Association of changes in self-reported sleep duration with mild cognitive impairment in the elderly: a longitudinal study

Abstract

As a symptomatic predementia stage with progressive cognitive decline, mild cognitive impairment (MCI) is common with aging. How changes in self-reported sleep duration affect MCI risk in the older adults remains unclear. Participants aged ≥ 65 years and enrolled at least two waves in the Chinese Longitudinal Healthy Longevity Survey were included in present longitudinal study. Changes in sleep duration were calculated as the difference between two waves and categorized into five groups: decreased >2 h, decreased 0-2h, stable, increased 0-2 h, and increased >2 h. MCI was measured by the Chinese version of the Mini-Mental State Examination. Generalized estimating equation model and restricted cubic spline function was applied to investigate the association. Among 9,005 participants (mean age, 81.19 years; 4,391 male), 2,877 developed MCI. Comparing with individuals with stable sleep duration, MCI risk [odds ratio (95% confidence intervals)] was: 1.15 (0.99-1.34) for decreased >2 h, 0.99 (0.87-1.13) for decreased 0-2h, 1.09 (0.95-1.24) for increased 0-2 h, and 1.57 (1.36-1.81) for increased >2 h, respectively. Similar patterns were observed among subgroup analyses by sex, age, and sleep quality at baseline. For participants with long sleep duration at baseline (>8h), further increased >2 h was associated with higher MCI risk [2.23 (1.55-3.21)]. Either in the whole or subgroup population, a U-shaped association was observed (P_{non-linearity}<0.05). In conclusion, changes in self-reported sleep duration were associated with MCI risk in a U-shaped pattern. Strategies that shifting sleep duration into normal range and keeping it stable are essential to prevent MCI in clinical practice.

Keywords: China; changes in sleep duration; longitudinal study; mild cognitive impairment.

Figure 1

The adjusted dose-response association between changes in self-reported sleep duration and risk of mild cognitive impairment among the whole population, based on model 4. Changes in self-reported sleep duration was modeled using a restricted cubic spline function with knots at -2, 0, 2 hours. The reference value was set at zero.

Figure 2

The adjusted dose-response association between changes in self-reported sleep duration and risk of mild cognitive impairment among the subgroup population, stratified by gender, age, sleep time and sleep quality at baseline, based on model 4. Changes in self-reported sleep duration was modeled using a restricted cubic spline function with knots at -2, 0, 2 hours. The reference value was set at zero.

Figure 3

Flow chart of participant selection, a longitudinal study of changes in self-reported sleep duration with risk of mild cognitive impairment among the elderly adults in China, 2005-2019.