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VOLUME 35, ISSUE 09

EXCESSIVE SLEEPINESS IS PREDICTIVE OF COGNITIVE DECLINE IN THE ELDERLY
Excessive Sleepiness is Predictive of Cognitive Decline in the Elderly

http://dx.doi.org/10.5665/sleep.2070

Isabelle Jaussent, MSc1; Jean Bouyer, PhD2,3; Marie-Laure Ancelin, PhD1; Claudine Berr, PhD1; Alexandra Foubert-Samier, MD4; Karen Ritchie, PhD1,5; Maurice M. Ohayon, MD, DSc, PhD6; Alain Besset, PhD1; Yves Dauvilliers, MD, PhD1,7

1Inserm, U1061, Montpellier, France; Univ Montpellier 1, Montpellier, F-34000 France; 2Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, F-94807, Villejuif, France; 3Univ Paris Sud, UMR-S1018, Villejuif, France; 4Inserm, U897, Bordeaux, France; Université Victor Segalen Bordeaux 2, Bordeaux, France; 5Faculty of Medicine, Imperial College, London, UK; 6Stanford Sleep Epidemiology Research Center, School of Medicine, Stanford University, Stanford, CA; 7CHU Montpellier, Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac, Montpellier, France



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Study Objectives:

To examine the association of sleep complaints reported at baseline (insomnia complaints and excessive daytime sleepiness (EDS)) and medication, with cognitive decline in community-dwelling elderly.

Design:

An 8-yr longitudinal study.

Setting:

The French Three-City Study.

Participants:

There were 4,894 patients without dementia recruited from 3 French cities and having a Mini-Mental Status Examination (MMSE) score ≥ 24 points at baseline.

Measurements and Results:

Questionnaires were used to evaluate insomnia complaints (poor sleep quality (SQ), difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA)), EDS, and sleep medication at baseline. Cognitive decline was defined as a 4-point reduction in MMSE score during follow-up at 2, 4, and 8 yr. Logistic regression models were adjusted for sociodemographic, behavioral, physical, and mental health variables, and apolipoprotein E genotype. EDS independently increased the risk of cognitive decline (odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.02-1.56), especially for those patients who also developed dementia during the follow-up period (OR = 1.39, 95% CI = 1.00-1.97). The number of insomnia complaints and DMS were negatively associated with MMSE cognitive decline (OR = 0.77, 95% CI = 0.60-0.98 for 3-4 complaints, OR = 0.81, 95% CI = 0.68-0.96, respectively). The 3 other components of insomnia (SQ, DIS, EMA) were not significantly associated with MMSE cognitive decline.

Conclusions:

Our results suggest that EDS may be associated independently with the risk of cognitive decline in the elderly population. Such results could have important public health implications because EDS may be an early marker and potentially reversible risk factor of cognitive decline and onset of dementia.

Citation:

Jaussent I; Bouyer J; Ancelin ML; Berr C; Foubert-Samier A; Ritchie K; Ohayon MM; Besset A; Dauvilliers Y. Excessive sleepiness is predictive of cognitive decline in the elderly. SLEEP 2012;35(9):1201-1207.

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