Sleep duration and falls: a systemic review and meta-analysis of observational studies

Association between sleep duration and hip fracture risk among the older adults: a cross-sectional study based on the NHANES

BACKGROUND

There has been sharp increase in the incidence of hip fractures (HFs) with the increasing aging globally. However, it remains ambiguous regarding the association between HF risk and sleep duration. This study intended to explore the association between sleep duration and HF risk among the older adults.

METHODS

The study assessed a cohort of 7,540 participants aged at least 60 years old using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010, as well as from 2013 to 2014. Two distinct groups of HF and non-HF were constructed on the basis of their history of HFs. Based on the self-reported sleep duration through a structured questionnaire, multivariate logistic regression analyses were conducted to examine the relationship between sleep duration and HF risk. In addition, restricted cubic splines (RCS) were used to assess linearity. The receiver operating characteristic (ROC) curve was used to explore the threshold of sleep duration for HF risk.

RESULTS

HFs were found in 129 patients among the 7,540 participants over 60 years of age with mean age of 70.17 ± 7.1 years. Significant differences in sleep duration were observed between the HF and non-HF groups (7.73 ± 1.68 h vs. 7.11 ± 1.42 h; p = 0.006). The multivariate analysis was adjusted for sociodemographic, behavioral lifestyle, and comorbidities. A 1-h increase in sleep duration was associated with higher odds of having prior hip fractures in unadjusted models [odds ratio (OR) = 1.36; 1.11, 1.67; p = 0.004], minimally adjusted models (OR = 1.23; 1.03, 1.48; p = 0.025), second adjusted models (OR = 1.22; 1.02,1.45; p = 0.026) and fully adjusted models (OR = 1.22; 1.03,1.45; p = 0.026). The relationship remained consistent across all four models, indicating the correlation of a longer sleep duration with an elevated HF risk. RCS analysis revealed a statistically linear relationship between sleep duration and HF risk (p-nonlinear = 0.244, p-overall < 0.01). In addition, the identified threshold of sleep duration linked to HF risk was determined to be 7.5 h among the older adults (AUC = 0.611).

CONCLUSION

This study suggests an linear association between sleep duration and the risk of HFs. Further research is needed to validate these findings and more clearly identify the clinical relevance of this potential relationship.

The effects of sleep improving interventions in medical hospital wards: the WEsleep study - A randomized clinical trial

OBJECTIVE

Hospitalized patients often experience disturbed sleep, affecting general health. While some randomized studies have assessed individual non-pharmacological interventions, none have evaluated approaches that combine multiple strategies to improve sleep. This study aimed to assess the effects of a multicomponent sleep-enhancing protocol in hospitalized medical patients.

METHODS

The WEsleep cluster randomized controlled trial was conducted between July 2023 and March 2024 across six medical departments in a large Dutch academic hospital. Adult medical patients who were able to provide informed consent and were expected to stay at least two nights were eligible for inclusion. The multicomponent intervention included delaying early morning nursing rounds, training healthcare professionals, optimizing sleep-disturbing medication timing, offering earplugs and eye masks, and conducting evening sleep rounds. The primary outcome was sleep quality on the second night, assessed with the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcomes included sleep quantity, 30-day mortality, delirium incidence, and use of sleep-enhancing tools.

RESULTS

Data from 291 patients were analyzed. The intervention group reported better sleep quality, with a median RCSQ score of 66.6 (IQR 44.3-78.9), compared to 55.7 (IQR 38.2-74.3) in the control group (p = 0.033). No significant differences were observed in sleep quantity, 30-day mortality or delirium incidence. Protocol adherence ranged from 42 % to 73 %.

CONCLUSIONS

This study provides a valuable roadmap for hospitals aiming to enhance patient care through improved sleep management. A multicomponent intervention can lead to significantly better sleep quality in medical wards, highlighting the potential of structured, non-pharmacological strategies in routine hospital care.

A comprehensive investigation to examine the factors associated with previous falls, recurrent falls, and concerns about falling among outpatient older individuals: a cross-sectional study

PURPOSE

Although numerous studies have assessed factors associated with falls among older adults, only a few studies have comprehensively evaluated multiple dimensions that may lead to falls. This study aims to investigate in a comprehensive way factors associated with previous falls, previous recurrent falls, and concerns about falling among general geriatrics outpatients.

METHODS

A cross-sectional study was conducted to examine factors associated with falls among older outpatients in accordance with established falls guidelines. The assessment included the following dimensions: sociodemographic, habits, physical activity, sensory, environment, physical examination, cognitive function, mental health status, frailty, sleep quality, functional status, presence of diseases, medication usage, and mobility. Logistic and linear regression models were used.

RESULTS

This study involved 335 older patients (78.8% women with a mean age of 74.5 years). Four out of ten had fallen in the previous year. Over half of the falls resulted in physical injuries and nearly one-third required hospital care. The main factors directly associated with falls were anxiety, visual impairment, number of medications, and environmental risk while being married and walking faster were inversely associated. As for recurrent falls, anticonvulsant use and increased depressive symptoms were directly associated with falls. At least six out of ten older outpatients feared falling, and associated factors were depressive symptoms, difficulties in climbing stairs, visual impairment, sleep problems, sedentarism behavior, hypothyroidism, hypertension and balance and gait abnormalities.

CONCLUSION

Predisposing factors to falls must be identified and included in a broader approach, focused on biologic, behavioral, environmental and socioeconomic dimensions.

Empowering Fall Prevention Through Integrated Lifestyle Medicine Strategies-From Recognition of Fall Risks to Implementation of Prevention of Falls for all in Practice

Falls remain the leading cause of unintentional injuries across all age groups, prompting many emergency room visits. The annual estimated cost associated with falls is believed to exceed 100 billion dollars. In addressing this trend, health professional team members emerge as key players and can assume a crucial role in bridging the gap between lifestyle medicine and fall prevention. By imparting strategies aligned with the 6 pillars of lifestyle medicine, these professionals can educate individuals on risk factors, assess fall risk, and offer activities to mitigate the likelihood of future falls. This collaborative approach empowers all to take immediate and informed action, fostering a proactive stance against the prevalent issue of fall-related injuries. Through the background and practical strategies described in this paper, health professionals of various disciplines will have access to tools and knowledge to enhance their role in preventing falls using the lens of lifestyle medicine.

Health literacy and falls among community-dwelling older people in China: is there a sex difference?

BACKGROUND

Health literacy is one of the important determinants of healthy aging, yet few studies have focused on the association between health literacy and falls.

AIMS

This study aims to explore the relationship between health literacy and falls, with a focus on sex differences among older people in China.

METHODS

This cross-sectional study enrolled 2,144 older people aged ≥ 60 years from Shandong Province, China in 2021. We used general health literacy screening scale to assess health literacy, and collected the incidence of falls in the past year. Logistic regression models were employed to analyze the relationship between health literacy and falls. We investigated the sex differences by subgroup analyses.

RESULTS

The prevalence of adequate health literacy and falls was 21.7% (95% CI: 20.0-23.5%) and 25.4% (95% CI: 23.6-27.3%), respectively. In a fully-adjusted model, adequate health literacy was associated with a lower prevalence of falls in older adults (OR = 0.71, 95%CI: 0.52-0.96). Subgroup analysis revealed sex differences in this relationship (Pfor interaction <0.05). Specifically, the female group showed no significant relationship between health literacy and falls (OR = 0.92, 95% CI: 0.59-1.44); however, the male group demonstrated a robust and significant relationship (OR = 0.58, 95% CI: 0.37-0.90).

CONCLUSIONS

Older people with adequate health literacy have lower prevalence of falls, which appears to differ by sex. This relationship was significant among men but not among women. These findings emphasize the need for policymakers and healthcare providers to consider sex differences when designing and implementing programs aimed at improving health literacy and preventing falls in the older population. Improving health literacy among older women could be a strategic component in bridging sex inequality in falls.

Sleep quality and falls in middle-aged and older adults: ELSI-Brazil study

OBJECTIVE

To verify the association between low self-reported sleep quality (LSQ) and fall in middle-aged and older adults every half-decade of life.

METHOD

A cross-sectional study was conducted using data from the first wave (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is nationally representative. The sample consisted of 8,950 participants who were allocated into eight age groups: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥ 85 years. The questionnaires used included self-reported sleep quality and the International Physical Activity Questionnaire short version. Fisher's exact test followed by binary logistic regression analysis was performed to identify the odds ratio of sleep quality for fall occurrence, controlled for confounding variables.

RESULTS

Individuals aged 50-105 years (63.6 ± 10.2 years), 57.0% females and 43.0% males, participated in this study. Overall, 21.5% of participants experienced at least one fall. The relative frequency of participants classified as having high or LSQ remained constant across each half-decade of life. The LSQ exhibited a statistically significant OR (p < 0.05) for falls across age groups up to 84, even after accounting for confounding variables.

CONCLUSION

LSQ is significantly associated with an increased occurrence of fall in adults aged >50 years, but not for ≥ 85 years regardless of sex and physical activity level.

Association Between Sleep Duration and Atrial Fibrillation: A Narrative Review

Sleep duration is a substantial risk factor for several cardiovascular diseases, including atrial fibrillation (AF). Despite much research, the precise nature of the relationship between the amount of sleep and AF remains unclear. This narrative review explores the relationship between AF and sleep duration, looking at genetic, mechanistic, and epidemiological data to explain this association. A U-shaped association (nonlinear relationship or curvilinear association) between sleep duration and AF has been seen, where longer and shorter sleep duration, more or less than seven to eight hours, have been associated with increased AF risk. Multiple mechanisms such as autonomic dysfunction, inflammation, and structural atrial remodeling have been proposed linking sleep disturbances to AF. Moreover, confounding factors such as individual lifestyle, comorbidities, and sleep quality could affect this association. Additionally, the interpretation of study results is further impacted by methodological limitations, including self-reported sleep duration and observational study designs. It is imperative to comprehend the complex relationship between sleep duration and AF to develop effective preventive and therapeutic methods. The main goals of future research should focus on prospective cohort studies with objective sleep metrics, exploring the mechanistic pathways, and comprehensive confounder adjustments that link sleep disturbances to AF. In summary, addressing sleep disturbances may represent one of the novel approaches to AF prevention and management, with potential implications for improving cardiovascular health and reducing AF-related morbidity and mortality.

Prevalence and risk factors for falls among older Chinese adults in the community: findings from the CLHLS study

Older adults have a high prevalence of falls due to a decline in physiological functions and various chronic diseases. This study aimed to investigate the prevalence of and risk factors for falls among older individuals in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We collected information from 9737 older individuals (average age=84.26 years) from the CLHLS and used binary logistic regression analysis to explore the independent risk factors and protective factors for falls. The logistic regression analysis results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs). The prevalence of falls among older adults in China was 21.6%, with women (24.6%) having a higher prevalence than men (18.1%). Logistic regression analysis revealed that never (or rarely) eating fresh fruit, difficulty with hearing, cataracts, and arthritis were the common independent risk factors for falls in older Chinese men and women. Among men, age ≥80 years (aOR=1.86), never doing housework (aOR=1.36), and dyslipidemia (aOR=1.47) were risk factors, while eating milk products once a week was a protective factor. Alcohol consumption (aOR=1.40), physical labor (aOR=1.28), and heart disease (aOR=1.21) were risk factors for falls in women, while a daily sleep duration of 6-12 h and garlic consumption once a week were protective factors. The prevalence of falls among older adults in China is 21.6% and is greater in women than in men. These risk and protective factors can be used to formulate reasonable recommendations for living habits, diet, and chronic disease control strategies.

Factors Related to Recurrent Falls Among Older Adults Attending Primary Health Care: A Biopsychosocial Perspective

The objective of this study was to investigate factors related to recurrent falls among older adults attending primary health care, considering the biopsychosocial perspective. A representative sample of 201 older adults were interviewed in three Primary Health Care units randomly selected in a city in southeastern Brazil. Outcome included self-report of two or more falls in the past 12 months. Exposures included personal and environmental aspects, according to domains of International Classification of Functioning of the World Health Organization (ICF-WHO). Recurrent falls were reported by 24.4% of the participants. Associations with depressive symptoms (p = .003), having osteoporosis (p = .031), chronic musculoskeletal pain (p = .020), frailty (p = .013), sleep satisfaction (p < .001), and functional status (p < .001) were found. In logistic regression models, cognitive status, musculoskeletal pain, and functional status were predictors of recurrent falls; however, only sleep satisfaction remained significant in the final model. Strategies aimed at preventing recurrent falls in primary health care should consider assessments and interventions targeting sleep aspects among older adults.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging

OBJECTIVES

Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited.

METHODS

We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex.

RESULTS

Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex.

CONCLUSIONS

Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

Use of hypnotic-sedative medication and risk of falls and fractures in adults: A self-controlled case series study

OBJECTIVE

To evaluate the risk of falls and fractures in users of benzodiazepines, Z-drugs, or melatonin.

METHODS

We followed 699,335 adults with a purchase of benzodiazepines, Z-drugs, or melatonin in the Danish National Prescription Registry between 2003 and 2016 for falls and fractures in the Danish National Patient Registry between 2000 and 2018. A self-controlled case-series analysis and conditional Poisson regression were used to derive incidence rate ratios (IRR) of falls and fractures during six predefined periods.

RESULTS

In total 62,105 and 36,808 adults, respectively, experienced a fall or fracture. For older adults, the risk of falls was highest during the 3-month pre-treatment period (IRRmen+70 , 4.22 (95% confidence interval, 3.53-5.05), IRRwomen + 70 , 3.03 (2.59-3.55)) compared to the baseline (>1 year before initiation). The risk continued to be higher in the later treatment periods. Contrarily, in men and women aged 40-69 years, the risk was only higher in the 3-month pre-treatment period. The incidence of falls among young men and women was slightly lower after initiation of sedating medication (treatment period, IRRmen15-39 , 0.66 (0.50-0.86), IRRwomen15-39 , 0.65 (0.51-0.83)). Analyses with fractures as outcome yielded similar results.

CONCLUSIONS

Although falls and fractures occur more often in persons using sedative-hypnotic medication, the higher risk of falls and fractures in the pre-treatment period relative to the period directly after treatment, suggests that this association is better explained by other factors that elicited the prescription of this medication rather than the adverse effects of the sedative-hypnotic medication.

Association between dependency and long sleep duration among elderly people: a community-based study

BACKGROUND

Long sleep duration is a common sleep disorder among elderly people. Dependency increases with increasing age. This study aimed to assess the association between dependency and long sleep duration among elderly people.

METHODS

This study is a population-based cross-sectional study. A total of 1152 participants aged ≥ 60 years were selected from 26 locations in China by a complex multistage sampling design. Data were collected through face-to-face interviews. Sleep duration was measured using the Pittsburgh Sleep Quality Index. Dependency was assessed using Minnesota Multiphasic Personality Inventory-II. Hierarchical multiple linear regression analysis was used to evaluate the efficacy of sleep-related factors and psychological factors for sleep duration. Analysis of covariance and logistic regression analysis were performed to evaluate the association between the dependency score and sleep duration, and the strength of dependency effect on sleep duration.

RESULTS

A total of 1120 participants were valid for the analysis. Among them, 15.8% of participants had a dependency score ≥60 points. The results of hierarchical multiple linear regression analysis showed that sleep duration was positively associated with dependency scores. Analysis of covariance indicated a J-shaped association between dependency scores and sleep duration. The results of logistic regression analysis showed dependency was significantly associated with long sleep duration, and the odds ratio was 3.52 (95% CI, 1.87-6.63; P < 0.001).

CONCLUSION

Dependency was significantly associated with long sleep duration among elderly people. The results suggested that dependent intervention may be a strategy that needs urgent implementation to reduce long sleep duration among elderly people.

Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging

Background

Autoimmune diseases are more common among people with unhealthy sleep behaviors, and these conditions have been linked to aging-related bone health. However, there have been few studies that examined the correlation between recently developed sleep patterns based on sleep duration, sleepiness, chronotype, snoring, insomnia, and the incidence of falls and fractures.

Methods

We used a newly developed sleep pattern with components of sleep 7 to 8 h per day, absence of frequent excessive daytime sleepiness, early chronotype, no snoring, and no frequent insomnia as healthy factors to study their relationship with the incidence of falls and fractures. The analysis was conducted among 289,000 participants from the UK Biobank.

Results

The mean follow-up period was 12.3 years (3.5 million person-years of follow-up), and 12,967 cases of falls and 16,121 cases of all fractures were documented. Compared to participants exhibiting an unfavorable sleep pattern, those adhering to a healthy sleep pattern experienced a 17% and 28% reduction in the risks of incident falls (hazard ratio [HR], 0.83; 95% CI, 0.74-0.93) and all fractures (HR, 0.72; 95% CI, 0.66-0.79) during follow-up. In addition, participants exhibiting a healthy sleep pattern, together with a high genetically determined bone mineral density (BMD), showed the lowest risks of falls and fractures.

Conclusion

A healthy sleep pattern was significantly linked to decreased risks of incident falls and fractures. The protective association was not modified by genetically determined BMD.

The Role of Wearable Sensors to Monitor Physical Activity and Sleep Patterns in Older Adult Inpatients: A Structured Review

Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials.

SLeep Education for Everyone Program (SLEEP) Results in Sustained Improvements in Sleep Outcomes at Six Months

OBJECTIVE

Community-delivered sleep education interventions have been demonstrated to be effective in improving sleep outcomes, but whether these benefits persist once the program ends is not well characterized. This study sought to determine whether the previously reported positive effects attributed to the SLeep Education for Elders Program (SLEEP) were maintained six months after program completion.

METHOD

Nineteen participants were surveyed three times: at baseline, program completion (six weeks), and the six-month post-program timepoint. Sleep outcomes for quality, duration, insomnia symptoms, sleep hygiene behaviors, and excessive daytime sleepiness were assessed using validated surveys, including the Pittsburgh Sleep Quality Index (from which duration was also extracted), the Insomnia Severity Index, the Sleep Hygiene Index, and the Epworth Sleepiness Scale.

RESULTS

Longitudinal models adjusted for baseline sleep problems revealed the benefits achieved immediately after the program were retained at six months for sleep quality (estimate: -2.0 (95%CI: -2.7, -1.3)), sleep duration (estimate: 0.9 (95%CI: 0.6, 1.2)), insomnia symptoms (estimate: -3.5 95%CI: (-4.6, -2.3)), and sleep hygiene behaviors (estimate: -2.6 (-4.3, -0.9)).

CONCLUSIONS

These results suggest that a community-delivered sleep education intervention can produce sustained benefits for participants and should be considered as a tool to address uncomplicated sleep issues.

Evaluation of Nonpharmacologic Interventions and Sleep Outcomes in Hospitalized Medical and Surgical Patients: A Nonrandomized Controlled Trial

IMPORTANCE

Inadequate sleep negatively affects patients' physical health, mental well-being, and recovery. Nonpharmacologic interventions are recommended as first-choice treatment. However, studies evaluating the interventions are often of poor quality and show equivocal results.

OBJECTIVE

To assess whether the implementation of nonpharmacologic interventions is associated with improved inpatient night sleep.

DESIGN, SETTING, AND PARTICIPANTS

In a nonrandomized controlled trial, patients were recruited on the acute medical unit and medical and surgical wards of a Dutch academic hospital. All adults who spent exactly 1 full night in the hospital were recruited between September 1, 2019, and May 31, 2020 (control group), received usual care. Patients recruited between September 1, 2020, and May 31, 2021, served as the intervention group. The intervention group received earplugs, an eye mask, and aromatherapy. Nurses received sleep-hygiene training, and in the acute medical unit, the morning medication and vital sign measurement rounds were postponed from the night shift to the day shift. All interventions were developed in collaboration with patients, nurses, and physicians.

MAIN OUTCOMES AND MEASURES

Sleep was measured using actigraphy and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System sleep disturbance item bank. Other outcomes included patient-reported sleep disturbing factors and the use of sleep-enhancing tools.

RESULTS

A total of 374 patients were included (222 control, 152 intervention; median age, 65 [IQR, 52-74] years). Of these, 331 were included in the analysis (195 [59%] men). Most patients (138 [77%] control, 127 [84%] intervention) were in the acute medical unit. The total sleep time was 40 minutes longer in the intervention group (control: median, 6 hours and 5 minutes [IQR, 4 hours and 55 minutes to 7 hours and 4 minutes]; intervention: 6 hours and 45 minutes [IQR, 5 hours and 47 minutes to 7 hours and 39 minutes]; P < .001). This was mainly due to a 30-minute delay in final wake time (median clock-time: control, 6:30 am [IQR, 6:00 am to 7:22 am]; intervention, 7:00 am [IQR, 6:30-7:30 am]; P < .001). Sleep quality did not differ significantly between groups. For both groups, the main sleep-disturbing factors were noises, pain, toilet visits, and being awakened by hospital staff. Sleep masks (23 of 147 [16%]) and earplugs (17 of 147 [12%]) were used most. Nightly vital sign checks decreased significantly (control: 54%; intervention: 11%; P < .001).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that sleep of hospitalized patients may be significantly improved with nonpharmacologic interventions. Postponement of morning vital sign checks and medication administration rounds from the night to the day shift may be a useful way to achieve this.

TRIAL REGISTRATION

Netherlands Trial Registry Identifier: NL7995.

Sleep duration and health outcomes: an umbrella review

PURPOSE

To collect existing evidence on the relationship between sleep duration and health outcomes.

METHODS

A thorough search was conducted in PubMed, Web of Science, Embase, and the Cochrane Database of Systematic Reviews from inception to January, 2021. Meta-analyses of observational and interventional studies were eligible if they examined the associations between sleep duration and human health.

RESULTS

In total, this umbrella review identified 69 meta-analyses with 11 outcomes for cancers and 30 outcomes for non-cancer conditions. Inappropriate sleep durations may significantly elevate the risk for cardiovascular disease (CVD), cognitive decline, coronary heart disease (CHD), depression, falls, frailty, lung cancer, metabolic syndrome (MS), and stroke. Dose-response analysis revealed that a 1-h reduction per 24 hours is associated with an increased risk by 3-11% of all-cause mortality, CHD, osteoporosis, stroke, and T2DM among short sleepers. Conversely, a 1-h increment in long sleepers is associated with a 7-17% higher risk of stroke mortality, CHD, stroke, and T2DM in adults.

CONCLUSION

Inappropriate sleep duration is a risk factor for developing non-cancer conditions. Decreasing and increasing sleep hours towards extreme sleep durations are associated with poor health outcomes.

Gender-Specific Association Between Nighttime Sleep Duration and Falls Among Community-Dwelling Middle-Aged and Older Adults in China

This study was conducted using the data from 2015 China Health and Retirement Longitudinal Study (CHARLS). Gender-specific association between nighttime sleep duration (NSD) and falls were evaluated through multiple logistic regression by adjusting for confounding variables. Of the 22,899 respondents, 18,446 were eligible and 3,144 (16.99%) had more than a single fall. Short and long NSD were associated with high occurrences of falls in the total and female population, but only a short NSD was associated with a high occurrence of falls in the male population. In conclusion, NSD was strongly and significantly associated with falls, but the association was gender-specific. Accordingly, increasing targeted, evidence-based and gender-specific preventions for NSD and sleep disturbance are necessary among primary care interventions to prevent falls.

The Value of Cognitive and Physical Function Tests in Predicting Falls in Older Adults: A Prospective Study

Introduction

Previous studies suggested that physical and cognitive function can be indicators to assess the risk of falls in the elderly. Various tests are widely used in geriatric clinical studies as assessment tools of physical and cognitive function. However, large sample studies comparing the fall predictive value of these tests are still sparse. This study was conducted to investigate the value of cognitive and physical function tests in predicting the risk of subsequent falls in the elderly, with the overarching goal of providing more evidence on fall-risk assessment.

Methods

The current study was based on the data of respondents aged 60 and above from the China Health and Retirement Longitudinal Study (CHARLS). Data from the 2015 CHARLS national survey were used as the baseline data, and the fall data in 2018 were used as the follow-up data. Physical function tests included balance, walking speed, the five times sit-to-stand test (FTSST), and grip strength. The value of cognitive and physical function tests in predicting falls was evaluated by logistic regression analysis and receiver operating characteristic (ROC) curves.

Results

The incidence of falls among the 4,857 subjects included in this study was 20.86%. Results showed that cognition (OR = 0.83, 95% CI: 0.70–0.98), the FTSST (OR = 3.51, 95% CI: 1.66–7.46), and grip strength (OR = 1.02, 95% CI: 1.01–1.03) were independent predictors of falls in the full sample after adjusting for various confounders. Notably, the above tests showed better predictive value for falls for the oldest-old (≥ 80 years) subjects.

Conclusion

Overall, results showed that grip strength, the FTSST, and cognition tests are simple and practicable tools for identifying individuals at higher risk of falls in the community. Moreover, the fall predictive performance of physical and cognitive function tests was age-dependent, with a higher predictive value in older adults aged 80 and above.

The Association Between Cognitive Impairment and Subsequent Falls Among Older Adults: Evidence From the China Health and Retirement Longitudinal Study

Introduction

Previous studies have suggested that cognitive impairment is associated with falls in older adults. However, the consistency of results among different subgroups defined by multiple characteristics of the elderly has not yet been tested. Additionally, results are inconsistent regarding the effects of different cognitive domains on falls. Therefore, this study sought to use representative data from a nationwide study to better understand the longitudinal association between cognitive impairment and subsequent falls in older adults.

Methods

The current study was conducted based on the China Health and Retirement Longitudinal Study (CHARLS) data of respondents aged ≥60 years in 2015 and the fall data in 2018. The respondents were divided into subgroups according to different demographic characteristics. Multiple logistic regression analysis was conducted to adjust for various confounding factors and evaluate the association between cognitive impairment and falls.

Results

Of the 5,110 respondents included in this study, 1,093 (21.39%) had falls within the last 2 years. A significant association was found between cognitive impairment and subsequent falls (OR = 0.97, 95% CI 0.95–0.99, P = 0.001) after adjusting for all of the covariates related to falls. Analysis of different cognitive domains showed that orientation (OR = 0.94, 95% CI 0.90–0.99, P = 0.013) and memory (OR = 0.93, 95% CI 0.90–0.97, P = 0.001) were significantly associated with falls. In subgroup analysis, the ORs of people aged 60–74 years, male, with lower education level were 0.97 (95% CI 0.95–0.99, P = 0.008), 0.96 (95% CI 0.93–0.98, P = 0.001), and 0.97 (95% CI 0.95–0.99, P = 0.001), respectively, suggesting that the associations were also statistically significant in these subgroups. There was also a significant association both in urban (OR = 0.97, 95% CI 0.95–0.99, P = 0.001) and in rural residents (OR = 0.97, 95% CI 0.95–0.99, P = 0.003).

Conclusions

Our results suggest that the associations between cognition and falls vary depending on the different demographic characteristics of older adults. These findings may be useful for designing more accurate identification and intervention for the fall risk for specific high-risk groups.

Sleep Disruption and Bone Health

PURPOSE OF REVIEW

Review recent literature investigating the relationship between bone health and sleep/circadian disruptions (e.g., abnormal sleep duration, night shift work).

RECENT FINDINGS

Short and long sleep are associated with low bone mineral density (BMD). Recent data from observational studies identified an increased risk of fracture in women with short sleep. Studies suggest that age, sex, weight change, and concurrent circadian misalignment may modify the effects of sleep restriction on bone metabolism. Interventional studies demonstrate alterations in bone metabolism and structure in response to circadian disruption that could underlie the increased fracture risk seen with night shift work. The effects of sleep and circadian disruption during adolescence may have lifelong skeletal consequences if they adversely impact bone modeling. Data suggest that short sleep and night shift work negatively impact bone metabolism and health. Rigorous studies of prevalent sleep and circadian disruptions are needed to determine mechanisms and develop prevention strategies to optimize lifelong skeletal health.

Does poor sleep quality and excessive daytime sleepiness influence fear of falling among older adults? A cross-sectional study

Poor sleep is a risk factor for falling among older adults. This study aimed to investigate whether poor sleep quality and excessive daytime sleepiness in older people was associated with fear of falling. Participants aged 60 years or older were interviewed, with those who did not have preserved cognitive skills being excluded. Data on age, gender, body mass index, alcohol consumption, mental status, depression, excessive daytime sleepiness, sleep quality, comorbidities and fear of falling were collected. Univariate and multivariate linear regression were conducted. The logistic regression assessed the association between daytime sleepiness and fear of falling. The odds of an older adult being afraid of falling was 3 times higher among those with excessive daytime sleepiness, in comparison to those with no excessive daytime sleepiness. The higher the daytime sleepiness, the greater the fear of falling. Health professionals should be aware of older patients' sleepiness because it can increase fear of falling and influence their treatment.

Risk factors of falls in elderly patients with visual impairment

OBJECTIVE

To examine the risk factors for falls in elderly patients with visual impairment (VI) and assess the predictive performance of these factors.

METHODS

Between January 2019 and March 2021, a total of 251 elderly patients aged 65-92 years with VI were enrolled and then prospectively followed up for 12 months to evaluate outcomes of accidental falls via telephone interviews. Information of demographics and lifestyle, gait and balance deficits, and ophthalmic and systemic conditions were collected during baseline visits. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors of falls in elderly patients with VI, and a derived nomogram was constructed.

RESULTS

A total of 143 falls were reported in 251 elderly patients during follow-up, with an incidence of 56.97%. The risk factors for falls in elderly patients with VI identified by multivariable logistic regression were women [odds ratio (OR), 95% confidence interval (CI): 2.71, 1.40-5.27], smoking (3.57, 1.34-9.48), outdoor activities/3 months (1.31, 1.08-1.59), waking up frequently during the night (2.08, 1.15-3.79), disorders of balance and gait (2.60, 1.29-5.24), glaucoma (3.12, 1.15-8.44), other retinal degenerations (3.31, 1.16-9.43) and best-corrected visual acuity (BCVA) of the better eye (1.79, 1.10-2.91). A nomogram was developed based on the abovementioned multivariate analysis results. The area under receiver operating characteristic curve of the predictive model was 0.779.

CONCLUSIONS

Gender, smoking, outdoor activities, waking up at night, disorders of balance and gait, glaucoma, other retinal degeneration and BCVA of the better eye were independent risk factors for falls in elderly patients with VI. The predictive model and derived nomogram achieved a satisfying prediction of fall risk in these individuals.

Do Daytime Activity, Mood and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, unit tumult, and mood were associated with sleep quality. A convenience sample of 53 long-term care (LTC) residents participated in this correlational study. Objective sleep quality was measured using actigraphy, and comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than 80% and was awake for more than 90 min at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor sleep. Findings suggest daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality.

Association Between Sleep Quality and Falls: A Nationwide Population-Based Study from South Korea

Purpose

There are few large studies evaluating the association between sleep quality and the risk of falls. We aimed to determine the independent effect of poor sleep quality on an increased risk of falls using a large-sample dataset.

Methods

We conducted a retrospective, cross-sectional study using population-based data from the 2018 Korean Community Health Survey on 201,700 participants. Sociodemographic, mental health-related, and physical health-related variables as well as sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) were compared between 2499 fallers who have experienced at least one fall during the past 12 months and 199,201 non-fallers. Multivariable logistic regression was performed to identify sleep quality variables significantly associated with an increased risk of falls.

Results

Fallers had poorer sleep quality (PSQI score >5) and higher scores for global PSQI and individual PSQI components than did non-fallers (all p < 0.001). Multivariable logistic regression adjusted for potential confounders including socioeconomic, physical health-related, and mental health-related variables showed that an increased risk of falls was associated with poor sleep quality (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.19–1.42). Subgroup analyses by age revealed that poor sleep quality was significantly associated with an increased risk of falls in all three adult age groups. Multivariable logistic regression using the seven PSQI components revealed that an increased risk of falls was associated with short sleep duration (OR 1.14, CI 1.09–1.20), increased sleep disturbances (OR 1.30, CI 1.16–1.46), and increased daytime dysfunctions (OR 1.21, CI 1.08–1.13).

Conclusion

Poor sleep quality caused by short sleep duration may be a principal risk factor of falls in adult populations. Increased sleep disturbances and daytime dysfunctions may also contribute to an increased risk of falls. Our results have clinical and public health perspectives that increasing sleep duration and reducing daytime dysfunctions and sleep disturbances could mitigate unintentional falls.

Relevance of Sleep Disturbances to Orthopaedic Surgery: A Current Concepts Narrative and Practical Review

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Sleep disturbances can increase the risk of falls and motor vehicle accidents and may reduce bone density.

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Poor sleep can lead to worse outcomes after fracture, such as chronic pain and delayed recovery.

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Orthopaedic surgeons can play an important role in the screening of sleep disorders among their patients.

Hypothetical Interventions for Falls Among Older Adults: An Application of the Parametric G-Formula

Introduction: Falls, which have a higher incidence and mortality due to accidental injuries, are a major global health challenge. The effects of lifestyle factor, health indicator, psychological condition, and functional status interventions on the risk of falls are unknown and the conventional regression model would not adjust for the confounders. This study aimed to evaluate the 4-year risk of falls on the basis of these hypothetical interventions among Chinese older adults.

Methods: Data were obtained from 9,692 aged 65 years and over older adults in the China Health and Retirement Longitudinal Study wave, from 2011 to 2015. We used the parametric g-formula to evaluate the risk of falls on the basis of independent hypothetical interventions of sleep duration, social activities, smoking status, drinking status, body mass index (BMI), systolic blood pressure (SBP), vision, depression, activities of daily living (ADL), and their different joint intervention combinations.

Results: During the follow-up of 4 years, we documented 1,569 falls. The observed risk of falls was 23.58%. The risk ratios (95% confidence intervals [CIs]) of falls under the intensive hypothetical interventions on increasing sleep duration, participating in more social activities, quit smoking and drinking, reducing BMI and SBP, better vision, alleviating depressive symptoms, and improving ADL capability were 0.93 (0.87–0.96), 0.88 (0.79–0.92), 0.98 (0.95–1.03), 0.97 (0.95–1.02), 0.92 (0.86–1.03), 0.93 (0.87–1.04), 0.86 (0.74–0.91), 0.91 (0.85–0.96), and 0.79 (0.74–0.85), respectively. The feasible and intensive joint hypothetical intervention reduced the 4-year fall risk by 22% (95% CI: 0.52–0.91) and 33% (95% CI: 0.56–0.72), respectively.

Conclusions: Hypothetical interventions for increasing sleep duration, participating in more social activities, better vision, alleviating depressive symptoms, and improving ADL capability help protect older adults from falls. Our findings suggest that a combination of lifestyle factors, health indicators, psychological conditions, and functional status may prove to be an effective strategy for preventing falls among older adults.

Sleep disturbance and bone mineral density, risk of falls and fracture: Results from a 10.7-year prospective cohort study

Sleep problems are common in the general population and have been linked to bone health, falls risk and fracture. However, longitudinal studies on sleep-bone health outcomes are lacking and no study has investigated whether an increased risk of fracture is attributable to sleep-related low bone mineral density (BMD) and an increased risk of falls. This study was designed to examine the associations of sleep disturbance with bone mineral density (BMD), risk of falls and fractures over 10.7 years. The analyses were performed in a population-based cohort study with 1099 participants (mean age 62.9 years) enrolled at baseline, and 875, 768 and 563 participants traced at a mean follow-up of 2.6, 5.1 and 10.7 years, respectively. At each visit, self-reported sleep disturbance was recorded. BMD (by dual-energy x-ray absorptiometry), falls risk score and fracture were measured at each visit. The short-form Physiological Profile Assessment was used to measure falls risk score expressed as Z-score. Fractures were self-reported. Mixed-effects model and generalized estimating equations were used for the analyses. In multivariable analysis, there was a dose-response relationship between the extent of sleep disturbance and falls risk score with the strongest association in those reporting the worst sleep disturbance (β = 0.15/unit; 95%CI 0.02-0.28). The worst sleep disturbance was associated with an increased risk of any (relative risk [RR] 1.30/unit; 95%CI 1.01-1.67) and vertebral fracture (RR 2.41/unit; 95%CI 1.00-5.80) compared with those reporting no interrupted sleep. Women but not men with sleep disturbance had a higher risk of vertebral fracture (RR: 2.07 to 6.02, P < 0.05). These were independent of covariates, hip BMD and falls risk. There was no statistically significant association between sleep disturbance and BMD at the hip, spine or total body. Sleep disturbance was independently associated with a greater falls risk score and an increased risk of fractures. Further research is needed to confirm and identify underlying mechanisms for these associations.

[The prevalence of severe falls and associated factors among elderly Brazilians: Results of the 2013 National Health Survey]

The scope of this study was to estimate the prevalence and factors associated with severe falls among elderly Brazilians. It included a transversal study of 10,537 elderly individuals who participated in the National Health Survey (2013). The dependent variable was a report of severe falls in the past year. The independent variables comprised, hierarchically, socio-demographic factors, behavior, health status and functional capacity. Logistic regression was used to obtain the odds ratio (OR) and the confidence interval (95%CI), using the 13.1 Stata program. The prevalence of severe falls was 7.5% (95%CI: 6.7-8.3) and the highest odds were among women (OR: 1.35; 95%CI: 1.03-1.77), 70 to 79 years of age (OR: 1.47; 95%CI: 1.12-1.95) and 80 years and above (OR: 2.00; 95%CI: 1.46-2.74), living without a spouse/partner (OR: 1.37; 95%CI: 1.08-1.74), sedentary in leisure time (OR: 1.55; 95%CI: 1.06-2.26), having multimorbities (OR: 1.54; 95%CI: 1.19-2.00), sleeping difficulties (OR: 2.18; 95%CI: 1.65-2.88), limitations in daily activities (OR: 2.25; 95%CI 1.63 -3.10) and use of a walking aid (OR: 1.89; 95%CI: 1.30-2.73). The prevalence of severe falls was high and multifactorial, enabling the identification of profiles of greater vulnerability, which should be considered in public policies for specific interventions.

Sleep Education for Elders Program (SLEEP): Promising Pilot Results of a Virtual, Health Educator-Led, Community-Delivered Sleep Behavior Change Intervention

PURPOSE

Sleep problems pose serious public health concerns, and evidence suggests that the problem is worsening. Both sufficient sleep quantity and quality are needed for optimal health, particularly among older adults, but access to sleep care can be difficult. This study examined the efficacy of a six-week sleep behavior change program designed for older adults that was delivered virtually by health educators.

PARTICIPANTS AND METHODS

This quasi-experimental pilot study (intervention n = 22; control n = 31) explored the effects of the Sleep Education for Elders Program (SLEEP) on sleep outcomes, which included: 1) sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI); 2) sleep duration, extracted from the PSQI; 3) insomnia symptoms, measured by the Insomnia Severity Index; 4) sleep hygiene behaviors, obtained from the Sleep Hygiene Index; and 5) excessive daytime sleepiness, measured by the Epworth Sleepiness Scale.

RESULTS

After SLEEP, the intervention group experienced significantly improved sleep quality (p < 0.001), a reduction in maladaptive sleep hygiene behaviors (p = 0.007), and reduced daytime sleepiness (p < 0.027) compared to the control group. Effect sizes for all five sleep measures were medium or large. In the intervention group, all changes were judged to be clinically meaningful (≥ 0.5 SD) except for improvements in daytime sleepiness.

CONCLUSION

These data support the efficacy of a group-based, virtual behavior change intervention in improving sleep outcomes among older adults.

Social Network and Risk of Poor Sleep Outcomes in Older Adults: Results from a Spanish Prospective Cohort Study

BACKGROUND

Not having social support has been associated with poor sleep, but most prospective studies were based on social support in the workplace, did not account for baseline sleep characteristics or did not assess sleep duration. Moreover, no previous research has evaluated the relationship between social network and sleep outcomes in an older Spanish population.

METHODS

1444 individuals aged ≥60 years were followed between 2012 and 2015. At baseline (2012), a poor social network index (SNI) was computed by summing the following dichotomous indicators: not being married; living alone; not having daily contact with family, friends or neighbors; being alone ≥8h/day; lacking someone to go for a walk with; not having emotional support; lacking instrumental support. Higher values in SNI indicate less social support. In 2012 and 2015, information was collected on sleep duration (hours/day) and on symptoms of sleep disturbance: bad overall sleep; difficulty falling asleep, awakening during nighttime, early awakening with difficulty getting back to sleep, use of sleeping pills, feeling restless in the morning, being asleep at daytime, and having an Epworth Sleepiness Scale>10. Poor sleep duration was defined as short (<6 h) or long (>9 h) nighttime sleep, and poor sleep quality as having ≥4 indicators of sleep disturbance. Linear or logistic regression models were used to assess the relationship of SNI with changes in sleep duration and in number of sleep disturbance indicators, or with the risk of developing poor nighttime sleep or poor sleep quality.

RESULTS

Compared to individuals in the lowest (best) quartile of the SNI in 2012, those in the second, third and fourth quartiles, respectively, displayed a mean (95%confidence interval [95% CI]) change of 2.32 (-7.58-12.22), -2.70 (-13.19-7.79) and -13.04 (-23.41- -2.67) minutes in sleep duration from 2012 to 2015; p for trend=0.02. A 1-point increase in the SNI at baseline was associated with an increased risk of short nighttime sleep (Odds Ratio [OR] and 95% CI: 1.22 (1.05-1.42)), poor sleep quality (OR: 1.13; 95% CI: 1.00-1.30), and of the indicator of sleep disturbance "early awakening with difficulty getting back to sleep" (OR: 1.20; 95% CI: 1.07-1.35).

CONCLUSION

A poorer social network is associated with a higher risk of short sleep and poor sleep quality in older adults.

Sleep duration and health in adults: an overview of systematic reviews

The objective of this overview of systematic reviews was to examine the associations between sleep duration and health outcomes in adults. Four electronic databases were searched in December 2018 for systematic reviews published in the previous 10 years. Included reviews met the a priori determined population (community-dwelling adults aged 18 years and older), intervention/exposure/comparator (various levels of sleep duration), and outcome criteria (14 outcomes examined). To avoid overlap in primary studies, we used a priority list to choose a single review per outcome; reviews that examined the effect of age and those that looked at dose–response were prioritized. A total of 36 systematic reviews were eligible and 11 were included. Reviews included comprised 4 437 101 unique participants from 30 countries. Sleep duration was assessed subjectively in 96% of studies and 78% of studies in the reviews were prospective cohort studies. The dose–response curves showed that the sleep duration that was most favourably associated with health was 7–8 h per day. Modification of the effect by age was not apparent. The quality of the evidence ranged from low to high across health outcomes. In conclusion, the available evidence suggests that a sleep duration of 7–8 h per day is the one most favourably associated with health among adults and older adults. (PROSPERO registration no.: CRD42019119529.)

Novelty This is the first overview of reviews that examines the influence of sleep duration on a wide range of health outcomes in adults. Seven to 8 h of sleep per day was most favourably associated with health. Effect modification by age was not evident.

Night-time Noise Levels and Patients’ Sleep Experiences in a Medical Assessment Unit in Northern England

Background:

Hospital in-patients need sleep so that restorative process and healing can take place. However, over one third of in-patients experience sleep disturbance, often caused by noise. This can compromise patients’ perceptions of care quality and cause physical and psychological ill health.

Aims:

To assess 1) in-patients sleep quality, quantity, reported sources of sleep disturbance and their suggestions for improvement 2) objectively measure decibel levels recorded at night.

Methods:

This descriptive study conducted in a Medical Assessment Unit used multi-methods; a semi-structured ‘sleep experience’ questionnaire administered to a purposive sample of in-patients; recording of night-time noise levels, on 52 consecutive nights, using two calibrated Casella sound level meters.

Results:

Patient ratings of ‘in-hospital’ sleep quantity (3.25; 2.72 SD) and quality (2.91; 2.56 SD) was poorer compared to ‘home’ sleep quantity (5.07; 2.81 SD) and quality (5.52; 2.79 SD). The difference in sleep quality (p<0.001) and quantity (p<0.001) ratings whilst in hospital, compared to at home, was statistically significant. Care processes, noise from other patients and the built environment were common sources of sleep disturbance. Participants’ suggestions for improvement were similar to interventions identified in current research. The constant noise level ranged from 38-57 decibels (equivalent to an office environment), whilst peak levels reached a maximum of 116 decibels, (equivalent to banging a car door one metre away).

Conclusion:

The self-rated patient sleep experience was significantly poorer in hospital, compared to home. Noise at night contributed to sleep disturbance. Decibel levels were equivalent to those reported in other international studies. Data informed the development of a ‘Sleep Smart’ toolkit designed to improve the in-patient sleep experience.

Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome

BACKGROUND

Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance.

OBJECTIVE

To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent.

METHODS

Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC).

RESULTS

DHI and ESS scores were increased in MFS patients (p < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients.

CONCLUSIONS

An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients.

Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work

A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.

Melatonin, temazepam and placebo in hospitalised older patients with sleeping problems (MATCH): a study protocol of randomised controlled trial

INTRODUCTION

Hospitalised older patients frequently suffer from inadequate sleep, which can lead to patient distress and delayed recovery from acute illness or surgical procedure. Currently, no evidence-based treatments exist for sleeping problems in hospitalised older patients. Benzodiazepines, such as temazepam, are regularly prescribed by physicians, although they have serious side effects; for older patients in particular. Melatonin is proposed as a safe alternative for sleeping problems in hospitalised older patients, but the efficacy of melatonin is unclear in this population. Therefore, the aim of this study is to investigate the effects of melatonin and temazepam compared with placebo on sleep quality among hospitalised older patients with sleeping problems.

METHODS AND ANALYSIS

This study is a multicentre, randomised, placebo-controlled trial. A total of 663 patients will be randomised in a 1:1:1 fashion to receive either melatonin (n=221), temazepam (n=221) or placebo (n=221). The study population consists of hospitalised patients aged 60 years and older, with new or aggravated sleeping problems for which an intervention is needed. The primary outcome is sleep quality measured with the Leeds Sleep Evaluation Questionnaire (LSEQ). Secondary outcomes include sleep parameters measured with actigraphy and medication-related adverse effects.

ETHICS AND DISSEMINATION

This study was approved by the Medical Ethics Committee of the Academic Medical Centre Amsterdam, (No 2015_302). Study findings will be disseminated through presentations at professional and scientific conferences and publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NTR6908; Pre-results.

The effects of mechanical ventilation on the quality of sleep of hospitalised patients in the Intensive Care Unit

Aim

To examine the effects of mechanical ventilation on the quality of sleep in patients in the intensive care unit (ICU) using recent and relevant literature.

Methods

To verify the examined objective, the results of the analysis of available original scientific works have been used including defined inclusion/exclusion criteria and search strategy. Appropriate works found were analysed further. The applied methodology was in line with the general principles of Evidence-Based Medicine. The following literary databases were used: CINAHL, Medline and gray literature: Google Scholar.

Results

A total of 91 trials were found. Eleven of these relevant to the follow-up analysis were selected: all trials were carried out under real ICU conditions and the total of 192 patients were included in the review. There is an agreement within all trials that sleep in patients requiring mechanical ventilation is disturbed. Most reviewed trials have shown that mechanical ventilation is probably not the main factor causing sleep disturbances, but an appropriate ventilation strategy can significantly help to improve its quality by reducing the frequency of the patient-ventilator asynchrony.

Conclusion

Based on the analysis, it appears that an appropriate ventilation mode setting can have a beneficial effect on the quality of sleep in ICU patients.