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.

年龄≥50岁的三分之一的女性和五分之一的男性会经历骨质疏松性骨折 一生中跌倒很常见，25% 的老年人每年跌倒 1 次以上，12-15% 的老年人每年跌倒 2 次以上。 2015 年医疗保险费用达 310 亿美元。最近，美国的跌倒死亡率稳步上升。 因此，识别跌倒和骨折的可改变危险因素至关重要。 这种情况在美国很常见，高达 60% 的老年人符合睡眠呼吸障碍 (SDB) 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、昼夜休息活动节律紊乱以及骨折事件 老年女性和男性经常跌倒 科学前提是睡眠不足会增加跌倒的风险。 该提案建立在两个大型井的基础上。 招募老年男性和女性的特色研究： WHISPER：女性健康倡议 (WHI) 睡眠 缺氧对老年男性恢复能力的影响以及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、癌症的关系的观察性研究 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 天腕部活动记录仪 我们建议将 WHISPER 扩展到包括 我们还建议利用反复跌倒和骨折的重要临床和老年结局。 基于 MrOS 睡眠研究的现有数据，提供男性的可比较数据，以测试是否 第 2865 章 男性参加了睡眠评估，包括手腕活动记录仪和家庭多导睡眠图 我们证明夜间低氧血症与复发风险较高有关。 然而，目前还没有针对老年男性的综合睡眠措施的研究。 包括老年女性的 IH、跌倒和骨折，尽管在睡眠障碍和睡眠障碍方面存在性别差异 我们将测试以下假设：通过睡眠时间血氧饱和度 (SaO2) 百分比测量的 IH <90%。 SDB 与反复跌倒（目标 1）和骨折（目标 2）风险增加相关 睡眠碎片化的次要目标将测试睡眠持续时间短或长的假设。 效率和碎片化以及昼夜节律紊乱（全部来自体动记录）也与 反复跌倒（目标 1）和骨折（目标 2），这些关联与 IH 无关。 对男性进行平行分析以探索性别差异（目标 3）将 WHISPER 扩展到包括跌倒和跌倒。 骨折是一个具有成本效益的机会，可以大大提高我们对睡眠对身体影响的认识。 老年人的健康。

项目成果

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

绝经后女性初次骨折后，后续骨折会发生在哪里？

• 发表时间: 2021-05
• 影响因子: 15.1
• 作者: Crandall, Carolyn J;Hunt, Rebecca P;LaCroix, Andrea Z;Robbins, John A;Wactawski;Johnson, Karen C;Sattari, Maryam;Stone, Katie L;Weitlauf, Julie C;Gure, Tanya R;Cauley, Jane A
• 通讯作者: Cauley, Jane A

Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures.

绝经后妇女非创伤性骨折与创伤性骨折后发生后续骨折的风险。

• DOI: 10.1001/jamainternmed.2021.2617
• 发表时间: 2021-06-07
• 期刊: JAMA internal medicine
• 影响因子: 39
• 作者: C. Cr;all;all;J. Larson;A. LaCroix;J. Robbins;J. Wactawski‐Wende;K. Johnson;M. Sattari;K. Stone;J. Weitlauf;T. Gure;J. Cauley
• 通讯作者: J. Cauley