| Objective:To clarify the risk factors of cognitive impairment related to chronic insomnia in the elderly;to explore whether melatonin can improve chronic insomnia and related cognitive impairment and its possible mechanism through polysomnography.Materials and methods:150 elderly patients with chronic insomnia were screened and divided into cognitive impairment group and non-cognitive impairment group.The general clinical information,insomnia severity index(ISI)and Pittsburgh sleep quality index(PSQI)were compared between the two groups.Factor logistic regression to explore the independent risk factors of cognitive impairment related to chronic insomnia in the elderly.Elderly patients with complaints of insomnia were recruited continuously,and a randomized control design was conducted,including exogenous melatonin intervention group(MT group),endogenous melatonin intervention group(BLFG group)and control group(CON group).Correspondingly,2 mg of melatonin tablets were administered orally,blue-light glasses were worn for 2 hours every night,and 2 mg of placebo was administered orally.Before and after 4 weeks of treatment,the subjective and objective sleep quality was evaluated by polysomnography(PSG)and PSQI,the cognitive function of the patients was evaluated by Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment Scale(MOCA),the level of melatonin was detected by ELISA,and the relative expression level of CLOCK gene mRNA was detected by RT-qPCR.Results:1.1.Subjective sleep disturbance(P=0.004),sleep latency(P=0.036),habitual sleep efficiency(P=0.005),and sleep disturbance(P=0.007)were independent risk factors for cognitive impairment in elderly patients with chronic insomnia.2.In elderly patients with chronic insomnia,N1%and SOL increased,while N3%and REM%decreased significantly.3.After 4 weeks of treatment,the PSQI scores of the MT group and the BLFG group were significantly decreased(P<0.05).Compared with the BLFG and CON groups,the PSQI scores of the MT group were significantly decreased(P<0.05).4.After 4 weeks of treatment,1)SOL,WASO,ArI,N1%,N2%in MT group were significantly decreased(P<0.05),TST,SE,N3%,REM%were increased(P<0.05);In BLFG group,SOL,WASO and N1%were significantly decreased(P<0.05),and SE was significantly increased(P<0.05);2)Compared with CON group,SOL,WASO,ArI,N1%,N2%were significantly decreased(P<0.05),SE,N3%,REM%were significantly increased(P<0.05);Compared with the BLFG group,ArI and N2 were decreased in the MT group(P<0.05),and SE was increased(P<0.05);5.After 4 weeks of treatment,1)MMSE and MOCA scores in MT group were significantly increased,and higher than those in CON group(P<0.05);MOCA scores in BLFG group were significantly increased(P<0.05);2)The delayed memory and attention were significantly improved in the MT group and the BLFG group(P<0.05).6.After 4 weeks of treatment,the level of melatonin in the MT group was significantly increased(P<0.05)and was significantly higher than that in the CON group(P<0.05).7.After 4 weeks of treatment,the relative expression level of CLOCK gene mRNA in the MT group was significantly increased(P<0.05)and was significantly higher than that in the CON group(P<0.05);Conclusion:1.Subjective sleep quality,sleep latency,habitual sleep efficiency and sleep disturbance are independent risk factors for cognitive impairment related to chronic insomnia in the elderly.2.The sleep structure of elderly patients with chronic insomnia is disturbed.PSG indicates that N3%and R%are decreased,while N1%and SOL are increased.3.Melatonin can improve sleep disturbance in elderly patients with chronic insomnia,reduce their sleep-onset latency,increase slow-wave sleep time,sleep efficiency,subjective and objective sleep quality,and improve sleep fragmentation.4.Melatonin regulates the circadian rhythm by increasing the level of the clock gene CLOCK,thereby improving its delayed memory and attention,and the intervention of exogenous melatonin is better than that of endogenous melatonin. |
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