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Shen C, Wang H, Djiotsop AN, Wiener RC, Pathak M, Mitra S, Findley PA, Sambamoorthi U. Association of reported sleep disturbances with objectively assessed mild cognitive impairment among adults in the United States. SAGE Open Med 2025; 13:20503121251317912. [PMID: 39925957 PMCID: PMC11803677 DOI: 10.1177/20503121251317912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 01/16/2025] [Indexed: 02/11/2025] Open
Abstract
Background Sleep is a multifaceted phenomenon influenced by both duration and quality. Various sleep disturbances have been associated with mild cognitive impairment, but the role of specific disturbances in mild cognitive impairment pathophysiology remains unclear. This study investigated the associations between distinct sleep disturbances and mild cognitive impairment in adults aged 50 and older using nationally representative data. Methods Longitudinal data from the Health and Retirement Study were analyzed to explore the association between mild cognitive impairment and three types of sleep disturbances: trouble falling asleep, trouble waking up, and waking up too early. Logistic regression models estimated unadjusted (Model 1) and adjusted associations accounting for sex, race/ethnicity, age, social determinants of health (Model 2), general health (Model 3), depression (Model 4), and pain and physical activity (Model 5). Results The study cohort included 8877 participants aged ⩾50 years in 2018 (baseline) who were followed up in 2020. Overall, 15.4% reported trouble falling asleep, 23.2% reported trouble waking up, and 12.8% reported waking up too early and being unable to fall back asleep most of the time. Among older adults, approximately 13.1% reported experiencing mild cognitive impairment; The prevalence of mild cognitive impairment was even higher in those who experienced sleep disturbances. The unadjusted odds ratio (uOR) for experiencing trouble falling asleep most of the time was 1.69 (95% CI: 1.42-2.03), for trouble waking up most of the time was 1.31 (95% CI: 1.10-1.57), and for waking up early most of the time was 1.88 (95% CI: 1.51-2.35). However, these positive associations attenuated depending on the covariate adjustment. Conclusions Nearly one in seven adults had mild cognitive impairment. The relationship between sleep disturbances and mild cognitive impairment has been challenging to delineate. Our findings demonstrate a positive association between sleep disturbances and mild cognitive impairment, although these associations were sensitive to covariate adjustments. These findings suggest multifaceted pathways for reducing the risk of mild cognitive impairment.
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Affiliation(s)
- Chan Shen
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX, USA
| | - Arthur Nguimatsa Djiotsop
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, WV, USA
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sophie Mitra
- Department of Economics, Fordham University, Bronx, NY, USA
| | - Patricia A Findley
- Dean of the School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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Wang J, Wang W, Liu Y, Yao M, Du Q, Wei Y, Lu K, Li C, Li X, Li S, Tian X, Zhang T, Yin F, Ma Y. Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts. Arch Gerontol Geriatr 2024; 127:105585. [PMID: 39096555 DOI: 10.1016/j.archger.2024.105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions. METHODS We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability. RESULTS Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (β) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: βfemale/βmale = 1.615, P = 0.020), marital statuses (orientation: βunmarried/βmarried = 2.074, P < 0.001), education levels (orientation:βuneducated/βeducated = 2.074, P < 0.001) and chronic disease statuses (memory: βunhealthy/βhealthy = 1.560, P = 0.005). CONCLUSIONS Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.
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Affiliation(s)
- Junyu Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Wei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Yaqiong Liu
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Menghan Yao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Qianqian Du
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Yuxin Wei
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Kai Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Chen Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Xuelin Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Sheng Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Xinyue Tian
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, Sichuan 610036, China.
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Sagaspe P, Sanchez-Ortuno MM, Dupuy L, Pecune F, Coelho J, Micoulaud-Franchi JA, Levavasseur Y, de Sevin E, Chanteclair A, Philip P, Salles N. Perceptions and Effectiveness of a Fully Automated Brief Behavioral Insomnia Therapy, Delivered by a Virtual Companion, in Older and Young Adults. Innov Aging 2024; 9:igae086. [PMID: 40206328 PMCID: PMC11979755 DOI: 10.1093/geroni/igae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 04/11/2025] Open
Abstract
Background and Objectives One of the most common sleep disturbances in older people is insomnia. Cognitive-behavioral therapy is the first-line treatment for this condition in older adults, but in-person treatment is costly and often unavailable. In this study, in a group of older and young subjects, we aimed to compare: (a) their initial perceptions of a fully automated mobile health intervention to manage insomnia, (b) how these perceptions related to treatment completion, and (c) the effects of the intervention on insomnia severity and related outcomes. Research Design and Methods A case-series study was conducted with a self-selected sample of older (≥65 years) and young (18-35 years) adults (n = 5,660) who downloaded a free app, available in France, that delivers a brief behavioral intervention for insomnia aided by a virtual companion (VC). The 17-day intervention included sleep hygiene and stimulus control recommendations. Primary outcome was treatment completion (yes/no). At the beginning of the intervention, treatment acceptability and trust in the VC were assessed with 2 short questionnaires (completion rate: 1,597 users). Insomnia was evaluated with the Insomnia Severity Index. Results Logistic regression analyses showed that higher credibility and trust in the app's VC were associated with higher odds of treatment completion, but only in older adults (trust scores × age group: odds ratio [OR] = 1.12; 95% confidence interval [CI] = 1.01-1.25; p < .05, and credibility scores × age group: OR = 1.25 [95% CI = 1.06-1.47], p < .01). Within the subset of users who completed the intervention (n = 289), insomnia remission (χ2 = 2.72, NS) and insomnia response rates (χ2 = 2.34, NS) were comparable across both groups. Discussion and Implications This brief behavioral intervention appears to be efficacious for the self-management of insomnia symptoms in older adults. The integration of persuasive interaction elements, such as avatars and virtual coaches, in fully automated interventions could be particularly useful to stimulate older adults' engagement. Clinical Trials Registration Number NCT05074901.
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Affiliation(s)
- Patricia Sagaspe
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- Sleep Medicine Service, University Hospital Pellegrin, Bordeaux, France
| | - Maria Montserrat Sanchez-Ortuno
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- School of Nursing, University of Murcia, Murcia, Spain
| | - Lucile Dupuy
- Bordeaux Population Health, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Florian Pecune
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
| | - Julien Coelho
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- Sleep Medicine Service, University Hospital Pellegrin, Bordeaux, France
| | - Jean Arthur Micoulaud-Franchi
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- Sleep Medicine Service, University Hospital Pellegrin, Bordeaux, France
| | | | - Etienne de Sevin
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
| | - Alex Chanteclair
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- Department of Clinical Gerontology, University Hospital Pellegrin, Bordeaux, France
| | - Pierre Philip
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- Sleep Medicine Service, University Hospital Pellegrin, Bordeaux, France
| | - Nathalie Salles
- SANPSY Laboratory, UMR CNRS 6033, University of Bordeaux, Bordeaux, France
- Department of Clinical Gerontology, University Hospital Pellegrin, Bordeaux, France
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Rezende TA, Giatti L, de Menezes ST, Griep RH, Ribeiro PCC, Barreto SM. Sleep duration, insomnia and cognitive performance in the Elsa-Brasil cohort: a cross-sectional analysis. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240006. [PMID: 38324870 PMCID: PMC10846421 DOI: 10.1590/1980-549720240006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To investigate the single and combined associations between sleep disturbances (sleep duration, insomnia symptoms in the last 30 nights, and daytime tiredness) and performance in cognitive tests. METHODS Cross-sectional analysis of data from visit 2 (2012-2014) of the Longitudinal Study of Adult Health from a cohort of active and retired civil servants from six Brazilian capitals. Polynomial regression with quadratic term and multiple linear regression models were performed to assess single and combined associations between sleep disturbances and memory performance, fluency, executive functions, and global cognition. RESULTS A total of 7,248 participants were included, with a mean age of 62.7 years (standard deviation [SD]=5.9), and 55.2% were women. Inverted U-shaped associations were observed between sleep duration and performance on all cognitive abilities, suggesting that durations shorter or longer than seven hours are associated with worse performance, regardless of age. Reported insomnia was associated with worse executive function (β: -0.08; 95% confidence interval [CI]: -0.15 to -0.01), and the magnitudes of associations were higher for individuals with insomnia at two or more moments (β: -0.12; 95%CI -0.19 to -0.05) or, especially, insomnia combined with short sleep (β: -0.18; 95%CI -0.24 to -0.11). Insomnia in two or more periods was also associated with lower memory and global cognition. There was no association between any sleep disturbance tested and verbal fluency. Isolated daytime tiredness was not associated with performance in the evaluated tests. CONCLUSION The results suggest that extreme sleep durations are detrimental to almost all cognitive abilities investigated, whereas insomnia appears to affect more severely the executive function.
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Affiliation(s)
- Tamiris Amanda Rezende
- Universidade Federal de Minas Gerais, Posgraduate Program in Public Health, Medical School – Belo Horizonte (MG), Brazil
| | - Luana Giatti
- Universidade Federal de Minas Gerais, Medical School and Clinical Hospital/EBSERH – Belo Horizonte (MG), Brazil
| | - Sara Teles de Menezes
- Universidade Federal de Minas Gerais, Medical School and Clinical Hospital/EBSERH – Belo Horizonte (MG), Brazil
| | - Rosane Harter Griep
- Instituto Oswaldo Cruz, Laboratory of Health and Environment Education – Rio de Janeiro (RJ), Brazil
| | - Pricila Cristina Correa Ribeiro
- Universidade Federal de Minas Gerais, Department of Psychology, Faculty of Philosophy and Human Sciences – Belo Horizonte (MG), Brazil
| | - Sandhi Maria Barreto
- Universidade Federal de Minas Gerais, Medical School and Clinical Hospital/EBSERH – Belo Horizonte (MG), Brazil
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Curtis AF, Costa AN, Musich M, Schmiedeler A, Jagannathan S, Connell M, Atkinson A, Miller MB, McCrae CS. Sex as a moderator of the sleep and cognition relationship in middle-aged and older adults: A preliminary investigation. Behav Sleep Med 2024; 22:14-27. [PMID: 36809223 DOI: 10.1080/15402002.2023.2177293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Despite known sex differences in the prevalence of sleep disturbance and cognitive impairment, research investigating sex differences in sleep/cognition associations is limited. We examined sex as a moderator of associations between self-reported sleep and objective cognition in middle-aged/older adults. METHODS Adults aged 50+ (32 men/31 women, Mage = 63.6 ± 7.7) completed the Pittsburgh Sleep Quality Index (PSQI) and cognitive tasks: Stroop (processing speed, inhibition), Posner (spatial attentional orienting) and Sternberg (working memory). Multiple regressions examined whether PSQI metrics (global score, sleep quality ratings, sleep duration, sleep efficiency) were independently or interactively (with sex) associated with cognition, controlling for age and education. RESULTS Sex interacted with sleep quality ratings in its association with endogenous spatial attentional orienting (∆R2 = .10, p = .01). Worse ratings of sleep quality were associated with worse orienting in women (B = 22.73, SE = 9.53, p = .02), not men (p = .24). Sex interacted with sleep efficiency in its associations with processing speed (∆R2 = .06, p = .04). Lower sleep efficiency was associated with slower Stroop control trial performance in women (B = -15.91, SE = 7.57, p = .04), not men (p = .48). CONCLUSIONS Preliminary findings suggest middle-aged/older women are more vulnerable to associations between poor sleep quality and low sleep efficiency on spatial attentional orienting and processing speed, respectively. Future studies in larger samples investigating sex-specific prospective sleep and cognition associations are warranted.
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Affiliation(s)
- Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, Florida, USA
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Madison Musich
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Anthony Schmiedeler
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
- Department of Educational, School, and Counseling Psychology, University of Missouri-Columbia, Columbia, Missouri, USA
| | | | - Maggie Connell
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Angela Atkinson
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
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Esiaka D, Odo O, Luth E. Unraveling the Threads: Sleep Difficulties, Neighborhood Physical Disorder, and Subjective Cognitive Decline in Older Americans. J Alzheimers Dis 2024; 100:1345-1354. [PMID: 38995787 DOI: 10.3233/jad-240142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Research suggests that the neighborhood in which people live can be a risk or protective factor for various health outcomes, including cognitive decline to Alzheimer's disease. Similar to the impact of neighborhood on health outcomes, sleep difficulties have been linked to cognitive function in older adults. However, few studies have examined how neighborhood physical disorders moderate the effects of sleep on subjective cognitive decline (SCD). Objective The study examined the moderating effect of neighborhood factors on the relationship between sleep difficulties and SCD. Methods Data were obtained from 2,494 respondents (1,065 males and 1,429 females) from Wave 11 of the National Health and Aging Trends (NHATS) data. Sleep difficulties were operationalized as the presence of difficulties in falling and staying asleep. Neighborhood physical disorder (e.g., vandalism, graffiti) was based on interviewer observations of respondents' neighborhoods. SCD was operationalized as subjective reports of increasing or worse memory loss in the past 12 months and present memory rating. We utilized Linear regression to test neighborhood physical disorder as a moderator of the relationship between sleep difficulties and SCD. Results We found a significant interaction between sleep difficulties and neighborhood physical disorder on SCD (β=0.046, p = 0.031, 95% CI[0.00,0.51], p < 0.001). Participants who reported higher average sleep difficulties and higher levels of neighborhood physical disorder were more likely to report SCD. Conclusions Our findings add to inform future health interventions and policy recommendations that address modifiable sources of cognitive decline and risk of Alzheimer's disease.
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Affiliation(s)
- Darlingtina Esiaka
- Department of Behavioral Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Obinna Odo
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Elizabeth Luth
- Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Zaheed AB, Chervin RD, Spira AP, Zahodne LB. Mental and physical health pathways linking insomnia symptoms to cognitive performance 14 years later. Sleep 2023; 46:zsac262. [PMID: 36309871 PMCID: PMC9995792 DOI: 10.1093/sleep/zsac262] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2022] [Indexed: 12/04/2022] Open
Abstract
STUDY OBJECTIVES Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender. METHODS Participants included 2595 adults ages 51-88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition. RESULTS Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06 ≤ β ≤ -0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender. CONCLUSIONS Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
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Affiliation(s)
- Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD 21205, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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Gao F, Wei S, Dang L, Gao Y, Gao L, Shang S, Chen C, Huo K, Wang J, Wang J, Qu Q. Sleep disturbance is associated with mild cognitive impairment: a community population-based cross-sectional study. BMC Public Health 2022; 22:2000. [PMID: 36320021 PMCID: PMC9624002 DOI: 10.1186/s12889-022-14391-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/02/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Sleep is conducive to the elimination of brain metabolites and the recovery of brain function. However, the relationship between sleep disturbance and Mild Cognitive Impairment is not fully been determined. METHODS This was a community population-based cross-sectional study. A total of 1,443 participants from a village in the suburbs of Xi'an, China were enrolled in 2017. Sleep quality was evaluated using the Pittsburgh sleep quality index (PSQI), and sleep disturbance was defined as a PSQI score > 5. Mini-Mental State Examination (MMSE) was used to assess cognitive function and Mild Cognitive Impairment(MCI) was defined as the MMSE score less than cutoff values and meets the diagnostic criteria. Univariate and multivariate analyses were used to analyze the relationships between sleep disturbance and MCI. RESULTS Among 1,443 subjects, 69(4.78%) had MCI, and 830 (57.52%) had sleep disturbance. In bivariate analysis, MCI was associated with sleep disturbance (ρ = 0.094, P<0.001). In the binary logistic regression, MCI was positively associated with the sleep disturbance (OR = 2.027, 95%CI = 1.112-3.698, P = 0.021). In the internal constitution of PSQI, MCI was negatively associated with the habitual sleep efficiency (OR = 0.447, 95%CI = 0.299-0.669, P < 0.001). Compared with waking up before or at 7 am, waking up after 7 am (OR = 0.555, 95%CI = 0.309-0.995, P = 0.048), or 8 am (OR = 0.296, 95%CI = 0.097-0.902, P = 0.032) was probably more likely to have normal cognition. However, people who slept more than 8 h a day might be more likely to suffer from MCI (OR = 5.560, 95%CI = 1.419-21.789, P = 0.014). CONCLUSION Sleep disturbance is associated with Mild Cognitive Impairment. However, the causal relationship between them is not clear. It needs to be further studied.
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Affiliation(s)
- Fan Gao
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Shan Wei
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Liangjun Dang
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Yao Gao
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Ling Gao
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Suhang Shang
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Chen Chen
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Kang Huo
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Jingyi Wang
- Huyi Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Jin Wang
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
| | - Qiumin Qu
- grid.452438.c0000 0004 1760 8119Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, 710061 Xi’an, China
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Exalto LG, Hendriksen HM, Barkhof F, van den Bosch KA, Ebenau JL, van Leeuwenstijn‐Koopman M, Prins ND, Teunissen CE, Visser LN, Scheltens P, van der Flier WM. Subjective cognitive decline and self-reported sleep problems: The SCIENCe project. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12287. [PMID: 35603141 PMCID: PMC9107682 DOI: 10.1002/dad2.12287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022]
Abstract
We aim to investigate the frequency and type of sleep problems in memory clinic patients with subjective cognitive decline (SCD) and their association with cognition, mental health, brain magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) biomarkers. Three hundred eight subjects (65 ± 8 years, 44% female) were selected from the Subjective Cognitive Impairment Cohort (SCIENCe) project. All subjects answered two sleep questionnaires, Berlin Questionnaire (sleep apnea) and Pittsburgh Sleep Quality Index (sleep quality) and underwent a standardized memory clinic work-up. One hundred ninety-eight (64%) subjects reported sleep problems, based on 107 (35%) positive screenings on sleep apnea and 162 (53%) on poor sleep quality. Subjects with sleep problems reported more severe depressive symptoms, more anxiety, and more severe SCD. Cognitive tests, MRI, and CSF biomarkers did not differ between groups. Our results suggest that improvement of sleep quality and behaviors are potential leads for treatment in many subjects with SCD to relieve the experienced cognitive complaints.
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Affiliation(s)
- Lieza G. Exalto
- Department of Neurology, UMCU Brain CentreUniversity Medical Center UtrechtUtrechtthe Netherlands
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Heleen M.A. Hendriksen
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- UCL Institutes of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - Karlijn A. van den Bosch
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Jarith L. Ebenau
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Mardou van Leeuwenstijn‐Koopman
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Niels D. Prins
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Brain Research CenterAmsterdamthe Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry LaboratoryDepartment of Clinical Chemistry, Amsterdam NeuroscienceAmsterdam University Medical Centers, Vrije UniversiteitAmsterdamthe Netherlands
| | - Leonie N.C. Visser
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of NeurobiologyCare Sciences and Society, Karolinska InstitutetStockholmSweden
| | - Philip Scheltens
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer's Center Amsterdam, Department of NeurologyAmsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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Using Actigraphy and Heart Rate Variability (HRV) to Assess Sleep Quality and Sleep Arousal of Three App-Based Interventions: Sleep Music, Sleepcasts, and Guided Mindfulness. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robbins R, Quan SF, Weaver MD, Bormes G, Barger LK, Czeisler CA. Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States. Aging (Albany NY) 2021; 13:3254-3268. [PMID: 33570509 PMCID: PMC7906211 DOI: 10.18632/aging.202591] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/29/2020] [Indexed: 04/21/2023]
Abstract
BACKGROUND Sleep disturbance and deficiency are common among older adults and have been linked with dementia and all-cause mortality. Using nationally representative data, we examine the relationship between sleep disturbance and deficiency and their risk for incident dementia and all-cause mortality among older adults. METHODS The National Health and Aging Trends Study (NHATS) is a nationally-representative longitudinal study of Medicare beneficiaries in the US age 65 and older. Surveys that assessed sleep disturbance and duration were administered at baseline. We examined the relationship between sleep disturbance and deficiency and incident dementia and all-cause mortality over the following 5 years using Cox proportional hazards modeling, controlling for confounders. RESULTS Among the sample (n = 2,812), very short sleep duration (≤5 hours: HR = 2.04, 95% CI: 1.26 - 3.33) and sleep latency (>30 minutes: HR = 1.45, 95% CI: 1.03 - 2.03) were associated with incident dementia in adjusted Cox models. Difficulty maintaining alertness ("Some Days": HR = 1.49, 95% CI: 1.13 - 1.94 and "Most/Every Day": HR = 1.65, 95% CI: 1.17 - 2.32), napping ("Some days": HR = 1.38, 95% CI: 1.03 - 1.85; "Most/Every Day": HR = 1.73, 95% CI: 1.29 - 2.32), sleep quality ("Poor/Very Poor": HR = 1.75, 95% CI: 1.17 - 2.61), and very short sleep duration (≤5 hours: HR = 2.38, 95% CI: 1.44 - 3.92) were associated with all-cause mortality in adjusted Cox models. CONCLUSIONS Addressing sleep disturbance and deficiency may have a positive impact on risk for incident dementia and all-cause mortality among older adults.
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Affiliation(s)
- Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Stuart F. Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Gregory Bormes
- Department of Mathematics, Boston College, Boston, MA 02467, USA
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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12
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Sagherian K, Byon HD, Zhu S, Rose K. Insomnia symptoms, fatigue, and future job exit in American older adults. Am J Ind Med 2021; 64:127-136. [PMID: 33155335 DOI: 10.1002/ajim.23197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND As older adults prolong working life and face age-related health changes, insomnia symptoms and fatigue may jeopardize their ability to stay in the labor force. Our study explored the relationships between insomnia symptoms, fatigue, and job exit in workers aged 65 years and older. METHODS Data from the National Health and Aging Trends Study were used (2011-2017). The sample included 953 Medicare beneficiaries with paid work at the time of the interview. Workers were followed annually for 6 years to the time of job exit. Insomnia measures included the number and type of symptoms, and fatigue (measured as low energy). Crude and adjusted odds ratios and 95% confidence intervals were estimated within discrete-time survival analysis. Models were adjusted for health, lifestyle, and sociodemographic characteristics. RESULTS At baseline, approximately 49% of workers had either one or two insomnia symptoms. Difficulty falling asleep and difficulty maintaining asleep were prevalent in 35% and 37% of the sample. Fatigue was common in <30% of the sample. Workers with difficulty falling asleep were 1.29 times at higher odds to have job exit when compared with workers with no insomnia (p = 0.033). Conversely, fatigued workers were 0.73-0.77 times at lower odds to have job exit when compared with nonfatigued workers (p < 0.05). CONCLUSION Difficulty falling asleep negatively affects future work status, unlike feeling fatigued. Healthcare providers are encouraged to assess for insomnia and discuss treatments with workers, and workplaces should be flexible with the start of workdays to support worker longevity.
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Affiliation(s)
- Knar Sagherian
- College of Nursing The University of Tennessee Knoxville Knoxville Tennessee USA
| | - Ha D. Byon
- School of Nursing University of Virginia Charlottesville Virginia USA
| | - Shijun Zhu
- School of Nursing University of Maryland Baltimore Baltimore Maryland USA
| | - Karen Rose
- Center for Healthy Aging, Self‐Management and Complex Care, College of Nursing The Ohio State University Columbus Ohio USA
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