Objective Sleep Measures and Cognition in Middle-Aged and Older Adults: A Cross-Sectional and Longitudinal Analysis in the ALBION Study

Introduction: Sleep disturbances are common as we age and have been linked to poor cognition and increased cognitive decline. Objective: We aimed to examine cross-sectional and longitudinal associations between objective sleep measures and cognition in middle-aged and older adults, including cognitively healthy (CH) individuals and those with mild cognitive impairment (MCI). Methods: Participants from the Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION) study (age > 40) underwent 7-day wrist actigraphy (Actiwatch 2). Sleep exposures included sleep duration, sleep efficiency, sleep variability, sleep onset latency, wake after sleep onset (WASO), and number of awakenings. A neuropsychological battery was administered examining memory, executive function, visuospatial ability, language, attention speed, and a global composite score. Cross-sectional associations were tested using generalized linear models (adjusted for age, sex, education). Longitudinal associations with cognitive trajectories were examined with linear mixed-effect models. Results: In total (N = 184; 65% women; mean age 65 years), average sleep duration was 7.2 h and mean sleep efficiency was at 80%. Cross-sectionally, more nightly awakenings were associated with poor memory and attention speed. In a 1.5-year follow-up, (n = 93), higher baseline sleep efficiency was associated with better memory and language performance, while longer WASO, more awakenings, and longer sleep onset latency showed nominal associations with less favorable cognitive trajectories, although these associations did not remain statistically significant after FDR correction. Time-varying analyses indicated that sleep variability showed robust non-linear associations with poorer memory trajectories over follow-up and remained significant after FDR adjustment; significant mean change in awakenings and variability appeared to intensify in later follow-up phases. The association between sleep characteristics and cognitive decline varied across follow-up time, with stronger adverse changes observed during later follow-up phases. Discussion: Objective indicators of sleep continuity, especially sleep variability, were most consistently related to domain-specific cognitive outcomes, with strongest evidence for memory over time. Sleep fragmentation and irregular sleep patterns may represent potentially modifiable targets for future strategies aimed at preserving cognitive health during aging.