在社区居住的老年人中,睡眠障碍与运动性认知风险综合征的发病率和发病率之间的关系。

IF 7.7 1区 医学 Q1 CLINICAL NEUROLOGY
Neurology Pub Date : 2024-12-10 Epub Date: 2024-11-06 DOI:10.1212/WNL.0000000000210054
Victoire Leroy, Emmeline Ayers, Dristi Adhikari, Joe Verghese
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引用次数: 0

摘要

背景和目的:越来越多的证据表明,睡眠障碍与认知障碍风险有关,但睡眠障碍与运动性认知风险综合征(MCR)--一种以步速缓慢和认知抱怨为特征的痴呆前期综合征--发病率的关系尚不清楚。我们的目的是研究睡眠障碍(总体和特定亚型)与(1)老年人运动性认知风险综合征的发生率和(2)发病率之间的关系:方法:我们从人口名单中招募了居住在社区的 65 岁及以上无痴呆症的成年人,并将其纳入纽约州布朗克斯阿尔伯特-爱因斯坦医学院的前瞻性队列研究 "行动能力与老龄化中央控制"。我们纳入了具有 MCR 和匹兹堡睡眠质量指数 (PSQI) 数据的参与者。MCR的定义是在标准化问卷中报告的认知抱怨和在电子跑步机上记录的缓慢步速,并在基线和年度随访时进行判定。根据既定的 PSQI 临界分值,参与者被分为睡眠 "良好 "者(≤5 分)和睡眠 "不良 "者(>5 分)。在基线时没有发生 MCR 的参与者中,采用了调整了以下因素的 Cox 比例危险模型:(1)年龄、性别和教育程度;(2)进一步调整了合并症指数、老年抑郁量表评分和总体认知评分,以研究基线睡眠障碍与 MCR 发生率之间的关系。采用多变量逻辑回归分析法探讨了睡眠质量差与基线MCR发病率之间的关系:共纳入 445 名参与者(56.9% 为女性,平均年龄:75.9 岁 [75.3; 76.5])。在基线时没有发生 MCR 的参与者(n = 403)中,有 36 人在平均 2.9 年的随访期间发生了 MCR。与睡眠好的人相比,睡眠差的人发生 MCR 的风险更高(HR = 2.7 [1.2; 5.2]),但在调整抑郁症状后,这种关联并不显著(调整后危险比 [aHR] = 1.6 [0.7-3.4])。在 PSQI 的 7 个组成部分中,只有与睡眠相关的日间功能障碍(过度嗜睡和热情降低)在完全调整模型中显示出 MCR 的显著风险(aHR = 3.3 [1.5-7.4])。MCR发病率与睡眠质量差无关(OR [95% CI] = 1.1 [0.5-2.3]):讨论:总体而言,睡眠质量差与MCR事件有关,但与MCR流行率无关。具体而言,患有与睡眠相关的日间功能障碍的老年人罹患MCR的风险更高。需要进一步研究来验证这种关系的机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of Sleep Disturbances With Prevalent and Incident Motoric Cognitive Risk Syndrome in Community-Residing Older Adults.

Background and objectives: There is growing evidence that sleep disturbances are associated with cognitive impairment risk, but their association with the incidence of motoric cognitive risk syndrome (MCR)-a predementia syndrome characterized by slow gait speed and cognitive complaints-is unknown. We aimed to examine the association of sleep disturbances, overall and specific subtypes, with (1) incident and (2) prevalent MCR in older adults.

Methods: Community-residing adults aged 65 years and older without dementia were recruited from population lists and included in Central Control of Mobility and Aging, a prospective cohort study, in Albert Einstein College of Medicine, Bronx, NY. We included participants with available data for MCR and Pittsburgh Sleep Quality Index (PSQI). MCR was defined as cognitive complaints reported on standardized questionnaires and slow gait speed as recorded on an electronic treadmill and was adjudicated at baseline and annual follow-up visits. Participants were divided into "good" sleepers (≤5) and "poor" sleepers (>5) based on an established PSQI cut score. Among participants without MCR at baseline, Cox proportional hazard models adjusted for (1) age, sex, and education and (2) further for comorbidity index, Geriatric Depression Scale score, and global cognitive score were used to examine the association of baseline sleep disturbances with MCR incidence. Association between poor sleep quality and prevalent MCR at baseline in the overall population was explored using multivariate logistic regression analysis.

Results: 445 participants were included (56.9% women, mean age: 75.9 years [75.3; 76.5]). In MCR-free participants at baseline (n = 403), 36 developed incident MCR over a mean follow-up of 2.9 years. Poor sleepers had a higher risk of incident MCR (HR = 2.7 [1.2; 5.2]) compared with good sleepers, but this association was not significant after adjustment for depressive symptoms (adjusted hazard ratio [aHR] = 1.6 [0.7-3.4]). Among the 7 PSQI components, only sleep-related daytime dysfunction (excessive sleepiness and lower enthusiasm) showed a significant risk of MCR in fully adjusted models (aHR = 3.3 [1.5-7.4]). Prevalent MCR was not associated with poor sleep quality (OR [95% CI] = 1.1 [0.5-2.3]).

Discussion: Overall poor sleep quality was associated with incident MCR, but not with prevalent MCR. Specifically, older adults with sleep-related daytime dysfunction are at increased risk of developing MCR. Further studies are needed to validate mechanisms of this relationship.

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来源期刊
Neurology
Neurology 医学-临床神经学
CiteScore
12.20
自引率
4.00%
发文量
1973
审稿时长
2-3 weeks
期刊介绍: Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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