老年人睡眠障碍与肌少症：临床关联、潜在机制及管理策略

文献信息

中文摘要

肌少症是一种与年龄相关的综合征，其特征为骨骼肌质量减少、肌力下降和躯体功能受损，是老年人跌倒、残疾、住院和死亡的重要促成因素。睡眠障碍，包括睡眠时长异常、睡眠质量差、失眠、昼夜节律紊乱和阻塞性睡眠呼吸暂停（OSA），在该人群中也非常普遍，并可能与较差的躯体功能相关。越来越多的观察性证据提示睡眠障碍与肌少症之间存在关联，但其方向性仍不确定。本叙述性综述总结了当前将老年人睡眠障碍与肌少症联系起来的临床证据，讨论了该关系潜在的生物学和行为学通路，并概述了具有临床意义的管理策略。特别关注的是跨睡眠领域、肌少症组成部分和研究设计对证据进行比较，区分临床定义的肌少症与个体肌肉特征，以及区分生物学合理性与已证实的中介作用。潜在通路涉及昼夜节律紊乱、神经内分泌和代谢失调、慢性炎症、线粒体功能障碍和氧化应激，尽管在老年人中的直接机制证据仍然有限。睡眠评估和对临床识别出的睡眠障碍进行管理可能补充运动和营养支持，但其对肌少症结局的影响仍不确定。现有临床证据主要为观察性且常为横断面研究；需要在同时患有这两种情况的老年人中开展前瞻性研究和有足够把握度的随机试验，以阐明因果关系和治疗获益。

英文摘要

Sarcopenia is an age-related syndrome characterized by reduced skeletal muscle mass, decreased muscle strength, and impaired physical performance, and is an important contributor to falls, disability, hospitalization, and mortality in older adults. Sleep disturbances, including abnormal sleep duration, poor sleep quality, insomnia, circadian disruption, and obstructive sleep apnea (OSA), are also highly prevalent in this population and may be associated with poorer physical performance. Accumulating observational evidence suggests an association between sleep disturbances and sarcopenia, although its directionality remains uncertain. This narrative review summarizes current clinical evidence linking sleep disturbances to sarcopenia in older adults, discusses potential biological and behavioral pathways underlying this relationship, and outlines clinically relevant management strategies. A particular focus is the comparison of evidence across sleep domains, sarcopenia components, and study designs, distinguishing clinically defined sarcopenia from individual muscle traits and biological plausibility from demonstrated mediation. Potential pathways involve circadian disruption, neuroendocrine and metabolic dysregulation, chronic inflammation, mitochondrial dysfunction and oxidative stress, although direct mechanistic evidence in older adults remains limited. Sleep assessment and management of clinically identified sleep disturbances may complement exercise and nutritional support, but their effects on sarcopenia outcomes remain uncertain. The available clinical evidence is predominantly observational and often cross-sectional; prospective studies and adequately powered randomized trials in older adults with both conditions are needed to clarify causality and treatment benefits.