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. 2023 Dec 1;6(12):e2346006.
doi: 10.1001/jamanetworkopen.2023.46006.

Longitudinal Sleep Patterns and Cognitive Impairment in Older Adults

Samantha A Keil  1   2   3 , Abigail G Schindler  1   2   4   5 , Marie X Wang  1   2   6 , Juan Piantino  7   8 , Lisa C Silbert  8   9   10 , Jonathan E Elliott  8   11 , Madeleine L Werhane  1 , Ronald G Thomas  12 , Sherry Willis  2 , Miranda M Lim  1   8   9   10   13 , Jeffrey J Iliff  1   2   14
Affiliations

Longitudinal Sleep Patterns and Cognitive Impairment in Older Adults

Samantha A Keil et al. JAMA Netw Open. .

Abstract

Importance: Sleep disturbances and clinical sleep disorders are associated with all-cause dementia and neurodegenerative conditions, but it remains unclear how longitudinal changes in sleep impact the incidence of cognitive impairment.

Objective: To evaluate the association of longitudinal sleep patterns with age-related changes in cognitive function in healthy older adults.

Design, setting, and participants: This cross-sectional study is a retrospective longitudinal analyses of the Seattle Longitudinal Study (SLS), which evaluated self-reported sleep duration (1993-2012) and cognitive performance (1997-2020) in older adults. Participants within the SLS were enrolled as part of a community-based cohort from the Group Health Cooperative of Puget Sound and Health Maintenance Organization of Washington between 1956 and 2020. Data analysis was performed from September 2020 to May 2023.

Main outcomes and measures: The main outcome for this study was cognitive impairment, as defined by subthreshold performance on both the Mini-Mental State Examination and the Mattis Dementia Rating Scale. Sleep duration was defined by self-report of median nightly sleep duration over the last week and was assessed longitudinally over multiple time points. Median sleep duration, sleep phenotype (short sleep, median ≤7 hours; medium sleep, median = 7 hour; long sleep, median ≥7 hours), change in sleep duration (slope), and variability in sleep duration (SD of median sleep duration, or sleep variability) were evaluated.

Results: Of the participants enrolled in SLS, only 1104 participants who were administered both the Health Behavior Questionnaire and the neuropsychologic battery were included for analysis in this study. A total of 826 individuals (mean [SD] age, 76.3 [11.8] years; 468 women [56.7%]; 217 apolipoprotein E ε4 allele carriers [26.3%]) had complete demographic information and were included in the study. Analysis using a Cox proportional hazard regression model (concordance, 0.76) showed that status as a short sleeper (hazard ratio, 3.67; 95% CI, 1.59-8.50) and higher sleep variability (hazard ratio, 3.06; 95% CI, 1.14-5.49) were significantly associated with the incidence of cognitive impairment.

Conclusions and relevance: In this community-based longitudinal study of the association between sleep patterns and cognitive performance, the short sleep phenotype was significantly associated with impaired cognitive performance. Furthermore, high sleep variability in longitudinal sleep duration was significantly associated with the incidence of cognitive impairment, highlighting the possibility that instability in sleep duration over long periods of time may impact cognitive decline in older adults.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Piantino reported being a member of the scientific advisory board of Applied Cognition, Inc, outside the submitted work. Dr Silbert reported receiving funding from the National Institutes of Health (NIH) and Department of Defense and had a patent issued outside the submitted work. Dr Lim reported receiving personal fees from Applied Cognition, Inc, outside the submitted work. Dr Iliff reported serving as the chair of the scientific advisory board for Applied Cognition, Inc, and has received stock options and received compensation for this role. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Enrollment Flowchart
APOE indicates apolipoprotein E; CES-D, Center for Epidemiologic Studies–Depression Scale; HBQ, Health Behavior Questionnaire.
Figure 2.
Figure 2.. Representative Sleep Patterns Across the Cohort
Graphs show sleep duration across 5 visits (A) and differences between the first and last visits (B).
Figure 3.
Figure 3.. Survival Associated With Sleep Patterns
Curves show modeled survival risk curves for patients classified as short sleepers (A) and for those with high sleeping variability (B). Data are not derived from actual patients.
See this image and copyright information in PMC

References

    1. GBD 2019 Dementia Forecasting Collaborators . Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105-e125. doi: 10.1016/S2468-2667(21)00249-8 - DOI - PMC - PubMed
    1. Alzheimer’s Association . 2021 Alzheimer’s disease facts and figures. Alzheimers Dement. 2021;17(3):327-406. doi: 10.1002/alz.12328 - DOI - PubMed
    1. Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement. 2007;3(3):186-191. doi: 10.1016/j.jalz.2007.04.381 - DOI - PubMed
    1. Villemagne VL, Burnham S, Bourgeat P, et al. ; Australian Imaging Biomarkers and Lifestyle (AIBL) Research Group . Amyloid β deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer’s disease: a prospective cohort study. Lancet Neurol. 2013;12(4):357-367. doi: 10.1016/S1474-4422(13)70044-9 - DOI - PubMed
    1. Holdridge KC, Yaari R, Hoban DB, Andersen S, Sims JR. Targeting amyloid β in Alzheimer’s disease: meta-analysis of low-dose solanezumab in Alzheimer’s disease with mild dementia studies. Alzheimers Dement. 2023;19(10):4619-4628. doi: 10.1002/alz.13031 - DOI - PubMed

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