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. 2026 Jan 24.
doi: 10.1111/joor.70152. Online ahead of print.

Oral Frailty and Physical Frailty Associated With Sleep Quality in Community-Dwelling Adults: A Cross-Sectional Study

Pei-Chen Lin  1   2   3 , Ai-Hua Chang  4 , Shin-Ru Liao  5 , Koichiro Matsuo  6 , Yuji Kabasawa  5 , Ju-Hui Wu  1   2 , Pei-Chao Lin  7   8 , Hsiao-Ling Huang  1   3
Affiliations

Oral Frailty and Physical Frailty Associated With Sleep Quality in Community-Dwelling Adults: A Cross-Sectional Study

Pei-Chen Lin et al. J Oral Rehabil. .

Abstract

Background: Oral frailty and physical frailty are linked to adverse health outcomes in older adults, but their relationship with sleep quality is not well understood. This study examined the association between oral frailty and sleep quality, and the combined effects of oral and physical frailty on sleep in community-dwelling older adults.

Methods: A cross-sectional study was conducted in Kaohsiung City, Taiwan (2018-2019), including 1180 adults aged ≥ 65 years selected by multistage stratified cluster sampling. Data were collected through questionnaires and dental exams. Sleep quality was measured by the Pittsburgh Sleep Quality Index. Oral frailty was assessed using indicators such as oral diadochokinesis, swallowing difficulty, masticatory performance, dry mouth, tongue coating, and number of natural teeth. Oral health-related quality of life (OHRQoL) was evaluated with the GOHAI. Logistic regression identified factors associated with poor sleep quality.

Results: Swallowing difficulty (AOR = 2.69) and dry mouth (AOR = 2.06) were significantly linked to poor sleep quality. A dose-response relationship was observed across stages of swallowing difficulty, with both suspected and confirmed cases reporting significantly poorer sleep quality compared to individuals without swallowing issues (p for trend < 0.001). Higher OHRQoL scores were linked to better sleep quality (AOR = 0.97). Additionally, the combined presence of oral frailty and physical frailty was significantly associated with poor sleep quality (AOR = 2.71).

Conclusion: Oral and physical frailty are significantly associated with sleep quality in older adults. Interventions targeting swallowing difficulty, dry mouth, and physical frailty may improve sleep quality in this population.

Keywords: OF; dry mouth; oral; oral frailty; rehabilitation; sleep quality.

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