阻塞性睡眠呼吸暂停风险与认知特征减退相关：来自加拿大老龄化纵向研究的发现

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）和失眠在老年人中高度普遍，且两者均与认知功能下降有关。然而，目前尚不清楚OSA的生理负担还是与失眠相关的睡眠碎片化更能预测认知损害。本研究考察了在社区居住的加拿大老年人中，OSA风险或失眠哪一个与记忆问题和认知迟缓的关联更强。鉴于横断面设计，本研究评估的是相关性而非因果关系。
方法： 数据来自加拿大老龄化纵向研究（CLSA）的946名参与者，包括473名报告有医生诊断的记忆问题的个体和473名按年龄和性别匹配的对照。OSA风险使用经过验证的STOP-BA(N)G问卷进行评估。同时，失眠根据基于入睡潜伏期、入睡后觉醒时间和睡眠时长的操作性研究标准来定义。认知处理速度通过选择反应时（CRT）进行测量。采用一般线性模型、logistic回归和判别分析来检验睡眠参数与认知结局之间的关联，并控制年龄、性别、体质指数、收入和糖尿病。
结果： 与对照组相比，有记忆问题的参与者STOP-BA(N)G评分显著更高（F(1,931) = 7.10，p = 0.008），CRT更慢（p = 0.05）。单纯失眠或与OSA共病（COMISA）与认知结局无关。在判别分析中，STOP-BA(N)G评分（r = 0.45）和糖尿病（r = 0.26）是记忆问题的最强预测因素，正确分类了66.6%的病例。按性别分层分析显示，较高的STOP-BA(N)G评分与记忆问题之间的关联在男性和女性中均仍然显著，尽管效应量在男性中略大。
结论： 较高的OSA风险与老年人较差的记忆和较慢的认知处理速度相关，而失眠与这些结局无关。由于采用横断面设计，无法推断因果关系。对有记忆主诉的患者进行OSA和代谢共病筛查，可能有助于识别认知损害风险增加的个体。

英文摘要

BACKGROUND: Obstructive sleep apnea (OSA) and insomnia are highly prevalent in older adults and both have been linked to cognitive decline. However, it remains unclear whether the physiological burden of OSA or the sleep fragmentation associated with insomnia more strongly predicts cognitive impairment. This study examined whether OSA risk or insomnia better was associated with memory problems and cognitive slowing among community-dwelling older Canadians. Given the cross-sectional design, the study evaluated associations rather than causal relationships.
METHODS: Data were drawn from 946 participants in the Canadian Longitudinal Study on Aging (CLSA), including 473 individuals reporting a physician-diagnosed memory problem and 473 age- and sex-matched controls. OSA risk was assessed using the validated STOP-BA(N)G questionnaire. At the same time, insomnia was defined using operational research criteria based on sleep onset latency, wake after sleep onset, and duration. Cognitive processing speed was measured via Choice Reaction Time (CRT). General linear models, logistic regression, and discriminant analyses examined associations between sleep parameters and cognitive outcomes, controlling for age, sex, body mass index, income, and diabetes.
RESULTS: Participants with memory problems had significantly higher STOP-BA(N)G scores (F(1,931) = 7.10, p = 0.008) and slower CRTs (p = 0.05) compared to controls. Insomnia alone or comorbid with OSA (COMISA) was not associated with cognitive outcomes. In discriminant analysis, STOP-BA(N)G score (r = 0.45) and diabetes (r = 0.26) were the strongest predictors of memory problems, correctly classifying 66.6% of cases. Sex-stratified analyses demonstrated that the association between higher STOP-BA(N)G scores and memory problems remained significant in both men and women, although effect sizes were somewhat larger in men.
CONCLUSION: Higher OSA risk was associated with poorer memory and slower cognitive processing in older adults, whereas insomnia was not associated with these outcomes. Because of the cross-sectional design, causality cannot be inferred. Screening for OSA and metabolic comorbidities in patients with memory complaints may help identify individuals at increased risk of cognitive impairment.