Abstract
In a recent meta-analysis, we confirmed the association between sleep and cognitive impairment or Alzheimer’s Disease (AD), and, for the first time, consolidated the evidence to provide an “average” magnitude of effect. To examine whether disturbed sleep is associated with changes in AD biomarkers predictive of persons that ultimately develop AD, further subgroup analyses were conducted examining disturbed sleep and the risks of cognitive impairment; preclinical AD and symptomatic AD respectively. Original published literature assessing any association of sleep problems or disorders with cognitive impairment or AD was identified by searching PubMed, Embase, Web of Science, and the Cochrane library. Our outcome measures included the use of cognitive tests by studies examining sleep and the risks of cognitive impairment; the use of AD biomarkers or abnormal proteins by studies examining sleep and the risk of preclinical AD; and the use of ICD9/DSMIV diagnoses of AD by studies examining the risk of sleep and symptomatic AD respectively. Effect estimates of individual studies were pooled and relative risks (RR) and 95% confidence intervals (CI) were calculated using random effects models. Meta-regression analyses examining the effect of potential influencing factors was also conducted. Subgroup meta-analytic findings from 27 studies showed a RR increase inverse to diagnostic confidence (e.g., 1.60, 1.70 and 3.80 for AD, Cognitive Impairment and preclinical AD, P-value <.001 for all). The RR of 3.80 finding suggests that disturbed sleep is associated with changes in Alzheimer’s Disease biomarkers predictive of persons that ultimately develop AD and may reflect the use of more objective diagnostic measures to identify individuals with sleep problems and preclinical AD among studies that examined this association. Meta-regression results suggested that sample size may have significantly influenced the effect size such that larger sample size studies tended to result in smaller risk and vice versa. Overall our results highlight potential mechanistic relationships suggesting that sleep is not only associated with cognitive impairment, or symptomatic AD but is also associated with changes in AD biomarkers predictive of persons that ultimately develop AD. These findings are vital for potential prevention of AD. None
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