Longitudinal Sleep Patterns and Cognitive Impairment in Older Adults.

TitleLongitudinal Sleep Patterns and Cognitive Impairment in Older Adults.
Publication TypeJournal Article
Year of Publication2023
AuthorsKeil SA, Schindler AG, Wang MX, Piantino J, Silbert LC, Elliott JE, Werhane ML, Thomas RG, Willis S, Lim MM, Iliff JJ
JournalJAMA Netw Open
Volume6
Issue12
Paginatione2346006
Date Published2023 Dec 01
ISSN2574-3805
KeywordsAged, Cognitive Dysfunction, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Retrospective Studies, Sleep, Sleep Wake Disorders
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.

DOI10.1001/jamanetworkopen.2023.46006
Alternate JournalJAMA Netw Open
PubMed ID38048131
PubMed Central IDPMC10696486
Related Institute: 
Brain Health Imaging Institute (BHII)

Weill Cornell Medicine
Department of Radiology
525 East 68th Street New York, NY 10065