J Int Med Res. 2026 Aug;54(8):3000605261476845. doi: 10.1177/03000605261476845. Epub 2026 Aug 17.
ABSTRACT
ObjectiveThis retrospective cross-sectional study aimed to investigate the independent and joint associations of low sleep efficiency and carotid plaque with cognitive impairment in older adults with chronic diseases and to evaluate potential interaction effects between these two factors.MethodsWe conducted a retrospective cross-sectional study of 160 hospitalized older adults with chronic diseases. Cognitive function, sleep characteristics, carotid vascular status, depressive symptoms, and anxiety symptoms were assessed using the Mini-Mental State Examination, Pittsburgh Sleep Quality Index, carotid ultrasonography, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, respectively. Multivariable logistic regression models were used to examine the independent and joint associations of low sleep efficiency and carotid plaque with cognitive impairment. Additive and multiplicative interactions between low sleep efficiency and carotid plaque were also assessed.ResultsLow sleep efficiency was independently associated with cognitive impairment after adjustment for potential confounders (odds ratio = 5.053, 95% confidence interval: 2.384-10.709). Carotid plaque was also independently associated with cognitive impairment (odds ratio = 2.988, 95% confidence interval: 1.491-5.990). Participants with both low sleep efficiency and carotid plaque had a markedly higher likelihood of cognitive impairment than those with neither exposure (odds ratio = 18.304, 95% confidence interval: 5.914-56.647). A significant additive interaction was observed between low sleep efficiency and carotid plaque, with a relative excess risk due to interaction of 13.051 (95% confidence interval: 2.760-69.783) and an attributable proportion due to interaction of 0.713 (95% confidence interval: 0.311-0.920). No significant multiplicative interaction was found.ConclusionsLow sleep efficiency and carotid plaque were independently and jointly associated with cognitive impairment in hospitalized older adults with chronic diseases. Their co-occurrence showed suggestive evidence of a positive additive interaction, although the estimates were imprecise. These findings indicate that combined sleep and vascular assessment may help identify older adults at higher risk of cognitive impairment. Future prospective studies using objective sleep monitoring and neuroimaging are needed to confirm these findings.
PMID:42606316 | DOI:10.1177/03000605261476845