The association between sleep and Alzheimer's disease: a systematic review

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

doi:10.1590/1980-5764-DN-2023-0049

Acessibilidade / Reportar erro

Brasil

Dementia & Neuropsychologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

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

The association between sleep and Alzheimer's disease: a systematic review

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

It is estimated that 45% of individuals with cognitive impairment experience sleep disturbances prior to the onset of cognitive symptoms. Assessing sleeping problems and enhancing sleep quality are critical first steps to reduce the risk of cognitive impairment.

Objective:

To review existing literature based on predefined eligibility criteria to understand the connection between sleep disturbance and Alzheimer's disease.

Methods:

A thorough and systematic evaluation of numerous studies was carried out to assess one or more of the following epidemiological factors: (1) sleep disorders, (2) cognitive impairment, and (3) risk estimates for cognitive impairment due to sleep.

Results:

Studies suggest that individuals who experience memory loss may encounter sleep disturbances before noticing other symptoms. Numerous sleep disorders, such as excessive and inadequate sleep duration, poor sleep quality, circadian rhythm abnormalities, insomnia, and obstructive sleep apnea were found to increase the risk of cognitive dysfunction and dementia. Additionally, lower sleep quality and shorter sleep duration have been linked to higher cerebral-β-amyloid levels. Objective evidence for the development of cognitive impairment is provided by the architecture of sleep stages. Patients experiencing sleep problems may benefit from specific types of sleep medicine as a preventative measure against cognitive decline.

Conclusion:

Sleep disorders can have adverse effects on cognitive health. The duration and quality of sleep are fundamental factors for maintaining a healthy brain as we age. Proper sleep can aid prevent cognitive impairment, particularly Alzheimer's disease and dementia.

Keywords:
Cognitive Dysfunction; Alzheimer Disease; Sleep Initiation and Maintenance Disorders; Sleep; Sleep Wake Disorders; Sleep Quality; Electroencephalography; Pharmaceutical Sleep Aids; Sleep stages

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

Acompanhe os números deste periódico no seu leitor de RSS

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