Abstract
Introduction Insufficient and excessive sleep are associated with cognitive dysfunction in older adults. Limited studies are available for adults < 50 years of age and the influence of race/ethnicity in a nationally representative population. We investigated the association between sleep duration and cognitive decline and the influence of age and race/ethnicity, in U.S adults >40 years of age. Methods Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) was used. Twelve states collected data on cognitive decline, assessed with: “During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?” among individuals aged 40 or older (N=63,948). Population-weighted logistic regression analyses examined this in relation to self-reported habitual sleep duration in models that also included age (by decade), sex, race/ethnicity, education, and depression history. Results In adjusted analyses, increased likelihood of perceived cognitive decline was seen for ≤4h (OR=2.50), 5h (OR=2.06), 6h (OR=1.51), 9h (OR=1.34), and 10+hr (OR=2.15), compared to 7h. A 3-way interaction was found (p=0.0001), as well as a 2-way interaction for sleep-by-age (p< 0.0001) but not sleep-by-race (p=0.16). There was an age gradient, such that for participants in their 40s, short sleep duration was more strongly associated with cognitive decline, and as age increased, these relationships generally weakened. However, a sleep-by-race interaction was seen for older adults only, where the relationship between cognitive decline and both short and long sleep duration was stronger among Blacks/African-Americans compared to Non-Hispanic Whites. Further, secondary analyses among those who reported cognitive decline showed that those with ≤4h sleep duration were more likely to talk about it with a doctor (OR=1.67), and greater ordinal likelihood of cognitive decline interfering with social functioning was associated with both short and long sleep duration. Conclusion Sleep duration is related to cognitive decline and its social effects, though this depends on age and race/ethnicity, especially among older adults. Interventions should focus on effects of insufficient sleep in younger populations in general, and older Black/African-American groups. Support (if any)