Self-revorted sleep and nap habits and risk of falls and fractures in older women: The study of osteoporotic fractures

OBJECTIVES: To test the association between self-reported sleep and nap habits and risk of falls and fractures in a large cohort of older women. DESIGN: Study of Osteoporotic Fractures prospective cohort study. SETTING: Clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, near Pittsburgh, Pennsylvania. PARTICIPANTS: Eight thousand one hundred one community-dwelling Caucasian women aged 69 and older (mean 77.0). MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Fall frequency during the subsequent year was ascertained using tri-annual questionnaire. Incident hip and nonspinal fractures during 6 years of follow-up were confirmed using radiographic reports. RESULTS: Five hundred fifty-three women suffered hip fractures, and 1,938 suffered nonspinal fractures. In multivariate models, women who reported napping daily had significantly higher odds of suffering two or more falls during the subsequent year (odds ratio = 1.32, 95% confidence interval (CI) = 1.03-1.69) and were more likely to suffer a hip fracture (hazard ratio (HR) = 1.33, 95% CI = 0.99-1.78) than women who did not nap daily. Those sleeping at least 10 hours per 24 hours had a higher risk of nonspinal fracture than (HR = 1.26, 95% CI = 1.00-1.58) and a similar but nonsignificant increased risk of hip fracture to (HR = 1.43, 95% Cl = 0.95-2.15) those who reported sleeping between 8 and 9 hours. CONCLUSION: Self-reported long sleep and daily napping are associated with greater risk of falls and fractures in older women. Interventions to improve sleep may reduce their risk of falls and fractures. Future research is needed to determine whether specific sleep disorders contribute to these relationships.