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Sleep. 2019 May 15. pii: zsz114. doi: 10.1093/sleep/zsz114. [Epub ahead of print]

Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

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Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal.
PERFORM Centre and Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University.
Canadian Sleep and Circadian Network.
Center for Advanced Research in Sleep Medicine, Hopital du Sacre-Coeur de Montreal, CIUSSS du Nord-de-l'Île-de-Montréal.
Division of Neurology, McGill University.
Department of Psychology, Université de Montréal.



This study examined the differences in cognitive function between middle-aged and older adults with insomnia disorder, insomnia symptoms only or no insomnia symptoms, in the context of other health and lifestyle factors.


28,485 participants >45 years completed questionnaires, physical examinations, and neuropsychological testing across domains of processing speed, memory and executive functions. An 8-question instrument assessed participants' sleep, defining subjects with insomnia symptoms, probable insomnia disorder or no insomnia symptoms. The associations between these three groups and cognitive performance were examined with linear regression models adjusted for lifestyle and clinical factors.


Probable insomnia disorder was identified in 1,068 participants (3.7% of the sample) while 7,813 (27.5%) experienced insomnia symptoms only. Participants with probable insomnia disorder exhibited greater proportions of adverse medical and lifestyle features such as anxiety, depression, and diabetes than both other groups. Analyses adjusting for age, sex, education, as well as medical and lifestyle factors demonstrated that adults with probable insomnia disorder exhibited declarative memory deficits (Rey Auditory Verbal Learning Test) compared to insomnia symptoms only or no insomnia symptoms. Adults with insomnia symptoms exhibited better performance on a task of mental flexibility than both other groups.


These findings suggest that insomnia disorder in middle-aged and older adults is associated with poorer health outcomes and worse memory performance than adults with insomnia symptoms alone or without any sleep complaints, even after adjustment for comorbidities. The assessment of longitudinal data within this cohort will be critical to understand if insomnia disorder may increase the risk of further cognitive decline.


CLSA; aging; cognition; cohort; insomnia


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