Association between sleep disturbance and sarcopenia among older adults
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
ASSOCIATION BETWEEN SLEEP DISTURBANCE AND
SARCOPENIA AMONG OLDER ADULTS
Nguyen Trung Anh1,2, Bui Thi Thu Trang2
Dang Thi Xuan3, Nguyen Xuan Thanh1,2
SUMMARY
Objectives: To investigate the association between sleep disturbances and sarcopenia
among older adults. Subjects and methods: A cross-sectional study on 522 patients aged 60
years old and over treated at the National Geriatric Hospital. Patients were interviewed
according to a uniform questionnaire; sleep disturbances were assessed by using the PSQI
instrument. The definition of the Asian Working Group for Sarcopenia 2019 was used for
diagnosis of sarcopenia. Results: The mean age of the patients was 70.91 8.67 years. The
ratio of female/male was 1.45. The prevalence of sleep disturbances in older adults was 85.8%.
There was an association between sleep disturbance and sarcopenia among older adults with
statistical significance after using both unilabiate and multivariable model logistic. Conclusion:
The prevalence of sleep disturbance was high and was associated with sarcopenia among older
people. Sleep disorders are very common in older adults and there was an association between
sleep disturbance and sarcopenia. The sleep disturbance among patients in general, those with
sarcopenia in particular, should be paid much attention.
* Keywords: Sleep disturbance; The elderly; Sarcopenia.
INTRODUCTION
The above factors are attributed to a
reduction in skeletal muscle mass,
strength, and function. A combination of
these changes has been called sarcopenia.
Sarcopenia is a common clinical problem
in people over 50 years of age, which
leads to severe adverse outcomes,
including loss of function, disability, and
frailty. Degenerative changes in muscle
tissue, unrelated to sarcopenia, were
diagnosed in 14% of the male population
and 13% of the female population in the
age group 65 - 75 years, and 56% of men
and 53% of women in the age group 80
years or older [2].
Aging is a worldwide phenomenon with
significant social, economic, and health
implications. Sleep disturbance is a group
of conditions that affect the ability to sleep
well on a regular basis and a decline in the
quality of life, and it is considered to be a
serious health problem. Approximately
50% of older adults have complaints of
sleep problems in their daily life [1]. Sleep
disturbance is associated with a decline in
activities of daily living, cognitive function,
falling and slows down basic metabolism.
1National Geriatric Hospital
2Hanoi Medical University
3Vietnam Poison Control Center
Corresponding author: Nguyen Trung Anh (trunganhvlk@gmail.com)
Date received: 22/3/2021
Date accepted: 26/4/2021
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Nonetheless, the medical literature study was 522. Data were collected by
using a unified research record.
shows a gap between the role of sleep
quality and its effects on the prevalence
of sarcopenia [3]. Vietnam will soon move
to an aging population pyramid, so earlier
understanding of the relationship between
sleep disturbance and sarcopenia is
important for providing potential targets
for preventing and treating sarcopenia.
Besides, prevention is an advantage for
improving people’s health status and
decreasing the cost burden. We conduct
this study: To investigate the association
between sleep disturbances and sarcopenia
among older adults.
* Variables:
- Demographic information includes:
full name, age, sex, residual place, marital
status, educational level.
- Sleep disturbance was assessed by
using the PSQI instrument. Total score
PSQI is calculated by the sum of 7
components. Evaluation results: Good
sleep (< 5 points), poor sleep (≥ 5 points).
- Sarcopenia diagnosis was performed
by the standards of the Asian Working
Group for Sarcopenia (AWGS). Based on
the AWGS, sarcopenia is diagnosed with
(1) low muscle mass and (2) low HGS [4].
SUBJECTS AND METHODS
1. Subjects
* Evaluation of results:
Table 1: Evaluation of results.
The study was performed on 522 elderly
patients at the National Geriatrics Hospital
from June 1st to October 1st 2020.
AWGS
Men
< 7.0 kg/m2 < 5.4 kg/m2
< 28 kg < 18 kg
Women
(1) Low muscle
mass (ASM/ht2)
* Inclusion criteria:
- Patients aged 60 years and older
were examined and treated in National
Geriatric Hospital from June 1st to October
1st 2020.
(2) Low HGS
* Data processing and data analysis:
Descriptive statistics were adopted to
examine characteristic data: frequency,
percentage, mean. Inferential statistics
was done to perform comparisons between
groups: Chi-square, multivariable regression.
Statistical significance was accepted at
the 95% confidence level (p < 0.05).
- The patients had the physical and
cognitive abilities to do a face-to-face
interview.
* Exclusion criteria:
- Patients or families refused to
participate in the study.
* Ethical consideration:
- Patients with inability to communicate.
Study subjects were explained clearly
about the purpose of the study, and they
were willing to participate in the study.
Collected data was used for research.
The results of the study were proposed
for improving health of the community, not
for other purposes.
2. Methods
The study was a cross-sectional study.
The sample was selected according to the
entire sampling method. The estimated
sample size was 380 elderly patients.
The number of elderly patients in our
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
RESULTS
1. Demographic characteristic
Table 2: Description of demographic characteristics (n = 522).
Total
Sarcopenia
p
Variables
Yes
No
n = 522 (%)
n = 327 (%)
n = 195 (%)
70.91 8.67 73.32 9.02 66.85 6.22
(
SD)
60 - 69
265 (50.8)
156 (29.9)
101 (19.3)
213 (40.8)
309 (59.2)
191 (50.3)
107 (28.2)
46 (12.1)
37 (9.5)
128 (43.8)
105 (67.3)
94 (93.1)
150 (70.4)
177 (57.3)
183 (69.3)
79 (56.4)
18 (36.1)
47 (77.1)
233 (56.)
94 (84.7)
305 (61.5)
3 (100.0)
17 (81.0)
2 (100.0)
174 (69.9)
153 (56)
137 (51.7)
51 (32.7)
7 (6.9)
Age
< 0.001
70 - 79
≥ 80
Male
63 (29.6)
132 (42.7)
81 (30.7)
61 (43.6)
39 (68.4)
14(22.9)
178 (43.3)
17 (15.3)
191 (38.5)
0 (0.0)
Gender
0.002
Female
Primary school or below
Secondary school
High school
College/university and above
Married
< 0.001
Educational
level
411 (78.7)
111 (21.3)
496 (95.0)
3 (0.6)
Marital status
Living status
< 0.001
0.099
Other
With family
With caregiver
Alone
21 (4.0)
4 (19.0)
Others
2 (0.4)
0 (0.0)
Rural
249 (47.7)
73 (52.3)
75 (30.1)
120 (44.0)
Current living
place
0.007
Urban
A total of 522 participants, the age ranged from 60 to 98, with the mean age being
70.91 8.67 years old. The greatest distribution was generated by people aged from
60 to 69, with the percentage of 50.8%, of which the highest percentage of sarcopenia
in the older adults aged 80 and above was 93.1%. Female accounted for 59.2% (n = 309),
higher than the male (40.8%) (n = 213). The ratio of female/male was 1.45. More than
half of the participants (78.7%) got married. The majority lived with family (95.8%).
Among participants living in rural, the prevalence of sarcopenia was higher compared
to people living in urban (69.9% and 56.0%). These differences were statistically
significant with p = 0.001, respectively.
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
THE PREVALENCE OF SLEEP DISTURBANCES (N=522)
14.20%
Good sleep
Po or sleep
85.80%
Figure 2: Prevalence of sleep disturbances among older adults (n = 522).
Fig 2 presented sleep disturbances among older people. The prevalence of poor sleep
was 85.80% (448 people), the prevalence of good sleepers was 14.2% (74 people).
Table 2: Characteristics of some components of sleep disturbances by PSQI
questionnaire (n = 522).
Component of PSQI
Classification
n (%)
Can sleep within 30 minutes
354 (67.8)
Sleep latency
Cannot sleep within 30 minutes
≥ 85%
168 (32.2)
136 (26.1)
384 (73.9)
46 (8.8)
Sleep efficiency
Sleep quality
< 85%
Very good
Fairly good
476 (59.8)
136 (26.1)
340 (5.4)
433 (83.0)
89 (67.6)
274(52.5)
302 (58.0)
119 (22.8)
124 (23.8)
177 (33.9)
293 (56.1)
15 (2.9)
Fairly bad
Very bad
Getting up at midnight or early morning
Getting up to use the bathroom
Feeling difficult to breath
Coughing or snoring
Feeling cold
Sleep disturbance
Feeling hot
Having bad dreams
Having pain
Other
Non-users
412 (78.9)
110 (21.1)
217 (41.6)
277 (53.1)
268 (51.3)
254 (48.7)
Sleep medication
Daytime function
Taking sleeping pills
Difficult in staying awake
Difficult in enthusiasm
No suffering from difficult in acting in daytime
Difficult in acting in daytime
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Almost all patients cannot sleep within patients feeling pain when sleeping was
30 minutes occupying 32.2%.
56.1%. The rates of patients coughing or
snoring and feeling difficult to breathe
were 58.0% and 52.5%, respectively.
33.9% of patients had bad dreams. The
proportion of patients feeling cold and hot
were 22.8% and 23.8%, respectively.
The prevalence of people having sleep
efficiency of more than 85% was 26.1%
and less than 85% was 73.9%. Sleep quality
showed that the highest prevalence of
older adults having fairly good sleep was
59.8% and the lowest prevalence of older
adults having very bad sleep was 5.40%.
Only 8.80% of people had a good sleep.
The majority of the elderly people did
not use sleeping pills (78.9%).
The proportion of patients no having
difficulty in daytime activities and having
difficulty in daytime activities were 48.7%
and 51.3%, respectively.
Regarding sleep disturbance, the
majority of people had to get up at
midnight or early morning (83.0%). 67.6%
of patients must get up to use the
bathroom like notarial. The percentage of
*
Association
between
sleep
disturbance and sarcopenia:
Table 3: Univariate regression association between sleep disturbance and sarcopenia.
95%CI
Characteristic
OR
p
Lower
1.006
0.759
0.977
1.801
1.160
1.501
1.270
Upper
1.028
0.983
0.999
3.288
2.071
2.683
3.425
Long sleep latency
Sleep duration
1.017
0.863
0.988
2.434
1.550
2.007
2.086
0.002
0.027
High sleep efficiency
Low sleep quality
0.026
< 0.001
0.003
Use sleep medication
Impair daytime function
Sleep disturbance
< 0.001
0.004
Table 2 demonstrated sleep disturbance factors related to sarcopenia. Among sarcopenia
older adults, the people had long sleep latency more than the ones getting short sleep
latency with OR = 1.017, 95%CI: 1.006 - 1.028. This rate was significant (p = 0.002).
Patients with long sleep duration (OR = 0.759, 95%CI: 1.047 - 10.041, p = 0.027)
and best sleep efficiency (OR = 0.988, 95%CI: 0.977 - 0.999, p = 0.026) had lower
odds in sarcopenia. Patients with bad sleep quality (OR = 2.434, 95%CI: 1.801 - 3.288,
p < 0.001) had higher odds in sarcopenia.
Patients with sleep medication (OR = 1.550, 95%CI:1.160 - 2.071, p = 0.003) had higher
odds in sarcopenia.
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Regarding physical function in poor sleepers, the rate of impaired people higher
2.007 times than the rate of normal ones (95%CI: 1.501 - 2.683). It was statistic significant
(p < 0.001).
Patients with sleep disturbances 2.086 (95%CI: 1.270 - 3.425) had higher odds in
sarcopenia. This rate was significant (p = 0.004).
Table 3: Logistic regression of sleep disturbances and sarcopenia (n = 522).
Adjust odds ratios for being sarcopenia
1.700 (1.006 - 2.872)
p
Model 1
Model 2
Model 3
0.047
0.048
0.007
1.715 (1.004 - 2.929)
2.090 (1.224 - 3.568)
* Model 1 adjustment age.
* Model 2 adjustment age, low education level.
* Model 3 adjustment age, low education level, malnutrition, depression.
After adjustment for age, low education level, malnutrition, depression was associated
with increased odds of greater sarcopenia remain significant (multivariable odds ratio
(MOR) 2.090, 95%CI (1.224 - 3.568) higher than before adjustment OR = 2.086,
95%CI: 1.270 - 3.425) for sleep disturbances.
DISCUSSION
After adjustment for age, education level,
nutrition status, and depression were
associated with increased odds of greater
sarcopenia remain significant (multivariable
odds ratio (MOR) 2.090, 95%CI (1.224 -
3.568), p = 0.007). This result similar to a
systematic review research [7] showed
that the prevalence of sarcopenia appears
to be associated with sleep quality, with
higher prevalence values in older adults
who have an inadequate sleep. In addition,
this prevalence seems to be higher in
men than in women. This result lower with
a study in Japan in 2019 with 318 patients.
Adjusted odds ratios of sarcopenia and
sleep disorder were 6.04 in men (95%CI:
1.71 - 21.36, p=ꢀ0.005) and 6.33 in women
The majority of the elderly getting poor
sleep was 448 people (85.80%) with the
score of PSQI ranging from 1 to 23, mean
score of 9.39 (SD = 4.37).
In Malaysia’s study, the PSQI score
ranged from 0 to 16 with a mean score of
7.1 (SD 3.4) and the majority of poor
sleep (76.8%, n = 116) [5]. The result was
higher than a study in Japan (2019), the
prevalence of sleep disorder was 44.8%.
There was a statistically significant
association between sleep disturbance
and sarcopenia (p = 0.004). Patients with
sleep disturbances (OR = 2.086, 95%CI:
1.270 - 3.425) had high odds in sarcopenia.
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
(95%CI: 1.91 - 20.97, pꢀ=ꢀ0.003) found a
statistically significant association between
sarcopenia and sleep disorder in older
patients with diabetes using SARC‐F
questionnaire [6]. This difference between
this study and research can be explained
by the fact that the sample size (n = 522
> 318) and the prevalence of sarcopenia
between each research were different.
Among sarcopenia older adults, the people
had long sleep latency more than the
ones getting short sleep latency with
OR = 1.017, 95%CI: 1.006 - 1.028. This
rate was significant (p = 0.002). In the
sarcopenia group, the prevalence of sleep
disturbance was higher than in this study
[8]. A research in 2019 reported lowest
category of sleep duration (under 6h)
versus the reference category (6 - 8h)
was significantly related to the increased
risk of sarcopenia (OR = 1.71; 95%CI:
1.11 - 2.64). This meta-analysis indicates
that the public should be aware of the
negative consequences of long and short
sleep for sarcopenia, especially among
women [9]. A cross-sectional study of 607
participants aged 60 years and older
living in China. In women, the prevalence
of sarcopenia was significantly higher in
the short sleep duration group (< 6 ꢁhours
- 27.5%) and long sleep duration group
(> 8ꢁ hours - 22.2%) compared with
women in the normal sleep duration group
(6 - 8 ꢁhours - 13.9%) (respectively; p
=ꢁ0.014). Similar results were found in
men; however, the differences between
groups were not statistically significant
(18.5%, 20.6%, and 13.0%, respectively; p
= 0ꢁ.356). A U-shape relationship between
self-reported
sleep
duration
and
sarcopenia was identified in a population
of Chinese community-dwelling older
adults, especially in women. These results
could have a practical application for
public health since they can help us to
consider sleep quality as a risk factor, as
well as the need to incorporate therapies
in order to improve the sleep quality and
to reduce the negative effects of age-
associated sarcopenia.
CONCLUSION
The prevalence of sleep disturbance
was high and was associated with
sarcopenia among older people. Sleep
disorders are very common in older adults
and there was an association between
sleep disturbance and sarcopenia.
Medical staffs should concern more about
the patient’s sleep disturbance, especially
in patients with sarcopenia.
REFERENCES
1. Neikrug AB, Ancoli-Israel S. Sleep
disorders in the older adult - a mini-review.
Gerontology 2010; 56(2):181-189.
2. Baumgartner Richard N, Koehler
Kathleen M, Gallagher Dympna, et al.
Epidemiology of sarcopenia among the elderly
in New Mexico. American Journal of
Epidemiology 1998; 147(8):755-763.
3. Chien MY, Wang LY, Chen HC. The
Relationship of sleep duration with obesity
and sarcopenia in community-dwelling older
adults. Gerontology 2015; 61(5):399-406.
176
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Effect of sleep quality on the prevalence of
sarcopenia in older adults: A systematic
review with meta-analysis. Clinical Medicine
2019.
4. Chen LK, Woo J, Assantachai P, et al.
Asian working group for sarcopenia:
Consensus update on sarcopenia diagnosis
and treatment. J Am Med Dir Assoc 2019;
21(3):300-307.
8. Nagaura Yuki, Kondo Hideaki,
Nagayoshi Mako, et al. Sarcopenia is
associated with insomnia in Japanese older
adults: A cross-sectional study of data from
the Nagasaki Islands study. BMC Geriatrics
2010; 20(1):256.
5. Rashid Abdul, Ong Eng Keat, Wong
Eleanor Shu Yi. Sleep quality among residents
of an old folk’s home in Malaysia. Iranian
Journal of Nursing and Midwifery Research
2012; 17(7):512.
6. Satoshi Ida, Ryutaro Kaneko, Hiroaki
Nagata, et al. Association between sarcopenia
and sleep disorder in older patients with
diabetes 2019.
9. Pourmotabbed Ali, Ghaedi Ehsan,
Babaei Atefeh, et al. Sleep duration and
sarcopenia risk: A systematic review and
dose-response meta-analysis. Sleep and
Breathing 2019.
7. Martínez-Aranda, Jacobo Á, Rubio-Arias,
Raquel Rodríguez-Fernández, Luis Andreu.
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