局灶性癫痫患者的睡眠、认知与痴呆风险关系
基于英国生物银行前瞻性队列（482,207人，随访至2021年），局灶性癫痫患者中最佳睡眠（6-8小时）与更好执行功能相关，且该关联强于健康对照；非最佳睡眠的局灶性癫痫患者痴呆风险为健康对照最佳睡眠者的5.15倍（HR 5.15，95%CI 3.77-7.04），高于卒中伴不良睡眠者的3.48倍。改善睡眠可能有助于改善认知和降低痴呆风险。
要点
- 局灶性癫痫患者中，最佳睡眠（6-8小时）与更好执行功能相关，交互作用p=0.009。
- 非最佳睡眠的局灶性癫痫患者痴呆风险为健康对照最佳睡眠者的5.15倍（95%CI 3.77-7.04）。
- 最佳睡眠对痴呆风险的改善在局灶性癫痫中显著（交互p=0.017），卒中组无显著差异（p=0.991）。
核心结论
- 最佳睡眠可改善局灶性癫痫患者的认知表现并降低痴呆风险，且效果强于卒中患者和健康对照。
研究设计与样本
- 前瞻性UK Biobank队列研究，基线评估于2006-2010年，随访至2021年，纳入482,207名38-72岁无痴呆参与者，其中嵌套影像子样本42,345人。
主要发现
- 最佳睡眠（6-8小时）与健康对照、局灶性癫痫和卒中组更好的执行功能相关。
- 最佳睡眠对执行功能的影响在局灶性癫痫中显著高于对照（交互项p=0.009），卒中组不显著（p=0.574）。
- 非最佳睡眠与局灶性癫痫诊断前长达8年的执行功能较差相关。
- 局灶性癫痫伴非最佳睡眠者痴呆风险为健康对照最佳睡眠者的5.15倍（HR 5.15，95%CI 3.77-7.04，p<0.001），高于卒中伴不良睡眠者的3.48倍（HR 3.48，95%CI 2.82-4.26，p<0.001）。
- 最佳睡眠相比非最佳睡眠对痴呆风险的改善在局灶性癫痫中显著大于健康对照（交互项p=0.017），卒中组无显著差异（p=0.991）。
关键数值与推荐
- 最佳睡眠定义为6-8小时。
- 痴呆风险比较：局灶性癫痫伴非最佳睡眠 vs 健康对照最佳睡眠，HR 5.15（95%CI 3.77-7.04，p<0.001）。
- 卒中伴不良睡眠 vs 健康对照最佳睡眠，HR 3.48（95%CI 2.82-4.26，p<0.001）。
临床怎么用
- 对局灶性癫痫患者应评估睡眠时长及睡眠障碍，并将改善睡眠作为改善认知和降低痴呆风险的潜在干预措施。
局限性
- 睡眠数据基于自我报告。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND AND OBJECTIVES: Sleep disruption and cognitive impairment are important comorbidities of focal epilepsy. However, the nature to which sleep affects cognition and long-term dementia risk in focal epilepsy, compared with other brain conditions, remains unclear. We examined the relationship between sleep, cognition, and dementia risk in patients with focal epilepsy compared with healthy controls and stroke patients. METHODS: We conducted an analysis of the prospective UK Biobank cohort study, with baseline assessments performed between 2006 and 2010 and follow-up until 2021. Study groups were mutually exclusive participants with focal epilepsy and stroke at baseline assessment and healthy controls. Sleep characteristics included reports of sleep duration, obstructive sleep apnea, insomnia, napping, and dozing. Main outcomes were risk of incident all-cause dementia and Alzheimer disease from Cox proportional hazard modeling and comparison of executive function measures and brain total hippocampal and gray matter volumes using generalized linear modeling. RESULTS: We examined a sample of 482,207 participants, aged between 38 and 72 years (mean [SD] 57.6 [8.1] years; 53.8% female), without dementia at baseline and a nested imaging subsample of 42,345 participants. Optimal sleep duration (6-8 hours) was associated with better executive function in control, focal epilepsy, and stroke groups. The impact of optimal sleep was significantly higher in individuals with focal epilepsy compared with controls (interaction term, p = 0.009), but not in the stroke group (interaction term, p = 0.574). Nonoptimal sleep was associated with worse executive function up to 8 years before the diagnosis of focal epilepsy. A 5-fold increased risk of developing dementia was seen in individuals with focal epilepsy and nonoptimal sleep (hazard ratio [HR] 5.15, 95% CI 3.77-7.04, p < 0.001) compared with healthy controls with optimal sleep. This was greater than in stroke individuals with poor sleep (HR 3.48, 95% CI 2.82-4.26, p < 0.001). Optimal sleep compared with nonoptimal sleep modified the dementia risk in in individuals focal epilepsy, with a significantly greater improvement compared with healthy controls (interaction term p = 0.017), while no significant difference was seen in the stroke group (interaction term p = 0.991). DISCUSSION: Optimal sleep modified both cognitive performance and dementia risk in individuals with focal epilepsy compared with stroke patients and healthy controls. Based on self-reported sleep data, these findings suggest that improving sleep may be an impactful intervention to improve cognition and reduce dementia risk particularly in focal epilepsy.
引用
- Tai XY, Zhao S, Liem B, et al. The Relationship Between Sleep, Cognition, and Dementia Risk in People With Focal Epilepsy. Neurology. 2026. PMID: 42018962. doi:10.1212/WNL.0000000000214985
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。