Application of ambulatory methods for assessing short- and long-term associations of sleep health with cognitive decline in older adults

摘要/摘要 预计到2050年，阿尔茨海默病(AD)的患病率将增加两倍。人们越来越重视 需要针对认知功能下降和轻度认知障碍(MCI)或 由于缺乏可用的治疗方法，这是一种新的治疗方法。睡眠障碍在老年人中很常见，而且 越来越多的证据表明，睡眠障碍可能是认知能力下降和MCI的先兆。 通过与正在进行的、久负盛名的爱因斯坦老龄化研究项目(EAS；NIA- AG03949)，我们将把睡眠健康的动态测量添加到EAS强化的“突发”认知中 应用智能手机技术多次评估认知表现的评估 一天，超过14天，在自然主义的背景下。该项目将通过以下方式衡量睡眠健康的主要维度 增加睡眠健康的日常测量(腕部活动和自我的日常生态瞬时评估 报告的睡眠质量和日间警觉性)，以及夜间氧气的动态测量 降低到EAS突发协议的饱和度，该协议每年跟踪500名以社区为基础的老年人 评估。使用这种方法，我们将评估短期(分几天)和长期(分几年) 睡眠健康指数对认知表现、认知衰退和MCI风险的影响。我们将是第一个 一项同时评估睡眠健康和认知能力的生态有效指标的研究 在一群老年人中进行的密集测量设计。通过将自然发生的影响降至最低 在睡眠健康和认知表现的两个指数中的变异性，密集的测量改善了 估计的可靠性，并提高检测随时间变化的敏感度。因此，这将澄清 睡眠健康的变化与认知能力下降有关。 此外，这一设计还将允许对个体内部变异性进行新的探索，包括： 描述睡眠健康对认知的近期影响(日常影响)；确定是否 睡眠健康的可变性可以预测长期的认知衰退，并决定个体 容易受到睡眠不良对认知的短期影响的人长期认知的风险增加 拒绝。对年度跟踪的纵向评估将使我们能够加深对 通过定义睡眠的纵向变化之间的关联来确定睡眠和认知衰退之间的关系 认知上的变化。拟议的新睡眠措施与EAS突发和核心相结合 评估将允许我们在睡眠健康的多个维度和认知的多个领域进行评估 功能。通过解决文献中的差距，拟议的研究将提供早期目标的方法 通过更好地了解近期效应来预防或延缓认知能力下降的干预措施 通过识别睡眠的特定维度和认知表现的领域 关系最密切的几个国家。

SUMMARY/ABSTRACT Alzheimer’s disease (AD) prevalence is projected to triple by 2050. There is increasing emphasis on the need for preventive interventions targeting cognitive decline and onset of mild cognitive impairment (MCI) or AD given the lack of treatments available. Sleep disturbances are common among older individuals and a growing body of evidence suggests that disrupted sleep may be a precursor of cognitive decline and MCI. By partnering with the ongoing, well-established Einstein Aging Study Program Project (EAS; NIA- AG03949), we will add ambulatory measures of sleep health to the EAS intensive “burst” cognitive assessments in which smartphone technology is applied to assess cognitive performance multiple times per day, over 14-days, in naturalistic settings. The project will measure the major dimensions of sleep health by adding daily measures of sleep health (wrist actigraphy and daily ecological momentary assessment of self- reported sleep quality and daytime alertness), as well as an ambulatory measure of overnight oxygen desaturation to the EAS burst protocol which is following 500 community based older adults over four annual evaluations. Using this approach, we will assess both short-term (over days) and long term (over years) effects of indices of sleep health on cognitive performance, cognitive decline and MCI risk. we will be the first study to concurrently assess ecologically valid measures both of sleep health and cognitive performance using an intensive measurement design in a cohort of older adults. By minimizing the effects of naturally occurring variability in both indices of sleep health and cognitive performance, the intensive measurement improves the reliability of estimates and improves sensitivity for detecting change over time. This will thus clarify how changes in sleep health are associated with cognitive decline. Additionally, this design will also allow for novel explorations of intra-individual variability including: characterizing the proximal effects of sleep health on cognition (day-to-day effects); determining whether variability in sleep health predicts cognitive decline over the long term; and determining whether individuals vulnerable to the short-term effects of poor sleep on cognition are at increased risk for long term cognitive decline. Longitudinal assessments over annual follow-ups will allow us to advance understanding of the relation between sleep and cognitive decline by defining associations between longitudinal changes in sleep with changes in cognition. The proposed new sleep measures combined with the EAS burst and core assessments will allow us to do so over multiple dimensions of sleep health and multiple domains of cognitive function. By addressing gaps in the literature, the proposed study will inform ways to target early interventions for prevention or delay of cognitive decline by better understanding the proximal effects of sleep and by identifying the particular dimensions of sleep and domains of cognitive performance that are most closely related.