Sleep Fragmentation and the Risk of Incident Alzheimer's Disease and Cognitive Decline in Older Persons
Sleep Fragmentation and the Risk of Incident Alzheimer's Disease and Cognitive Decline in Older Persons
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DOI：
10.5665/sleep.2802
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发表时间：
2013-07-01
期刊：
影响因子：
5.6
通讯作者：
Bennett, David A.
中科院分区：
文献类型：
--
作者：
Lim, Andrew S. P.;Kowgier, Matthew;Bennett, David A.
目的：横断面研究表明，睡眠碎片与老年人的认知能力有关。我们测试了这一假设，即睡眠碎片与事件阿尔茨海默氏病（AD）和老年人认知能力下降的速度。设计：前瞻性队列研究。设置：社区为基础的Participants：737社区居住的老年人没有dementials.Measurements和结果：睡眠碎片被量化，从最多连续10天的体动记录。受试者每年接受19项神经心理学测试的AD评估。在长达6年（平均3.3年）的随访期内，97人发展为AD。在控制年龄、性别和受教育程度的考克斯比例风险模型中，睡眠碎片化水平越高，AD风险越高（HR = 1.22，95%CI 1.03-1.44，P = 0.02/睡眠碎片化增加1 SD）。与睡眠碎片低的人（第10百分位数）相比，睡眠碎片高的人（第90百分位数）患AD的风险是1.5倍。睡眠碎片与AD事件的相关性没有沿着人口统计学线变化，并且在控制了潜在的混杂因素（包括每日总休息时间、慢性疾病和可能影响睡眠的常用药物的使用）后保持不变。在线性混合效应分析中，睡眠碎片增加0.01个单位与认知能力下降的年增长率（相对于队列中的平均下降率）增加22%相关（估计值=-0.016，SE = 0.007，P = 0.03）。结论：老年人睡眠碎片与AD事件和认知能力下降率相关。
Objective: Cross-sectional studies suggest that sleep fragmentation is associated with cognitive performance in older adults. We tested the hypothesis that sleep fragmentation is associated with incident Alzheimer's disease (AD) and the rate of cognitive decline in older adults.Design: Prospective cohort study.Setting: Community-basedParticipants: 737 community dwelling older adults without dementia.Measurements and Results: Sleep fragmentation was quantified from up to 10 consecutive days of actigraphy. Subjects underwent annual evaluation for AD with 19 neuropsychological tests. Over a follow-up period of up to 6 years (mean 3.3 years), 97 individuals developed AD. In a Cox proportional hazards model controlling for age, sex, and education, a higher level of sleep fragmentation was associated with an increased risk of AD (HR = 1.22, 95%CI 1.03-1.44, P = 0.02 per 1SD increase in sleep fragmentation). An individual with high sleep fragmentation (90th percentile) had a 1.5-fold risk of developing AD as compared with someone with low sleep fragmentation (10th percentile). The association of sleep fragmentation with incident AD did not vary along demographic lines and was unchanged after controlling for potential confounders including total daily rest time, chronic medical conditions, and the use of common medications which can affect sleep. In a linear mixed effect analysis, a 0.01 unit increase in sleep fragmentation was associated with a 22% increase in the annual rate of cognitive decline relative to the average rate of decline in the cohort (Estimate = -0.016, SE = 0.007, P = 0.03).Conclusions: Sleep fragmentation in older adults is associated with incident AD and the rate of cognitive decline.