University of Sussex, Brighton, England, UK.
Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, England, UK.
J Alzheimers Dis. 2017;58(4):993-1002. doi: 10.3233/JAD-161287.
Sleep disturbances are routinely encountered in Alzheimer's disease (AD) and affect about 25-40% of patients in the mild-to-moderate stages of the disease. In many, sleep pathology may represent a symptom of the underlying neurodegeneration. However, a history of sleep disruption occurring years prior to onset of cognitive symptoms could represent a potential risk factor for AD. The aim of the present narrative review was to evaluate current evidence linking sleep disturbances with AD development and to understand the mechanisms that may contribute to this. Although the mechanisms by which poor sleep may contribute to AD genesis is not fully understood, emerging evidence linking disturbances in the sleep wake cycle with Aβ deposition is shedding light on the relationship between sleep pathology and the subsequent development of AD. Aβ burden appears to be enhanced by sleep-wake cycle disruptions and is suspected as being an important mechanism by which sleep disruptions contribute in AD development. Other mechanisms triggered by sleep disruption may also be involved in AD development, such as brain hypoxia, oxidative stress, circadian activity rhythms disturbances, overexpression of orexins, and blood-brain barrier impairment. Further understanding of the link between sleep disturbances and future development of AD is still needed before sleep disturbances are clearly marked as a preventable risk factor for AD. In these circumstances, early lifestyle interventions to help increase the quantity and quality of sleep may have a favorable outcome on decreasing the incidence of AD and this needs to be investigated further.
睡眠障碍在阿尔茨海默病（AD）中经常出现，影响约 25-40%的轻度至中度疾病患者。在许多情况下，睡眠病理学可能是潜在神经退行性变的症状。然而，在认知症状出现前多年就存在睡眠中断的病史可能代表 AD 的一个潜在风险因素。本综述的目的是评估将睡眠障碍与 AD 发展联系起来的现有证据，并了解可能导致这种情况的机制。尽管睡眠不良如何导致 AD 发生的机制尚不完全清楚，但将睡眠-觉醒周期紊乱与 Aβ沉积联系起来的新证据揭示了睡眠病理学与 AD 后续发展之间的关系。睡眠-觉醒周期紊乱似乎增强了 Aβ负担，并且被怀疑是睡眠紊乱导致 AD 发展的重要机制。睡眠中断引发的其他机制也可能参与 AD 的发展，例如脑缺氧、氧化应激、昼夜活动节律紊乱、食欲素表达过度和血脑屏障损伤。在将睡眠障碍明确标记为 AD 的可预防风险因素之前，仍需要进一步了解睡眠障碍与 AD 未来发展之间的联系。在这种情况下，早期的生活方式干预措施以帮助增加睡眠的数量和质量可能对降低 AD 的发病率有有利的结果，这需要进一步研究。
