Association between sleep duration and cognitive function and emotional disorders in middle-aged and elderly patients with cerebral small vessel disease

Abstract

Objectives: To investigate the association between the sleep duration with cognitive impairment in middle-aged and elderly patients with cerebral small vessel disease (CSVD).

Methods: This cross-sectional study enrolled hospitalized patients aged ≥55 years diagnosed with CSVD between November 2021 and August 2023. Comprehensive neuropsychological assessments were conducted using seven standardized measures: the mini-mental state examination (MMSE), clock drawing test (CDT), verbal fluency test (VFT), auditory verbal learning test (AVLT), digit span test (DST), self-rating anxiety scale (SAS), and self-rating depression scale, along with objective sleep monitoring using a portable sleep monitoring device. Participants were stratified into three sleep duration groups based on self-reported nocturnal sleep: short (≤6 h; n = 86), normal (6-9 h; n = 77), and long duration (≥9 h; n = 53). Additionally, they were categorized by daytime napping patterns: no nap (n = 97), short nap (≤1 h; n = 59), and long nap (>1 h; n = 60). Multivariate linear regression models were used to calculate 95% confidence intervals (95% CIs) for cognitive impairment and emotional disorders.

Results: The study cohort comprised 216 participants (56.50% male) with a mean age of 66.83 ± 8.16 years. Both short and long sleep durations were associated with poorer MMSE and CDT scores compared to normal sleep duration (short vs. normal sleep: β = −0.201, 95% CI [−2.388, −0.360], p < 0.001 for MMSE; β = −0.201, 95% CI [−0.480, −0.061], p < 0.05 for CDT; long vs. normal sleep: β = −0.355, 95% CI [−3.879, −1.643], p < 0.001 for MMSE; β = −0.329, 95% CI [−0.735, −0.273], p < 0.01 for CDT). Compared to short nap duration, both no nap and long nap durations showed worse performance on MMSE, VFT, AVLT, and DST (no nap vs. short nap: MMSE β = −0.304, 95% CI [−6.106, −2.078], p < 0.001; VFT β = −0.240, 95% CI [−5.808, −1.246], p < 0.01; AVLT β = −0.253, 95% CI [−6.136, −1.598], p < 0.01; DST β = −0.209, 95% CI [−1.172, −0.160], p < 0.05; long nap vs. short nap: MMSE β = −0.304, 95% CI [−6.106, −2.078], p < 0.001; VFT β = −0.200, 95% CI [−5.881, −0.625], p < 0.05; AVLT β = −0.188, 95% CI [−5.809, −0.580], p < 0.05; DST β = −0.207, 95% CI [−1.371, −0.151], p < 0.05). Short nighttime sleep duration was associated with higher SAS scores compared to normal sleep duration (β = 0.172, 95% CI [0.105, 2.542], p < 0.05), whereas long sleep duration showed no significant association.

Conclusion: Individuals with nighttime sleep duration of 6-9 h and daytime napping ≤1 h exhibited the best overall cognitive scores. This finding supports the U-shaped relationship model of “moderate sleep-cognitive protection.”

Keywords

cerebral small vessel disease / cognitive impairment / emotional disorders / nap duration / nighttime sleep duration

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