Objective: Sleep problems are common in general population and have substantial adverse health outcomes including type 2 diabetes and depression which may increase risk of falls and fractures. However, no study has investigated the associations of sleep problems with risk of falls and fractures in general population. This study sought to examine the associations between sleep disturbance and risk of falls and fractures.
Methods: Data from a population-based prospective cohort study with 1,099 participants (aged 50–80 years) enrolled at baseline were analysed. 875, 768 and 563 participants attended subsequent three follow-ups at 2.6, 5.1 and 10.7 years, respectively. Self-reported sleep disturbance was recorded at each visit. The Short‐Form Physiological Profile Assessment was used to measure falls risk expressed as Z-score. Fractures were self-reported at each visit. Mixed-effects linear and logistic regression were used for the analyses.
Results: There was a dose-response relationship between the extent of sleep disturbance and falls risk score (β=0.05, 95%CI 0.02-0.09) and reported-fractures at any site (odds ratio [OR]=1.11, 95%CI 1.01-1.22). After adjusting for covariates including age, sex, body mass index, physical activity, smoking history, and comorbidities, participants reporting more severe sleep disturbance had greater falls risk score (β ranging from 0.11 to 0.15, all p<0.05) compared to those without sleep disturbance. In multivariable analyses with adjustment for covariates, bone mineral density and falls risk, participants reporting being awake most of the night had highest odds of fractures at any site (OR=1.47, 95%CI 1.04-2.08). In addition, more severe sleep disturbance was associated with fractures at vertebral (OR=1.43, 95%CI 1.04-1.97), but not non-vertebral site.
Conclusion: Sleep disturbance was independently associated with risk of falls and fractures, highlighting that sleep intervention has potential to reduce falls risk and fractures. Inconsistent associations of sleep disturbance with fractures at vertebral and non-vertebral may reflect a difference in underlying mechanisms.