睡眠与认知减退的关系：西安农村人群4年前瞻性队列研究

Sleep and cognitive decline: a 4-year prospective cohort study in rural Xi'an

摘要

目的 探讨西安市农村地区中老年人群睡眠对4年后认知减退的影响。方法 基于“西安市农村地区中老年人群认知障碍队列”2016年基线认知正常人群,于2020年完成4年随访。采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index, PSQI)评价睡眠状况,包括睡眠质量、入睡时间、睡眠时长、睡眠效率、睡眠障碍、催眠药物和日间功能障碍7个亚项。采用简易智能量表(Mini-Mental State Examination, MMSE)评估认知功能,4年随访MMSE降幅≥2分定义为认知减退。采用单因素分析和多因素Logistic回归研究睡眠与认知减退的关系。结果 基线共纳入1 660名受试者[年龄(57.40±9.71)岁；男性40.9%],睡眠较差者(PSQI＞5分)占57.47%(954名)。对随访4年研究人群进行分析,单因素分析结果显示,认知减退组PSQI睡眠效率评分显著高于认知稳定组(1.41±1.22 vs. 1.26±1.22,P=0.036),其余PSQI亚项无统计学差异。总人群多因素Logistic回归分析结果提示,基线睡眠效率较低组认知减退风险显著增加(OR=3.039,95%CI:1.240～7.448,P=0.015),且基线睡眠效率与受教育程度的交互项与认知减退显著相关(OR=0.836,95%CI:0.701～0.996,P=0.045),提示受教育程度越高,低睡眠效率对认知减退的影响越小。单因素分层分析显示,女性亚组中,基线睡眠效率较低者认知减退发生率显著增高(33.4% vs. 25.6%,P=0.017)；文盲亚组中,和基线睡眠效率较高组相比,基线睡眠效率较低组认知减退发生率显著增高(48.1% vs. 25.0%,P=0.014)；多因素分层分析结果同样提示女性亚组及文盲亚组基线睡眠效率较低者认知减退风险增高(女性亚组:OR=1.152,95%CI:1.011～1.313,P=0.034；文盲亚组:OR=1.564,95%CI:1.113～2.200,P=0.010)。结论 基线睡眠效率与认知减退的关联存在性别及受教育程度依赖性:在女性群体及文盲人群中,基线睡眠效率低者,4年后发生认知减退的风险显著增加。

Abstract

Objective To investigate sleep's impact on 4-year cognitive decline in rural middle-aged and elderly populations in Xi'an. Methods Using the “cognitive impairment cohort of middle-aged and elderly people in rural areas of Xi'an”, we analyzed cognitively normal participants from 2016 with a 4-year follow-up completed in 2020. Sleep was assessed via Pittsburgh Sleep Quality Index (PSQI: 7 domains including sleep efficiency). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Cognitive decline was defined as a drop of ≥2 points on the MMSE. Relationships between sleep and cognitive decline were examined using univariate analysis and multivariate Logistic regression. Results A total of 1660 participants (mean age 57.40±9.71 years； 40.9% men； 57.47% PSQI＞5). In the analysis of the 4-year follow-up cohort, univariate analysis showed that the PSQI sleep efficiency subscore was significantly higher in the cognitive decline group than in the cognitively stable group (1.41±1.22 vs. 1.26±1.22,P=0.036). No significant association was found in the other PSQI domains. Multivariate analysis demonstrated increased cognitive decline risk with low sleep efficiency (OR=3.039,95% CI:1.240-7.448,P=0.015) and significant sleep efficiency × education interaction (OR=0.836,95% CI:0.701-0.996,P=0.045), indicating that higher education attenuated the effect of sleep efficiency on cognitive decline. Stratified analysis revealed a higher cognitive decline incidence with low sleep efficiency in the females (33.4% vs. 25.6%,P=0.017) and the illiterates (48.1% vs. 25.0%,P=0.014), with elevated adjusted risk in the former (OR=1.152,95%CI:1.011-1.313,P=0.034) and in the latter (OR=1.564,95%CI:1.113-2.200,P=0.010). Conclusion Sleep efficiency exhibits gender- and education-dependent associations with cognitive decline, showing significantly higher 4-year risk in women and illiterates with low sleep efficiency.

关键词

认知减退 / 危险因素 / 睡眠效率 / 队列研究

Key words

cognitive decline / risk factor / sleep efficiency / cohort study

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基金资助

国家科技部科技创新2030-“脑科学与类脑研究”重大项目(2021ZD0201808)

国家自然科学基金青年科学基金项目(82301364)

国家自然科学基金青年科学基金项目(82201580)

陕西省自然科学基金项目(2021JM-277)