Sleep Timing and Risk of Dementia Among the Chinese Elderly in an Urban Community: The Shanghai Aging Study.
Sleep Timing and Risk of Dementia Among the Chinese Elderly in an Urban Community: The Shanghai Aging Study.
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DOI：
10.3389/fneur.2021.629507
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发表时间：
2021
影响因子：
3.4
通讯作者：
Leng Y
中科院分区：
文献类型：
--
作者：
Li X;Ding D;Zhao Q;Wu W;Xiao Z;Luo J;Yaffe K;Leng Y
背景：越来越多的证据表明睡眠质量差与痴呆风险增加之间存在联系。然而，对于睡眠时间（昼夜节律的重要行为标志）与老年人痴呆风险之间的关联，以及这是否独立于睡眠持续时间或质量，人们知之甚少。方法：我们纳入了来自上海老龄化研究的 1,051 名社区居住的老年男性和女性（年龄≥ 60 岁）的数据，这些男性和女性没有患痴呆症。在基线时，参与者使用中文版匹兹堡睡眠质量指数 (CPSQI) 报告睡眠时间、持续时间和质量。接下来 7.3 年的痴呆症诊断由神经科医生使用 DSM-IV 标准确定。我们使用 Cox 比例风险模型来研究就寝时间（晚上 9 点之前、晚上 11 点之后与晚上 9 点至 11 点）、起床时间（早上 6 点之前、上午 8 点之后与上午 6 点至 8 点）和痴呆风险之间的关联。结果：共有 238 名（22.8%）、675 名（64.5%）和 133 名（12.7%）参与者分别表示在晚上 9 点之前、晚上 9 点至 11 点之间以及晚上 11 点之后就寝，而 272 名（26%）、626 名（59.9%）和 148 名（14.2%）受访者表示在晚上 9 点之前起床。分别为早上 6 点、早上 6 点至 8 点之间以及上午 8 点之后。与晚睡的参与者相比，早睡的参与者受教育程度较低，吸烟的可能性较小，患高血压或糖尿病的可能性较高，睡眠时间较长，但睡眠质量较差。我们对 584 名参与者进行了平均 7.3 年的随访，发现了 47 起痴呆症事件。在对人口统计数据、教育程度、收入、体重指数、抑郁症状、吸烟、饮酒、体力活动、合并症、APOE4 基因型和基线 MMSE 进行调整后，那些晚上 9 点之前就寝的人与晚上 9 点至 11 点之间睡觉的人相比，患痴呆症的可能性高出两倍[风险比 (HR)=2.16 (95%CI: 1.06–4.40)]。较晚的就寝时间（即晚上 11 点之后）表现出相反的结果，但与痴呆风险没有显着相关性（HR=0.15，95%CI：0.02-1.29）。我们没有发现起床时间与痴呆风险之间的关联。结论：没有痴呆症的老年人较早的睡眠时间与痴呆症风险增加相关。未来的研究应该检查这种关联的潜在机制，并探索睡眠时间作为痴呆症临床前标志的有用性。
Background: Growing evidence has suggested a link between poor sleep quality and increased risk of dementia. However, little is known about the association between sleep timing, an important behavior marker of circadian rhythms, and dementia risk in older adults, and whether this is independent of sleep duration or quality. Methods: We included data from 1,051 community-dwelling older men and women (aged≥ 60y) without dementia from the Shanghai Aging Study. At baseline, participants reported sleep timing, duration, and quality using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Dementia diagnosis over the following 7.3 years was determined by neurologists using DSM-IV criteria. We used Cox proportional hazards models to examine the association between bedtime (before 9 p.m., after 11 p.m. vs. 9–11 p.m.), rise time (before 6 a.m., after 8 a.m. vs. 6–8 a.m.), and risk of dementia. Results: A total of 238 (22.8%), 675 (64.5%), and 133 (12.7%) participants reported going to bed before 9 p.m., between 9 and 11 p.m., and after 11 p.m., respectively, while 272 (26%), 626 (59.9%), and 148 (14.2%) reported getting up before 6 a.m., between 6 and 8 a.m., and after 8 a.m., respectively. Participants who reported going to bed earlier had a lower education level, were less likely to be smokers, more likely to have hypertension or diabetes, and had longer sleep duration but poorer sleep quality compared to those who reported a later bedtime. We found 47 incidents of dementia among 584 participants followed up over an average of 7.3 years. After adjustment for demographics, education, income, body mass index, depressive symptoms, smoking, alcohol use, physical activity, comorbidities, APOE4 genotype, and baseline MMSE, those with a bedtime of before 9 p.m. were two times more likely to develop dementia [hazard ratio (HR)=2.16 (95%CI: 1.06–4.40)], compared to those going to bed between 9 and 11 p.m. Later bedtime (i.e., after 11 p.m.) showed the opposite but had a non-significant association with dementia risk (HR=0.15, 95%CI: 0.02–1.29). We did not find an association for rise time and risk of dementia. Conclusion: Earlier sleep timing in older adults without dementia was associated with an increased risk of dementia. Future studies should examine the underlying mechanisms of this association and explore the usefulness of sleep timing as a preclinical marker for dementia.
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