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

总结/摘要 阿尔茨海默病（AD）的患病率预计到2050年将增加两倍。人们越来越强调 需要针对认知下降和轻度认知障碍（MCI）发作的预防性干预措施，或 由于缺乏可用的治疗方法。睡眠障碍在老年人中很常见， 越来越多的证据表明，睡眠中断可能是认知能力下降和MCI的前兆。 通过与正在进行的，完善的爱因斯坦衰老研究计划项目（EAS; NIA- AG 03949），我们将增加睡眠健康的动态措施，以EAS密集的“突发”认知 智能手机技术应用于评估认知性能， 一天，超过14天，在自然环境中。该项目将测量睡眠健康的主要方面， 增加睡眠健康的日常措施（手腕活动记录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 EAS突发协议的去饱和，该协议每年跟踪500名社区老年人超过4年 评价。使用这种方法，我们将评估短期（几天）和长期（几年） 睡眠健康指数对认知能力、认知能力下降和MCI风险的影响。我们将率先 一项同时评估睡眠健康和认知能力的生态有效措施的研究， 在老年人队列中进行密集测量设计。通过最大限度地减少自然发生的 在睡眠健康和认知表现两个指标的变化中，密集测量改善了睡眠质量。 估计的可靠性，并提高了检测随时间变化的灵敏度。这将说明如何 睡眠健康的变化与认知能力下降有关。 此外，该设计还允许对个体内变异性进行新的探索，包括： 表征睡眠健康对认知的近端影响（日常影响）;确定是否 睡眠健康的变化预测长期认知能力下降;并确定个体是否 易受睡眠不良对认知的短期影响的人， 下降年度随访的纵向评估将使我们能够进一步了解 通过定义睡眠中纵向变化之间的关联来研究睡眠与认知能力下降之间的关系 随着认知的变化。所提出的新的睡眠措施结合EAS突发和核心 评估将使我们能够在睡眠健康的多个维度和认知的多个领域这样做， 功能通过解决文献中的空白，拟议的研究将为早期确定目标提供信息 通过更好地了解近端效应来预防或延迟认知能力下降的干预措施 并通过识别睡眠的特定维度和认知表现的领域 关系最为密切

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.