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Original research
Sleep problems and risk of all-cause cognitive decline or dementia: an updated systematic review and meta-analysis
  1. Wei Xu1,
  2. Chen-Chen Tan1,
  3. Juan-Juan Zou2,
  4. Xi-Peng Cao3,
  5. Lan Tan1
  1. 1 Neurology Department, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
  2. 2 Department of Otorhinolaryngology, Qilu Hospital of Shandong University; NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, China
  3. 3 Clinical Research Center, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
  1. Correspondence to Dr Wei Xu, Neurology department, Qingdao Municipal Hospital Group, Qingdao, Shandong, China; 1037219730{at}


Objectives To conduct an updated systematic review and meta-analysis of association between sleep and all-cause cognitive disorders.

Methods PubMed and EMBASE were searched from inception to 18 February 2019. Cohort studies exploring longitudinal associations of sleep with cognitive decline or dementia were included. The multivariable-adjusted effect estimates were pooled by random-effects models, with credibility assessment. The robust error meta-regression model was used to conduct the dose–response meta-analysis for sleep duration.

Results 11 155 reports were searched and 51 eligible cohorts with 15 sleep problems were included for our meta-analyses. Ten types of sleep conditions or parameters, including six (insomnia, fragmentation, daytime dysfunction, prolonged latency, rapid eye movement sleep behaviour disorder and excessive time in bed) with moderate-to-high levels of evidence, were linked to higher risk of all-cause cognitive disorders. Furthermore, a U-shaped relationship was revealed for the associations with sleep duration.

Conclusions Sleep management might serve as a promising target for dementia prevention.

  • Sleep
  • Dementia
  • Cognitive decline
  • Systematic review
  • Meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors WX: conceptualisation and design of the study, collection and analysis of the data, drafting and revision of the manuscript, and prepared all the figures. C-CT: collection and analysis of the data, and revision of the manuscript. J-JZ, X-PC and LT: revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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