Wong Roger, Grullon Jason Rafael
Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, New York, USA; and Department of Geriatrics, SUNY Upstate Medical University, New York; USA.
Norton College of Medicine, SUNY Upstate Medical University, New York, USA.
BJPsych Open. 2024 Dec 4;10(6):e219. doi: 10.1192/bjo.2024.814.
Race/ethnicity and sleep disturbances are associated with dementia risk.
To explore racial-ethnic disparities in sleep disturbances, and whether race/ethnicity moderates the relationship between sleep disturbances and dementia risk among older adults.
We analysed ten annual waves (2011-2020) of prospective cohort data from the National Health and Aging Trends Study, a nationally representative USA sample of 6284 non-Hispanic White ( = 4394), non-Hispanic Black ( = 1311), Hispanic ( = 342) and non-Hispanic Asian ( = 108) community-dwelling older adults. Sleep disturbances were converted into three longitudinal measures: (a) sleep-initiation difficulty (trouble falling asleep within 30 min), (b) sleep-maintenance difficulty (trouble falling asleep after waking up early) and (c) sleep medication usage (taking medication to sleep). Cox proportional hazards models analysed time to dementia, after applying sampling weights and adjusting for sociodemographic characteristics and health.
Black, Hispanic and Asian respondents exhibited higher frequencies of sleep-initiation and sleep-maintenance difficulties, but had less sleep medication usage, compared with White older adults. Among Hispanic respondents, sleep-initiation difficulty was associated with significantly decreased dementia risk (adjusted hazard ratio (aHR) = 0.34, 95% CI 0.15-0.76), but sleep-maintenance difficulty was associated with increased dementia risk (aHR = 2.68, 95% CI 1.17-6.13), compared with White respondents. Asian respondents using sleep medications had a significantly higher dementia risk (aHR = 3.85, 95% CI 1.64-9.04). There were no significant interactions for Black respondents.
Sleep disturbances are more frequent among older Black, Hispanic and Asian adults, and should be considered when addressing dementia disparities. Research is needed to explore how certain sleep disturbances may elevate dementia risk across different racial and ethnic subgroups.
种族/族裔与睡眠障碍与痴呆风险相关。
探讨睡眠障碍中的种族差异，以及种族/族裔是否调节老年人睡眠障碍与痴呆风险之间的关系。
我们分析了来自美国国家健康与老龄化趋势研究的十次年度前瞻性队列数据（2011 - 2020年），该研究是一个具有全国代表性的样本，包含6284名非西班牙裔白人（n = 4394）、非西班牙裔黑人（n = 1311）、西班牙裔（n = 342）和非西班牙裔亚洲人（n = 108）社区居住的老年人。睡眠障碍被转化为三种纵向测量指标：（a）入睡困难（30分钟内难以入睡），（b）维持睡眠困难（早醒后难以再次入睡），以及（c）使用助眠药物（服用药物助眠）。在应用抽样权重并调整社会人口统计学特征和健康状况后，使用Cox比例风险模型分析痴呆发生时间。
与白人老年人相比，黑人、西班牙裔和亚洲受访者出现入睡困难和维持睡眠困难的频率更高，但使用助眠药物的情况较少。在西班牙裔受访者中，与白人受访者相比，入睡困难与痴呆风险显著降低相关（调整后风险比[aHR]=0.34，95%置信区间0.15 - 0.76），但维持睡眠困难与痴呆风险增加相关（aHR = 2.68，95%置信区间1.17 - 6.13）。使用助眠药物的亚洲受访者患痴呆症的风险显著更高（aHR = 3.85，95%置信区间1.64 - 9.04）。黑人受访者没有显著的交互作用。
老年黑人、西班牙裔和亚洲成年人中睡眠障碍更为常见，在解决痴呆差异问题时应予以考虑。需要开展研究以探索某些睡眠障碍如何在不同种族和族裔亚组中提高痴呆风险。
