Sleep disorders increase the risk of dementia, Alzheimer’s disease, and cognitive decline: a meta-analysis

Abstract

Sleep disorders, particularly insomnia and obstructive sleep apnea, are increasingly implicated as significant contributors to cognitive decline, dementia, and neurodegenerative diseases such as Alzheimer’s disease (AD) and vascular cognitive impairment and dementia (VCID). However, the extent and specificity of these associations remain uncertain. This meta-analysis evaluates the impact of common sleep disorders on the risk of developing dementia and cognitive decline. A comprehensive search of the literature was conducted to identify prospective cohort studies assessing sleep disorders and dementia risk. Studies reporting risk estimates for dementia, AD, or cognitive decline associated with obstructive sleep apnea, insomnia, and other sleep disorders (e.g., restless legs syndrome, circadian rhythm sleep disorders, excessive daytime sleepiness) were included. Meta-analyses were performed using a random-effects model to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Thirty-nine cohort studies were included, with subgroup analyses showing significant associations between all-cause dementia and obstructive sleep apnea (HR 1.33, 95% CI 1.09–1.61), insomnia (HR 1.36, 95% CI 1.19–1.55), and other sleep disorders (HR 1.33, 95% CI 1.24–1.43). Obstructive sleep apnea increased the risk for AD (HR 1.45, 95% CI 1.24–1.69), though its association with vascular dementia did not reach statistical significance (HR 1.35, 95% CI 0.99–1.84). Insomnia was significantly associated with increased risk for both vascular dementia (HR 1.59, 95% CI 1.01–2.51) and AD (HR 1.49, 95% CI 1.27–1.74). This meta-analysis highlights the critical role of sleep disorders in dementia risk, emphasizing the need for early detection and management of sleep disturbances. Targeted interventions could play a pivotal role in reducing dementia risk, particularly among high-risk populations.