Sleep Disordered Breathing and Incident Cognitive Decline and Dementia: ARIC

描述(申请人提供)：痴呆症和轻度认知障碍在美国老年人中很常见，尽管他们的负担巨大且不断增加，但对导致认知能力下降的特征知之甚少。最近的流行病学和病理生理学证据表明，睡眠特征异常与由血管病因和阿尔茨海默病引起的认知障碍之间可能存在联系。然而，对这种关系的理解还处于初级阶段。我们建议利用社区动脉粥样硬化风险(ARIC)队列和睡眠心脏健康研究的数据，在15年的随访中探索异常睡眠特征与认知损害风险的关系。ARIC是一个以人群为基础的前瞻性流行病学队列，已经进行了几次后续访问，包括1996-1998年的访问(访问4，年龄54-73岁)和正在进行的访问(ARIC访问5/神经认知研究(ARIC NCS，2011-2013，年龄69-88))。睡眠心脏健康研究包括ARIC参与者的一个子集，在(1995-1998)与ARIC访视4几乎同时进行。共有1,892人参加了ARIC访视4，并作为睡眠心脏健康研究的一部分在家中进行了通宵多导睡眠监测。我们假设，中年的异常睡眠特征(包括缺氧和呼吸障碍、睡眠碎片和睡眠持续时间的测量)与晚年认知损害的风险有关。将利用目前通过ARIC-NCS收集的全面的神经认知数据来探索几种认知表型。这些包括1)临床痴呆症和轻度认知障碍，2)认知能力下降，通过在ARIC Access 4(1996-1998)和ARIC NCS(2011-2013)中重复进行的3项认知测试的变化来评估，以及3)脑血管疾病的脑磁共振标记物(即白质高信号体积、腔隙梗死数量)和阿尔茨海默病(即海马体和灰质体积)。这项拟议的研究结果将对理解中年睡眠与晚年认知之间的关系产生深远的影响。异常睡眠特征和认知障碍在老年人中非常普遍，异常睡眠特征可以通过现有的干预措施进行修改。因此，阐明异常睡眠特征是否在认知障碍的病因中起作用具有重要的公共卫生意义。

DESCRIPTION (provided by applicant): Dementia and mild cognitive impairment are common among U.S elderly, yet despite their immense and growing burden relatively little is known about characteristics which lead to cognitive decline. Recent evidence, both epidemiological and pathophysiological, has suggested a possible relation between abnormal sleep characteristics and cognitive impairment due to both vascular etiologies and Alzheimer's disease. However, understanding of this relation is in its infancy. We propose to explore the relation of abnormal sleep characteristics to risk of cognitive impairment over 15 years of follow-up utilizing data fro the Atherosclerosis Risk in Communities (ARIC) cohort and the Sleep Heart Health Study. ARIC is a population-based prospective epidemiologic cohort, which has had several follow-up visits, including a visit in 1996-1998 (Visit 4, ages 54-73) and an ongoing visit (ARIC Visit 5/Neurocognitive Study (ARIC NCS, 2011-2013, ages 69-88)). The Sleep Heart Health Study, which included a subset of ARIC participants, took place in (1995-1998), at approximately the same time as ARIC Visit 4. A total of 1,892 individuals participated in both ARIC Visit 4 and had in-home overnight polysomnography as part of the Sleep Heart Health Study. We hypothesize that that abnormal sleep characteristics (inclusive of measures of hypoxia and disordered breathing, sleep fragmentation, and sleep duration) in middle age are associated with risk of cognitive impairment later in life. Several cognitive phenotypes will be explored, utilizing comprehensive neurocognitive data presently being collected through ARIC-NCS. These include 1) clinical dementia and mild cognitive impairment, 2) cognitive decline as assessed by change in 3 cognitive tests administered at ARIC Visit 4 (1996-1998) and repeated in ARIC NCS (2011-2013), and 3) brain MRI markers of cerebral vascular disease (i.e. white matter hyper-intensity volume, number of lacunar infarcts) and Alzheimer's disease (i.e. hippocampal and gray matter volume). Results from the proposed study will have a profound impact on the understanding of relations between sleep in middle-age and cognition in later life. Abnormal sleep characteristics and cognitive impairment are both highly prevalent among older adults, and abnormal sleep characteristics are amenable to modification through existing interventions. Therefore, elucidating whether abnormal sleep characteristics play a role in the etiology of cognitive impairment is of vital public health importance.