Abstract
BackgroundSleep disturbances are common in elderly and occur frequently in dementia. The impact of excessive daytime sleepiness (EDS), insomnia complaints, sleep quality, and hypnotics on the risk of all-cause dementia, Alzheimer disease (AD), and dementia with vascular component (DVC) remains unclear, as does the association between sleep profile and plasma β-amyloid levels.MethodsAnalyses were carried out on 6851 participants aged 65 years and over randomly recruited from three French cities and free of dementia at baseline. A structured interview and self-questionnaire assessed sleep complaints (EDS, insomnia complaints, sleep quality) and medications at baseline. Incident cases of dementia were diagnosed systematically over a 12-year period. Multivariate Cox models were used to estimate the risk of dementia associated with the sleep complaints considered individually and globally. Plasma β-amyloid levels were measured by an xMAP-based assay technology in 984 subjects.ResultsAfter adjustment for socio-demographic characteristics, lifestyle, APOE-ε4, cardiovascular factors, and depressive status, EDS had a higher risk of all-cause dementia (HR = 1.21; 95%CI = [1.01–1.46]) and DVC (HR = 1.58; 95%CI = [1.07–2.32]) but not AD. Persistent use of hypnotics increased the risk for all-cause dementia, specifically AD (HR = 1.28; 95%CI = [1.04–1.58]), but not DVC. No association was found for insomnia complaints and sleep quality taken as individual factors or combined with EDS on the risk of dementia. No association was found between β-amyloid, sleep complaints, and incident dementia.ConclusionsThe results suggest a deleterious role of EDS and hypnotics on dementia. Further studies are required to elucidate the mechanisms involved in these associations and whether its management can prevent the risk of dementia.
Highlights
The burden of dementia is important and continues to increase [1]
The presence of excessive daytime sleepiness (EDS), Difficulty with initiating sleep (DIS), Difficulty in maintaining sleep (DMS), and Early morning awakening (EMA) was reported by 18.1%, 35.3%, 63.7%, and 36.8% of the participants respectively, while the presence of a poor Sleep quality (SQ) was reported by 52.6% of the participants
Among these subjects treated with hypnotics at baseline, 28.2% had a poor SQ, 21.5% EDS, 57.4% DIS, 70.2% DMS, and 51.3% EMA
Summary
The burden of dementia is important and continues to increase [1]. Since no pharmacological treatment has shown to be effective, the need to prevent dementia is a major public health issue. Cavaillès et al Alzheimer’s Research & Therapy (2022) 14:12 problems insomnia and excessive daytime sleepiness (EDS) which have been associated with a higher risk of all-cause cognitive decline or dementia [2,3,4,5,6,7,8,9,10,11]. Few studies have investigated the associations between sleep disturbances and the type of dementia and showed that insomnia was often predictive of all-cause dementia and AD [7, 8, 10], and EDS of DVC [3]. The impact of excessive daytime sleepiness (EDS), insomnia complaints, sleep quality, and hypnotics on the risk of all-cause dementia, Alzheimer disease (AD), and dementia with vascular component (DVC) remains unclear, as does the association between sleep profile and plasma β-amyloid levels
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