Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women.
Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women.
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DOI：
10.1001/jama.2011.1115
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发表时间：
2011-08-10
影响因子：
120.7
通讯作者：
Stone, Katie L.
中科院分区：
文献类型：
--
作者：
Yaffe, Kristine;Laffan, Alison M.;Harrison, Stephanie Litwack;Redline, Susan;Spira, Adam P.;Ensrud, Kristine E.;Ancoli-Israel, Sonia;Stone, Katie L.
睡眠呼吸障碍（SDB）的特点是反复从睡眠中惊醒和间歇性低氧血症，在老年人中很常见。横断面研究已将 SDB 与认知能力差联系起来；然而，目前尚不清楚老年人的睡眠呼吸障碍是否先于认知障碍。确定睡眠呼吸障碍与认知障碍之间的前瞻性关系，并研究这种关联的潜在机制。在骨质疏松性骨折研究的一项子研究中，对 298 名无痴呆症的女性（平均 [SD] 年龄：82.3 [3.2] 岁）进行了前瞻性睡眠和认知研究，这些女性在 2002 年 1 月至 2004 年 4 月期间进行了夜间多导睡眠图 (PSG) 测量。睡眠呼吸障碍被定义为每小时睡眠中呼吸暂停-呼吸不足指数达到或超过 15 次。使用多变量逻辑回归来确定睡眠呼吸障碍与轻度认知障碍或痴呆风险的独立关联，并根据年龄、种族、体重指数、教育程度、吸烟状况、是否患有糖尿病、是否患有高血压、药物使用（抗抑郁药、苯二氮卓类药物或非苯二氮卓类抗焦虑药）和基线认知评分进行调整。研究人员对缺氧、睡眠碎片和睡眠持续时间的测量作为这种关系的潜在机制进行了研究。根据 2006 年 11 月至 2008 年 9 月期间收集的数据判定认知状态（正常、痴呆或轻度认知障碍 [MCI]） 与 193 名没有睡眠呼吸障碍的女性相比，即使经过多变量调整（调整后），105 名患有 SDB 的女性 (35.2%) 更有可能出现 MCI/痴呆（n=60 (31.1%) vs n=47 (44.8%)） OR=1.85，95% CI 1.11-3.08）。氧饱和度指数升高（≥15 次事件/小时）和呼吸暂停或呼吸不足的睡眠时间百分比较高（>7%）（这两种呼吸障碍的测量方法）与发生 MCI/痴呆的风险相关（调整后 OR=1.71，95% CI 1.04 – 2.83 和调整 OR=2.04，95% CI 1.10 – 3.78）。睡眠碎片（觉醒指数和入睡后觉醒）或睡眠持续时间（总睡眠时间）的测量与认知障碍风险无关。在老年女性中，与没有睡眠呼吸障碍的女性相比，患有睡眠呼吸障碍的女性患认知障碍的风险增加。
Sleep-disordered breathing (SDB), characterized by recurrent arousals from sleep and intermittent hypoxemia, is common among older adults. Cross-sectional studies have linked SDB to poor cognition; however, it remains unclear whether sleep disordered breathing precedes cognitive impairment in older adults. To determine the prospective relationship between sleep disordered breathing and cognitive impairment and to investigate potential mechanisms of this association. Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography (PSG) measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep disordered breathing with risk of mild cognitive impairment or dementia and adjustments were made for age, race, body mass index, education, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or non-benzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Adjudicated cognitive status (normal, dementia, or mild cognitive impairment [MCI]) based on data collected between November 2006 and September 2008 Compared with the 193 women without sleep disordered breathing, the 105 women (35.2%) with SDB were more likely to develop MCI/dementia (n=60 (31.1%) vs n=47 (44.8%)) even after multivariate adjustment (adjusted OR=1.85, 95% CI 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage (>7%) of sleep time in apnea or hypopnea, both measures of disordered breathing, were associated with risk of developing MCI/dementia (adjusted OR=1.71, 95% CI 1.04 − 2.83 and adjusted OR=2.04, 95% CI 1.10 − 3.78, respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Among older women, those with sleep disordered breathing, compared with those without SDB, were associated with an increased risk of developing cognitive impairment.
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DOI：
10.1016/j.beem.2010.08.011
发表时间：
2010-10
期刊：
Best practice & research. Clinical endocrinology & metabolism
影响因子：
--
作者：
Drager LF;Jun JC;Polotsky VY
通讯作者：
Polotsky VY
影响因子：
7.2
作者：
McDowell, I;Kristjansson, B;Hebert, R
通讯作者：
Hebert, R
影响因子：
5
作者：
Punjabi, NM;Shahar, E;Resnick, HE
通讯作者：
Resnick, HE
治疗阿尔茨海默氏病中阻塞性睡眠呼吸暂停的认知作用：一项随机对照研究。
影响因子：
6.3
作者：
Ancoli-Israel S;Palmer BW;Cooke JR;Corey-Bloom J;Fiorentino L;Natarajan L;Liu L;Ayalon L;He F;Loredo JS
通讯作者：
Loredo JS
DOI：
10.1111/j.1532-5415.1996.tb01397.x
发表时间：
1996-11-01
影响因子：
6.3
作者：
Dealberto, MJ;Pajot, N;Alperovitch, A
通讯作者：
Alperovitch, A