Self-reported poor sleep on multiple dimensions is associated with higher total health care costs in older men.

STUDY OBJECTIVES: To estimate the association of self-reported poor sleep in multiple dimensions with health care costs in older men. METHODS: Participants were 1,413 men (mean [SD] age 76.5 [5.7] years) enrolled in both the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study and Medicare Fee-for-Service. Poor sleep was characterized at the baseline MrOS Sleep visit on five dimensions (satisfaction, daytime sleepiness, timing, latency, and duration). Health care costs and utilization were ascertained over 3 years of follow-up using Medicare Claims. RESULTS: Median (interquartile range [IQR]) annualized total health care costs (2018 US dollars) rose from $3,616 (IQR 1,523-7,875) for those with no impaired sleep dimensions to $4,416 (IQR 1,854-11,343) for men with two impaired sleep dimensions and $5,819 (IQR 1,936-15,569) for those with at least three impaired sleep dimensions. After multivariable adjustment, the ratio of total health care costs (CR) was significantly higher for men with two (1.24, 95% confidence interval [CI] 1.03- to 1.48) and men with at least three impaired sleep dimensions (1.78, 95% CI 1.42 to 2.23) vs. those with no impaired sleep dimensions. After excluding 101 men who died during the 3-year follow-up period, these associations were attenuated and not significant (CR 1.22, 95% CI 0.98 to 1.53 for men ≥3 impaired sleep dimensions vs. none). CONCLUSIONS: Self-reported poor sleep on multiple dimensions is associated with higher subsequent total health care costs in older men, but this may be due to higher mortality and increased health care costs toward the end of life among those with poor sleep health.

Multidimensional sleep health and subsequent health-care costs and utilization in older women.

STUDY OBJECTIVES: Determine the association of poor multidimensional sleep health with health-care costs and utilization. METHODS: We linked 1,459 community-dwelling women (mean age 83.6 years) participating in the Study of Osteoporotic Fractures Year 16 visit (2002-2004) with their Medicare claims. Five dimensions of sleep health (satisfaction, daytime sleepiness, timing, latency, and duration) were assessed by self-report. The number of impaired dimensions was expressed as a score (range 0-5). Total direct health-care costs and utilization were ascertained during the subsequent 36 months. RESULTS: Mean (SD) total health-care costs/year (2017 dollars) increased in a graded manner across the sleep health score ranging from $10,745 ($15,795) among women with no impairment to up to $15,332 ($22,810) in women with impairment in three to five dimensions (p = 0.01). After adjustment for age, race, and enrollment site, women with impairment in three to five dimensions vs. no impairment had greater mean total costs (cost ratio [CR] 1.34 [95% CI = 1.13 to 1.60]) and appeared to be at higher risk of hospitalization (odds ratio (OR) 1.31 [95% CI = 0.96 to 1.81]). After further accounting for number of medical conditions, functional limitations, and depressive symptoms, impairment in three to five sleep health dimensions was not associated with total costs (CR 1.02 [95% CI = 0.86 to 1.22]) or hospitalization (OR 0.91 [95% CI = 0.65 to 1.28]). Poor multidimensional sleep health was not related to outpatient costs or risk of skilled nursing facility stay. CONCLUSIONS: Older women with poor sleep health have higher subsequent total health-care costs largely attributable to their greater burden of medical conditions, functional limitations, and depressive symptoms.

Cystatin C and the Risk of Frailty and Mortality in Older Men.

BACKGROUND: This study examines the association between cystatin C (cysC) levels and risks of progression of frailty status or death in older men. METHODS: Prospective study of 2,613 men without overt frailty aged 67 years and older enrolled in the MrOS ancillary sleep study. Baseline measurements included serum cysC, serum creatinine, and frailty status. Repeat frailty status, performed an average of 3.4 years later, was assessed as an ordinal outcome of robust, intermediate stage (prefrail), frail or dead. RESULTS: Mean age was 75.7 years. Men with higher cysC were older and had a higher comorbidity burden. After adjusting for age, clinical site, and race, higher cysC was associated with nearly twofold greater odds of being classified as intermediate stage versus robust (OR quartile 4 vs 1; 1.82, 95% confidence interval [CI] 1.35-2.45), a threefold greater odds of frailty versus robust (OR quartile 4 vs 1; 3.13, 95% CI 2.03-4.82), and a more than fivefold greater odds of death versus robust (OR quartile 4 vs 1; 5.48, 95% CI 2.98-10.08). Results were similar for cysC-based estimated glomerular filtration rate (eGFR). This relationship was attenuated but persisted after adjusting for additional potential confounders including baseline frailty status, body mass index, smoking status, comorbidity burden, self-reported disability, and serum albumin. In contrast, neither serum creatinine nor creatinine-based eGFR was associated in a graded manner with higher risks of development of frailty or death. CONCLUSIONS: In this cohort of older men without overt frailty, higher cysC and cysC-based eGFR, but not creatinine or creatinine-based estimates of GFR, were associated with increased risks of frailty or death. These findings suggest that higher cysC level may be a promising biomarker for unsuccessful aging as manifested by increased risks of frailty and death.

Objective assessment of activity, energy expenditure, and functional limitations in older men: the Osteoporotic Fractures in Men study.

BACKGROUND: The relationship between objectively assessed activity, energy expenditure, and the development of functional limitations is unknown. METHODS: Energy expenditure and activity levels were measured objectively using the multisensor SenseWear Pro Armband worn for greater than or equal to 5 days in 1,983 MrOS men (aged ≥ 78.3 years) free of functional limitations. Validated algorithms calculated energy expenditure; standard cut points defined moderate or greater activity (≥ 3.0 METS); and sedentary behavior (time awake ≤ 1.5 METS). Self-reported functional limitation was determined at the activity assessment and 2.0 years later as inability to perform instrumental activities of daily living (managing money, managing medications, shopping, housework, and meal preparation) and activities of daily living (climb stairs, walk two to three blocks, transfer, or bathe). RESULTS: Each standard deviation decrease in total energy expenditure (420.6 kcal/day) increased the likelihood of inability to perform an instrumental activity of daily living (multivariate odds ratio [mOR]: 1.61, 95% CI: 1.30-2.00) or activity of daily living (mOR: 1.35, 95% CI: 1.12-1.63). Each standard deviation decrease in moderate or greater activity (61.1 minutes/day) increased the likelihood of inability to perform an instrumental activity of daily living (mOR: 1.47, 95% CI: 1.22-1.78) or activity of daily living (mOR: 1.36, 95% CI: 1.14-1.61). Each standard deviation increase in minutes of sedentary behavior (105.2 minutes/day) increased the likelihood of inability to perform an instrumental activity of daily living (mOR: 1.20, 95% CI: 1.03-1.40) or activity of daily living (mOR: 1.17, 95% CI: 1.01-1.35). CONCLUSION: Older men with lower total energy expenditure, lower moderate activity, or greater sedentary time were more likely to develop a functional limitation.