Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York.
Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York.
Am J Prev Med. 2023 Jun;64(6):781-787. doi: 10.1016/j.amepre.2023.01.008. Epub 2023 Jan 26.
Previous research has identified a link between sleep disturbances and cognitive impairment; however, no study has examined this relationship using a national United States sample. This study examines how multiple longitudinal measures of sleep disturbances (sleep-initiation insomnia, sleep-maintenance insomnia, sleep-medication usage) are associated with dementia risk.
Ten annual waves (2011-2020) of prospective cohort data from a nationally representative U.S. sample of adults aged ≥65 years were analyzed from the National Health and Aging Trends Study. Sleep disturbances were converted into a longitudinal score and measured as sleep-initiation insomnia (trouble falling asleep in 30 minutes), sleep-maintenance insomnia (trouble falling asleep after waking up early), and sleep-medication usage (taking medication to help sleep). Cox regression models analyzed time to dementia diagnosis for a sample of 6,284 respondents.
In the unadjusted model, sleep-initiation insomnia was significantly associated with a 51% increased dementia risk (hazard ratio=1.51, 95% CI=1.19, 1.90). Adjusted for sociodemographics, sleep-medication usage was significantly associated with a 30% increased dementia risk (adjusted hazard ratio=1.30, 95% CI=1.08-1.56). Adjusted for sociodemographics and health, sleep-maintenance insomnia was significantly associated with a 40% decreased dementia risk (adjusted hazard ratio=0.60, 95% CI=0.46, 0.77).
These findings suggest that sleep-initiation insomnia and sleep-medication usage may elevate dementia risk. On the basis of the current evidence, sleep disturbances should be considered when assessing the risk profile for dementia. Future research is needed to examine other sleep disturbance measures and to explore the mechanisms for decreased dementia risk among older adults with sleep-maintenance insomnia.
先前的研究已经确定了睡眠障碍与认知障碍之间存在关联；然而，尚无研究使用美国全国样本对此关系进行检验。本研究使用美国全国具有代表性的成年人样本，考察了多种纵向睡眠障碍指标（入睡期失眠、睡眠维持期失眠、睡眠用药）与痴呆风险之间的关联。
分析了来自美国全国健康老龄化趋势研究的一个年龄在 65 岁及以上的具有全国代表性的成年人的前瞻性队列数据的 10 个年度波次（2011-2020 年）。睡眠障碍被转化为纵向评分，以入睡期失眠（入睡 30 分钟内有困难）、睡眠维持期失眠（早醒后入睡有困难）和睡眠用药（使用药物帮助睡眠）进行衡量。Cox 回归模型分析了 6284 名受访者的痴呆诊断时间。
在未调整模型中，入睡期失眠与痴呆风险增加 51%显著相关（风险比=1.51，95%可信区间=1.19，1.90）。调整社会人口统计学因素和睡眠用药后，睡眠维持期失眠与痴呆风险增加 30%显著相关（调整后的风险比=1.30，95%可信区间=1.08-1.56）。调整社会人口统计学因素和健康状况后，睡眠维持期失眠与痴呆风险降低 40%显著相关（调整后的风险比=0.60，95%可信区间=0.46，0.77）。
这些发现表明入睡期失眠和睡眠用药可能会增加痴呆风险。根据现有证据，在评估痴呆风险状况时应考虑睡眠障碍。需要进一步研究来检验其他睡眠障碍指标，并探索睡眠维持期失眠的老年人痴呆风险降低的机制。
