The proposed study is a 5-year competitive renewal of the study, Outcomes of Sleep Disorders in Older Men (MrOS Sleep Study). The MrOS Sleep Study was designed to test several hypotheses regarding consequences of sleep disorders in community-dwelling older, by taking advantage of the established cohort that was enrolled for the Osteoporotic Fractures in Men (MrOS) study. From December 2003 through March 2005, 3135 MrOS participants (>100% of goal) were enrolled into the ancillary MrOS Sleep Study. Comprehensive and objective assessments of sleep (including overnight in-home polysomnography (PSG), 5-day wrist actigraphy and self-reported measures of sleep quality), adjudication of incident cardiovascular (CVD) events, and other measures including biological specimens were added to the expansive dataset of the MrOS parent study. During the initial cycle, we identified sleep disordered breathing (SDB) and hypoxemia as significant independent predictors of CVD, arrhythmias, mortality and non-spine fractures. We now propose continued follow-up of the MrOS Sleep Study cohort to provide sufficient power to determine risk of specific CVD outcomes and disease-specific mortality associated with SDB, rather than aggregate outcomes (Aim 1). Initial findings will also be extended in the renewal by testing several potential mechanisms for the observed relationships between SDB/hypoxemia and outcomes, including i) biochemical determinants that may elucidate mechanistic pathways;ii) lung function and daytime oxygen saturation levels;and iii) objectively measured sleep duration (Aim 2). We further propose to strengthen several of our cross- sectional findings relating sleep to age-related conditions including frailty, physical and cognitive function, by performing longitudinal assessments of these conditions (Aim 3). Finally, repeat measures of PSG and actigraphy will enable us to characterize patterns of change in sleep characteristics among older men during 5 years of follow-up, and to determine the correlates and consequences of these changes (Aim 4). This rare opportunity to continue follow-up in over 3000 men who participated in the original wave of the MrOS Sleep Study, and to re-examine a subset of the cohort who have already contributed such a wealth of data, will provide new insights into the relationships between SDB and sleep patterns with subsequent morbidity and mortality.

Public Health Relevance

Sleep disorders are very common, particularly in older adults. The proposed renewal of the study, Outcomes of Sleep Disorders in Older Men, will provide new insights into the relationships between sleep disordered breathing, hypoxemia, and sleep patterns (measured comprehensively and objectively) with subsequent risk of morbidity and mortality in a large cohort of community-dwelling older men. Several mechanistic pathways will be explored, in addition to extending follow-up to allow for analysis of more specific CVD outcomes and disease-specific mortality (rather than aggregate outcomes).

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Cardiovascular and Sleep Epidemiology (CASE)
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Twery, Michael
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California Pacific Medical Center Research Institute
San Francisco
United States
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Smagula, Stephen F; Ancoli-Israel, Sonia; Blackwell, Terri et al. (2015) Circadian rest-activity rhythms predict future increases in depressive symptoms among community-dwelling older men. Am J Geriatr Psychiatry 23:495-505
Stone, Katie L; Blackwell, Terri L; Ancoli-Israel, Sonia et al. (2014) Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study. J Am Geriatr Soc 62:299-305
Smagula, Stephen F; Ancoli-Israel, Sonia; Barrett-Connor, Elizabeth et al. (2014) Inflammation, sleep disturbances, and depressed mood among community-dwelling older men. J Psychosom Res 76:368-73
Bajaj, Archna; Stone, Katie L; Peters, Katherine et al. (2014) Circulating vitamin D, supplement use, and cardiovascular disease risk: the MrOS Sleep Study. J Clin Endocrinol Metab 99:3256-62
Patel, S R; Hayes, A L; Blackwell, T et al. (2014) The association between sleep patterns and obesity in older adults. Int J Obes (Lond) 38:1159-64
Koo, Brian B; Mehra, Reena; Blackwell, Terri et al. (2014) Periodic limb movements during sleep and cardiac arrhythmia in older men (MrOS sleep). J Clin Sleep Med 10:7-11
Cauley, Jane A; Blackwell, Terri L; Redline, Susan et al. (2014) Hypoxia during sleep and the risk of falls and fractures in older men: the Osteoporotic Fractures in Men Sleep Study. J Am Geriatr Soc 62:1853-9
Blackwell, Terri; Yaffe, Kristine; Laffan, Alison et al. (2014) Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. Sleep 37:655-63
Rao, Madhu N; Blackwell, Terri; Redline, Susan et al. (2013) Association between sleep duration and 24-hour urine free cortisol in the MrOS Sleep Study. PLoS One 8:e75205
Fung, Maple M; Peters, Katherine; Ancoli-Israel, Sonia et al. (2013) Total sleep time and other sleep characteristics measured by actigraphy do not predict incident hypertension in a cohort of community-dwelling older men. J Clin Sleep Med 9:585-91

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