General characteristics of the study population
Among 1,353 non-sarcopenic participants at baseline, 1,160(85.7%) were classified as non-sarcopenic and 193(14.3 %) as sarcopenic after 2 years, according to the AWGS guidelines of 2019. (Table 1) The median ages of non-sarcopenic and sarcopenic participants were 75.3, 76.4 years in men, and 74.9, 76.4 in women, respectively. The prevalence of cerebrovascular disease (CVD), angina, and depression was higher in men in the sarcopenic group than in those in the non-sarcopenic group. The prevalence of CVD was higher in women with sarcopenia. Rates of low physical activity in non-sarcopenic and sarcopenic participants were 4.5%, 12.6% in men and 7.0%, 16.7% in women, respectively. The median duration of sleep was 6.4 hours in both groups in men, and 5.9, 6.0 hours in non-sarcopenic and sarcopenic women, respectively. The rates of long sleep duration (total sleep time > 8 hours per night) in non-sarcopenic and sarcopenic participants were 5.7%, 11.7% in men and 3.5%, 6.7 % in women, respectively. (Table 1)
Table 1. Characteristics of study participants, according to sarcopenia status at 2 years
|
Male (n=631)
|
Female (n=722)
|
|
Non-Sarcopenic
(n=528)
|
Sarcopenic
(n=103)
|
p-value
|
Non-Sarcopenic
(n=632)
|
Sarcopenic
(n=90)
|
p-value
|
Age, year
|
75.3±3.6
|
76.4±4.0
|
0.012
|
74.9±3.6
|
76.4±4.2
|
0.002
|
BMI, kg/m2
|
24.6±2.9
|
24.1±2.4
|
0.103
|
25.3±2.9
|
23.9±2.8
|
<0.001
|
Polypharmacya
|
166(31.4%)
|
42(40.8%)
|
0.065
|
157(24.8%)
|
21(23.3%)
|
0.756
|
Smokingb
|
405(76.7%)
|
71(68.9%)
|
0.094
|
14(2.2%)
|
2(2.2%)
|
0.997
|
Alcohol drinkingc
|
181(34.3%)
|
32(31.1%)
|
0.528
|
22(3.5%)
|
3(3.3%)
|
0.943
|
Married
|
346(65.5%)
|
62(60.2%)
|
0.3
|
446(70.6%)
|
56(62.2%)
|
0.107
|
Live alone
|
30(5.7%)
|
8(7.8%)
|
0.416
|
212(33.5%)
|
32(35.6%)
|
0.706
|
Education d
|
423(80.1%)
|
74(71.8%)
|
0.061
|
322(50.9%)
|
39(43.3%)
|
0.176
|
Working
|
149(28.2%)
|
27(26.2%)
|
0.678
|
138(21.8%)
|
21(23.3%)
|
0.748
|
Low physical activitye
|
24(4.5%)
|
13(12.6%)
|
0.001
|
44(7.0%)
|
15(16.7%)
|
0.002
|
MNA score
|
12.8±1.6
|
12.9±1.2
|
0.598
|
12.8±1.4
|
12.8±1.7
|
0.934
|
Risk of malnutritionf
|
94(17.3%)
|
13(14.9%)
|
0.59
|
98(16.3%)
|
20(16.3%)
|
0.984
|
Hypertension
|
271(51.3%)
|
60(58.3%)
|
0.198
|
362(57.3%)
|
50(55.6%)
|
0.757
|
Diabetes
|
120(22.7%)
|
31(30.1%)
|
0.109
|
107(16.9%)
|
20(22.2%)
|
0.217
|
Dyslipidemia
|
142(26.9%)
|
27(26.2%)
|
0.887
|
267(42.2%)
|
31(34.4%)
|
0.16
|
Angina
|
31(5.9%)
|
13(12.6%)
|
0.014
|
30(4.7%)
|
8(8.9%)
|
0.1
|
CHF
|
4(0.8%)
|
0(0.0%)
|
0.376
|
2(0.3%)
|
1(1.1%)
|
0.273
|
CVD
|
24(4.5%)
|
14(13.6%)
|
<0.001
|
19(3.0%)
|
7(7.8%)
|
0.023
|
Arthritis
|
56(10.6%)
|
14(13.6%)
|
0.377
|
204(32.3%)
|
31(34.4%)
|
0.682
|
Osteoporosis
|
81(15.3%)
|
15(14.6%)
|
0.841
|
92(14.6%)
|
15(16.7%)
|
0.598
|
Depressiong
|
43(8.1%)
|
16(15.5%)
|
0.018
|
160(25.3%)
|
22(24.4%)
|
0.859
|
HRTh
|
|
|
|
143(22.6%)
|
14(15.6%)
|
0.128
|
Sleep duration
|
6.4±1.3
|
6.4±1.5
|
0.563
|
5.9±1.4
|
6.0±1.5
|
0.34
|
6-8hour
|
352(66.7%)
|
60(58.3%)
|
0.057
|
332(52.5%)
|
50(55.6%)
|
0.234
|
<6hour
|
146(27.7%)
|
31(30.1%)
|
278(44.0%)
|
34(37.8%)
|
>8hour
|
30(5.7%)
|
12(11.7%)
|
22(3.5%)
|
6(6.7%)
|
Sleep latency
|
20.6±24.8
|
21.3±22.4
|
0.771
|
29.3±30.0
|
24.7±26.4
|
0.163
|
>60min
|
49(9.3%)
|
13(12.6%)
|
0.297
|
129(20.4%)
|
13(14.4%)
|
0.183
|
Continuous variables are presented as mean ± standard deviation or numbers with (percentages). BMI, body mass index; CHF, chronic heart failure; CVD, cerebrovascular Diseases; a. polypharmacy: use of 5 or more drugs more than 3 months; b. Smoking: ≥5pack-yr/lifetime; c. Alcohol drinking: ≥ 2-3 times/ week; d. Education: ≥ 7years; e. Low physical activity: <494.65 kcal for men and <283.50 kcal for women; f. Risk of malnutrition: MNA score≤11; g. Depression: GDS score ≥6; h. HRT, hormone replacement therapy ≥ 1 month
Sleep pattern and incident sarcopenia in men
Long sleep duration (> 8 hours) in men was associated with greater odds of incident sarcopenia after 2 years compared to the reference (6-8 hours). After adjusting for multiple factors including age, body mass index (BMI), smoking, polypharmacy, education, angina, CVD, depression, and physical activity, the association between long sleep duration and incident sarcopenia remained significant (odds ratio [OR] 2.410, 95% confidence interval [CI] 1.125-5.166, p-value[P]=.024). In comparison, short sleep duration (< 6 hours) was not associated with sarcopenia development in men (OR 1.192, CI 0.725-1.960, P=.488). Prolonged sleep latency (≥60 min) was not associated with sarcopenia in men (OR 1.014, CI 0.505-2.036, P=.969). (Table 2,3)
Table 2. Odds ratio of sleep duration relationship to incident sarcopenia, by sex
|
sleep duration in men
|
sleep duration in women
|
|
|
OR
|
95% CI
|
P
|
OR
|
95% CI
|
P
|
Model1
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.246
|
0.775
|
2.002
|
0.364
|
0.812
|
0.511
|
1.291
|
0.379
|
>8h
|
2.347
|
1.139
|
4.837
|
0.021
|
1.811
|
0.7
|
4.684
|
0.221
|
Model2
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.258
|
0.78
|
2.031
|
0.347
|
0.814
|
0.506
|
1.309
|
0.395
|
>8h
|
2.409
|
1.158
|
5.012
|
0.019
|
2.085
|
0.778
|
5.582
|
0.144
|
Model3
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.217
|
0.744
|
1.992
|
0.434
|
0.821
|
0.504
|
1.339
|
0.43
|
>8h
|
2.407
|
1.124
|
5.152
|
0.024
|
2.124
|
0.778
|
5.796
|
0.142
|
Model4
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.192
|
0.725
|
1.96
|
0.488
|
0.852
|
0.52
|
1.393
|
0.522
|
>8h
|
2.41
|
1.125
|
5.166
|
0.024
|
2.093
|
0.753
|
5.812
|
0.157
|
Model 1: unadjusted
Model 2: adjusted for age and BMI
Model 3: adjusted for age, BMI, smoking, polypharmacy, education, angina, CVD, and depression
Model 4: adjusted for age, BMI, smoking, polypharmacy, education, angina, CVD, depression, and low physical activity
* P-value was obtained by logistic regression analysis; OR, odds ratio; CI, confidence interval; BMI, body mass index; CVD, cerebrovascular disease
Table 3. Odds ratio of sleep latency relationship to incident sarcopenia, by sex
|
sleep latency >60min in men
|
sleep latency >60min in women
|
|
OR
|
95% CI
|
P
|
OR
|
95% CI
|
P
|
Model1
|
1.412
|
0.736
|
2.709
|
0.299
|
0.658
|
0.355
|
1.222
|
0.185
|
Model2
|
1.355
|
0.702
|
2.614
|
0.366
|
0.621
|
0.329
|
1.174
|
0.143
|
Model3
|
1.001
|
0.5
|
2.004
|
0.997
|
0.636
|
0.332
|
1.219
|
0.173
|
Model4
|
1.014
|
0.505
|
2.036
|
0.969
|
0.674
|
0.351
|
1.296
|
0.237
|
Model 1: unadjusted
Model 2: adjusted for age and BMI
Model 3: adjusted for age, BMI, smoking, polypharmacy, education, angina, CVD, and depression
Model 4: adjusted for age, BMI, smoking, polypharmacy, education, angina, CVD, depression, and low physical activity
* P-value was obtained by logistic regression analysis; OR, odds ratio; CI, confidence interval; BMI, body mass index; CVD, cerebrovascular disease
Sleep pattern and incident sarcopenia in women
Compared to normal sleep duration, the adjusted ORs of long sleep duration and short sleep duration for sarcopenic women were 2.093 (CI 0.753–5.812, P=.157) and 0.852 (CI 0.520–1.393, P=.522), respectively, which were not significant. Prolonged sleep latency (≥60 min) was not associated with sarcopenia in women (OR 0.674, CI 0.351-1.296, P=.237). (Table 2) (Table 3)
The effect of sleep duration on sarcopenia components in men
In men, after adjusting for multiple factors (such as age, BMI, polypharmacy, alcohol, education, working, hypertension, osteoporosis, and depression), the association between long sleep duration and low muscle mass was significant (OR 2.163, 95% CI 1.016-4.605, P=.045) (Table 4). Also, the association between long sleep duration and low muscle strength remained significant after adjusting for multiple correlates (OR 2.695, 95% CI 1.130-6.431, P=.025). (Table 5) In comparison, long sleep duration was not associated with low gait speed (OR 1.075, 95% CI 0.546-2.117, P=.833) in men. (table 6) Short sleep duration (<6 hours) was not associated with any sarcopenia component (low muscle mass, low muscle strength, or low physical performance) in unadjusted or adjusted analyses. (Table 4,5,6)
Table 4. Odds ratio of sleep duration relationship to low height-adjusted ASM index, 2-year follow-up, by sex
|
sleep duration in men
|
sleep duration in women
|
|
|
OR
|
95% CI
|
P
|
OR
|
95% CI
|
P
|
Model1
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.814
|
0.571
|
1.159
|
0.254
|
0.932
|
0.669
|
1.298
|
0.678
|
>8h
|
1.818
|
0.939
|
3.517
|
0.076
|
0.657
|
0.26
|
1.665
|
0.376
|
Model2
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.808
|
0.542
|
1.205
|
0.296
|
0.928
|
0.65
|
1.326
|
0.682
|
>8h
|
1.891
|
0.908
|
3.937
|
0.089
|
0.711
|
0.26
|
1.941
|
0.505
|
Model3
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.828
|
0.552
|
1.24
|
0.359
|
0.975
|
0.675
|
1.408
|
0.893
|
>8h
|
2.163
|
1.016
|
4.605
|
0.045
|
0.766
|
0.278
|
2.105
|
0.605
|
Model 1: unadjusted
Model 2: adjusted for age and BMI
Model 3: adjusted for age, BMI, polypharmacy, alcohol consumption, education, working, HTN
osteoporosis and depression
* P-value was obtained by logistic regression analysis; ASM, appendicular skeletal muscle; OR, odds ratio; CI, confidence interval; BMI, body mass index; HTN, hypertension
Table 5. Odds ratio of sleep duration relationship to low muscle strength, 2-year follow-up, by sex
|
sleep duration in men
|
sleep duration in women
|
|
|
OR
|
95% CI
|
P
|
OR
|
95% CI
|
P
|
Model1
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.219
|
0.733
|
2.028
|
0.446
|
1.196
|
0.829
|
1.726
|
0.337
|
>8h
|
2.212
|
1.026
|
4.769
|
0.043
|
2
|
0.921
|
4.342
|
0.08
|
Model2
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.199
|
0.716
|
2.009
|
0.491
|
1.231
|
0.845
|
1.793
|
0.278
|
>8h
|
2.396
|
1.09
|
5.264
|
0.03
|
2.091
|
0.944
|
4.636
|
0.069
|
Model3
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.155
|
0.677
|
1.971
|
0.597
|
1.208
|
0.822
|
1.775
|
0.335
|
>8h
|
2.637
|
1.105
|
6.296
|
0.029
|
1.943
|
0.862
|
4.382
|
0.109
|
Model4
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
1.137
|
0.664
|
1.947
|
0.639
|
1.223
|
0.831
|
1.801
|
0.307
|
>8h
|
2.695
|
1.13
|
6.431
|
0.025
|
1.997
|
0.884
|
4.511
|
0.096
|
Model 1: unadjusted
Model 2: adjusted for age and BMI
Model 3: Age, BMI, polypharmacy, smoking, HTN, DM, angina, CVD, arthritis
Model 4: adjusted for age, BMI, polypharmacy, smoking, HTN, DM, angina, CVD, arthritis, and low physical activity
* P-value was obtained by logistic regression analysis; OR, odds ratio; CI, confidence interval; BMI, body mass index; HTN, hypertension; DM, diabetes; CVD, cerebrovascular disease
Table 6. Odds ratio of sleep duration relationship to low physical performance, 2-year follow-up, by sex
|
sleep duration in men
|
sleep duration in women
|
|
|
OR
|
95% CI
|
P
|
OR
|
95% CI
|
P
|
Model1
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.923
|
0.638
|
1.336
|
0.672
|
0.882
|
0.675
|
1.152
|
0.357
|
>8h
|
1.094
|
0.59
|
2.029
|
0.775
|
2.171
|
1.091
|
4.321
|
0.027
|
Model2
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.915
|
0.626
|
1.337
|
0.645
|
0.894
|
0.675
|
1.185
|
0.437
|
>8h
|
1.212
|
0.641
|
2.294
|
0.554
|
2.08
|
1.011
|
4.282
|
0.047
|
Model3
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.842
|
0.563
|
1.258
|
0.401
|
0.781
|
0.58
|
1.051
|
0.102
|
>8h
|
1.073
|
0.547
|
2.103
|
0.837
|
1.87
|
0.887
|
3.941
|
0.1
|
Model4
|
6-8h
|
1
|
Ref
|
Ref
|
1
|
Ref
|
Ref
|
<6h
|
0.824
|
0.55
|
1.235
|
0.349
|
0.8
|
0.591
|
1.084
|
0.151
|
>8h
|
1.075
|
0.546
|
2.117
|
0.833
|
1.885
|
0.879
|
4.042
|
0.103
|
Model 1: unadjusted
Model 2: adjusted for age and BMI
Model 3: Age, BMI, education, living alone, polypharmacy, HTN, DM, CVD, dyslipidemia, arthritis, depression
Model 4: Age, BMI, education, living alone, polypharmacy, HTN, DM, CVD, dyslipidemia, arthritis, depression, low physical activity
* P-value was obtained by logistic regression analysis; OR, odds ratio; CI, confidence interval; BMI, body mass index; HTN, hypertension; DM, diabetes; CVD, cerebrovascular disease
The effect of sleep duration on sarcopenia components in women
In women, after adjusting for multiple factors, the OR of long sleep duration in relation to low height-adjusted ASM was 0.766 (CI 0.278-2.105, P=.605) (Table 4); in relation to low muscle strength was 1.997 (CI 0.884-4.511, P=.096) (Table 5); and in relation to low physical performance was 1.885 (CI 0.879-4.042, P=.103) (Table 6). Also, short sleep duration (<6 hours) was not associated with any sarcopenia component (low muscle mass, low muscle strength, or low physical performance) in adjusted analyses.