Association of Short and Long Sleep Duration With Amyloid-β Burden and Cognition in Aging

IMPORTANCE Disrupted sleep is common in aging and is associated with cognition. Age-related changes to sleep are associated with multiple causes, including early Alzheimer disease pathology (amyloid beta [A beta]), depression, and cardiovascular disease. OBJECTIVE To investigate the associations between self-reported sleep duration and brain A beta burden as well as the demographic, cognitive, and lifestyle variables in adults with normal cognition. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study obtained data from participants in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) study, which is being conducted in 67 sites in the United States, Canada, Australia, and Japan. The sample for this analysis consisted of individuals aged 65 to 85 years who underwent an A beta positron emission tomography (PET) scan, had complete apolipoprotein E (APOE) genotype data, and were identified as clinically normal (per a Clinical Dementia Rating score of 0) and cognitively unimpaired (per a Mini-Mental State Examination score of 25 to 30 and Logical Memory Delayed Recall test score of 6 to 18). Data were analyzed from April 3, 2020, to June 20, 2021. MAIN OUTCOMES AND MEASURES The outcomewas self-reported nightly sleep duration (grouped by short sleep duration: <= 6 hours, normal sleep duration: 7-8 hours, and long sleep duration: >= 9 hours) compared with demographic characteristics, A beta burden (as measured with a fluorine 18-labeled-florbetapir PET scan), objective and subjective cognitive function measures, and lifestyle variables. RESULTS The 4417 participants in the study included 2618 women (59%) and had a mean (SD) age of 71.3 (4.7) years. Self-reported shorter sleep duration was linearly associated with higher A beta burden (beta [SE] = -0.01 [0.00]; P =.005), and short sleep duration was associated with reduced cognition that was mostly in memory domains. No difference in A beta was found between long and normal sleep duration groups (beta [SE] = 0.00 [0.01]; P =.99). However, compared with normal sleep duration, both short and long sleep durations were associated with higher body mass index (short vs normal sleep duration: beta [SE] = 0.48 [0.17], P =.01; long vs normal sleep duration: beta [SE] = 0.97 [0.31], P =.002), depressive symptoms (short vs normal sleep duration: beta [SE] = 0.31 [0.05], P <.001; long vs normal sleep duration: beta [SE] = 0.39 [0.09], P <.001), and daytime napping (short vs normal sleep duration: beta [SE] = 2.66 [0.77], P =.001; long vs normal sleep duration: beta [SE] = 3.62 [1.38], P =.01). Long sleep duration was associated with worse performance across multiple cognitive domains. CONCLUSIONS AND RELEVANCE In this cross-sectional study, both short and long sleep durations were associated with worse outcomes for older adults, such as greater A beta burden, greater depressive symptoms, higher body mass index, and cognitive decline, emphasizing the importance of maintaining adequate sleep.

Automated summary

In older adults, both short and long sleep durations are associated with worse outcomes, such as greater A beta burden, more severe depressive symptoms, higher body mass index, and cognitive decline. This emphasizes the importance of maintaining adequate sleep for older adults.