ith kidney failure (United States Renal Data System; 2008-2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional-hazard 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 five-year unadjusted cumulative incidence for any type of dementia (36.2% vs. 32.3%; P<0.001), vascular dementia (4.4% vs. 3.7%; P<0.001), and other/mixed dementia (29.3% vs. 25.8%; P<0.001). Higher risk of any type of dementia was identified in patients with insomnia (aHR=1.42; 95%CI: 1.34-1.51), sleep-related breathing disorders (SRBDs) (aHR=1.20; 95%CI: 1.17-1.23), and other sleep disorders (aHR=1.24; 95%CI: 1.11-1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR=1.43; 95%CI: 1.19-1.73), SRBDs (aHR=1.15; 95%CI: 1.07-1.24). Patients with SRBDs (aHR=1.07; 95%CI: 1.00-1.15) were at higher risk of Alzheimer’s disease. Among patients with OSA, PAP therapy was associated with lower risk for any type of dementia (aHR=0.82; 95%CI: 0.76-0.90), and vascular dementia (aHR=0.65; 95%CI: 0.50-0.85). Conclusion: 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. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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老年肾衰竭患者的睡眠障碍和痴呆风险：一项回顾性队列研究


由于肾衰竭（美国肾脏数据系统；2008-2019），我们使用带有倾向评分加权的 Cox 比例风险模型估计了与睡眠障碍相关的痴呆（包括亚型）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；这些患者的任何类型痴呆（36.2% vs. 32.3%；P<0.001）、血管性痴呆（4.4% vs. 3.7%；P<0.001）和其他/混合性痴呆的五年未调整累积发病率均较高（ 29.3% 对比 25.8%；P<0.001)。失眠患者（aHR=1.42；95%CI：1.34-1.51）、睡眠相关呼吸障碍（SRBD）（aHR=1.20；95%CI：1.17-1.23）和睡眠障碍患者患任何类型痴呆的风险较高。其他睡眠障碍（aHR=1.24；95%CI：1.11-1.39）。失眠患者 (aHR=1.43; 95%CI: 1.19-1.73)、SRBDs (aHR=1.15; 95%CI: 1.07-1.24) 患者患血管性痴呆的风险较高。患有 SRBD 的患者（aHR=1.07；95%CI：1.00-1.15）患阿尔茨海默病的风险较高。在 OSA 患者中，PAP 治疗与任何类型痴呆（aHR=0.82；95%CI：0.76-0.90）和血管性痴呆（aHR=0.65；95%CI：0.50-0.85）的风险降低相关。结论：患有肾衰竭和睡眠障碍的老年患者患痴呆症的风险较高。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措施，以减轻肾衰竭患者的痴呆风险。对于 OSA 患者，PAP 治疗可降低痴呆风险。版权所有 © 2024 美国肾脏病学会...