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. 2025 Sep 2;24(1):52.
doi: 10.1186/s12991-025-00593-7.

Combined effect of cognitive dysfunction and sleep disturbance on mortality risk: NHANES 2011-2014

Tian-Shin Yeh  1   2 , Yi-Chen Huang  3   4 , Shu-Chuan Ho  5   6 , Co-Yih Siow  7 , Hsin-Chien Lee  8   9 , Jose I Recio-Rodriguez  10   11   12   13 , Jia-Ying Sung  3   4   14 , Jowy Tani  15   16   17   18   19
Affiliations

Combined effect of cognitive dysfunction and sleep disturbance on mortality risk: NHANES 2011-2014

Tian-Shin Yeh et al. Ann Gen Psychiatry. .

Abstract

Background: Both cognitive dysfunction and sleep disturbances are individually linked to heightened risks of chronic illnesses and mortality. However, their combined impact on all-cause and cardiovascular mortality remains underexplored.

Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, focusing on participants aged ≥ 60 years who completed cognitive tests and sleep-related questionnaires. Cognitive function was evaluated using three standardized tests: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency Test, and the Digit Symbol Substitution Test. Participants with global cognitive z-scores below - 1 were classified as having low cognitive function. Sleep disturbance was identified based on self-reported diagnoses of sleep disorders or complaints of trouble sleeping. Mortality data were sourced from the National Death Index. Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHR) for all-cause and cardiovascular mortality, with adjustments for potential confounders.

Results: A total of 3,170 participants ≥ 60 years of age were included for analysis. Participants with low cognitive function alone had an adjusted hazard ratio (aHR) of 1.59 (95% CI: 1.12-2.26) for all-cause mortality. The risk increased to an aHR of 1.73 (95% CI: 1.07-2.79) when both low cognitive function and sleep disturbances were present. Stratified analyses revealed that the associations between cognitive function, sleep disturbance, and mortality risks varied across sex, BMI, and chronic kidney disease status.

Conclusions: The combination of low cognitive function and sleep disturbances is associated with a higher risk of all-cause and cardiovascular mortality, exceeding the risk of either condition alone. These findings emphasize the need to consider both factors together when assessing mortality risk in older adults.

Keywords: Cognitive dysfunction; Mortality; National health and nutrition examination survey (NHANES); Sleep disturbance.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The NCHS Research Ethics Review Board (ERB) reviewed and approved NHANES, and all survey participants provided written informed consent. Therefore, no further ethical approval and informed consent was required to perform this secondary analyses. For additional information see the NHANES website for NCHS Research ERB Approval ( https://www.cdc.gov/nchs/nhanes/about/erb.html ). All NHANES data released by the NCHS are de-identified and the data remain anonymous during data analysis. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study population selection process
Fig. 2
Fig. 2
Kaplan–Meier Survival Curves for (A) overall survival and (B) CVD-specific survival
See this image and copyright information in PMC

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