Sleep health may impact mobility for women with chronic conditions

Poor sleep health can lead to many daily problems, and for people with chronic illnesses, one of those problems can be difficulty with daily movement.

Researchers from University of Michigan Health used data from the Nurse’s Health Study - a cohort study of more than 70,000 women nurses followed over time with surveys given every 2 years and used the dataset to focus on the impact of sleep on future mobility, with a special focus on chronic health conditions that are known to affect mobility.

The study findings, published in Sleep Epidemiology suggested that poor sleep health predicted a decline in mobility over the eight years following a chronic health diagnosis.

Women with diabetes, osteoarthritis or multiple sclerosis who also had signs or symptoms of obstructive sleep apnea were more particularly likely to have future problems with mobility compared to counterparts who didn’t have signs of sleep apnea.

“Poor sleep is often overlooked or assumed to be a consequence of aging, functional decline or disability in those with chronic health conditions,” said senior author Tiffany J. Braley, M.D., M.S., associate professor of neurology.

“However, sleep disturbances and disorders may also be an upstream contributor to these issues,” said Braley, also the director of the multiple sclerosis and neuroimmunology division at the University of Michigan Health.

“Treating sleep problems can have positive effects on other parts of life, including physical functions like mobility. In our clinical experiences within medical and rehabilitation contexts, we have observed that how someone is sleeping can have a direct impact on how they engage in physical activities as part of their treatment or self-management,” said first author Daniel Whibley, Ph.D., assistant professor of physical medicine and rehabilitation at University of Michigan Health.

The study found that signs of obstructive sleep apnea, reported sleep durations outside of the recommended guidelines, and a perception of inadequate sleep were all associated with an increase in the future use of assistive devices to help with mobility, such as a cane or wheelchair.

“Identifying sleep disturbances or signs of a sleep disorder, providing information about healthy sleep habits and referral to a specialist when needed may help to reduce the progression of mobility issues,” said Whibley.

“Our study is the first to observe this association in women, including those with and without long term conditions, making this research important to consider when addressing ways to better the long-term health of women with these conditions.”

“Reasons for these findings may vary depending on the condition, but require further study,” said Braley, who encourages providers to screen patients with chronic conditions for sleep disturbances and refer to sleep specialists early if an underlying sleep disorder is suspected, as “the vast majority of sleep disorders are highly treatable.”

For patients, Whibley recommends speaking up about problems with sleep.

"Consider sleep as an important part of overall health, especially for those who want to take a proactive role in addressing treatable causes of disability," notes Whibley, "as it can help patients take control of their physical health."

Additional authors: Monica M. Shieu and Galit Levi Dunietz from the Department of Neurology, Division of Sleep Medicine, University of Michigan.

Whibley, Braley and Dunietz are members of the U-M Institute for Healthcare Policy and Innovation.

Paper cited: “Sleep disturbances and progression of mobility and disability: Longitudinal findings from the Nurses’ Health Study,” Sleep Epidemiology. DOI: 10.1016/j.sleepe.2023.100071