Department of Neurology, The Second People's Hospital of Hefei, Hefei, China.
Anhui Provincial Center for Disease Control and Prevention, Hefei, China.
Front Public Health. 2024 Jan 5;11:1047025. doi: 10.3389/fpubh.2023.1047025. eCollection 2023.
To examine associations of sleep duration and quality with cognitive impairment in older adults and the moderating role of gender and age in these associations.
This community-based cross-sectional study included 4,837 participants aged 60 years and above. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE), and the participants were grouped based on the presence of cognitive impairment. The duration and quality of sleep were assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression models were used to analyze associations of sleep duration and quality with cognitive impairment. The role of age and gender in these associations have also been explored.
The age (mean ± SD) of the participants was 71.13 ± 5.50 years. Of all older adults, 1,811 (37.44%) were detected as cognitive impairment, and 1755 (36.8%) had poor sleep quality. Among those with cognitive impairment, 51.09% were female. The proportion of the participants with cognitive impairment is significantly higher in those with symptoms of depression (49.73%, 273/549) ( = 41.275, < 0.001) than in those without depressive symptoms. After adjustment for multiple confounding factors and the crucial covariate (depressive symptoms), the odds ratios (OR) (95% confidence interval [CI]) of cognitive impairment (with 7-7.9 h regarded as the reference group) for individuals with a sleep duration of <6, 6-6.9, 8-8.9, and ≥ 9 h were 1.280 (1.053-1.557), 1.425 (1.175-1.728), 1.294 (1.068-1.566), and 1.360 (1.109-1.668), respectively. Subgroup analysis showed a V-shaped association between night sleep duration and cognitive impairment in males ( ≤ 0.05), and the association was stronger for individuals aged 60-80 years. With regard to sleep quality, the fully adjusted OR (95%CI) of cognitive impairment were 1.263 (1.108-1.440). According to scores of subscales in the PSQI, daytime dysfunction was associated with an increased risk of cognitive impairment (OR: 1.128, 95%CI: 1.055-1.207). Subgroup analysis also revealed a statistically significant correlation between poor sleep quality (including daytime dysfunction) and cognitive impairment in different gender and age groups, with the association being stronger in females (OR: 1.287, 95%CI: 1.080-1.534) and those aged 81-97 years (OR: 2.128, 95%CI: 1.152-3.934). For cognitive impairment, the group aged 81-97 years with daytime dysfunction was associated with a higher odds ratio than other age groups.
The present study showed that inadequate or excessive sleep was associated with cognitive impairment, especially in males, who exhibited a V-shaped association. Cognitive impairment was also associated with poor sleep quality as well as daytime dysfunction, with females and individuals aged 81-97 years exhibiting the strongest association.
探讨老年人睡眠时长和睡眠质量与认知障碍的关系，以及性别和年龄在这些关系中的调节作用。
本社区横断面研究纳入了 4837 名年龄在 60 岁及以上的参与者。使用简易精神状态检查量表（MMSE）中文版评估认知功能，根据认知障碍的存在将参与者分组。使用匹兹堡睡眠质量指数（PSQI）评估睡眠时长和睡眠质量。采用多变量逻辑回归模型分析睡眠时长和睡眠质量与认知障碍的关联。还探讨了年龄和性别在这些关联中的作用。
参与者的年龄（平均值±标准差）为 71.13±5.50 岁。在所有老年人中，1811 人（37.44%）被检测出认知障碍，1755 人（36.8%）睡眠质量差。在认知障碍患者中，51.09%为女性。有抑郁症状（49.73%，273/549）的参与者中认知障碍的比例显著更高（ = 41.275， < 0.001）。在调整了多个混杂因素和关键协变量（抑郁症状）后，睡眠时长<6、6-6.9、8-8.9 和≥9 h 的个体发生认知障碍的比值比（OR）（95%置信区间[CI]）分别为 1.280（1.053-1.557）、1.425（1.175-1.728）、1.294（1.068-1.566）和 1.360（1.109-1.668）。亚组分析显示，男性的夜间睡眠时长与认知障碍呈 V 形关联（ ≤ 0.05），60-80 岁的个体关联更强。关于睡眠质量，认知障碍的完全调整后 OR（95%CI）为 1.263（1.108-1.440）。根据 PSQI 各分量表的评分，日间功能障碍与认知障碍的风险增加相关（OR：1.128，95%CI：1.055-1.207）。亚组分析还显示，在不同性别和年龄组中，睡眠质量差（包括日间功能障碍）与认知障碍之间存在统计学上显著的相关性，在女性（OR：1.287，95%CI：1.080-1.534）和 81-97 岁年龄组（OR：2.128，95%CI：1.152-3.934）中相关性更强。对于认知障碍，日间功能障碍的 81-97 岁年龄组的个体发生认知障碍的比值比更高。
本研究表明，睡眠不足或过多与认知障碍有关，尤其是男性，他们呈 V 形关联。认知障碍还与睡眠质量差以及日间功能障碍有关，女性和 81-97 岁的个体关联最强。
