Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample

Abstract

Background: Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods: This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results: Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR = 2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p < .001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR = 2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p = 0.06), however, age explained this relationship (age adjusted OR = 2.20, 95 % CI 1.03-1.10). Conclusions: For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.

Balance and Mobility in Community‐Dwelling Older Adults: Effect of Daytime Sleepiness

“…The effect of BMI on falls in this dataset was explored previously and was not found to have an influence, but the effect of fall‐related comorbidities or medication effect on falls cannot be excluded. The current findings corroborate those of other larger studies that have shown that reporting daytime sleepiness have a significantly higher percentage of falls . The ESS cutoff used in the current analysis was more conservative than in those larger cohort studies (≥10), yet 48% of participants with daytime sleepiness reported falling in the previous year, which may indicate the importance of subjective sleep complaints in this population.…”

“…Parent Study N= 120 falls. 44,45 The ESS cutoff used in the current analysis was more conservative than in those larger cohort studies (≥10), 44,45 yet 48% of participants with daytime sleepiness reported falling in the previous year, which may indicate the importance of subjective sleep complaints in this population. The analysis showed that, even after controlling for various covariates, daytime sleepiness is related to slower gait speed.…”

Anxiety disorders and falls among older adults

“…Other factors that increase the risk of falls through effects on neurological and cognitive function have also been identified, such as excessive daytime sleepiness, dizziness, fear of falling and depression (Bath et al, 2000;Hayley et al, 2015;Iinattiniemi et al, 2009;Painter et al, 2012;Williams et al, 2015b). However, there has been little research in the area of anxiety as a risk factor for falls.…”

Can Sleep Problems Have a Negative Impact on Falls in Older People?

“…7 A cross-section study demonstrated that women with excessive daytime sleepiness have reported at least one previous fall. 8 Recent literature showed that men with short sleep duration had increased risk of fall, 9 and, in adolescents, sleep deprivation had increased falls in different conditions. 10 The effects of sleep deprivation cause significant harm to self-regulation abilities that influences attention, decision making and impulsiveness, 10 this aspect has detrimental input in outcome falls in all ages.…”

“…10 The effects of sleep deprivation cause significant harm to self-regulation abilities that influences attention, decision making and impulsiveness, 10 this aspect has detrimental input in outcome falls in all ages. 8,10 The relationship between sleep problems and risk of falls can be influenced by several factors, such as associated diseases, depression, balance problems, impaired cognitive functions, and use of medication. Health professionals should pay more attention to the mechanisms that cause sleep deprivation and provide non-drug interventions that improve both risk of falls and sleep problems.…”