Skip to main content

Advertisement

SpringerLink
Log in

A systematic review and dose-response meta-analysis of sleep duration and the occurrence of cognitive disorders

  • Epidemiology • Review
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Previous researches have shown inconsistent findings on the relationship between sleep duration and cognitive disorders (including cognitive decline, dementia, Alzheimer’s disease, and cognitive impairment). Furthermore, the possible dose-response association of sleep duration and cognitive disorders is still not clear.

Methods

Two databases (PubMed and Embase) were searched for relevant studies from inception to May 4, 2016. We used the generic inverse-variance method to combine the outcomes with a random-effects model for the association between sleep duration (the shortest or longest vs. middle category) and cognitive disorders. Additionally, we used the generalized least-squares trend estimation model to estimate the potential dose-response association.

Results

Finally, nine eligible cohort studies involving 22,187 participants were included in the present systematic review and meta-analysis. Compared with the middle category, both short and long sleep duration were accompanied by a significantly higher incident risk of cognitive disorders, and the relative risks (RRs) and 95% confidence intervals (CIs) were 1.34 (1.15, 1.56) and 1.21 (1.06, 1.39), respectively. Moreover, an approximately “U-shaped” dose-response relationship was observed. Stratified analyses showed that the association between short sleep duration and cognitive disorders was more robust in the subgroup of the measurement of sleep duration based on self-report.

Conclusions

The lowest incident risk of cognitive disorders was found at the sleep duration of 7–8 h per day. The present study includes a small number of studies, and the study participants mostly consist of Caucasian population. In the future, researches are also warranted to confirm the association in different groups of people.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Alzheimer's Association (2013) 2013 Alzheimer’s disease facts and figures. Alzheimers Dement 9(2):208–245

    Article  Google Scholar 

  2. Brookmeyer R, Gray S, Kawas C (1998) Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. Am J Public Health 88(9):1337–1342

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Ott A, Breteler MM, van Harskamp F, Stijnen T, Hofman A (1998) Incidence and risk of dementia. The Rotterdam Study. Am J Epidemiol 147(6):574–580

    Article  PubMed  CAS  Google Scholar 

  4. Chen JC, Espeland MA, Brunner RL, Lovato LC, Wallace RB, Leng X, Phillips LS, Robinson JG, Kotchen JM, Johnson KC, Manson JE, Stefanick ML, Sarto GE, Mysiw WJ (2016) Sleep duration, cognitive decline, and dementia risk in older women. Alzheimers Dement 12(1):21–33

    Article  PubMed  Google Scholar 

  5. Virta JJ, Heikkilä K, Perola M, Koskenvuo M, Räihä I, Rinne JO, Kaprio J (2013) Midlife sleep characteristics associated with late life cognitive function. Sleep 36(10):1533–1541 1541A

    Article  PubMed  PubMed Central  Google Scholar 

  6. Benito-León J, Bermejo-Pareja F, Vega S, Louis ED (2009) Total daily sleep duration and the risk of dementia: a prospective population-based study. Eur J Neurol 16(9):990–997

    Article  PubMed  Google Scholar 

  7. Keage HA, Banks S, Yang KL, Morgan K, Brayne C, Matthews FE (2012) What sleep characteristics predict cognitive decline in the elderly? Sleep Med 13(7):886–892

    Article  PubMed  Google Scholar 

  8. Niu J, Han H, Wang Y, Wang L, Gao X, Liao S (2016) Sleep quality and cognitive decline in a community of older adults in Daqing City, China. Sleep Med 17:69–74

    Article  PubMed  Google Scholar 

  9. Potvin O, Lorrain D, Forget H, Dubé M, Grenier S, Préville M, Hudon C (2012) Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults. Sleep 35(4):491–499

    Article  PubMed  PubMed Central  Google Scholar 

  10. Blackwell T, Yaffe K, Laffan A, Ancoli-Israel S, Redline S, Ensrud KE, Song Y, Stone KL, Osteoporotic Fractures in Men (MrOS) Study Group (2014) Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. Sleep 37(4):655–663

    Article  PubMed  PubMed Central  Google Scholar 

  11. Diem SJ, Blackwell TL, Stone KL, Yaffe K, Tranah G, Cauley JA, Ancoli-Israel S, Redline S, Spira AP, Hillier TA, Ensrud KE (2016) Measures of sleep-wake patterns and risk of mild cognitive impairment or dementia in older women. Am J Geriatr Psychiatry 24(3):248–258

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, Ancoli-Israel S, Stone KL (2011) Sleep disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 306(6):613–619

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Liu TZ, Xu C, Rota M, Cai H, Zhang C, Shi MJ, Yuan RX, Weng H, Meng XY, Kwong JS, Sun X (2016) Sleep duration and risk of all-cause mortality: a flexible, non-linear, meta-regression of 40 prospective cohort studies. Sleep Med Rev 32:28–36

    Article  PubMed  CAS  Google Scholar 

  14. Shen X, Wu Y, Zhang D (2016) Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: ameta-analysis of prospective cohort studies. Sci Rep 6:21480

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, Rong Y, Jackson CL, Hu FB, Liu L (2015) Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 38(3):529–537

    Article  PubMed  Google Scholar 

  16. Zhao H, Yin JY, Yang WS, Qin Q, Li TT, Shi Y, Deng Q, Wei S, Liu L, Wang X, Nie SF (2013) Sleep duration and cancer risk: a systematic review and meta-analysis of prospective studies. Asian Pac J Cancer Prev 14(12):7509–7515

    Article  PubMed  Google Scholar 

  17. Lo JC, Groeger JA, Cheng GH, Dijk DJ, Chee MW (2016) Self-reported sleep duration and cognitive performance in older adults: a systematic review and meta-analysis. Sleep Med 17:87–98

    Article  PubMed  Google Scholar 

  18. Higgins JPT, Green S, eds; Cochrane handbook for systematic reviews of interventions, Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available: http://www.cochrane-handbook.org

  19. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  PubMed  CAS  Google Scholar 

  20. GA Wells, B Shea, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Available: http://www.evidencebasedpublichealth.de/ download/Newcastle_Ottowa_Scale_Pope_Bruce.pdf

  21. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  22. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101

    Article  PubMed  CAS  Google Scholar 

  23. Egger M, Davey Smith G, Schneider M, Minder C (1997) Biasin meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Orsini N, Bellocco R, Greenland S (2006) Generalized least squares for trend estimation of summarized dose-response data. Stata J 6:40–57

    Google Scholar 

  25. Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D (2012) Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol 175(1):66–73

    Article  PubMed  Google Scholar 

  26. Ram S, Seirawan H, Kumar SK, Clark GT (2010) Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep Breath 14(1):63–70

    Article  PubMed  Google Scholar 

  27. Spira AP, Blackwell T, Stone KL, Redline S, Cauley JA, Ancoli-Israel S, Yaffe K (2008) Sleep-disordered breathing and cognition in older women. J Am Geriatr Soc 56(1):45–50

    Article  PubMed  Google Scholar 

  28. Kerner NA, Roose SP (2016) Obstructive sleep apnea is linked to depression and cognitive impairment: evidence and potential mechanisms. Am J Geriatr Psychiatry 24(6):496–508

    Article  PubMed  PubMed Central  Google Scholar 

  29. Knutson KL, Rathouz PJ, Yan LL, Liu K, Lauderdale DS (2007) Intra-individual daily and yearly variability in actigraphically recorded sleep measures: the CARDIA study. Sleep 30(6):793–796

    Article  PubMed  PubMed Central  Google Scholar 

  30. Trksak GH, Bracken BK, Jensen JE, Plante DT, Penetar DM, Tartarini WL, Maywalt MA, Dorsey CM, Renshaw PF, Lukas SE (2013) Effects of sleep deprivation on brain bioenergetics, sleep, and cognitive performance in cocaine-dependent individuals. Sci World J 2013:947879

    Article  CAS  Google Scholar 

  31. Tartar JL, McKenna JT, Ward CP, McCarley RW, Strecker RE, Brown RE (2010) Sleep fragmentation reduces hippocampal CA1 pyramidal cell excitability and response to adenosine. Neurosci Lett 469(1):1–5

    Article  PubMed  CAS  Google Scholar 

  32. Ju YE, McLeland JS, Toedebusch CD, Xiong C, Fagan AM, Duntley SP, Morris JC, Holtzman DM (2013) Sleep quality and preclinical Alzheimer disease. JAMA Neurol 70(5):587–593

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kang JE, Lim MM, Bateman RJ, Lee JJ, Smyth LP, Cirrito JR, Fujiki N, Nishino S, Holtzman DM (2009) Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle. Science 326(5955):1005–1007

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O'Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M (2013) Sleep drives metabolite clearance from the adult brain. Science 342(6156):373–377

    Article  PubMed  CAS  Google Scholar 

  35. Minkel J, Moreta M, Muto J, Htaik O, Jones C, Basner M, Dinges D (2014) Sleep deprivation potentiates HPA axis stress reactivity in healthy adults. Health Psychol 33(11):1430–1434

    Article  PubMed  Google Scholar 

  36. Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ (2008) Self-reported and measured sleep duration: how similar are they? Epidemiology 19(6):838845

    Article  Google Scholar 

  37. Tsapanou A, Gu Y, Manly J, Schupf N, Tang MX, Zimmerman M, Scarmeas N, Stern Y (2015) Daytime sleepiness and sleep inadequacy as risk factors for dementia. Dement Geriatr Cogn Dis Extra 5(2):286–295

    Article  PubMed  PubMed Central  Google Scholar 

  38. Zhong G, Wang Y, Tao T, Ying J, Zhao Y (2015) Daytime napping and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Sleep Med 16(7):811–819

    Article  PubMed  Google Scholar 

  39. Ohayon MM, Vecchierini MF (2002) Daytime sleepiness and cognitive impairment in the elderly population. Arch Intern Med 162(2):201–208

    Article  PubMed  Google Scholar 

  40. Fernandez-Mendoza J, Vgontzas AN, Calhoun SL, Vgontzas A, Tsaoussoglou M, Gaines J, Liao D, Chrousos GP, Bixler EO (2014) Insomnia symptoms, objective sleep duration and hypothalamic-pituitary-adrenal activity in children. Eur J Clin Investig 44(5):493–500

    Article  CAS  Google Scholar 

  41. Cortoos A, De Valck E, Arns M, Breteler MH, Cluydts R (2010) An exploratory study on the effects of tele-neurofeedback and tele-biofeedback on objective and subjective sleep in patients with primary insomnia. Appl Psychophysiol Biofeedback 35(2):125–134

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, Institute of Geriatrics, Chinese People’s Liberation Army General Hospital, Beijing, China

    Lei Wu

  2. Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA

    Dali Sun

  3. Editorial Department, Academic Journal of Chinese PLA Medical School, Chinese People’s Liberation Army General Hospital, Beijing, China

    Yan Tan

Authors
  1. Lei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dali Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Lei Wu and Yan Tan were responsible for the conception and design. All authors took part in the acquisition, analysis, and interpretation of data.

Corresponding authors

Correspondence to Lei Wu or Yan Tan.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Funding

No funding was received for this research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Table S1

(DOCX 20 kb)

Table S2

(DOCX 20 kb)

Table S3

(DOCX 21 kb)

Figure S1

(DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, L., Sun, D. & Tan, Y. A systematic review and dose-response meta-analysis of sleep duration and the occurrence of cognitive disorders. Sleep Breath 22, 805–814 (2018). https://doi.org/10.1007/s11325-017-1527-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1527-0

Keywords

Search

Navigation