JGABS:中年工作压力大竟会导致晚年痴呆症发生?

2022-05-14 医路坦克 MedSci原创

工作中的心理社会压力和睡眠障碍都可能在以后的生活中导致认知功能受损和痴呆。然而,睡眠是否在工作压力和随后的痴呆症之间起到了中介作用还有待调查,本文就此展开研究。

对于绝大多数人来说,工作涵盖了很长一段人生历程。以工作需求(如工作量和压力)和工作控制(如作出决定的自由)为特征的工作心理社会压力是一种相当大的现象,已被确定为各种不利健康后果的风险因素,如心血管疾病和抑郁症。近年来,越来越多的证据支持,中年工作压力与晚年认知障碍和痴呆症风险增加有关。具体地说,与职业生活中工作控制力较高的人相比,工作控制力较低的人在年龄较大时患痴呆症和阿尔茨海默病(AD)的风险更高。

充足、高质量的睡眠对大脑健康至关重要。睡眠障碍,如失眠症状和睡眠呼吸障碍,可诱导夜间觉醒,并可能通过改变淀粉样β蛋白动力学而导致阿尔茨海默病和痴呆症的发病。鉴于心理社会压力和睡眠质量之间的密切联系,工作压力尤其令人担忧,因为它具有慢性、重复性,以及它可能对睡眠产生的长期影响。一项研究表明,工作压力,无论是在家里的紧张经历,都与睡眠质量差有关。在另一项研究中,工作负担过重与睡眠质量差的频率有关,角色冲突与入睡困难和非恢复性睡眠有关,工作自主性与非恢复性睡眠负相关。

尽管工作压力和睡眠障碍与痴呆症风险之间存在平行联系,但目前尚不清楚这两个痴呆症风险因素之间是否存在互动关系。更具体地说,睡眠能否在工作压力和痴呆症发展之间起到中介作用?因此,将工作压力和睡眠的复杂性分开可能有助于在现实生活中预防痴呆症。因此,我们假设,工作压力的各个维度,如工作需求和控制力,以及工作报酬,可能与睡眠障碍有关的晚年痴呆风险不同。

这项研究使用了欧洲健康、老龄化和退休调查的数据。对7799名非痴呆者(年龄71.1±0.2岁)进行了平均4.1年的痴呆事件随访。工作需求和控制是使用卡拉塞克工作内容问卷中的问题来估计的。睡眠障碍是通过EURO抑郁量表中的一个问题确定的。根据年龄、性别、教育程度、认知测试分数和其他潜在协变量调整后的Cox比例风险模型被用来估计与不同工作压力水平有关的痴呆症的危险比(HR)和95%可信区间(CI)。

工作需求和睡眠障碍之间的交互作用与痴呆症的风险有关。数据显示,与低工作需求相比,高水平的工作需求对睡眠障碍患者的痴呆症具有保护作用(HR[95%CI]:0.69[0.47,1.00])。基于工作需求和工作控制水平的四类工作压力模型表明,在有睡眠障碍的个体中,被动工作(低要求,低控制)与积极工作(高要求,高控制)相比,患痴呆症的风险更高(1.54[1.01,2.34])。

结果表明与工作相关的压力和痴呆症风险之间的联系仅限于患有睡眠障碍的个人。

 

文献来源:

Tan X,  Lebedeva A,  Åkerstedt T,Sleep mediates the association between stress at work and incident dementia: study from the Survey of Health, Ageing and Retirement in Europe.J Gerontol A Biol Sci Med Sci 2022 May 04;

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    2022-07-10 Boyinsh
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    2022-05-10 neuro.Dr

    老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!

    0

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