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Actigraphy-Measured Sleep Characteristics and Risk of Falls in Older Women
Katie L. Stone, PhD;
Sonia Ancoli-Israel, PhD;
Terri Blackwell, MA;
Kristine E. Ensrud, MD;
Jane A. Cauley, DrPH;
Susan Redline, MD;
Teresa A. Hillier, MD;
Jennifer Schneider, MPH;
David Claman, MD;
Steven R. Cummings, MD
Arch Intern Med. 2008;168(16):1768-1775.
Background Prior studies have suggested that insomnia and self-reported poor sleep are associated with increased risk of falls. However, no previous study, to our knowledge, has tested the independent associations of objectively estimated characteristics of sleep and risk of falls, accounting for the use of commonly prescribed treatments for insomnia.
Methods Study subjects were participants in the Study of Osteoporotic Fractures. In 2978 primarily community-dwelling women 70 years and older (mean age, 84 years), sleep and daytime inactivity were estimated using wrist actigraphy data collected for a minimum of 3 consecutive 24-hour periods (mean duration, 86.3 hours). Fall frequency during the subsequent year was ascertained by a triannual questionnaire. Use of medications was obtained by examiner interview.
Results In multivariate-adjusted models, relative to those with "normal" nighttime sleep duration (>7 to 8 hours per night), the odds of having 2 or more falls in the subsequent year was elevated for women who slept 5 hours or less per night (odds ratio, 1.52; 95% confidence interval, 1.03-2.24). This association was not explained by the use of benzodiazepines. Indexes of sleep fragmentation were also associated with an increased risk of falls. For example, women with poor sleep efficiency (<70% of time in bed spent sleeping) had 1.36-fold increased odds of falling compared with others (odds ratio, 1.36; 95% confidence interval, 1.07-1.74).
Conclusion Short nighttime sleep duration and increased sleep fragmentation are associated with increased risk of falls in older women, independent of benzodiazepine use and other risk factors for falls.
Author Affiliations: Research Institute, California Pacific Medical Center and San Francisco Coordinating Center, San Francisco (Drs Stone and Cummings and Mss Blackwell and Schneider); Department of Psychiatry, University of California, San Diego (Dr Ancoli-Israel); Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, and Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (Dr Ensrud); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Cauley); Center for Clinical Investigation and Department of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr Redline); Kaiser Permanente Center for Health Research Northwest and Hawaii, Portland, Oregon (Dr Hillier); and Departments of Medicine (Dr Claman) and Epidemiology and Biostatistics (Dr Cummings), University of California, San Francisco.
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