Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Neurology

24-04-2024 | Alzheimer's Disease | Review

Sleep characteristics and risk of Alzheimer’s disease: a systematic review and meta-analysis of longitudinal studies

Authors: Shichan Wang, Xiaoting Zheng, Jingxuan Huang, Jiyong Liu, Chunyu Li, Huifang Shang

Published in: Journal of Neurology

Login to get access

Abstract

Background

Alzheimer’s disease (AD) is on the rise in our aging society, making it crucial to identify additional risk factors to mitigate its increasing incidence. This systematic review and meta-analysis aimed to provide updated evidence regarding the association between sleep and AD.

Methods

We conducted a comprehensive search of MEDLINE, EMBASE, and Web of Science databases from inception to July 2023 to identify longitudinal studies. Adjusted relative risks were pooled for each sleep characteristic, and a dose–response analysis was performed specifically for sleep duration.

Results

A total of 15,278 records were initially retrieved, and after screening, 35 records were ultimately included in the final analysis. The results showed that insomnia (RR, 1.43; 95%CI, 1.17–1.74), sleep-disordered breathing (RR, 1.22; 95%CI, 1.07–1.39), as well as other sleep problems, including sleep fragmentation and sleep-related movement disorders, were associated with a higher risk of developing AD, while daytime napping or excessive daytime sleepiness (RR, 1.18; 95%CI, 1.00–1.40) only exhibited a trend toward a higher risk of AD development. Furthermore, our analysis revealed a significant association between self-reported sleep problems (RR, 1.34; 95%CI, 1.26–1.42) and the incidence of AD, whereas this association was not observed with sleep problems detected by objective measurements (RR, 1.14; 95%CI, 0.99–1.31). Moreover, both quite short sleep duration (< 4 h) and long duration (> 8 h) were identified as potential risk factors for AD.

Conclusions

Our study found the association between various types of sleep problems and an increased risk of AD development. However, these findings should be further validated through additional objective device-based assessments. Additional investigation is required to establish a definitive causal connection between sleep problems and AD.
Appendix
Available only for authorised users
Literature
1.
2.
Hou Y, Dan X, Babbar M et al (2019) Ageing as a risk factor for neurodegenerative disease. Nat Rev Neurol 15:565–581PubMedCrossRef
3.
Gómez-Gallego M, Gómez-Gallego JC (2021) Predictors of caregiver burden of patients with Alzheimer disease attending day-care centres. Int J Environ Res Public Health 18(20):10707PubMedPubMedCentralCrossRef
4.
5.
6.
Leong RLF, Chee MWL. Understanding the Need for Sleep to Improve Cognition. Annual review of psychology 2022.
7.
Uddin MS, Tewari D, Mamun AA et al (2020) Circadian and sleep dysfunction in Alzheimer’s disease. Ageing Res Rev 60:101046PubMedCrossRef
8.
Singh AK, Malviya R, Prakash A, Verma S (2023) Neuropsychiatric manifestations in Alzheimer’s disease patients: genetics and treatment options. CNS Neurol Disorders Drug Targets 23(1):39–54CrossRef
9.
Musiek ES, Bhimasani M, Zangrilli MA, Morris JC, Holtzman DM, Ju YS (2018) Circadian rest-activity pattern changes in aging and preclinical Alzheimer disease. JAMA Neurol 75:582–590PubMedCrossRef
10.
Luojus MK, Lehto SM, Tolmunen T, Brem A-K, Lonnroos E, Kauhanen J (2017) Self-reported sleep disturbance and incidence of dementia in ageing men. J Epidemiol Community Health 71:329–335PubMedCrossRef
11.
Larsson SC, Wolk A (2018) The role of lifestyle factors and sleep duration for late-onset dementia: a cohort study. J Alzheimer’s Dis 66:579–586CrossRef
12.
Li P, Yu L, Lim ASP et al (2018) Fractal regulation and incident Alzheimer’s disease in elderly individuals. Alzheimer’s Dementia 14:1114–1125PubMedCrossRef
13.
Lutsey PL, Misialek JR, Mosley TH et al (2018) Sleep characteristics and risk of dementia and Alzheimer’s disease: The atherosclerosis risk in communities study. Alzheimer’s Dementia 14:157–166PubMedCrossRef
14.
Lysen TS, Wolters FJ, Luik AI, Ikram MK, Tiemeier H, Ikram MA (2018) Subjective sleep quality is not associated with incident dementia: the rotterdam study. J Alzheimer’s Dis 64:239–247CrossRef
15.
16.
Shi L, Chen SJ, Ma MY et al (2018) Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Med Rev 40:4–16PubMedCrossRef
17.
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedPubMedCentralCrossRef
18.
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (moose) group. JAMA 283(15):2008–2012PubMedCrossRef
19.
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605PubMedCrossRef
20.
Orsini N (2010) From floated to conventional confidence intervals for the relative risks based on published dose-response data. Comput Methods Programs Biomed 98:90–93PubMedCrossRef
21.
Hirshkowitz M, Whiton K, Albert SM et al (2015) National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 1:40–43PubMedCrossRef
22.
Xu C, Doi SAR (2018) The robust error meta-regression method for dose-response meta-analysis. Int J Evid Based Healthc 16(3):138–144PubMedCrossRef
23.
Larsson SC, Orsini N, Wolk A (2011) Dietary potassium intake and risk of stroke: a dose-response meta-analysis of prospective studies. Stroke 42:2746–2750PubMedCrossRef
24.
Asada T, Motonaga T, Yamagata Z, Uno M, Takahashi K (2000) Associations between retrospectively recalled napping behavior and later development of Alzheimer’s disease: association with APOE genotypes. Sleep 23:629–634PubMed
25.
Dun C, Walsh CM, Chu NM, McAdams-DeMarco M, Hashim F, Makary MA (2022) Sleep disorders and the development of Alzheimer’s disease among U.S. Medicare beneficiaries. J Am Geriatr Soc 70:299–301PubMedCrossRef
26.
Lin W, Lin YK, Yang FC et al (2023) Risk of neurodegenerative diseases in patients with sleep disorders: a nationwide population-based case-control study. Sleep Med 107:289–299PubMedCrossRef
27.
Nedelec T, Couvy-Duchesne B, Darves-Bornoz A et al (2023) A comparison between early presentation of dementia with Lewy bodies, Alzheimer’s disease, and Parkinson’s disease: evidence from routine primary care and UK biobank data. Ann Neurol 7(2):e105
28.
Lobo A, López-Antón R, De-La-Cámara C, Quintanilla MÁ, Campayo A, Saz P (2008) Non-cognitive psychopathological symptoms associated with incident mild cognitive impairment and dementia, Alzheimer’s type. Neurotox Res 14:263–272PubMedCrossRef
29.
Benito-León J, Bermejo-Pareja F, Vega S, Louis ED (2009) Total daily sleep duration and the risk of dementia: A prospective population-based study. Eur J Neurol 16:990–997PubMedCrossRef
30.
Osorio RS, Pirraglia E, Agueera-Ortiz LF et al (2011) GREATER risk of Alzheimer’s disease in older adults with insomnia. J Am Geriatr Soc 59:559–562PubMedPubMedCentralCrossRef
31.
32.
Lim AS, Kowgier M, Yu L, Buchman AS, Bennett DA (2013) Sleep Fragmentation and the risk of incident Alzheimer’s disease and cognitive decline in older persons. Sleep 36:1027–1032PubMedPubMedCentralCrossRef
33.
34.
Hahn EA, Wang H-X, Andel R, Fratiglioni L (2014) A change in sleep pattern may predict alzheimer disease. Am J Geriatr Psychiatry 22:1262–1271PubMedCrossRef
35.
Benedict C, Byberg L, Cedernaes J et al (2015) Self-reported sleep disturbance is associated with Alzheimer’s disease risk in men. Alzheimer’s Dementia 11:1090–1097PubMedCrossRef
36.
Lin CC, Chou CH, Fan YM et al (2015) Increased risk of dementia among sleep-related movement disorders: a population-based longitudinal study in Taiwan. Medicine 94:e2331PubMedPubMedCentralCrossRef
37.
Yaffe K, Nettiksimmons J, Yesavage J, Byers A (2015) Sleep quality and risk of dementia among older male veterans. Am J Geriatr Psychiatry 23:651–654PubMedCrossRef
38.
39.
Sung P-S, Yeh C-C, Wang L-C et al (2017) Increased risk of dementia in patients with non-apnea sleep disorder. Curr Alzheimer Res 14:309–316PubMedCrossRef
40.
Westwood AJ, Beiser A, Jain N et al (2017) Prolonged sleep duration as a marker of early neurodegeneration predicting incident dementia. Neurology 88:1172–1179PubMedPubMedCentralCrossRef
41.
Burke SL, Cadet T, Alcide A, O’Driscoll J, Maramaldi P (2018) Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety. Aging Ment Health 22:1577–1584PubMedCrossRef
42.
Ohara T, Honda T, Hata J et al (2018) Association between daily sleep duration and risk of dementia and mortality in a Japanese community. J Am Geriatr Soc 66:1911–1918PubMedCrossRef
43.
Eun LJ, Wu YS, Jun JY, Kuk KS, Hong CK (2019) Sleep-disordered breathing and Alzheimer’s disease: A nationwide cohort study. Psychiatry Res 273:624–630CrossRef
44.
Lysen TS, Luik AI, Ikram MK, Tiemeier H, Ikram MA (2020) Actigraphy-estimated sleep and 24-hour activity rhythms and the risk of dementia. Alzheimer’s Dementia 16:1259–1267PubMedCrossRef
45.
46.
Yuan S, Ma W, Yang R et al (2022) Sleep duration, genetic susceptibility, and Alzheimer’s disease: a longitudinal UK Biobank-based study. BMC Geriatr 22:638PubMedPubMedCentralCrossRef
47.
Baek MS, Han K, Kwon HS, Lee YH, Cho H, Lyoo CH (2021) Risks and prognoses of Alzheimer’s disease and vascular dementia in patients with insomnia: a nationwide population-based study. Front Neurol 12:611446PubMedPubMedCentralCrossRef
48.
49.
Lee W, Gray SL, Barthold D, Maust DT, Marcum ZA (2022) Association between informant-reported sleep disturbance and incident dementia: an analysis of the national alzheimer’s coordinating center uniform data set. J Appl Gerontol 41:285–294PubMedCrossRef
50.
Kim KY, Kim EH, Lee M, Ha J, Jung I, Kim E (2023) Restless leg syndrome and risk of all-cause dementia: a nationwide retrospective cohort study. Alzheimer’s Res Therapy 15:46CrossRef
51.
Li P, Gao L, Yu L et al (2023) Daytime napping and Alzheimer’s dementia: apotential bidirectional relationship. Alzheimers Dement 19:158–168PubMedCrossRef
52.
Selbaek-Tungevåg S, Selbaek G, Strand BH et al (2023) Insomnia and risk of dementia in a large population-based study with 11-year follow-up: The HUNT study. J Sleep Res 32:e13820PubMedCrossRef
53.
de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS (2016) Insomnia and risk of dementia in older adults: Systematic review and meta-analysis. J Psychiatr Res 77:109–115PubMedCrossRef
54.
Leng Y, McEvoy CT, Allen IE, Yaffe K (2017) Association of sleep-disordered breathing with cognitive function and risk of cognitive impairment: a systematic review and meta-analysis. JAMA Neurol 74:1237–1245PubMedPubMedCentralCrossRef
55.
Zhu X, Zhao Y (2018) Sleep-disordered breathing and the risk of cognitive decline: a meta-analysis of 19,940 participants. Sleep Breath 22:165–173PubMedCrossRef
56.
Cai H, Su N, Li W, Li X, Xiao S, Sun L (2021) Relationship between afternoon napping and cognitive function in the ageing Chinese population. Gen Psychiatr 34:e100361PubMedPubMedCentralCrossRef
57.
Li J, Cacchione PZ, Hodgson N et al (2017) Afternoon napping and cognition in chinese older adults: findings from the china health and retirement longitudinal study baseline assessment. J Am Geriatr Soc 65:373–380PubMedCrossRef
58.
59.
Zhang Y, Ren R, Yang L et al (2022) Sleep in Alzheimer’s disease: a systematic review and meta-analysis of polysomnographic findings. Transl Psychiatry 12:136PubMedPubMedCentralCrossRef
60.
61.
Xu W, Tan L, Su BJ et al (2020) Sleep characteristics and cerebrospinal fluid biomarkers of Alzheimer’s disease pathology in cognitively intact older adults: the cable study. Alzheimer’s Dementia 16:1146–1152PubMedCrossRef
62.
Xu W, Tan CC, Zou JJ, Cao XP, Tan L (2020) Sleep problems and risk of all-cause cognitive decline or dementia: an updated systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 91:236–244PubMedCrossRef
63.
Cordone S, Scarpelli S, Alfonsi V, De Gennaro L, Gorgoni M (2021) Sleep-based interventions in alzheimer’s disease: promising approaches from prevention to treatment along the disease trajectory. Pharmaceuticals (Basel, Switzerland) 14(4):383PubMedCrossRef
64.
Xie L, Kang H, Xu Q et al (2013) Sleep drives metabolite clearance from the adult brain. Science 342:373–377PubMedCrossRef
65.
Astara K, Tsimpolis A, Kalafatakis K et al (2024) Sleep disorders and Alzheimer’s disease pathophysiology: The role of the GLYMPHATIC System. A scoping review. Mech Ageing Develop 217:111899CrossRef
66.
Emamian F, Khazaie H, Tahmasian M et al (2016) The association between obstructive sleep apnea and Alzheimer’s disease: a meta-analysis perspective. Front Aging Neurosci 8:78PubMedPubMedCentralCrossRef
67.
68.
69.
Cooke JR, Ayalon L, Palmer BW et al (2009) Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer’s disease and obstructive sleep apnea: a preliminary study. J Clin Sleep Med 5:305–309PubMedPubMedCentralCrossRef
70.
Metadata
Title
Sleep characteristics and risk of Alzheimer’s disease: a systematic review and meta-analysis of longitudinal studies
Authors
Shichan Wang
Xiaoting Zheng
Jingxuan Huang
Jiyong Liu
Chunyu Li
Huifang Shang
Publication date
24-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-024-12380-7