Sleep Disturbances and Sarcopenia in Older Adults: Clinical Associations, Potential Mechanisms, and Management Strategies

Sarcopenia is an age-related syndrome characterized by reduced skeletal muscle mass, decreased muscle strength, and impaired physical performance, and is an important contributor to falls, disability, hospitalization, and mortality in older adults. Sleep disturbances, including abnormal sleep duration, poor sleep quality, insomnia, circadian disruption, and obstructive sleep apnea (OSA), are also highly prevalent in this population and may be associated with poorer physical performance. Accumulating observational evidence suggests an association between sleep disturbances and sarcopenia, although its directionality remains uncertain. This narrative review summarizes current clinical evidence linking sleep disturbances to sarcopenia in older adults, discusses potential biological and behavioral pathways underlying this relationship, and outlines clinically relevant management strategies. A particular focus is the comparison of evidence across sleep domains, sarcopenia components, and study designs, distinguishing clinically defined sarcopenia from individual muscle traits and biological plausibility from demonstrated mediation. Potential pathways involve circadian disruption, neuroendocrine and metabolic dysregulation, chronic inflammation, mitochondrial dysfunction and oxidative stress, although direct mechanistic evidence in older adults remains limited. Sleep assessment and management of clinically identified sleep disturbances may complement exercise and nutritional support, but their effects on sarcopenia outcomes remain uncertain. The available clinical evidence is predominantly observational and often cross-sectional; prospective studies and adequately powered randomized trials in older adults with both conditions are needed to clarify causality and treatment benefits.