2）<90%测量的IH SDB与复发性福尔斯（Aim 1）和骨折（Aim 2）的风险增加相关， 睡眠碎片。第二个目标将测试的假设，短或长的睡眠时间，睡眠 效率和碎片化以及昼夜节律紊乱（均来自体动记录）也与 复发性福尔斯（Aim 1）和骨折（Aim 2），这些相关性与IH无关。最后我们将 在男性中进行平行分析，以探索性别差异（目标3）。扩展WHISPER以包括福尔斯和 骨折是一个具有成本效益的机会，可以大大增加我们对睡眠对大脑影响的认识。 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.