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Excessive sleep increased the risk of incidence of cognitive impairment among older Chinese adults: a cohort study based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Published online by Cambridge University Press:  04 March 2021

Ming Zhang ,
Xiaozhen Lv ,
Yulu Chen ,
Lihui Tu ,
Zili Fan ,
Yao Yao ,
Xin Yu ,
Nianhong Guan  and
Huali Wang Open the ORCID record for Huali Wang [Opens in a new window]
Ming Zhang
Affiliation:
Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou510630, China
Xiaozhen Lv
Affiliation:
Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China
Yulu Chen
Affiliation:
Department of Psychology, Teachers’ College, Beijing Union University, No. 5 Waiguan Xie Street, Chaoyang District, Beijing100011, China
Lihui Tu
Affiliation:
Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China
Zili Fan
Affiliation:
Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China
Yao Yao
Affiliation:
Center for Healthy Aging and Development Studies, National School of Development, Peking University, No.5 Yiheyuan Road, Haidian District, Beijing100871, China
Xin Yu
Affiliation:
Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China
Nianhong Guan*
Affiliation:
Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou510630, China
Huali Wang*
Affiliation:
Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), No. 51 Huayuanbei Road, Haidian District, Beijing100191, China
*
Correspondence should be addressed to: Prof. Huali Wang, Peking University Institute of Mental Health, Beijing100191, China. Phone +86-10-82801983. E-mail: huali_wang@bjmu.edu.cn or Prof. Nianhong Guan, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China. Phone +86-20-85252479. E-mail: kuwan_hong@163.com.
Correspondence should be addressed to: Prof. Huali Wang, Peking University Institute of Mental Health, Beijing100191, China. Phone +86-10-82801983. E-mail: huali_wang@bjmu.edu.cn or Prof. Nianhong Guan, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China. Phone +86-20-85252479. E-mail: kuwan_hong@163.com.
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Abstract

Study objectives:

Based on a cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we aimed to evaluate the relationship between sleep duration and the incidence of cognitive impairment among older Chinese adults.

Methods:

We conducted a prospective analysis based on 3692 participants from the CLHLS at baseline (in 2011), and as a 3-year follow-up (till 2014), 531 participants (14.4%) had cognitive impairment, which was defined as a Mini-Mental State Examination score <24. Sleep duration was classified into three groups: short (≤5 hours/day), normal (>5 but <10 hours), and long (≥10 hours/day). A logistic regression model was used to examine the association between baseline sleep duration and cognitive impairment after adjusting for sociodemographic data, living habits, and health conditions.

Results:

Five hundred sixty-two participants (15.2%) were in the short-duration group, and 608 participants (16.5%) were in the long-duration group. After adjusting for multiple potential confounders, compared with normal sleep duration, long sleep duration was associated with the incidence of cognitive impairment (OR = 1.309, 95% CI: 1.019–1.683), especially among men (OR = 1.527, 95% CI: 1.041–2.240) and those having a primary and above education level (OR = 1.559, 95% CI: 1.029–2.361). No significant association was observed between short sleep duration and cognitive impairment (OR = 0.860, 95% CI: 0.646–1.145).

Conclusions:

Excessive sleep may increase the risk of cognitive impairment in older individuals. It may be a suggestive sign of early neurodegeneration and may be a useful clinical tool to identify those at a higher risk of progressing to cognitive impairment.

Keywords

cognitive impairmentsleep durationcohortChinese
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 8: Issue Theme: Geriatric Mental Health among Chinese Older Adults , August 2022 , pp. 725 - 734
Copyright
© International Psychogeriatric Association 2021

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Footnotes

†

These authors contributed equally to this work.

References

An, R. and Liu, G. G. (2016). Cognitive impairment and mortality among the oldest-old Chinese. International Journal of Geriatric Psychiatry, 31, 1345–1353. doi: 10.1002/gps.4442 CrossRefGoogle ScholarPubMed
Auyeung, T. W. et al. (2013). Cognitive deficit is associated with phase advance of sleep-wake rhythm, daily napping, and prolonged sleep duration--a cross-sectional study in 2,947 community-dwelling older adults. Age (Dordrecht, Netherlands), 35, 479–486. doi: 10.1007/s11357-011-9366-6 CrossRefGoogle ScholarPubMed
Basta, M. et al. (2019). Associations between sleep duration and cognitive impairment in mild cognitive impairment. Journal of Sleep Research, 28, e12864. doi: 10.1111/jsr.12864 CrossRefGoogle ScholarPubMed
Blackwell, T. et al. (2006). Poor sleep is associated with impaired cognitive function in older women: the study of osteoporotic fractures. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 61, 405–410. doi: 10.1093/gerona/61.4.405 CrossRefGoogle ScholarPubMed
Blackwell, T. et al. (2014). Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. Sleep, 37, 655–663. doi: 10.5665/sleep.3562 Google ScholarPubMed
Chen, J. C. et al. (2016). Sleep duration, cognitive decline, and dementia risk in older women. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 12, 21–33. doi: 10.1016/j.jalz.2015.03.004 CrossRefGoogle ScholarPubMed
Cheng, G. et al. (2017). Factors of nocturnal sleep and daytime nap durations in community-dwelling elderly: a longitudinal population-based study. International Psychogeriatrics, 29, 1335–1344. doi: 10.1017/S104161021700062X CrossRefGoogle ScholarPubMed
Cheng, G. et al. (2018). Importance of social relationships in the association between sleep duration and cognitive function: data from community-dwelling older Singaporeans. International Psychogeriatrics, 30, 893–901. doi: 10.1017/S1041610217001041 CrossRefGoogle ScholarPubMed
Chew, M., Tan, N., Lamoureux, E., Cheng, C. Y., Wong, T. Y. and Sabanayagam, C. (2020). The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy. Diabetes Research and Clinical Practice, 159, 107967. doi: 10.1016/j.diabres.2019.107967 CrossRefGoogle ScholarPubMed
Ciarmiello, A. et al. (2019). Longitudinal cognitive decline in mild cognitive impairment subjects with early amyloid-β neocortical deposition. European Journal of Nuclear Medicine and Molecular Imaging, 46, 2090–2098. doi: 10.1007/s00259-019-04409-1 CrossRefGoogle ScholarPubMed
Cochrane, A., Robertson, I. H. and Coogan, A. N. (2012). Association between circadian rhythms, sleep and cognitive impairment in healthy older adults: an actigraphic study. Journal of Neural Transmission (Vienna, Austria: 1996), 119, 1233–1239. doi: 10.1007/s00702-012-0802-2 CrossRefGoogle ScholarPubMed
Croxford, R. (2016). Restricted cubic spline regression: a brief introduction. Toronto: Institute for Clinical Evaluative Sciences, 1–5.Google Scholar
Devore, E. E., Grodstein, F., Duffy, J. F., Stampfer, M. J., Czeisler, C. A. and Schernhammer, E. S. (2014). Sleep duration in midlife and later life in relation to cognition. Journal of the American Geriatrics Society, 62, 1073–1081. doi: 10.1111/jgs.12790 CrossRefGoogle Scholar
Dziechciaż, M. and Filip, R. (2014). Biological psychological and social determinants of old age: bio-psycho-social aspects of human aging. Annals of Agricultural and Environmental Medicine: AAEM, 21, 835–838. doi: 10.5604/12321966.1129943 CrossRefGoogle ScholarPubMed
Ferrie, J. E., Shipley, M. J., Akbaraly, T. N., Marmot, M. G., Kivimäki, M. and Singh-Manoux, A. (2011). Change in sleep duration and cognitive function: findings from the Whitehall II Study. Sleep, 34, 565–573. doi: 10.1093/sleep/34.5.565 CrossRefGoogle ScholarPubMed
Gaig, C. and Iranzo, A. (2012). Sleep-disordered breathing in neurodegenerative diseases. Current Neurology and Neuroscience Reports, 12, 205–217. doi: 10.1007/s11910-011-0248-1 CrossRefGoogle ScholarPubMed
Gildner, T. E., Liebert, M. A., Kowal, P., Chatterji, S. and Snodgrass, J. J. (2014). Associations between sleep duration, sleep quality, and cognitive test performance among older adults from six middle income countries: results from the Study on Global Ageing and Adult Health (SAGE). Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 10, 613–621. doi: 10.5664/jcsm.3782 Google Scholar
Gulia, K. K. and Kumar, V. M. (2018). Sleep disorders in the elderly: a growing challenge. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 18, 155–165. doi: 10.1111/psyg.12319 CrossRefGoogle ScholarPubMed
Hale, L. and Do, D. P. (2007). Racial differences in self-reports of sleep duration in a population-based study. Sleep, 30, 1096–1103. doi: 10.1093/sleep/30.9.1096 CrossRefGoogle ScholarPubMed
Harrison, F., Aerts, L. and Brodaty, H. (2016). Apathy in Dementia: Systematic Review of Recent Evidence on Pharmacological Treatments. Current Psychiatry Reports, 18, 103. doi: 10.1007/s11920-016-0737-7 CrossRefGoogle ScholarPubMed
Henry, A. et al. (2019). The relationship between sleep duration, cognition and dementia: a Mendelian randomization study. International Journal of Epidemiology, 48, 849–860. doi: 10.1093/ije/dyz071 CrossRefGoogle ScholarPubMed
Hwang, Y. T., Piguet, O., Hodges, J. R., Grunstein, R. and Burrell, J. R. (2020). Sleep and orexin: A new paradigm for understanding behavioural-variant frontotemporal dementia?. Sleep Medicine Reviews, 54, 101361. doi: 10.1016/j.smrv.2020.101361 CrossRefGoogle ScholarPubMed
Ju, Y. E., Lucey, B. P. and Holtzman, D. M. (2014). Sleep and Alzheimer disease pathology--a bidirectional relationship. Nature reviews. Neurology, 10, 115–119. doi: 10.1038/nrneurol.2013.269 CrossRefGoogle ScholarPubMed
Kondratova, A. A. and Kondratov, R. V. (2012). The circadian clock and pathology of the ageing brain. Nature reviews. Neuroscience, 13, 325–335. doi: 10.1038/nrn3208 CrossRefGoogle ScholarPubMed
Kyriacou, C. P. and Hastings, M. H. (2010). Circadian clocks: genes, sleep, and cognition. Trends in Cognitive Sciences, 14, 259–267. doi: 10.1016/j.tics.2010.03.007 CrossRefGoogle ScholarPubMed
Lao, X. Q. et al. (2018). Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 14, 109–117. doi: 10.5664/jcsm.6894 Google ScholarPubMed
Leger, D. et al. (2017). Alzheimer’s Disease Severity is Not Significantly Associated with Short Sleep: Survey by Actigraphy on 208 Mild and Moderate Alzheimer’s Disease Patients. Journal of Alzheimer’s disease: JAD, 55, 321–331. doi: 10.3233/JAD-160754 CrossRefGoogle Scholar
Liguori, C. et al. (2014). Orexinergic system dysregulation, sleep impairment, and cognitive decline in Alzheimer disease. JAMA neurology, 71, 1498–1505. doi: 10.1001/jamaneurol.2014.2510 CrossRefGoogle ScholarPubMed
Lo, J. C., Loh, K. K., Zheng, H., Sim, S. K. and Chee, M. W. (2014). Sleep duration and age-related changes in brain structure and cognitive performance. Sleep, 37, 1171–1178. doi: 10.5665/sleep.3832 CrossRefGoogle ScholarPubMed
Lv, X. et al. (2019). Cognitive decline and mortality among community-dwelling Chinese older people. BMC Medicine, 17, 63. doi: 10.1186/s12916-019-1295-8 CrossRefGoogle ScholarPubMed
Lv, Y. B. et al. (2018). Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study. BMJ (Clinical research ed.), 361, k2158. doi: 10.1136/bmj. k2158 CrossRefGoogle ScholarPubMed
Mong, J. A. and Cusmano, D. M. (2016). Sex differences in sleep: impact of biological sex and sex steroids. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 371, 20150110. doi: 10.1098/rstb.2015.0110 CrossRefGoogle ScholarPubMed
Nakakubo, S. et al. (2019). Sleep condition and cognitive decline in Japanese community-dwelling older people: data from a 4-year longitudinal study. Journal of Sleep Research, 28, e12803. doi: 10.1111/jsr.12803 Google ScholarPubMed
Otsuka, K. et al. (2014). Comprehensive geriatric assessment reveals sleep disturbances in community-dwelling elderly adults associated with even slight cognitive decline. Journal of the American Geriatrics Society, 62(3), 571–573. doi: 10.1111/jgs.12721 CrossRefGoogle ScholarPubMed
Ouyang, P. and Sun, W. (2019). Depression and sleep duration: findings from middle-aged and elderly people in China. Public Health, 166, 148–154. doi: 10.1016/j.puhe.2018.10.007 CrossRefGoogle ScholarPubMed
Patel, S. R. et al. (2004). A prospective study of sleep duration and mortality risk in women. Sleep, 27, 440–444. doi: 10.1093/sleep/27.3.440 CrossRefGoogle ScholarPubMed
Paterniti, S., Verdier-Taillefer, M. H., Dufouil, C. and Alpérovitch, A. (2002). Depressive symptoms and cognitive decline in elderly people. Longitudinal study. The British Journal of Psychiatry: The Journal of Mental Science, 181, 406–410. doi: 10.1192/bjp.181.5.406 CrossRefGoogle ScholarPubMed
Picca, A. et al. (2020). The “develOpment of metabolic and functional markers of Dementia IN Older people” (ODINO) Study: Rationale, Design and Methods. Journal of Personalized Medicine, 10, 22. doi: 10.3390/jpm10020022 CrossRefGoogle ScholarPubMed
Potvin, O. et al. (2012). Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults. Sleep, 35, 491–499. doi: 10.5665/sleep.1732 CrossRefGoogle ScholarPubMed
Ramos, A. R. et al. (2013). Association between sleep duration and the mini-mental score: the Northern Manhattan study. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 9, 669–673. doi: 10.5664/jcsm.2834 Google ScholarPubMed
Rubin, R. (2018). Exploring the Relationship Between Depression and Dementia. JAMA, 320, 961–962. doi: 10.1001/jama.2018.11154 CrossRefGoogle ScholarPubMed
Saint Martin, M., Sforza, E., Barthélémy, J. C., Thomas-Anterion, C. and Roche, F. (2012). Does subjective sleep affect cognitive function in healthy elderly subjects? The Proof cohort. Sleep Medicine, 13, 1146–1152. doi: 10.1016/j.sleep.2012.06.021 CrossRefGoogle ScholarPubMed
Seelye, A., Mattek, N., Howieson, D., Riley, T., Wild, K. and Kaye, J. (2015). The impact of sleep on neuropsychological performance in cognitively intact older adults using a novel in-home sensor-based sleep assessment approach. The Clinical Neuropsychologist, 29, 53–66. doi: 10.1080/13854046.2015.1005139 CrossRefGoogle ScholarPubMed
Seelye, K. et al. (2014). Comprehensive geriatric assessment reveals sleep disturbances in community-dwelling elderly adults associated with even slight cognitive decline. Journal of the American Geriatrics Society, 62, 571–573. doi: 10.1111/jgs.12721 Google Scholar
Song, Q. F. et al. (2017). Night Sleep Duration and Risk of Cognitive Impairment in a Chinese Population: A Cross-sectional Study. Biomedical and Environmental Sciences: BES, 30, 749–757. doi: 10.3967/bes2017.100 Google Scholar
Suh, S. W. et al. (2018). Sleep and cognitive decline: a prospective nondemented elderly cohort study. Annals of Neurology, 83, 472–482. doi: 10.1002/ana.25166 CrossRefGoogle ScholarPubMed
Tanaka, H. and Shirakawa, S. (2004). Sleep health, lifestyle and mental health in the Japanese elderly: ensuring sleep to promote a healthy brain and mind. Journal of Psychosomatic Research, 56, 465–477. doi: 10.1016/j.jpsychores.2004.03.002 CrossRefGoogle ScholarPubMed
Titova, O. E., Michaëlsson, K. and Larsson, S. C. (2020). Sleep Duration and Stroke: Prospective Cohort Study and Mendelian Randomization Analysis. Stroke, 51, 3279–3285. doi: 10.1161/STROKEAHA.120.029902 CrossRefGoogle ScholarPubMed
Tsuneki, H., Wada, T. and Sasaoka, T. (2018). Chronopathophysiological implications of orexin in sleep disturbances and lifestyle-related disorders. Pharmacology & Therapeutics, 186, 25–44. doi: 10.1016/j.pharmthera.2017.12.010 CrossRefGoogle ScholarPubMed
Westwood, A. J. et al. (2017). Prolonged sleep duration as a marker of early neurodegeneration predicting incident dementia. Neurology, 88, 1172–1179. doi: 10.1212/WNL.0000000000003732 CrossRefGoogle ScholarPubMed
Wu, L., Sun, D. and Tan, Y. (2018). A systematic review and dose-response meta-analysis of sleep duration and the occurrence of cognitive disorders. Sleep & Breathing, 22, 805–814. doi: 10.1007/s11325-017-1527-0 CrossRefGoogle ScholarPubMed
Xu, L. et al. (2014). Sleep duration and memory in the elderly Chinese: longitudinal analysis of the Guangzhou Biobank Cohort Study. Sleep, 37, 1737–1744. doi: 10.5665/sleep.4162 CrossRefGoogle ScholarPubMed
Zeng, Y. (2012). Towards Deeper Research and Better Policy for Healthy Aging --Using the Unique Data of Chinese Longitudinal Healthy Longevity Survey. China economic Journal, 5, 131–149. doi: 10.1080/17538963.2013.764677 CrossRefGoogle ScholarPubMed
Zeng, Y., Feng, Q., Hesketh, T., Christensen, K. and Vaupel, J. W. (2017). Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study. Lancet (London, England), 389, 1619–1629. doi: 10.1016/S0140-6736(17)30548-2 CrossRefGoogle ScholarPubMed
Zhang, Z., Gu, D., and Hayward, M. D. (2008). Early life influences on cognitive impairment among oldest old Chinese. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 63(1), S25–S33. doi: 10.1093/geronb/63.1.s25 CrossRefGoogle ScholarPubMed