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

男性和女性的睡眠、跌倒和骨折：夜间缺氧的作用

• 批准号: 10487391
• 负责人: JANE Ann CAULEY
• 金额: $ 51.94万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10487391
• 关键词: Age; Attention; Biological; Cardiovascular Diseases; Cardiovascular system; Characteristics; Circadian Rhythms; Clinical; Cognitive; Data; Death Rate; Diet; Elderly; Enrollment; Fracture; Goals; Health; High Prevalence; Hip region structure; Home; Hypoxemia; Hypoxia; Impaired cognition; Intervention; Malignant Neoplasms; Measures; Medicare; Minority; Observational Study; Obstructive Sleep Apnea; Outcome; Oxygen; Oxygen saturation measurement; Participant; Pharmaceutical Preparations; Physical activity; Polysomnography; Prevalence; Prospective Studies; Recurrence; Reporting; Rest; Risk; Risk Factors; Safety; Sex Differences; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Sleeplessness; Testing; Time; Vertebral column; Woman; Women' s Health; Women' s Role; Wrist; actigraphy; adjudicate; base; circadian; clinically relevant; cost; cost efficient; experience; fall risk; falls; follow-up; gender difference; healthy aging; humerus; hypnotic; improved; meetings; men; modifiable risk; nocturnal Hypoxemia; older men; older women; osteoporosis with pathological fracture; poor sleep; primary outcome; prospective; recruit; resilience; secondary outcome; sex

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.

三分之一的女性和五分之一的男性≥50岁将经历骨质疏松性骨折 寿命。跌倒很常见，有25％的老年人报告≥1跌倒，每年≥2跌落的年龄≥1 2015年的Medicare费用为310亿美元。最近，美国的跌倒率悄悄地提高了。 因此，确定跌倒和骨折的可修改风险因素至关重要。睡眠灾难是 在美国常见，多达60％的老年人符合睡眠呼吸的标准（SDB）。 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关联，包括IH，SDB的客观测量 睡眠持续时间，睡眠效率和昼夜节律的静止性节奏和入射骨折和 复发性落在老年男女中。科学的前提是睡眠不足会增加跌倒的风险 通过包括IH和SDB在内的几种机制进行断裂。该提议建立在两个大型井上 招募老年男女的研究的特征研究：窃窃私语：妇女健康计划（whi）睡眠 缺氧对韧性的影响以及老年男性研究中睡眠障碍的结果（MROS睡眠研究）。 耳语是对睡眠障碍的观察性研究及其与心血管疾病的关系 和认知障碍。耳语招募了4959名参与者参加家庭睡眠测试（包括 血氧仪和SDB评估）和6天手腕摄影。我们建议将耳语扩展到包括 复发跌落和骨折的重要临床和老年结局。我们还建议大写 关于MROS睡眠研究的现有数据，以提供有关男性的可比数据，以测试是否是否 睡眠不良与跌倒风险和性骨折之间的关联因性别与众不同。在MROS睡眠研究中，2865 男性参加了睡眠评估 过夜的血氧仪。我们证明夜间低氧血症与复发性更大有关 老年男性的瀑布和非脊柱骨折。但是，没有关于全面睡眠措施的研究 尽管睡眠障碍存在性别差异，但在老年女性中包括IH和Falls和骨折 断裂。我们将测试由IH按％睡眠时间氧气满意度（SAO2）<90％来衡量的假设 和SDB将与复发跌落（AIM 1）和断裂（AIM 2）独立的风险增加有关 睡眠破碎。次要目标将测试短时或长时间睡眠时间的假设 效率和分散性和破坏的昼夜节律（全部来自行动学）也与 经常性跌落（AIM 1）和断裂（AIM 2），这些关联与IH无关。最后，我们会的 对男性进行并行分析以探索性别差异（AIM 3）。将耳语扩展到包括瀑布和 骨折是一个经济高效的机会，可以实质上增加我们对睡眠影响的低估 老年人的健康。

项目成果

After the initial fracture in postmenopausal women, where do subsequent fractures occur?

• DOI: 10.1016/j.eclinm.2021.100826
• 发表时间: 2021-05
• 期刊: EClinicalMedicine
• 影响因子: 15.1
• 作者: Crandall CJ;Hunt RP;LaCroix AZ;Robbins JA;Wactawski-Wende J;Johnson KC;Sattari M;Stone KL;Weitlauf JC;Gure TR;Cauley JA
• 通讯作者: Cauley JA