Department of Neurology, University of New Mexico, Albuquerque, New Mexico, U.S.A.; and.
Department of Neurology, Cleveland Clinic, Cleveland, Ohio, U.S.A.
J Clin Neurophysiol. 2022 Jul 1;39(5):327-334. doi: 10.1097/WNP.0000000000000818. Epub 2022 Jan 19.
Middle-aged or older adults who self-report sleep-wake disorders are at an increased risk for incident dementia, mild cognitive impairment, and Alzheimer disease. Dementia in people with mild cognitive impairment and Alzheimer disease who complain of sleep-wake disorders progress faster than those without sleep-wake disorders. Removal of amyloid-beta and tau tangles occurs preferentially in non-rapid eye movement 3 sleep and fragmented or insufficient sleep may lead to accumulation of these neurotoxins even in preclinical stages. Selective atrophy in the medial temporal lobe on brain MRI has been shown to predict impaired coupling of slow oscillations and sleep spindles. Impaired slow wave-spindle coupling has been shown to correlate with impaired overnight memory consolidation. Whereas, a decrease in the amplitude of 0.6 to 1 Hz slow wave activity predicts higher cortical Aβ burden on amyloid PET scans. Overexpression of the wake-promoting neurotransmitter orexin may predispose patients with mild cognitive impairment and Alzheimer disease to increased wakefulness, decreasing time they need to clear from the brain the neurotoxic accumulation of amyloid-beta and especially tau. More research exploring these relationships is needed and continuing.
中年或老年人群体，如果自我报告存在睡眠-觉醒障碍，则发生痴呆、轻度认知障碍和阿尔茨海默病的风险会增加。在有睡眠-觉醒障碍的轻度认知障碍和阿尔茨海默病患者中，痴呆的进展速度比没有睡眠-觉醒障碍的患者更快。在非快速眼动睡眠 3 期和碎片化或不足的睡眠中，β淀粉样蛋白和 tau 缠结更易被清除，这可能导致这些神经毒素在临床前阶段的积累。脑 MRI 上内侧颞叶的选择性萎缩已被证明可以预测慢波和睡眠纺锤波的耦合受损。慢波-纺锤波耦合受损与夜间记忆巩固受损相关。而 0.6 至 1 Hz 慢波活动幅度的降低预示着淀粉样蛋白 PET 扫描中皮质 Aβ 负担更高。促醒神经递质食欲素的过度表达可能使轻度认知障碍和阿尔茨海默病患者更容易保持清醒状态，减少他们需要从大脑中清除淀粉样蛋白-β和 tau 神经毒性积累的时间。需要进一步研究和探索这些关系。
