National Institute on Drug Dependence, Peking University, Beijing 100191, China; Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China.
Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China.
Sleep Med Rev. 2018 Aug;40:4-16. doi: 10.1016/j.smrv.2017.06.010. Epub 2017 Jul 6.
Sleep disturbances and dementia are two common and significant health problems in older adults. Investigations suggest that sleep disturbances might increase the risk of dementia. The aim of the present study was to systematically review and meta-analyze the predictive roles of overall sleep disturbances, their subtypes (e.g., insomnia, sleep disordered breathing [SDB]), and other sleep problems (e.g., excessive daytime sleepiness, sleep-related movement disorder, circadian rhythm sleep disorder, and nonspecific sleep problems) in incident all-cause dementia and Alzheimer's disease (AD) and vascular dementia subtypes. We performed a systematic search of the PubMed, EMBase, ISI Web of Science, and PsycINFO databases for longitudinal studies that were published up to October 28, 2016. A total of 12,926 papers were retrieved. Eighteen longitudinal studies that included 246,786 subjects at baseline and 25,847 dementia cases after an average 9.49 y of follow-up were eligible for inclusion. Compared with individuals without sleep disturbances, subjects who reported sleep disturbances had a higher risk of incident all-cause dementia, AD, and vascular dementia. The subgroup analysis showed that insomnia increased the risk of AD but not vascular or all-cause dementia. In contrast, SDB was associated with a higher incidence of all-cause dementia, AD, and vascular dementia. This meta-analysis suggests that sleep disturbances may predict the risk of incident dementia. Moreover, insomnia was associated only with incident AD, and SDB was a risk factor of all-cause dementia, AD, and vascular dementia. However, sleep disturbances were evaluated mainly based on self-reports, and some confounders may mediate the relationship between sleep disturbances and dementia. Therefore, the results should be further validated. In summary, these findings may help identify individuals who are at risk for dementia and optimize early prevention strategies.
睡眠障碍和痴呆是老年人中两种常见且严重的健康问题。研究表明，睡眠障碍可能会增加痴呆的风险。本研究旨在系统地综述和荟萃分析总体睡眠障碍及其亚型（如失眠、睡眠呼吸障碍[SDB]）以及其他睡眠问题（如白天过度嗜睡、睡眠相关运动障碍、昼夜节律睡眠障碍和非特异性睡眠问题）在发生全因痴呆和阿尔茨海默病（AD）和血管性痴呆亚型中的预测作用。我们对PubMed、EMBase、ISI Web of Science 和 PsycINFO 数据库进行了系统检索，以查找截至 2016 年 10 月 28 日发表的纵向研究。共检索到 12926 篇论文。共有 18 项纵向研究符合纳入标准，这些研究共纳入了 246786 名基线期无睡眠障碍的受试者和 25847 名平均随访 9.49 年后发生痴呆的病例。与无睡眠障碍的个体相比，报告有睡眠障碍的个体发生全因痴呆、AD 和血管性痴呆的风险更高。亚组分析显示，失眠增加了 AD 的风险，但不会增加血管性或全因痴呆的风险。相反，SDB 与全因痴呆、AD 和血管性痴呆的发生率增加有关。这项荟萃分析表明，睡眠障碍可能预测痴呆的发病风险。此外，失眠仅与 AD 的发病有关，而 SDB 是全因痴呆、AD 和血管性痴呆的危险因素。然而，睡眠障碍主要是基于自我报告进行评估的，一些混杂因素可能会影响睡眠障碍与痴呆之间的关系。因此，结果还需要进一步验证。综上所述，这些发现可能有助于识别痴呆高危人群，并优化早期预防策略。
