Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo 173-0015, Japan.
Faculty of Health Sciences, University of Human Arts and Sciences, 1288 Magome, Iwatsuki, Saitama, Saitama 339-8539, Japan.
Arch Gerontol Geriatr. 2021 Nov-Dec;97:104519. doi: 10.1016/j.archger.2021.104519. Epub 2021 Sep 11.
Most previous studies that examined the association of insomnia with frailty used cross-sectional designs. The temporal relationship between these factors is therefore largely unknown. This study aimed to examine the bidirectional relationship between insomnia and frailty by sex.
A 2-year longitudinal study involving all community-dwelling older adults living in a rural area in Japan (n = 3844). Validated measures of insomnia and frailty were employed. Insomnia was assessed using the Athens insomnia scale, and frailty using the Kihon checklist. We performed a cross-lagged panel model, adjusted for age, sex, years of education, employment status, self-rated health, complications (hypertension, diabetes, stroke, or osteoarthritis), BMI, physical activity, alcohol consumption, and smoking status, and assessed differences by sex.
Poor sleep predicted the onset and worsening of frailty during follow up (standardized coefficient [95% confidence interval]: 0.076 [0.045, 0.107]). Frailty also predicted severe insomnia symptoms (0.074 [0.044, 0.104]). However, the temporal association between these conditions varied by sex. In older men, the effect of frailty on insomnia was stronger than that of insomnia on frailty. However, in women, the impact of insomnia on frailty was stronger than that of frailty on insomnia.
The primary potential cause of the association between insomnia and frailty may vary by sex, being frailty in men and insomnia in women. Sex-specific interventions to improve sleep quality and duration, and maintain functional abilities in daily life may contribute to the prevention and management of both frailty and insomnia in older adults.
大多数先前研究使用横断面设计来研究失眠与衰弱之间的关系。因此，这些因素之间的时间关系在很大程度上是未知的。本研究旨在按性别检查失眠与衰弱之间的双向关系。
一项涉及日本农村地区所有社区居住的老年人的为期 2 年的纵向研究（n=3844）。使用经过验证的失眠和衰弱测量方法。使用雅典失眠量表评估失眠，使用 Kihon 清单评估衰弱。我们进行了交叉滞后面板模型分析，调整了年龄、性别、受教育年限、就业状况、自我报告的健康状况、并发症（高血压、糖尿病、中风或骨关节炎）、BMI、身体活动、饮酒状况和吸烟状况，并按性别评估了差异。
睡眠质量差预示着衰弱在随访期间的发生和恶化（标准化系数[95%置信区间]：0.076 [0.045，0.107]）。衰弱也预示着严重的失眠症状（0.074 [0.044，0.104]）。然而，这些状况之间的时间关联因性别而异。在老年男性中，衰弱对失眠的影响强于失眠对衰弱的影响。然而，在女性中，失眠对衰弱的影响强于衰弱对失眠的影响。
失眠与衰弱之间关联的主要潜在原因可能因性别而异，男性为衰弱，女性为失眠。针对改善睡眠质量和持续时间以及维持日常生活功能能力的性别特异性干预措施可能有助于预防和管理老年人的衰弱和失眠。
