Institut Universitaire de Geriatrie de Montreal and CRIUGM, CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montreal, Canada.
PERFORM Centre, Concordia University, Montreal, Canada.
Sleep. 2019 Aug 1;42(8). doi: 10.1093/sleep/zsz114.
This study examined the differences in cognitive function between middle-aged and older adults with insomnia disorder, insomnia symptoms only (ISO) or no insomnia symptoms (NIS), in the context of other health and lifestyle factors.
Twenty-eight thousand four hundred eighty-five participants >45 years completed questionnaires, physical examinations, and neuropsychological testing across domains of processing speed, memory, and executive functions. An eight-question instrument assessed participants' sleep, defining subjects with insomnia symptoms, probable insomnia disorder (PID), or NIS. The associations between these three groups and cognitive performance were examined with linear regression models adjusted for lifestyle and clinical factors.
PID was identified in 1,068 participants (3.7% of the sample) while 7,813 (27.5%) experienced ISO. Participants with PID exhibited greater proportions of adverse medical and lifestyle features such as anxiety, depression, and diabetes than both other groups. Analyses adjusting for age, sex, education, as well as medical and lifestyle factors demonstrated that adults with PID exhibited declarative memory deficits (Rey Auditory Verbal Learning Test) compared with ISO or NIS. Adults with insomnia symptoms exhibited better performance on a task of mental flexibility than both other groups.
These findings suggest that insomnia disorder in middle-aged and older adults is associated with poorer health outcomes and worse memory performance than adults with insomnia symptoms alone or without any sleep complaints, even after adjustment for comorbidities. The assessment of longitudinal data within this cohort will be critical to understand if insomnia disorder may increase the risk of further cognitive decline.
本研究在考虑其他健康和生活方式因素的情况下，比较了中年和老年失眠障碍患者、仅有失眠症状（ISO）或无失眠症状（NIS）患者之间的认知功能差异。
28485 名年龄>45 岁的参与者完成了问卷调查、体格检查和神经心理测试，涵盖了处理速度、记忆和执行功能等领域。一个由 8 个问题组成的工具评估了参与者的睡眠情况，将有失眠症状、可能的失眠障碍（PID）或无失眠症状的受试者定义为 PID、ISO 或 NIS。使用线性回归模型，调整生活方式和临床因素，检验这三组与认知表现之间的关联。
在 28485 名参与者中，有 1068 名（3.7%）患有 PID，有 7813 名（27.5%）患有 ISO。患有 PID 的参与者比其他两组具有更多的不良医疗和生活方式特征，如焦虑、抑郁和糖尿病。在调整年龄、性别、教育程度以及医疗和生活方式因素后，分析表明，与 ISO 或 NIS 相比，患有 PID 的成年人在言语性陈述性记忆测试（Rey 听觉言语学习测试）中表现出记忆缺陷。与其他两组相比，有失眠症状的成年人在心理灵活性任务上的表现更好。
这些发现表明，中年和老年失眠障碍患者的健康状况较差，记忆表现较仅有失眠症状或无睡眠抱怨的成年人更差，即使在调整了合并症后也是如此。在该队列中评估纵向数据将是至关重要的，以了解失眠障碍是否会增加进一步认知能力下降的风险。
