A associação entre sono e doença de Alzheimer: uma revisão sistemática

Gonzales, Paul Nichol Galan; Villaraza, Steven Gayoles; Rosa, Joseree-Ann Catindig Dela

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Brasil

Dementia & Neuropsychologia

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Brasil

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Sumário

Original Article • Dement. neuropsychol. 18 • 2024 • https://doi.org/10.1590/1980-5764-DN-2023-0049 copiar

A associação entre sono e doença de Alzheimer: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Acredita-se que 45% dos indivíduos com comprometimento cognitivo experimentem distúrbios do sono antes do início dos sintomas cognitivos. Avaliar problemas de sono e melhorar a qualidade do sono são passos críticos iniciais para reduzir o risco de comprometimento cognitivo.

Objetivo:

Revisar a literatura existente com base em critérios de elegibilidade predefinidos para entender a conexão entre distúrbios do sono e a Doença de Alzheimer.

Métodos:

Uma avaliação completa e sistemática de vários estudos foi realizada para avaliar um ou mais dos seguintes fatores epidemiológicos: (1) distúrbios do sono, (2) comprometimento cognitivo e (3) estimativas de risco de comprometimento cognitivo decorrente do sono.

Resultados:

Os estudos sugerem que indivíduos que experimentam perda de memória podem enfrentar distúrbios do sono antes de notarem outros sintomas. Foi constatado que vários distúrbios do sono, como duração excessiva e inadequada do sono, má qualidade do sono, anormalidades no ritmo circadiano, insônia e apneia obstrutiva do sono, podem aumentar o risco de disfunção cognitiva e demência. Além disso, menor qualidade do sono e duração mais curta do sono têm sido associadas a níveis mais altos de β-amiloide cerebral. Evidências objetivas para o desenvolvimento de comprometimento cognitivo são fornecidas pela arquitetura dos estágios do sono. Pacientes que experimentam problemas de sono podem se beneficiar de tipos específicos de medicamentos para o sono como medida preventiva contra o declínio cognitivo.

Conclusão:

Os distúrbios do sono podem ter efeitos adversos na saúde cognitiva. A duração e a qualidade do sono são fatores fundamentais para manter um cérebro saudável à medida que envelhecemos. Um sono adequado pode ajudar a prevenir o comprometimento cognitivo, especialmente a Doença de Alzheimer e a demência.

Palavras-chave:
Disfunção Cognitiva; Doença de Alzheimer; Distúrbios do Início e da Manutenção do Sono; Sono; Transtornos do Sono-Vigília; Qualidade do Sono; Eletroencefalografia; Medicamentos Indutores do Sono; Fases do Sono

Study	Study design/quality	Sleep assessment/measure	Sample/location	Outcomes/findings
Borges et al.¹⁶16 Borges CR, Poyares D, Piovezan R, Nitrini R, Brucki S. Alzheimer's disease and sleep disturbances: a review. Arq Neuropsiquiatr. 2019;77(11):815-24. https://doi.org/10.1590/0004-282x20190149 https://doi.org/10.1590/0004-282x2019014...	Systematic review	Sleep disturbance/EEG	Patients with cognitive impairment or AD	Sleep disorders may be related to AD by reduction of non-REM sleep.
Bubu et al.⁵5 Bubu OM, Brannick M, Mortimer J, Umasabor-Bubu O, Sebastião YV, Wen Y, et al. Sleep, cognitive impairment, and alzheimer's disease: a systematic review and meta-analysis. Sleep. 2017;40(1). https://doi.org/10.1093/sleep/zsw032 https://doi.org/10.1093/sleep/zsw032...	Systematic review	Sleep disorders/amyloid PET	Patient with and without sleep problems	Long and short sleep duration, circadian rhythm abnormality, poor sleep quality, OSA, and insomnia were associated with a higher risk of cognitive impairment and dementia than individuals who did not have sleep problems.
Burke et al.¹⁹19 Burke SL, Hu T, Spadola CE, Li T, Naseh M, Burgess A, et al. Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications. Sleep Med. 2018;52:168-76. https://doi.org/10.1016/j.sleep.2018.09.001 https://doi.org/10.1016/j.sleep.2018.09....	Cross sectional study	Sleep medications/observation	Patients without dementia	Sleep medications potentially mitigate the risk of cognitive impairment.
Cordone et al.¹⁸18 Cordone S, Annarumma L, Rossini PM, De Gennaro L. Sleep and β-amyloid deposition in Alzheimer disease: insights on mechanisms and possible innovative treatments. Front Pharmacol. 2019;10:695. https://doi.org/10.3389/fphar.2019.00695 https://doi.org/10.3389/fphar.2019.00695...	Systematic review	Sleep deprivation and Aβ accumulation/EEG	Patients with sleep disturbance	Aβ accumulation in the brain is linked to the disruption of slow wave sleep.
De Gennaro et al.¹⁷17 De Gennaro L, Gorgoni M, Reda F, Lauri G, Truglia I, Cordone S, et al. The fall of sleep K-complex in Alzheimer disease. Sci Rep. 2017;7(1):39688. https://doi.org/10.1038/srep39688 https://doi.org/10.1038/srep39688...	Case control	Sleep quality/EEG	Patients with AD	Decrease in stage 2 sleep K-complexes in AD
Fan et al.⁹9 Fan L, Xu W, Cai Y, Hu Y, Wu C. Sleep duration and the risk of dementia: a systematic review and meta-analysis of prospective cohort studies. J Am Med Dir Assoc. 2019;20(12):1480-7.e5. https://doi.org/10.1016/j.jamda.2019.06.009 https://doi.org/10.1016/j.jamda.2019.06....	Meta-analysis	Sleep duration/questionnaire/interview	Patients with AD or dementia	Only long sleep duration is significantly associated with an increased risk of all AD and dementia.
Ferini-Strambi¹³13 Ferini-Strambi L. Sleep disorders and increased risk of dementia. Eur J Neurol. 2022;29(12):3484-5. https://doi.org/10.1111/ene.15562 https://doi.org/10.1111/ene.15562...	Systematic review	Sleep duration and sleep quality, sleep disorder/questionnaires, clinical diagnosis	Patient with and without sleep problem	Insomnia was discovered to be linked with AD, whereas sleep disorder breathing was associated with a high risk of developing dementia.
Henry et al.⁸8 Henry A, Katsoulis M, Masi S, Fatemifar G, Denaxas S, Acosta D, et al. The relationship between sleep duration, cognition and dementia: a Mendelian randomization study. Int J Epidemiol. 2019;48(3):849-60. https://doi.org/10.1093/ije/dyz071 https://doi.org/10.1093/ije/dyz071...	Mendelian randomization (MR)	Sleep duration/questionnaires, clinical diagnosis	Patient with and without sleep problems	The study's results may imply that time of sleep can develop cognitive impairment.
Insel et al.¹⁵15 Insel PS, Mohlenhoff BS, Neylan TC, Krystal AD, Mackin RS. Association of sleep and β-amyloid pathology among older cognitively unimpaired adults. JAMA Netw Open. 2021;4(7):e2117573. https://doi.org/10.1001/jamanetworkopen.2021.17573 https://doi.org/10.1001/jamanetworkopen....	Cross sectional study	Sleep disruption/PET Regional Aβ pathology	Patients without dementia	Increased risk of Aβ deposition with reduced nighttime sleep duration occurred early, before cognitive impairment or significant Aβ deposition.
Kinugawa et al.¹²12 Kinugawa K, Nguyen-Michel VH, Mariani J. Le syndrome d'apnées obstructives du sommeil: une cause de troubles cognitifs chez les personnes âgées? Rev Med Interne. 2014;35(10):664-9. https://doi.org/10.1016/j.revmed.2014.02.005 https://doi.org/10.1016/j.revmed.2014.02...	Cross sectional/medium	Brain damage/MRI	Normative aging participant	OSA was significantly connected to the development of dementia and other related disorder.
Lim et al.¹⁰10 Lim ASP, Kowgier M, Yu L, Buchman AS, Bennett DA. Sleep fragmentation and the risk of incident alzheimer's disease and cognitive decline in older persons. Sleep. 2013;36(7):1027-32. https://doi.org/10.5665/sleep.2802 https://doi.org/10.5665/sleep.2802...	Prospective cohort/high	Sleep fragmentation/wrist actigraphy	Community dwelling elderly	Sleep fragmentation is associated with dementia and cognitive impairment in older adults.
Lucey¹⁴14 Lucey BP. It's complicated: the relationship between sleep and Alzheimer's disease in humans. Neurobiol Dis. 2020;144:105031. https://doi.org/10.1016/j.nbd.2020.105031 https://doi.org/10.1016/j.nbd.2020.10503...	Review	Sleep questionnaires, logs, actigraphy, polysomnography, EEG	Older adults, varying cognitive statuses, with/without AD pathology	Sleep disturbances could be markers for AD pathology or a mechanism mediating increased AD risk.
Mander et al.²⁰20 Mander BA, Winer JR, Jagust WJ, Walker MP. Sleep: a novel mechanistic pathway, biomarker, and treatment target in the pathology of Alzheimer's disease? Trends Neurosci. 2016;39(8):552-66. https://doi.org/10.1016/j.tins.2016.05.002 https://doi.org/10.1016/j.tins.2016.05.0...	Systematic review	Sleep disruption/EEG	Cognitively healthy adults	Sleep disruption is an early diagnostic biomarker of AD risk.
Musiek et al.²¹21 Musiek ES, Xiong DD, Holtzman DM. Sleep, circadian rhythms, and the pathogenesis of Alzheimer disease. Exp Mol Med. 2015;47(3):e148. https://doi.org/10.1038/emm.2014.121 https://doi.org/10.1038/emm.2014.121...	Systematic review	Sleep disturbances/questionnaires, clinical diagnosis	Patients with AD	Therapeutic strategies for sleep may delay AD.
Shi et al.⁷7 Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, et al. Sleep disturbances increase the risk of dementia: a systematic review and meta-analysis. Sleep Med Rev. 2018;40:4-16. https://doi.org/10.1016/j.smrv.2017.06.010 https://doi.org/10.1016/j.smrv.2017.06.0...	Systematic review	Sleep disorder/self-reported symptoms, questionnaires, clinical diagnosis, or objective monitored sleep parameters	Patient with and without sleep problem	Sleep disorder and sleep disturbance influence the development of dementia, and it also highlights the importance of quality sleep.
Spira et al.⁴4 Spira AP, Gamaldo AA, An Y, Wu MN, Simonsick EM, Bilgel M, et al. Self-reported sleep and β-amyloid deposition in community-dwelling older adults. JAMA Neurol. 2013;70(12):1537-43. https://doi.org/10.1001/jamaneurol.2013.4258 https://doi.org/10.1001/jamaneurol.2013....	Cross sectional/medium	Sleep quality/Aβ PET	Normative aging participant	Lower sleep quality and shorter sleep are also connected with more significant Aβ burden, and it also increases the risk of dementia and AD.
Sterniczuk et al.⁶6 Sterniczuk R, Theou O, Rusak B, Rockwood K. Sleep disturbance is associated with incident dementia and mortality. Curr Alzheimer Res. 2013;10(7):767-75. https://doi.org/10.2174/15672050113109990134 https://doi.org/10.2174/1567205011310999...	Secondary analyses of sleep-related measure	Sleep disturbance/questionnaire	Men and women with and without experience of sleep disorder	A person who lacks sleep regularly can also increase the risk of dementia.
Zhou et al.¹¹11 Zhou G, Liu S, Yu X, Zhao X, Ma L, Shan P. High prevalence of sleep disorders and behavioral and psychological symptoms of dementia in late-onset Alzheimer disease: a study in Eastern China. Medicine (Baltimore). 2019;98(50):e18405. https://doi.org/10.1097/MD.0000000000018405 https://doi.org/10.1097/MD.0000000000018...	Cross sectional/medium	Sleep disorder/questionnaire	AD patient	The severity of sleep disorders is connected with the significance of cognitive decline in AD.

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence:
Paul Nichol G. Gonzales; Email: pnggonzales@gmail.com.