Healthy Brain Ageing Program, Brain and Mind Centre.
Faculty of Science, School of Psychology.
Curr Opin Psychiatry. 2018 Mar;31(2):153-159. doi: 10.1097/YCO.0000000000000397.
Research interest in sleep as a risk factor for dementia has grown, warranting an update in advances over the last 18 months, particularly in the mild cognitive impairment (MCI) stage in which interventions may be best targeted.
The current systematic review includes empiric research articles published since 2016 that have investigated sleep (excluding obstructive sleep apnea) in MCI. Published articles include case-control studies, those examining clinical correlates of sleep problems, sleep microarchitecture, neuroimaging studies and novel cerebrospinal and blood-based markers.
Evidence accumulated since 2016 continues to demonstrate that people with MCI manifest sleep disturbance on self-report measures. Neurophysiologically, sleep disturbance in MCI appears to be associated with diminished sleep spindles, key processes involved in overnight memory consolidation. Those with both MCI and sleep disturbance appear to have more pronounced functional connectivity alterations in temporoparietal brain regions and higher levels of the wake-promoting neurotransmitter orexin in cerebrospinal fluid than those with MCI alone. Novel findings also suggest that sleep may mediate homocysteine and oxidative stress mechanisms, warranting further exploration. Further studies focusing on novel interventions for sleep and circadian disturbance in MCI are warranted, particularly those targeting sleep spindles, orexin/hypocretin and the oxidative stress system.
作为痴呆症的危险因素，研究人员对睡眠的兴趣日益浓厚，这使得人们有必要对过去 18 个月来的研究进展进行更新，尤其是在轻度认知障碍（MCI）阶段，因为此时可能是干预的最佳时机。
本系统综述纳入了自 2016 年以来发表的实证研究文章，这些文章研究了 MCI 中的睡眠（不包括阻塞性睡眠呼吸暂停）。已发表的文章包括病例对照研究、那些检查睡眠问题的临床相关性、睡眠微结构、神经影像学研究以及新的脑脊液和基于血液的标志物的研究。
自 2016 年以来积累的证据继续表明，MCI 患者在自我报告测量中表现出睡眠障碍。神经生理学上，MCI 中的睡眠障碍似乎与睡眠纺锤波减少有关，而睡眠纺锤波是夜间记忆巩固的关键过程。与 MCI 患者相比，同时患有 MCI 和睡眠障碍的患者在颞顶叶脑区的功能连接改变更为明显，脑脊液中促进觉醒的神经递质食欲素水平也更高。新的研究结果还表明，睡眠可能介导同型半胱氨酸和氧化应激机制，值得进一步探索。需要进一步研究针对 MCI 中睡眠和昼夜节律障碍的新型干预措施，特别是针对睡眠纺锤波、食欲素/下丘脑分泌素和氧化应激系统的干预措施。
