airway pressure therapy is an intervention that is associated with lower dementia risk. Background Community-dwelling older adults with sleep disorders are at higher risk of developing dementia. Greater than 50% of older patients with kidney failure experience sleep disorders, which may explain their high burden of dementia. Methods Among 216,158 patients (aged 66 years and older) with kidney failure (United States Renal Data System; 2008–2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional hazards models with propensity score weighting. We tested whether positive airway pressure (PAP) therapy was associated with reduced dementia risk among patients with obstructive sleep apnea (OSA). Results 26.3% of patients were diagnosed with sleep disorders; these patients had a higher 5-year unadjusted cumulative incidence for any type of dementia (36.2% versus 32.3%; P < 0.001), vascular dementia (4.4% versus 3.7%; P < 0.001), and other/mixed dementia (29.3% versus 25.8%; P < 0.001). Higher risk of any type of dementia was identified in patients with insomnia (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [CI], 1.34 to 1.51), sleep-related breathing disorders (SRBDs) (aHR, 1.20, 95% CI, 1.17 to 1.23), and other sleep disorders (aHR, 1.24; 95% CI, 1.11 to 1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR, 1.43; 95% CI, 1.19 to 1.73) and SRBDs (aHR, 1.15; 95% CI, 1.07 to 1.24). Patients with SRBDs (aHR, 1.07; 95% CI, 1.00 to 1.15) were at higher risk of Alzheimer disease. Among patients with OSA, PAP therapy was associated with lower risk of any type of dementia (aHR, 0.82; 95% CI, 0.76 to 0.90) and vascular dementia (aHR, 0.65; 95% CI, 0.50 to 0.85). Conclusions Older patients with kidney failure and sleep disorders are at a higher risk of dementia. Sleep is an important modifiable factor that should be considered for targeted interventions to mitigate dementia risk in patients with kidney failure. For patients with OSA, PAP therapy is associated with lower dementia risk....

中文翻译：

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老年肾功能衰竭患者的睡眠障碍和痴呆风险：一项回顾性队列研究


气道压力疗法是一种与降低痴呆风险相关的干预措施。背景 患有睡眠障碍的社区老年人患痴呆的风险更高。超过 50% 的老年肾衰竭患者会出现睡眠障碍，这可能解释了他们痴呆的高负担。方法 在 216,158 名肾功能衰竭患者 （美国肾脏数据系统;2008-2019） 中，我们使用具有倾向评分加权的 Cox 比例风险模型估计了与睡眠障碍相关的痴呆（包括亚型）的风险。我们测试了气道正压通气 （PAP） 治疗是否与阻塞性睡眠呼吸暂停 （OSA） 患者痴呆风险降低相关。结果 26.3% 的患者被诊断为睡眠障碍;这些患者对于任何类型的痴呆都有较高的 5 年未经调整的累积发生率 （36.2% 对 32.3%;P < 0.001）、血管性痴呆 （4.4% 对 3.7%;P < 0.001），和其他/混合性痴呆（29.3% 对 25.8%;P < 0.001）。在失眠 （调整后的风险比 [aHR]，1.42;95% 置信区间 [CI]，1.34 至 1.51）、睡眠相关呼吸障碍 （SRBD） （aHR，1.20,95% CI，1.17 至 1.23）和其他睡眠障碍 （aHR，1.24;95% CI，1.11 至 1.39） 患者中发现任何类型的痴呆风险更高。在失眠患者 （aHR， 1.43;95% CI， 1.19 至 1.73） 和 SRBD （aHR， 1.15;95% CI， 1.07 至 1.24） 患者中观察到较高的血管性痴呆风险。SRBD 患者 （aHR， 1.07;95% CI， 1.00 至 1.15） 患阿尔茨海默病的风险更高。在 OSA 患者中，PAP 治疗与任何类型的痴呆 （aHR， 0.82;95% CI， 0.76 至 0.90） 和血管性痴呆 （aHR， 0.65;95% CI， 0.50 至 0.85） 的风险较低相关。 结论 老年肾功能衰竭和睡眠障碍患者发生痴呆的风险更高。睡眠是一个重要的可改变因素，应考虑进行有针对性的干预，以减轻肾衰竭患者的痴呆风险。对于 OSA 患者，PAP 治疗与较低的痴呆风险相关。