Wake-Up Call: Short Sleep Tied to Increased
Dementia Risk

Megan Brooks

April 22, 2021

People who sleep for less than 6 hours a night in their 50s and 60s appear to be more likely to develop dementia than their peers who get at least 7 hours of sleep each night, according to a new study.

"We showed that a consistent association between short sleep duration in midlife and risk of dementia. This association was not explained by mental disorders and other chronic conditions known to be associated with dementia," Séverine Sabia, PhD, from University of Paris, France, told Medscape Medical News.

"This study highlights the importance of having good sleep hygiene for brain health," Sabia added.

The study was published online April 20 in Nature Communications.

Novel Study

"In studies on dementia, it is important to keep in mind the long preclinical period of dementia," Sabia noted. As most dementias are characterized by various pathophysiological changes over 20 years or more, studies with a long follow-up are needed to gain insight into the association between sleep duration and subsequent dementia.

Until now, much of the evidence on this association comes from studies with follow-up lasting less than 10 years.

For the study, investigators examined the association in 7959 participants from the UK Whitehall II cohort who were followed for 25 years using repeated measures of sleep duration starting in midlife.

During follow-up, there were 521 diagnosed cases of dementia.

The results showed a higher dementia risk associated with a sleep duration of 6 hours or less at age 50 and 60, compared with a normal 7-hour sleep duration, although this was imprecisely estimated for sleep duration at age 70, the researchers note.

Table. Sleep duration <6 hours and risk for incident dementia

Age Fully adjusted HR (95% CI) P value
50 years 1.22 (1.01 - 1.48) .04
60 years 1.37 (1.10 - 1.72) .005
70 years 1.24 (0.98 - 1.57) .10

 

In addition, they found that persistent short sleep duration at age 50, 60 and 70 years, compared with persistent normal sleep duration, was also associated with a 30% increased risk for dementia, independent of sociodemographic, behavioral, cardiometabolic, and mental health factors.

The findings were confirmed using an objective measure (accelerometer) of sleep duration in a subsample of participants.

There was no clear evidence of an association between long sleep duration and incident dementia, as has been reported in some studies. 

Strong Supportive Evidence

"There is intense interest in whether poor sleep could cause or worsen dementia and, therefore, whether improving sleep might help prevent dementia," Elizabeth Coulthard, MBBS, PhD, consultant senior lecturer in dementia neurology, University of Bristol, UK, said in a statement from the UK nonprofit Science Media Centre.

"Before this study there was already strong evidence that sleep becomes abnormal before dementia is diagnosed. But this still does not tell us whether sleep triggers or exacerbates dementia because the brain changes that cause dementia start many years before a diagnosis. We know that established dementia is associated with poor sleep," said Coulthard, who was not involved in the study.

This new study, said Coulthard, "adds new information to the emerging picture" because sleep is reported in a middle-aged cohort followed for more than two decades.

"This means that at least some of the people who went on to develop dementia probably did not already have it at the start of the study when their sleep was first assessed. So it strengthens the evidence that poor sleep in middle age could cause or worsen dementia in later life," Coulthard said. 

Also weighing in on the study, Tom Dening, MD, head of the Centre for Dementia at the Institute of Mental Health, University of Nottingham, UK, said there is evidence that sleep disturbance can occur a long time before the onset of other clinical evidence of dementia.

"However, this study cannot establish cause and effect," Dening cautioned.

"Maybe it is simply a very early sign of the dementia that is to come, but it's also quite likely that poor sleep is not good for the brain and leaves it vulnerable to neurodegenerative conditions like Alzheimer's disease," Dening said.

"Turning off mobile phones and avoiding caffeine before bed are good habits to have as we already know the importance of good sleep on health more generally. However, we would need further studies to know if longer sleep in itself could reduce the risk of dementia later in life," he added.

The study had no commercial funding. Sabia, Coulthard, and Dening have disclosed no relevant financial relationships.

Nat Commun. Published online April 20, 2021. Full text

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