Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA.
Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA.
Sleep. 2021 Jan 21;44(1). doi: 10.1093/sleep/zsaa150.
Insomnia with objective short sleep duration has been previously associated with adverse cardiometabolic health outcomes as well as poorer cognitive performance in otherwise noncognitively impaired adults. However, studies demonstrating an increased prevalence of cognitive impairment (CI) in this insomnia phenotype are lacking.
We analyzed data from Penn State Adult Cohort (N = 1,524; 48.9 ± 13.4 years; 53.4% women). Self-reported sleep difficulty was defined as normal sleep (n = 899), poor sleep (n = 453), and chronic insomnia (n = 172). Objective short sleep duration was defined as less than 6-h of sleep, based on in-lab, 8-h polysomnography. CI (n = 155) and possible vascular cognitive impairment (pVCI, n = 122) were ascertained using a comprehensive neuropsychological battery. Analyses adjusted for age, sex, race, education, body mass index, apnea/hypopnea index, smoking, alcohol, psychoactive medication, and mental and physical health problems.
Participants who reported poor sleep or chronic insomnia and slept objectively less than 6 hours were associated with a 2-fold increased odds of CI (OR = 2.06, 95% confidence limits [CL] = 1.15-3.66 and OR = 2.18, 95% CL = 1.07-4.47, respectively) and of pVCI (OR = 1.94, 95% CL = 1.01-3.75 and OR = 2.33, 95% CL = 1.07-5.06, respectively). Participants who reported poor sleep or chronic insomnia and slept objectively more than 6 hours were not associated with increased odds of either CI (OR = 0.72, 95% CL = 0.30-1.76 and OR = 0.75, 95% CL = 0.21-2.71, respectively) or pVCI (OR = 1.08, 95% CL = 0.42-2.74 and OR = 0.76, 95% CL = 0.16-3.57, respectively).
Insomnia with objective short sleep duration is associated with an increased prevalence of CI, particularly as it relates to cardiometabolic health (i.e. pVCI). These data further support that this insomnia phenotype may be a more biologically severe form of the disorder associated with cardiovascular, cerebrovascular, and neurocognitive morbidity.
客观上睡眠时间短的失眠症与不良的心血管代谢健康结果以及认知表现较差有关，这些都是在非认知受损的成年人中观察到的。然而，目前缺乏在这种失眠表型中观察到认知障碍（CI）发生率增加的研究。
我们分析了宾夕法尼亚州成人队列的数据（N=1524；48.9±13.4 岁；53.4%为女性）。自我报告的睡眠困难定义为正常睡眠（n=899）、睡眠不佳（n=453）和慢性失眠（n=172）。客观上的短睡眠时间定义为少于 6 小时的睡眠，基于实验室的 8 小时多导睡眠图。使用综合神经心理学测试包确定 CI（n=155）和可能的血管性认知障碍（pVCI，n=122）。分析调整了年龄、性别、种族、教育程度、体重指数、呼吸暂停/低通气指数、吸烟、饮酒、精神活性药物以及心理和身体健康问题。
报告睡眠不佳或慢性失眠且客观睡眠时间少于 6 小时的参与者，其 CI（OR=2.06，95%置信区间[CL]为 1.15-3.66 和 OR=2.18，95%CL=1.07-4.47）和 pVCI（OR=1.94，95%CL=1.01-3.75 和 OR=2.33，95%CL=1.07-5.06）的发生风险增加了两倍。报告睡眠不佳或慢性失眠且客观睡眠时间超过 6 小时的参与者，其 CI（OR=0.72，95%CL=0.30-1.76 和 OR=0.75，95%CL=0.21-2.71）或 pVCI（OR=1.08，95%CL=0.42-2.74 和 OR=0.76，95%CL=0.16-3.57）的发生风险均无显著增加。
客观上睡眠时间短的失眠与 CI 的患病率增加有关，尤其是与心血管代谢健康相关的 pVCI。这些数据进一步支持这种失眠表型可能是与心血管、脑血管和神经认知发病率相关的更严重的生物学疾病形式。
