Association Between Sleep Duration and Cognitive Decline

Abstract

Importance: An association between sleep duration and the trajectory of cognitive decline has not been conclusively demonstrated.

Objective: To investigate the association between sleep duration and cognitive decline by a pooled analysis of 2 nationally representative aging cohorts.

Design, setting, and participants: A pooled cohort study using data from waves 4 to 8 (2008-2009 to 2016-2017) in the English Longitudinal Study of Ageing and waves 1 to 3 (2011 to 2015) in the China Health and Retirement Longitudinal Study in a population-based setting. Participants were 2 randomly enrolled cohorts comprising 28 756 individuals living in England who were 50 years or older and those living in China who were 45 years or older.

Exposure: Self-reported sleep duration per night according to face-to-face interviews.

Main outcomes and measures: Global cognitive z scores were calculated according to immediate and delayed recall test, an animal fluency test, the serial sevens test, an intersecting pentagon copying test, and a date orientation test.

Results: Data were analyzed from 20 065 participants, including 9254 from the English Longitudinal Study of Ageing (mean [SD] age, 64.6 [9.8] years; 55.9% [5174 of 9254] women; median follow-up duration, 8 [interquartile range, 6-8] years) and 10 811 from the China Health and Retirement Longitudinal Study (mean [SD] age, 57.8 [9.0] years; 50.2% [5425 of 10 811] men; median follow-up duration, 4 [interquartile range, 4-4] years). During 100 000 person-years of follow-up, global cognitive z scores in individuals with 4 hours or less (pooled β = -0.022; 95% CI, -0.035 to -0.009 SD per year; P = .001) and 10 hours or more (pooled β = -0.033; 95% CI, -0.054 to -0.011 SD per year; P = .003) of sleep per night declined faster than in the reference group (7 hours per night) after adjusting for a number of covariates. An inverted U-shaped association between sleep duration and global cognitive decline was also observed.

Conclusions and relevance: In this pooled cohort study, an inverted U-shaped association between sleep duration and global cognitive decline was found, indicating that cognitive function should be monitored in individuals with insufficient (≤4 hours per night) or excessive (≥10 hours per night) sleep duration. Future studies are needed to examine the mechanisms of the association between sleep duration and cognitive decline.

Figure 1.. Cross-sectional Associations Between Sleep Duration per Night and z Scores at Baseline

A-D, Participants who had a sleep duration of 7 hours per night served as the reference group. Solid lines represent adjusted least-squares means after adjusting for sex, age, body mass index, systolic blood pressure, level of education, Center for Epidemiologic Studies Depression Scale score, cohabitation status, current smoking, alcohol consumption, diabetes, coronary heart disease, stroke, cancer, chronic lung disease, and asthma. The shaded areas represent the 95% CIs. Detailed results are listed in Table 2 and eTables 1, 2, and 3 in the Supplement.

Figure 2.. Mean Differences in Rate of Change in z Scores During Follow-up

A-D, Participants who had a sleep duration of 7 hours per night served as the reference group. Solid lines represent adjusted mean differences after adjusting for sex, age, body mass index, systolic blood pressure, level of education, Center for Epidemiologic Studies Depression Scale score, cohabitation status, current smoking, alcohol consumption, diabetes, coronary heart disease, stroke, cancer, chronic lung disease, and asthma. The shaded areas represent the 95% CIs. Detailed results are listed in Table 3 and eTables 4, 5, and 6 in the Supplement.