Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA.
Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 292901, USA.
Int J Environ Res Public Health. 2021 Jan 5;18(1):351. doi: 10.3390/ijerph18010351.
There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study ( = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants' symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI, or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04-1.06) and dementia (HR = 1.05; 95% CI: 1.03-1.05), after fully adjusting. Using a nationally representative sample of adults age 51 and older, this study found that time-varying insomnia symptoms are associated with risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.
关于失眠与轻度认知障碍 (MCI) 或痴呆发病之间的关系，存在相互矛盾的证据。本研究旨在评估时变失眠是否与 MCI 和痴呆的发展有关。使用了 2002 年至 2014 年健康与退休研究 (n=13833，女性占 59.4%) 的数据。使用简短失眠问卷来确定失眠症状，并将其汇编为失眠严重指数，范围从 0 到 4。在分析中，参与者的症状可能会随时间而变化。痴呆症使用健康与退休研究 (HRS) 的全球认知评估工具的结果来定义。受访者被分为痴呆症、MCI 或认知健康。使用计数过程（开始-停止时间）的时变暴露 Cox 比例风险模型进行分析。对于失眠症状指数每增加一个单位，MCI（HR=1.05；95%CI：1.04-1.06）和痴呆症（HR=1.05；95%CI：1.03-1.05）的风险就会增加 5%，在充分调整后。本研究使用了一个代表年龄在 51 岁及以上的成年人的全国性样本，发现时变失眠症状与 MCI 和痴呆症的风险相关。这强调了识别睡眠障碍及其随时间变化的重要性，因为它们可能是 MCI 和痴呆症的重要风险因素。
