Yiallourou Stephanie, Baril Andree-Ann, Wiedner Crystal, Misialek Jeffrey R, Kline Christopher E, Harrison Stephanie, Cannon Ethan, Yang Qiong, Bernal Rebecca, Bisson Alycia, Himali Dibya, Cavuoto Marina, Weihs Antoine, Beiser Alexa, Gottesman Rebecca F, Leng Yue, Lopez Oscar, Lutsey Pamela L, Purcell Shaun M, Redline Susan, Seshadri Sudha, Stone Katie L, Yaffe Kristine, Ancoli-Israel Sonia, Xiao Qian, Vaou Eleni Okeanis, Himali Jayandra J, Pase Matthew P
School of Psychological Sciences & Turner Institute for Brain and Mental Health, Monash University, Australia.
Framingham Heart Study, MA, USA.
medRxiv. 2024 Nov 5:2024.11.05.24316677. doi: 10.1101/2024.11.05.24316677.
Poor sleep may play a role in the risk of dementia. However, few studies have investigated the association between polysomnography (PSG)-derived sleep architecture and dementia incidence. We examined the relationship between sleep macro-architecture and dementia incidence across five US-based cohort studies from the Sleep and Dementia Consortium (SDC).
Percent of time spent in stages of sleep (N1, N2, N3, REM sleep), wake after sleep onset and sleep maintenance efficiency were derived from a single night home-based PSG. Dementia was ascertained in each cohort using its cohort-specific criteria. Each cohort performed Cox proportional hazard regressions for each sleep exposure and incident dementia, adjusting for age, sex, body mass index, anti-depressant use, sedative use, and status. Results were then pooled in random effects meta-analyses.
The pooled sample comprised 4,657 participants (30% women) aged ≥60 years (mean age was 74 years at sleep assessment). There were 998 (21.4%) dementia cases (median follow-up time of 5 to 19 years). Pooled effects of the five cohorts showed no association between sleep architecture and incident dementia. When meta-analyses were restricted to the three cohorts which had dementia case ascertainment based on DSM-IV/V criteria (n=2,374), higher N3% was marginally associated with an increased risk of dementia (HR: 1.06; 95%CI: 1.00-1.12, per percent increase N3, p=0.050).
There were no consistent associations between sleep macro-architecture measured and the risk of incident dementia. Implementing more nuanced sleep metrics remains an important next step for uncovering more about sleep-dementia associations.
睡眠不佳可能在痴呆症风险中起作用。然而，很少有研究调查过多导睡眠图（PSG）得出的睡眠结构与痴呆症发病率之间的关联。我们通过睡眠与痴呆症联盟（SDC）开展的五项美国队列研究，研究了睡眠宏观结构与痴呆症发病率之间的关系。
从一晚的家庭PSG中得出睡眠各阶段（N1、N2、N3、快速眼动睡眠）所花费时间的百分比、睡眠开始后的觉醒时间和睡眠维持效率。每个队列使用其特定队列标准确定痴呆症。每个队列针对每次睡眠暴露和新发痴呆症进行Cox比例风险回归分析，并对年龄、性别、体重指数、抗抑郁药使用情况、镇静剂使用情况和状态进行调整。然后将结果汇总到随机效应荟萃分析中。
汇总样本包括4657名年龄≥60岁的参与者（30%为女性）（睡眠评估时的平均年龄为74岁）。有998例（21.4%）痴呆症病例（中位随访时间为5至19年）。五个队列的汇总效应显示睡眠结构与新发痴呆症之间无关联。当荟萃分析仅限于根据《精神疾病诊断与统计手册》第四版/第五版标准确定痴呆症病例的三个队列时（n = 2374），较高的N3%与痴呆症风险增加存在微弱关联（风险比：1.06；95%置信区间：1.00 - 1.12，N3每增加一个百分点，p = 0.050）。
所测量的睡眠宏观结构与新发痴呆症风险之间不存在一致的关联。实施更细致入微的睡眠指标仍然是进一步揭示睡眠与痴呆症关联的重要下一步。
