Abstract
Falls in older people constitute a major public health problem. A recent review states that approximately 30% to 60% of adults aged 65 and older fall each year, with 10% to 20% of these falls resulting in injury, hospitalization, or death. In Australia, approximately 1,014 persons aged 65 and older died from falls-related injuries in 1998, and in the United States more than 10,000 deaths per year have been reported since 1998. Sleep apnea produces sleep fragmentation, with resulting daytime sleepiness, cognitive impairment, and psychological disturbance. We investigated whether sleep fragmentation with reduced daytime efficiency is associated with a greater prevalence of falls in the elderly population. We demonstrated a doubling of the likelihood of falls in older persons with a previous diagnosis of sleep apnea. Hypoxemia and sleep disruption from sleep apnea are related to daytime functional impairments in executive function, vigilance, alertness, fine motor coordination, and psychological disturbance, which may be likely mechanisms. In our population, depression attenuated the magnitude of the association between sleep apnea and falls, suggesting that psychological disturbance may be one of the intermediary factors in the association between sleep apnea and falls. A relationship was not demonstrated between falls and our measure of daytime sleepiness, the Epworth Sleepiness Score, although this score does not differentiate underlying causes resulting in daytime sleepiness. Language: en
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