Sleep disorders in aging and dementia
Sleep disorders in aging and dementia
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衰老和痴呆症中的睡眠障碍
DOI：
10.1007/s12603-010-0052-7
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发表时间：
2010-03-01
影响因子：
5.8
通讯作者：
Monaca, C.
中科院分区：
文献类型：
--
作者：
Bombois, S.;Derambure, P.;Monaca, C.
本文综述了痴呆症高危人群中发现的睡眠障碍的特征：老年人、轻度认知障碍(MCI)患者和神经退行性疾病患者。睡眠结构改变和昼夜节律睡眠紊乱的频率随着年龄的增加而增加。尽管大约40%的老年人抱怨睡眠不佳，但真正的睡眠障碍在健康的老年人中远远不那么普遍，而且经常与共病有关。在阿尔茨海默病(AD)患者中观察到的睡眠障碍通常与非痴呆症老年人的睡眠障碍相似(但比非痴呆老年人更严重)。睡眠不良会增加痴呆症患者患重大疾病甚至死亡的风险，并构成照顾者的主要压力来源。原发性睡眠障碍的患病率随着年龄的增长而增加，如快速眼动(REM)、睡眠行为障碍(RBDS)、不宁腿综合征(RLS)、周期性肢体运动(PLM)和睡眠呼吸障碍。目前还没有关于痴呆症患者RLS和PLM的公开数据，但RBDS和睡眠呼吸暂停综合征已经得到了更广泛的研究。事实上，RBDS提示路易体痴呆(LBD)，并预测帕金森氏病的神经退化。阻塞性睡眠呼吸暂停(OSA)与AD具有共同的危险因素，甚至可能是AD病理过程中不可或缺的一部分。在MCI患者中，(I)睡眠障碍可能是进展为痴呆症的早期预测因素，以及(Ii)MCI是未诊断的睡眠障碍的症状的假设仍有待阐明。这篇综述中还考虑了老年人和痴呆患者睡眠障碍的药物和非药物治疗指南。对于健康但虚弱的老年人和早期AD患者，应该更彻底地描述睡眠特征(特别是使用标准化的访谈和多导睡眠图记录)。
This paper reviews the characteristics of sleep disorders found in people at a greater risk of dementia: the elderly adult, patients with mild cognitive impairment (MCI) and those with neurodegenerative diseases. The frequency of sleep architecture modifications and circadian rhythm sleep disturbances increases with age. Although around 40% of older adults complain of poor sleep, true sleep disorders are far less prevalent in healthy older adults and are frequently associated with comorbidities. The sleep disorders observed in Alzheimer's disease (AD) patients are often similar to (but more intense than) those found in non-demented elderly people. Poor sleep results in an increased risk of significant morbidities and even mortality in demented patients and constitutes a major source of stress for caregivers. The prevalence of primary sleep disorders such as rapid eye movement (REM) sleep behavior disorders (RBDs), restless legs syndrome (RLS), periodic limb movements (PLMs) and sleep-disordered breathing increases with age. There are no published data on RLS and PLMs in demented persons but RBDs and sleep apnea syndrome have been studied more extensively. In fact, RBDs are suggestive of Lewy body dementia (LBD) and are predictive for neurodegeneration in Parkinson's disease. Obstructive sleep apnea (OSA) shares common risk factors with AD and may even be an integral part of the pathological process in AD. In MCI patients, the hypotheses in which (i) sleep disorders may represent early predictive factors for progression to dementia and (ii) MCI is symptomatic of a non-diagnosed sleep disorder remain to be elucidated. Guidelines for drug and non-drug treatments of sleep disorders in the elderly and in demented patients are also considered in this review. In healthy but frail elderly people and in early-stage AD patients, sleep should be more thoroughly characterized (notably by using standardized interviews and polysomnographic recording).