Department of Pediatrics, University of California, Irvine, CA, USA.
Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA.
J Alzheimers Dis. 2024;100(2):613-629. doi: 10.3233/JAD-220750.
While obstructive sleep apnea (OSA) and insomnia symptoms in neurotypical populations are associated with Alzheimer's disease (AD), their association with dementia in adults with Down syndrome (DS) remains less clear, even though these symptoms are prevalent and treatable in DS. Understanding their associations with AD-related dementia status, cognitive impairment, and functional deterioration may lead to interventions to slow decline or disease progression in adults with DS.
To characterize differences in OSA and insomnia symptom expression by dementia status, and to determine which sleep factors support dementia diagnosis.
Multimodal consensus conference was used to determine dementia status in 52 adults with DS (52.2 ± 6.4 years, 21 women). Cognitive impairment, adaptive behavior skills, and symptoms of OSA and insomnia were quantified using validated assessments for adults with DS and their primary informants.
A sex by dementia status interaction demonstrated that older women with DS and dementia had more severe terminal insomnia but not OSA symptoms relative to older women with DS who were cognitively stable (CS). Greater insomnia symptom severity was associated with greater functional impairments in social and self-care domains adjusting for age, sex, premorbid intellectual impairment, and dementia status.
Insomnia symptoms are more severe in women with DS with dementia than in women with DS and no dementia, and regardless of dementia status or sex, more severe insomnia symptoms are associated with greater impairment in activities of daily living. These findings underscore the potential importance of early insomnia symptom evaluation and treatment in women with DS at risk of developing AD.
在神经典型人群中，阻塞性睡眠呼吸暂停（OSA）和失眠症状与阿尔茨海默病（AD）有关，但在唐氏综合征（DS）成人中，它们与痴呆的关系尚不清楚，尽管这些症状在 DS 中普遍存在且可治疗。了解它们与 AD 相关痴呆状态、认知障碍和功能恶化的关系，可能会促使我们采取干预措施，减缓 DS 成人的衰退或疾病进展。
通过痴呆状态来描述 OSA 和失眠症状表达的差异，并确定哪些睡眠因素支持痴呆诊断。
采用多模态共识会议确定 52 名 DS 成人（52.2±6.4 岁，21 名女性）的痴呆状态。使用针对 DS 成人及其主要知情人的经过验证的评估工具，对认知障碍、适应行为技能以及 OSA 和失眠症状进行量化。
性别与痴呆状态的交互作用表明，患有痴呆的老年女性 DS 患者比认知稳定（CS）的老年女性 DS 患者有更严重的终末期失眠，但 OSA 症状无差异。调整年龄、性别、发病前智力障碍和痴呆状态后，更严重的失眠症状与社会和自我护理领域的更大功能障碍相关。
与无痴呆的 DS 女性相比，患有痴呆的 DS 女性的失眠症状更严重，无论痴呆状态或性别如何，更严重的失眠症状与日常生活活动能力的更大损害相关。这些发现强调了在有发生 AD 风险的 DS 女性中，早期评估和治疗失眠症状的重要性。
