Original Study Association Between Sleep Disturbances and Frailty: Evidence From a Population-Based Study Vassilis Balomenos MD a , Eva Ntanasi MSc, PhD b, *, Costas A. Anastasiou PhD c , Socrates Charisis MD c , Georgios Velonakis MD d , Efstratios Karavasilis PhD d , Angeliki Tsapanou PhD e , Mary Yannakoulia PhD c , Mary H. Kosmidis PhD f , Efthimios Dardiotis MD, PhD g , Georgios Hadjigeorgiou MD, PhD h , Paraskevi Sakka MD, PhD i , Nikolaos Scarmeas MD, PhD b, e a School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece b 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Greece c Department of Nutrition and Dietetics, Harokopio University, Athens, Greece d 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, Medical School, Athens, Greece e Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, the Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY f Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece g School of Medicine, University of Thessaly, Larissa, Greece h Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus i Athens Association of Alzheimer’s Disease and Related Disorders, Athens, Greece Keywords: Frailty sleep quality sleep disturbances sleep abstract Objective: To explore the association between both self-reported quality and quantity sleep character- istics and frailty status in a large nonesex-specific population of older individuals in Greece. Design: Cross-sectional study. Setting and Participants: In total, 1984 older individuals (65 years old) were drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Measures: Frailty was assessed using 3 different definitions, the Frailty Index (FI), the Tilburg Frailty Indicator (TFI), and the Groningen Frailty Indicator (GFI). Sleep quality was evaluated through the Sleep Index II, which includes 9 of the 12 self-reported items of the Medical Outcomes Study-Sleep Scale. To examine sleep duration, participants were asked to report on how many hours they slept each night during the past 4 weeks. Logistic regression models adjusted for multiple covariates were explored. Additional analyses, stratified by gender, adjusting for sleep-related medications and excluding participants diagnosed with dementia, were also performed. Results: In total, 389 (20%), 619 (31.9%), and 608 (31.3%) participants were categorized as frail according to the FI, the TFI, and the GFI respectively. Sleep quality was significantly associated with frailty in all models. Even after adjusting for subjective sleep duration, compared with participants who subjectively reported high sleep quality, those with low sleep quality had 3.7, 2.6, and 2.5 more times to be frail as measured with FI, TFI, and GFI respectively. Regarding the associations between frailty and self-reported sleep duration, sex-specific associations were observed: prolonged sleep duration was associated with frailty in the subsample of male participants. Conclusions and Implications: The present study shows a strong correlation between subjective sleep quality and frailty status, contributing substantial information to the growing literature demon- The authors declare no conflicts of interest. IIRG-09133014 (Alzheimer’s Association),189 10,276/8/9/2011 (ESPA-EU program Excellence Grant, ARISTEIA, co-funded by the European Social Fund and Greek National resources), and DY2b/oik.51657/14.4.2009 (Ministry for Health and Social Solidarity, Greece). * Address correspondence to Eva Ntanasi, MSc, PhD, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, 72 Vassilisis Sofias Avenue, Athens, 11528, Greece. E-mail address: e.ntanasi@hotmail.com (E. Ntanasi). https://doi.org/10.1016/j.jamda.2020.08.012 1525-8610/Ó 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA journal homepage: www.jamda.com JAMDA xxx (2020) 1e8