Suemoto Claudia K, Santos Ronaldo B, Giatti Soraya, Aielo Aline N, Silva Wagner A, Parise Barbara K, Cunha Lorenna F, Souza Silvana P, Griep Rosane H, Brunoni Andre R, Lotufo Paulo A, Bensenor Isabela M, Drager Luciano F
Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.
Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.
J Sleep Res. 2023 Apr;32(2):e13659. doi: 10.1111/jsr.13659. Epub 2022 May 29.
Sleep disturbances often co-exist, which challenges our understanding of their potential impact on cognition. We explored the cross-sectional associations of insomnia and objective measures of sleep with cognitive performance in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study stratified by middle-aged and older adults. Participants aged ≥55 years underwent cognitive evaluations, polygraphy for 1 night, and actigraphy for 7 days. Insomnia was evaluated using the Clinical Interview Scheduled Revised. Obstructive sleep apnea (OSA) and short sleep duration (SSD) were defined by an apnea-hypopnea index (AHI) of ≥15 events/h and <6 h/ night, respectively. In 703 participants (mean [SD] age 62 [6] years, 44% men), cognition was evaluated using a 10-word list, verbal fluency, and trail-making tests. The frequencies of insomnia, SSD, and OSA were 11%, 24%, and 33%, respectively. In all, 4% had comorbid OSA and insomnia, and 11% had both OSA and SSD. Higher wake after sleep onset (β = -0.004, 95% confidence interval [CI] -0.008, -0.001) and the number of awakenings (β = -0.006, 95% CI -0.012, -0.001) were associated with worse verbal fluency performance. Compared to those without insomnia, older participants with insomnia had worse global performance (β = -0.354, 95% CI -0.671, -0.038). Insomnia was an effect modifier in the associations between AHI and executive function performance (p for the interaction between insomnia and AHI = 0.004) and between oxygen saturation <90% and memory performance (p for the interaction between insomnia and oxygen saturation = 0.02). Although some associations between sleep measures and cognition were significant, they should be considered with caution due to the large sample size and multiple testing performed in this study.
睡眠障碍常常并存，这对我们理解它们对认知的潜在影响提出了挑战。在巴西成人健康纵向研究（ELSA - Brasil）中，我们按中年和老年人分层，探讨了失眠及客观睡眠指标与认知表现之间的横断面关联。年龄≥55岁的参与者接受了认知评估、一晚的多导睡眠监测以及为期7天的活动监测。使用修订后的临床访谈日程表评估失眠情况。阻塞性睡眠呼吸暂停（OSA）和短睡眠时间（SSD）分别通过呼吸暂停低通气指数（AHI）≥15次/小时和每晚<6小时来定义。在703名参与者（平均[标准差]年龄62[6]岁，44%为男性）中，使用10词列表、语言流畅性和连线测验来评估认知。失眠、SSD和OSA的发生率分别为11%、24%和33%。总体而言，4%的人患有OSA和失眠共病，11%的人同时患有OSA和SSD。睡眠开始后较高的清醒时间（β = -0.004，95%置信区间[CI] -0.008，-0.001）和觉醒次数（β = -0.006，95% CI -0.012，-0.001）与较差的语言流畅性表现相关。与没有失眠的参与者相比，患有失眠的老年参与者的整体表现更差（β = -0.354，95% CI -0.671，-0.038）。失眠是AHI与执行功能表现之间（失眠与AHI之间交互作用的p值 = 0.004）以及血氧饱和度<90%与记忆表现之间（失眠与血氧饱和度之间交互作用的p值 = 0.02）关联的效应修饰因素。尽管一些睡眠指标与认知之间的关联具有显著性，但由于本研究样本量较大且进行了多次检验，这些关联应谨慎看待。
