Baek Min Seok, Han Kyungdo, Kwon Hyuk-Sung, Lee Yong-Ho, Cho Hanna, Lyoo Chul Hyoung
Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Seoul, South Korea.
Front Neurol. 2021 May 7;12:611446. doi: 10.3389/fneur.2021.611446. eCollection 2021.
This study aimed to investigate the risk and prognosis of Alzheimer's disease (AD) and vascular dementia (VaD) in patients with insomnia using the National Health Insurance Service database covering the entire population of the Republic of Korea from 2007 to 2014. In total, 2,796,871 patients aged 40 years or older with insomnia were enrolled, and 5,593,742 controls were matched using a Greedy digit match algorithm. Mortality and the rate of admission to a long-term care facility were estimated using multivariable Cox analysis. Of all patients with insomnia, 138,270 (4.94%) and 26,706 (0.96%) were newly diagnosed with AD and VaD, respectively. The incidence rate ratios for AD and VaD were 1.73 and 2.10, respectively, in patients with insomnia compared with those without. Higher mortality rates and long-term care facility admission rates were also observed in patients with dementia in the insomnia group. Known cardiovascular risk factors showed interactions with the effects of insomnia on the risk of AD and VaD. However, the effects of insomnia on the incidence of AD and VaD were consistent between the groups with and without cardiovascular risk factors. Insomnia is a medically modifiable and policy-accessible risk factor and prognostic marker of AD and VaD.
本研究旨在利用涵盖2007年至2014年韩国全体人口的国民健康保险服务数据库，调查失眠患者患阿尔茨海默病（AD）和血管性痴呆（VaD）的风险及预后情况。总共纳入了2796871名40岁及以上的失眠患者，并使用贪婪数字匹配算法匹配了5593742名对照。采用多变量Cox分析估计死亡率和入住长期护理机构的比率。在所有失眠患者中，分别有138270名（4.94%）和26706名（0.96%）被新诊断为AD和VaD。与无失眠的患者相比，失眠患者患AD和VaD的发病率比值分别为1.73和2.10。在失眠组的痴呆患者中也观察到较高的死亡率和长期护理机构入住率。已知的心血管危险因素显示出与失眠对AD和VaD风险的影响存在相互作用。然而，失眠对AD和VaD发病率的影响在有和没有心血管危险因素的组之间是一致的。失眠是一种医学上可改变且政策上可触及的AD和VaD的危险因素及预后标志物。
