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Long JJ, Chen Y, Kim B, Bae S, Li Y, Orandi BJ, Chu NM, Mathur A, Segev DL, McAdams-DeMarco MA. Sleep Disorders and Dementia Risk in Older Patients with Kidney Failure: A Retrospective Cohort Study. Clin J Am Soc Nephrol 2024:01277230-990000000-00412. [PMID: 38913442 DOI: 10.2215/cjn.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Key Points
Older patients with kidney failure who are newly diagnosed with sleep disorders are at higher risk of developing any type of dementia, vascular dementia, and other/mixed types of dementia.For older patients with kidney failure who are diagnosed with obstructive sleep apnea, positive airway pressure therapy is an intervention that is associated with lower dementia risk.
Background
Community-dwelling older adults with sleep disorders are at higher risk of developing dementia. Greater than 50% of older patients with kidney failure experience sleep disorders, which may explain their high burden of dementia.
Methods
Among 216,158 patients (aged 66 years and older) with kidney failure (United States Renal Data System; 2008–2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional hazards models with propensity score weighting. We tested whether positive airway pressure (PAP) therapy was associated with reduced dementia risk among patients with obstructive sleep apnea (OSA).
Results
26.3% of patients were diagnosed with sleep disorders; these patients had a higher 5-year unadjusted cumulative incidence for any type of dementia (36.2% versus 32.3%; P < 0.001), vascular dementia (4.4% versus 3.7%; P < 0.001), and other/mixed dementia (29.3% versus 25.8%; P < 0.001). Higher risk of any type of dementia was identified in patients with insomnia (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [CI], 1.34 to 1.51), sleep-related breathing disorders (SRBDs) (aHR, 1.20, 95% CI, 1.17 to 1.23), and other sleep disorders (aHR, 1.24; 95% CI, 1.11 to 1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR, 1.43; 95% CI, 1.19 to 1.73) and SRBDs (aHR, 1.15; 95% CI, 1.07 to 1.24). Patients with SRBDs (aHR, 1.07; 95% CI, 1.00 to 1.15) were at higher risk of Alzheimer disease. Among patients with OSA, PAP therapy was associated with lower risk of any type of dementia (aHR, 0.82; 95% CI, 0.76 to 0.90) and vascular dementia (aHR, 0.65; 95% CI, 0.50 to 0.85).
Conclusions
Older patients with kidney failure and sleep disorders are at a higher risk of dementia. Sleep is an important modifiable factor that should be considered for targeted interventions to mitigate dementia risk in patients with kidney failure. For patients with OSA, PAP therapy is associated with lower dementia risk.
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Affiliation(s)
- Jane J Long
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Yusi Chen
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Byoungjun Kim
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Sunjae Bae
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Yiting Li
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Babak J Orandi
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Medicine, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
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2
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Carpi M, Fernandes M, Mercuri NB, Liguori C. Sleep Biomarkers for Predicting Cognitive Decline and Alzheimer's Disease: A Systematic Review of Longitudinal Studies. J Alzheimers Dis 2024; 97:121-143. [PMID: 38043016 DOI: 10.3233/jad-230933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND Sleep disturbances are considered a hallmark of dementia, and strong evidence supports the association between alterations in sleep parameters and cognitive decline in patients with mild cognitive impairment and Alzheimer's disease (AD). OBJECTIVE This systematic review aims to summarize the existing evidence on the longitudinal association between sleep parameters and cognitive decline, with the goal of identifying potential sleep biomarkers of AD-related neurodegeneration. METHODS Literature search was conducted in PubMed, Web of Science, and Scopus databases from inception to 28 March 2023. Longitudinal studies investigating the association between baseline objectively-measured sleep parameters and cognitive decline were assessed for eligibility. RESULTS Seventeen studies were included in the qualitative synthesis. Sleep fragmentation, reduced sleep efficiency, reduced REM sleep, increased light sleep, and sleep-disordered breathing were identified as predictors of cognitive decline. Sleep duration exhibited a U-shaped relation with subsequent neurodegeneration. Additionally, several sleep microstructural parameters were associated with cognitive decline, although inconsistencies were observed across studies. CONCLUSIONS These findings suggest that sleep alterations hold promise as early biomarker of cognitive decline, but the current evidence is limited due to substantial methodological heterogeneity among studies. Further research is necessary to identify the most reliable sleep parameters for predicting cognitive impairment and AD, and to investigate interventions targeting sleep that can assist clinicians in the early recognition and treatment of cognitive decline. Standardized procedures for longitudinal studies evaluating sleep and cognition should be developed and the use of continuous sleep monitoring techniques, such as actigraphy or EEG headband, might be encouraged.
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Affiliation(s)
- Matteo Carpi
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Liguori
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Versace S, Pellitteri G, Sperotto R, Tartaglia S, Da Porto A, Catena C, Gigli GL, Cavarape A, Valente M. A State-of-Art Review of the Vicious Circle of Sleep Disorders, Diabetes and Neurodegeneration Involving Metabolism and Microbiota Alterations. Int J Mol Sci 2023; 24:10615. [PMID: 37445790 DOI: 10.3390/ijms241310615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
In the context of neurodegenerative disorders, cognitive decline is frequently reported in older population. Recently, numerous metabolic pathways have been implicated in neurodegeneration, including signaling disruption of insulin and other glucose-regulating hormones. In fact, Alzheimer's disease has now been considered as "type-3 diabetes". In this review, we tried to clarify the role of sleep impairment as the third major player in the complex relationship between metabolic and neurodegenerative diseases. Altered sleep may trigger or perpetuate these vicious mechanisms, leading to the development of both dementia and type 2 diabetes mellitus. Finally, we analyzed these reciprocal interactions considering the emerging role of the gut microbiota in modulating the same processes. Conditions of dysbiosis have been linked to circadian rhythm disruption, metabolic alterations, and release of neurotoxic products, all contributing to neurodegeneration. In a future prospective, gut microbiota could provide a major contribution in explaining the tangled relationship between sleep disorders, dementia and diabetes.
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Affiliation(s)
- Salvatore Versace
- Clinical Neurology, Udine University Hospital, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Gaia Pellitteri
- Clinical Neurology, Udine University Hospital, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
| | - Roberto Sperotto
- Clinical Neurology, Udine University Hospital, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Sara Tartaglia
- Clinical Neurology, Udine University Hospital, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Andrea Da Porto
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Internal Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Cristiana Catena
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Internal Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Alessandro Cavarape
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Internal Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology, Udine University Hospital, Piazza Santa Maria della Misericordia, 15, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Casagrande M, Forte G, Favieri F, Corbo I. Sleep Quality and Aging: A Systematic Review on Healthy Older People, Mild Cognitive Impairment and Alzheimer’s Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148457. [PMID: 35886309 PMCID: PMC9325170 DOI: 10.3390/ijerph19148457] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
Aging is characterized by changes in the structure and quality of sleep. When the alterations in sleep become substantial, they can generate or accelerate cognitive decline, even in the absence of overt pathology. In fact, impaired sleep represents one of the earliest symptoms of Alzheimer’s disease (AD). This systematic review aimed to analyze the studies on sleep quality in aging, also considering mild cognitive impairment (MCI) and AD. The review process was conducted according to the PRISMA statement. A total of 71 studies were included, and the whole sample had a mean age that ranged from 58.3 to 93.7 years (62.8–93.7 healthy participants and 61.8–86.7 pathological populations). Of these selected studies, 33 adopt subjective measurements, 31 adopt objective measures, and 10 studies used both. Pathological aging showed a worse impoverishment of sleep than older adults, in both subjective and objective measurements. The most common aspect compromised in AD and MCI were REM sleep, sleep efficiency, sleep latency, and sleep duration. These results underline that sleep alterations are associated with cognitive impairment. In conclusion, the frequency and severity of sleep disturbance appear to follow the evolution of cognitive impairment. The overall results of objective measures seem more consistent than those highlighted by subjective measurements.
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Affiliation(s)
- Maria Casagrande
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Roma, Italy;
- Correspondence: (M.C.); (I.C.)
| | - Giuseppe Forte
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Roma, Italy;
- Body and Action Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy;
| | - Francesca Favieri
- Body and Action Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy;
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Roma, Italy
| | - Ilaria Corbo
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Roma, Italy
- Correspondence: (M.C.); (I.C.)
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Guo H, Zhang Y, Wang Z, Shen H. Sleep Quality Partially Mediate the Relationship Between Depressive Symptoms and Cognitive Function in Older Chinese: A Longitudinal Study Across 10 Years. Psychol Res Behav Manag 2022; 15:785-799. [PMID: 35391717 PMCID: PMC8982800 DOI: 10.2147/prbm.s353987] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Huan Guo
- School of Human Resources, Guangdong University of Finance & Economics, Guangzhou, People’s Republic of China
- Institute of Analytical Psychology, City University of Macau, Macau, People’s Republic of China
| | - Yancui Zhang
- Postdoctoral Research Center of School of Psychology, Nanjing Normal University, Nanjing, People’s Republic of China
| | - Zhendong Wang
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Heyong Shen
- Institute of Analytical Psychology, City University of Macau, Macau, People’s Republic of China
- Correspondence: Heyong Shen, Email
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Chover-Sierra E, Pérez-Ros P, Julián-Rochina I, Long CO, Cauli O. Knowledge and Attitudes towards Palliative Care: Validation of the Spanish Version of Questionnaire on Palliative Care for Advanced Dementia. Healthcare (Basel) 2022; 10:healthcare10040656. [PMID: 35455834 PMCID: PMC9029205 DOI: 10.3390/healthcare10040656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Palliative care is essential in the care of people with advanced dementia, due to the increasing number of patients requiring care in the final stages of life. Nurses need to acquire specific knowledge and skills to provide quality palliative care. The Questionnaire on Palliative Care for Advanced Dementia (qPAD) is useful for assessing knowledge and attitudes toward palliative care, but its adaptation to the Spanish language and analysis of its effectiveness and usefulness for the Spanish culture is lacking. Objective: To report on the Spanish language adaptation and psychometric analysis of the qPAD. Methods: The Questionnaire on Palliative Care for Advanced Dementia Spanish version (qPAD-SV) was obtained from a process that included translation, back-translation, comparison with other language versions, expert review, and pilot study. Content validity, criterion validity, and reliability of the questionnaire were analyzed. The difficulty and discrimination indices of items composing the knowledge subscale were also calculated. Results: Adequate content validity index obtained after the analysis of qPAD-SV by a heterogeneous group of experts was found (overall CVI = 0.96; 0.95 for the Knowledge subscale and 0.99 for the Attitudes subscale). Significant correlations with the Palliative Care Knowledge test (rho = 0.368, p < 0.001) and Self-Efficacy in Palliative Care Scale (rho = 0.621, p < 0.001) show an adequate criterion validity. Cronbach’s alpha coefficients for the Knowledge subscale (0.60) and the Attitudes subscale (0.91) supported the reliability of the qPAD-SV. The questionnaire had an overall difficulty index of 0.71, with three items that could be considered difficult or very difficult, and eleven items that could be considered very easy. Discussion: Although it shows internal consistency, validity, and difficulty indices similar to those obtained by qPAD versions in other languages, a reformulation of the items with lower content validity or discrimination indices and those that show difficulties in their comprehension is an aspect to be taken into account to improve this tool. Conclusions: The qPAD-SV is a useful instrument in Spanish to measure the knowledge of Spanish nurses in palliative care and is suitable for international comparisons.
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Affiliation(s)
- Elena Chover-Sierra
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Pilar Pérez-Ros
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Carol O. Long
- “Palliative Care Essentials” Research Institute, Fredericksburg, VA 22407, USA;
| | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Correspondence:
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Ordóñez MDLÁ, Ordóñez PDLÁ. Sleep in Persons Living with Alzheimer's Disease and Related Dementias. Nurs Clin North Am 2021; 56:249-263. [PMID: 34023119 DOI: 10.1016/j.cnur.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over a typical lifespan, the amount of time people spend each day sleeping decreases. Sleep patterns also change as people age. Sleep disorders are common among persons of all ages, and older adults are particularly vulnerable. Development of age-related neurodegenerative diseases, such as Alzheimer's disease and related dementias, is associated with pronounced sleep disruption. This article provides evidence-based guidelines for diagnosis and clinical management of sleep disorders that occur during the course of treatment of Alzheimer's disease and related dementias. The article presents novel interventions and future directions for clinical practice and sleep research, and addresses diversity and inclusivity.
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Affiliation(s)
- María de Los Ángeles Ordóñez
- Louis and Anne Green Memory and Wellness Center of the Christine E. Lynn College of Nursing (CELCON), Florida Atlantic University (FAU), FAU CELCON; Alzheimer's Disease Initiative, Florida Department of Elder Affairs; Federal Advisory Council on Alzheimer's Research, Care, and Services, US Department of Health and Human Services, 777 Glades Rd, Bldg. AZ-79, Boca Raton, FL 33431, USA.
| | - Patricia de Los Ángeles Ordóñez
- Nova Southeastern University (NSU), College of Psychology; Care, Supportive Services, and Outreach Coordinator, Louis and Anne Green Memory; Wellness Center of the Christine E. Lynn College of Nursing (CELCON), Florida Atlantic University (FAU); Alzheimer's Disease Initiative, Florida Department of Elder Affairs, 777 Glades Rd, Bldg. AZ-79, Boca Raton, FL 33431, USA
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Abstract
Sleep duration and lifespan vary greatly across Animalia. Human studies have demonstrated that ageing reduces the ability to obtain deep restorative sleep, and this may play a causative role in the development of age-related neurodegenerative disorders. Animal models are widely used in sleep and ageing studies. Importantly, in contrast to human studies, evidence from laboratory rodents suggests that sleep duration is increased with ageing, while evidence for reduced sleep intensity and consolidation is inconsistent. Here we discuss two possible explanations for these species differences. First, methodological differences between studies in humans and laboratory rodents may prevent straightforward comparison. Second, the role of ecological factors, which have a profound influence on both ageing and sleep, must be taken into account. We propose that the dynamics of sleep across the lifespan reflect both age-dependent changes in the neurobiological substrates of sleep as well as the capacity to adapt to the environment.
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Muehlroth BE, Werkle-Bergner M. Understanding the interplay of sleep and aging: Methodological challenges. Psychophysiology 2020; 57:e13523. [PMID: 31930523 DOI: 10.1111/psyp.13523] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/21/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
In quest of new avenues to explain, predict, and treat pathophysiological conditions during aging, research on sleep and aging has flourished. Despite the great scientific potential to pinpoint mechanistic pathways between sleep, aging, and pathology, only little attention has been paid to the suitability of analytic procedures applied to study these interrelations. On the basis of electrophysiological sleep and structural brain data of healthy younger and older adults, we identify, illustrate, and resolve methodological core challenges in the study of sleep and aging. We demonstrate potential biases in common analytic approaches when applied to older populations. We argue that uncovering age-dependent alterations in the physiology of sleep requires the development of adjusted and individualized analytic procedures that filter out age-independent interindividual differences. Age-adapted methodological approaches are thus required to foster the development of valid and reliable biomarkers of age-associated cognitive pathologies.
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Affiliation(s)
- Beate E Muehlroth
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Markus Werkle-Bergner
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
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