Center for Memory Resources and Research, EA2691, Lille University Hospital, University of Lille Nord de France, Lille cedex, France.
J Nutr Health Aging. 2010 Mar;14(3):212-7. doi: 10.1007/s12603-010-0052-7.
This paper reviews the characteristics of sleep disorders found in people at a greater risk of dementia: the elderly adult, patients with mild cognitive impairment (MCI) and those with neurodegenerative diseases. The frequency of sleep architecture modifications and circadian rhythm sleep disturbances increases with age. Although around 40% of older adults complain of poor sleep, true sleep disorders are far less prevalent in healthy older adults and are frequently associated with comorbidities. The sleep disorders observed in Alzheimer's disease (AD) patients are often similar to (but more intense than) those found in non-demented elderly people. Poor sleep results in an increased risk of significant morbidities and even mortality in demented patients and constitutes a major source of stress for caregivers. The prevalence of primary sleep disorders such as rapid eye movement (REM) sleep behavior disorders (RBDs), restless legs syndrome (RLS), periodic limb movements (PLMs) and sleep-disordered breathing increases with age. There are no published data on RLS and PLMs in demented persons but RBDs and sleep apnea syndrome have been studied more extensively. In fact, RBDs are suggestive of Lewy body dementia (LBD) and are predictive for neurodegeneration in Parkinson's disease. Obstructive sleep apnea (OSA) shares common risk factors with AD and may even be an integral part of the pathological process in AD. In MCI patients, the hypotheses in which (i) sleep disorders may represent early predictive factors for progression to dementia and (ii) MCI is symptomatic of a non-diagnosed sleep disorder remain to be elucidated. Guidelines for drug and non-drug treatments of sleep disorders in the elderly and in demented patients are also considered in this review. In healthy but frail elderly people and in early-stage AD patients, sleep should be more thoroughly characterized (notably by using standardized interviews and polysomnographic recording).
本文综述了痴呆高危人群（老年人、轻度认知障碍患者和神经退行性疾病患者）的睡眠障碍特征。睡眠结构改变和昼夜节律睡眠障碍的频率随年龄增长而增加。虽然约 40%的老年人抱怨睡眠质量差，但真正的睡眠障碍在健康老年人中并不常见，且常与合并症相关。在阿尔茨海默病（AD）患者中观察到的睡眠障碍通常与非痴呆老年人相似（但更严重）。睡眠质量差会增加痴呆患者发生严重合并症甚至死亡的风险，并给护理人员带来巨大压力。原发性睡眠障碍（如快速眼动睡眠行为障碍、不宁腿综合征、周期性肢体运动和睡眠呼吸障碍）的患病率随年龄增长而增加。关于痴呆患者的 RLS 和 PLMs 尚无发表数据，但 RBDs 和睡眠呼吸暂停综合征已有较多研究。事实上，RBDs 提示路易体痴呆（LBD），且对帕金森病的神经退行性变具有预测作用。阻塞性睡眠呼吸暂停（OSA）与 AD 具有共同的危险因素，甚至可能是 AD 病理过程的一部分。在 MCI 患者中，以下两种假说仍有待阐明：（i）睡眠障碍可能是向痴呆进展的早期预测因素；（ii）MCI 是未确诊睡眠障碍的症状。本文还讨论了老年人和痴呆患者睡眠障碍的药物和非药物治疗指南。在健康但体弱的老年人和早期 AD 患者中，应更全面地描述睡眠情况（尤其是通过使用标准化访谈和多导睡眠图记录）。
