Sleep Research & Treatment Center, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA.
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA.
Sleep Health. 2020 Feb;6(1):71-78. doi: 10.1016/j.sleh.2019.09.003. Epub 2019 Nov 21.
Cognitive impairment is a leading cause of disability worldwide, and cardiometabolic conditions are key contributors to its development. Short sleep is also a potential contributor to brain health; however, its role in predicting mortality remains poorly understood. We investigated whether objective short sleep duration increases the risk of all-cause mortality associated with coexisting cognitive impairment and cardiometabolic conditions, i.e., possible vascular cognitive impairment (VCI).
This is a longitudinal study.
This is a population-based, in-lab study.
A total of 1,524 adults (aged 48.9±13.4 years, 53.4% women) from the Penn State Adult Cohort were included in the study.
All-cause mortality was estimated after 19.1±5.1 years of follow-up. Neuropsychological testing was performed to ascertain cognitive impairment. Clinical history and physical examination were performed to ascertain stage 2 hypertension, type 2 diabetes, heart disease, and stroke. Possible VCI was defined as the presence of any of these cardiometabolic conditions and cognitive impairment. In-lab, 8-hour polysomnography (PSG) was performed to ascertain short sleep duration (i.e., <6 hours).
Multivariable-adjusted Cox proportional-hazard models showed that the risk of all-cause mortality associated with cardiometabolic conditions (n=864) and possible VCI (n=122) was significantly increased in those who slept <6 hours at baseline (hazards ratio [HR] = 1.79, 95% confidence interval [CI] = 1.28-2.51 and HR = 4.01, 95% CI = 2.66-6.05, respectively), while it was negligible in those who slept ≥6 hours (HR = 1.44, 95% CI = 0.99-2.09 and HR = 1.41, 95% CI = 0.70-2.83, respectively).
Objective short sleep duration predicts the mortality prognosis of adults with possible VCI. Sleep duration and cognition should be objectively evaluated in patients presenting with a cluster of cardiometabolic conditions and sleep and cognitive complaints. Short sleep is a useful risk factor in the prediction of adverse cardiometabolic and brain health outcomes.
认知障碍是全球范围内导致残疾的主要原因，而心血管代谢状况是其发展的关键因素。睡眠不足也是大脑健康的潜在影响因素；然而，其预测死亡率的作用仍知之甚少。我们研究了客观的短睡眠时间是否会增加与共存认知障碍和心血管代谢状况相关的全因死亡率的风险，即可能的血管性认知障碍（VCI）。
这是一项纵向研究。
这是一项基于人群的实验室研究。
共有 1524 名成年人（年龄 48.9±13.4 岁，53.4%为女性）参与了宾夕法尼亚州立成人队列研究。
在 19.1±5.1 年的随访后估计全因死亡率。进行神经心理学测试以确定认知障碍。进行临床病史和体格检查以确定 2 期高血压、2 型糖尿病、心脏病和中风。可能的 VCI 定义为存在任何这些心血管代谢状况和认知障碍。在实验室中，进行 8 小时多导睡眠图（PSG）以确定短睡眠时间（即<6 小时）。
多变量调整的 Cox 比例风险模型显示，与心血管代谢状况（n=864）和可能的 VCI（n=122）相关的全因死亡率风险在基线时睡眠<6 小时的患者中显著增加（风险比 [HR] = 1.79，95%置信区间 [CI] = 1.28-2.51 和 HR = 4.01，95% CI = 2.66-6.05），而在睡眠≥6 小时的患者中则微不足道（HR = 1.44，95% CI = 0.99-2.09 和 HR = 1.41，95% CI = 0.70-2.83）。
客观的短睡眠时间预测了可能患有 VCI 的成年人的死亡率预后。在出现心血管代谢异常和睡眠及认知问题的患者中，应客观评估睡眠持续时间和认知能力。睡眠不足是预测不良心血管代谢和大脑健康结局的有用危险因素。
