Abstract
Introduction: Falls are a leading cause of injury, loss of independence and mortality in older people. Measures of physical performance, including balance, gait speed, and handgrip strength are significant predictors of falls. Emerging evidence suggests that obstructive sleep apnoea (OSA), a common sleep-related breathing disorder, may impair physical and cognitive performance in older adults, potentially through mechanisms including nocturnal hypoxemia, excessive daytime sleepiness, and impaired vasoreactivity. However, associations between the risk of OSA and fall-related physical performance remain unclear.
Materials and methods: Cross-sectional data from the 2016 Health and Retirement Study was analysed. OSA risk was derived using survey items aligned with the STOP-Bang questionnaire. Poor balance was defined as the inability to hold a semi-tandem stance for 10 seconds. Slow gait speed was defined as walking <0.8 m/s over 2.5 meters. Weak handgrip strength (HGS) was defined as HGS divided by body mass index (BMI) of <1.00 kg/BMI for males and <0.56 kg/BMI for females. Binomial logistic regression models were used to examine associations between high-risk OSA and physical performance measures. Potential confounders adjusted in the models include age, sex, BMI, physical activity, alcohol consumption, comorbidity burden, ethnicity, and treatment for sleep/snoring problems.
Results: Data from 6,911 participants (mean age 66+11 years; 57% female) were analysed. The prevalence of high-risk OSA, poor balance, slow gait speed and weak HGS was 36%, 32%, 63% and 15%, respectively. High-risk OSA was significantly associated with higher odds of poor balance (OR: 1.23, 95% bootstrapped confidence interval (BCI): 1.07-1.39, p=0.002), slow gait speed (OR: 1.29, BCI: 1.06-1.56, p=0.009), and weak HGS (OR: 2.20, BCI: 1.86-2.60, p=0.001).
Conclusions: High-risk OSA is associated with higher odds of poor balance, slow gait speed and weak relative HGS, which are key predictors of falls. Co-screening of OSA and poor fall-related physical performance may support early detection and preventative strategies to improve safety and maintain functional independence in older adults.
Acknowledgments: All participants of the health and retirement study.