Keil Samantha A, Schindler Abigail G, Wang Marie X, Piantino Juan, Silbert Lisa C, Elliott Jonathan E, Thomas Ronald G, Willis Sherry, Lim Miranda M, Iliff Jeffrey J
VISN 20 Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA.
medRxiv. 2023 Aug 4:2023.06.07.23291098. doi: 10.1101/2023.06.07.23291098.
Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions. It remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment.
To evaluate how longitudinal sleep patterns contribute to age-related changes in cognitive function in healthy adults.
This study utilizes retrospective longitudinal analyses of a community-based study within Seattle, evaluating self-reported sleep (1993-2012) and cognitive performance (1997-2020) in aged adults.
The main outcome is cognitive impairment as defined by sub-threshold performance on 2 of 4 neuropsychological batteries: Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, Trail Making Test, and Wechsler Adult Intelligent Scale (Revised). Sleep duration was defined through self-report of 'average nightly sleep duration over the last week' and assessed longitudinally. Median sleep duration, change in sleep duration (slope), variability in sleep duration (standard deviation, Sleep Variability), and sleep phenotype ("Short Sleep" median ≤7hrs.; "Medium Sleep" median = 7hrs; "Long Sleep" median ≥7hrs.).
A total of 822 individuals (mean age of 76.2 years [11.8]; 466 women [56.7%]; 216 allele positive [26.3%]) were included in the study. Analysis using a Cox Proportional Hazard Regression model (concordance 0.70) showed that increased Sleep Variability (95% CI [1.27,3.86]) was significantly associated with the incidence of cognitive impairment. Further analysis using linear regression prediction analysis (R=0.201, F (10, 168)=6.010, p=2.67E-07) showed that high Sleep Variability (β=0.3491; p=0.048) was a significant predictor of cognitive impairment over a 10-year period.
High variability in longitudinal sleep duration was significantly associated with the incidence of cognitive impairment and predictive of decline in cognitive performance ten years later. These data highlight that instability in longitudinal sleep duration may contribute to age-related cognitive decline.
睡眠障碍和临床睡眠疾病与全因性痴呆和神经退行性疾病相关。目前尚不清楚睡眠的纵向变化如何影响认知障碍的发生率。
评估纵向睡眠模式如何影响健康成年人认知功能的年龄相关变化。
设计、设置、参与者：本研究利用了西雅图一项基于社区研究的回顾性纵向分析，评估老年人自我报告的睡眠情况（1993 - 2012年）和认知表现（1997 - 2020年）。
主要结局是认知障碍，其定义为在以下4种神经心理测试中的2项测试成绩低于临界值：简易精神状态检查表（MMSE）、马蒂斯痴呆评定量表、连线测验和韦氏成人智力量表（修订版）。睡眠时长通过自我报告“过去一周的平均夜间睡眠时间”来定义，并进行纵向评估。中位睡眠时长、睡眠时长变化（斜率）、睡眠时长变异性（标准差，睡眠变异性）以及睡眠表型（“短睡眠”中位值≤7小时；“中等睡眠”中位值 = 7小时；“长睡眠”中位值≥7小时）。
共有822人（平均年龄76.2岁[11.8]；466名女性[56.7%]；216名携带等位基因阳性[26.3%]）纳入研究。使用Cox比例风险回归模型（一致性0.70）进行的分析表明，睡眠变异性增加（95%置信区间[1.27, 3.86]）与认知障碍的发生率显著相关。使用线性回归预测分析进一步分析（R = 0.201，F(10, 168) = 6.010，p = 2.67E - 07）表明，高睡眠变异性（β = 0.3491；p = 0.048）是10年内认知障碍的显著预测因素。
纵向睡眠时长的高变异性与认知障碍的发生率显著相关，并能预测10年后认知表现的下降。这些数据表明，纵向睡眠时长的不稳定性可能导致与年龄相关的认知衰退。
