Dissertation/Thesis Abstract

The relationships between sleep disturbance and falls among Veterans who have experienced strokes
by Knechel, Nancy Alice, Ph.D., Yale University, 2015, 177; 10012503
Abstract (Summary)

Falls result in more than 2.4 million injuries each year and are the most common adverse events after a stroke. Sleep disturbance is common after stroke and may be a risk factor for falls. The purpose of this study was to determine the predictive value of sleep disturbance for falls among Veterans who experienced ischemic strokes. The study was a secondary analysis of the data from the Diagnosis and Treatment of Sleep Apnea in Cerebrovascular Disease (GoToSleep) Study, a longitudinal multi-site randomized controlled strategy trial. The sample included 187 post-stroke Veterans, with a mean age of 70 years, which was predominately male (96.8%) and White (81.3%). The mean Charlson Comorbidity Index score was 2.5, and mean number of comorbid conditions was 6.3. The sample did not have significant stroke-related disability (NIHSS M= 1.9), or physical dependence (Modified Rankin Scale M = 1.0) Data included PSG, medical record review, questionnaires (Epworth Sleepiness Scale, Berlin, Saint Louis University Mental Status), and self-reported falls and injuries. Seventy-two participants had CPAP treatment. Univariate frequency distributions with summary statistics for central tendency and variability, t-tests, Chi-square tests, Fisher's Exact tests, Pearson correlations, and binary and multivariate logistic regression analyses were conducted. Fallers had shorter sleep duration, more frequent awakenings, longer time in bed, more N1 sleep, more spontaneous arousals and respiratory-event related arousals (RERAs), and Periodic Limb Movements (PLMs) per hour than non-fallers. Only the associations between frequency of awakenings per hour and PLM index and falls remained statistically significant in the fully adjusted multivariate model that accounted for approximately 13% of variance beyond the clinical and demographic variables. The odds of a fall increased by 40% for each awakening and 2% for each PLM per hour. After controlling for use of continuous positive airway pressure (CPAP) treatment among the patients with significant sleep apnea, the effects of the sleep variables were not statistically significant. This suggests that treatment of sleep disordered breathing may reduce the odds of falling. Future research is needed to improve confirm and extend these findings, understand the biobehavioral mechanisms for these relationships, and to evaluate the effects of sleep treatment on falls risk.

Indexing (document details)
Advisor: Redeker, Nancy
Commitee:
School: Yale University
School Location: United States -- Connecticut
Source: DAI-B 77/06(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Aging, Medicine, Nursing
Keywords: Continuous-Positive-Airway-Pressure (CPAD), Fall, Injury, Older Adult, Sleep Disturbance, Stroke
Publication Number: 10012503
ISBN: 978-1-339-47532-5
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