20th Annual Sleep and Health Benefit

Examining sleep deficiency and disturbance and risk for incident dementia and all-cause mortality in older adults across 5 years in the United States

Rebecca Robbins, PhD

Brigham and Women's Hospital

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Clinical Implications
Our study offers a contribution to the literature on sleep among aging populations in its assessment of incident dementia and all-cause mortality and a range of sleep characteristics among older adults. According to our findings from Cox proportional hazard models examining each sleep characteristic and outcome, we found that longer time to fall asleep and short sleep duration predicted incident dementia, while short sleep, difficulty maintaining alertness, napping, and poor sleep quality predict all-cause mortality. According to combined Cox proportional hazards models, short sleep duration was a strong predictor of both incident dementia and all-cause mortality suggesting this may be a sleep characteristic that is important – over and above the other predictors – of adverse outcomes among older adults. Also, future research may consider the development of novel behavioral interventions to improve sleep among older adults.
Research Narrative

Sleep disturbance and insufficiency has been shown to be associated with both the development and progression of Alzheimer’s disease and with all-cause mortality. Among a cohort of older adults without dementia, adults with high sleep fragmentation had a 1.5-fold risk of developing Alzheimer’s Disease compared to those with low sleep fragmentation. Similarly, in a prospective analyses, sleep disturbance was linked with incident cognitive impairment, while another prospective analysis found sleep disturbance was linked with both incident dementia as well as mortality. Furthermore, compared to cognitively normal individuals, those with either with self-reported obstructive sleep apnea (OSA) diagnosis or physician-diagnosed OSA, developed more Alzheimer’s disease biomarkers, such as amyloid-beta plaques or tau proteins, over time compared to those without OSA. In addition, previous research has found associations between both long (>9 hours) and short (9 hours) were associated with all-cause dementia and clinical Alzheimer disease, but not short sleep (<6 hours). However, according to meta-analysis of 27 studies, both short (< 7 hours) and long sleep duration (> 8 hours) were both associated with approximately 86% greater risk for Alzheimer’s disease and dementia. Prior research has also examined the association among sleep characteristics, sleep deficiency, alertness and all-cause mortality. In a prospective analysis, researchers found that older short (9 hours) was associated with greater risk of mortality. Therefore, research on sleep disturbance and deficiency and all-cause mortality has shown conflicting results. Further, few studies measure a comprehensive set of sleep characteristics in one study. We examine, using nationally representative longitudinal data collected among US adults, several sleep characteristics, dementia, and mortality across a 5-year follow-up duration.

Research Category
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