研究背景：
輕度認知功能障礙是介於正常老化和失智症之間的過渡階段，其特徵為記憶力或其他認知功能的輕微衰退，但不足以診斷為失智症。由於目前尚無有效的治療藥物或介入措施避免其進展成失智症，因此現有的研究重點聚焦於可調控的風險因子。研究顯示管理可調控的風險因子如：心血管疾病、糖尿病、睡眠障礙及生活方式等皆可有效延緩或降低進展成阿茲海默氏症的風險。過去的研究雖指出失眠為進展成阿茲海默氏症的風險因子，而輕度認知功能障礙則被視為進展至阿茲海默氏症的高危險族群，但失眠是否為輕度認知功能障礙進展成阿茲海默氏症的風險因子，仍需進一步探討。以期為臨床與預防提供依據，進而降低輕度認知功能障礙患者進展成阿茲海默氏症的風險。
研究目的：
本研究透過系統性回顧和統合分析的方法，確認失眠是否為輕度認知功能障礙進展至阿茲海默氏症的風險因子。
研究方法：
本研究依照PRISMA 2020指引進行系統性回顧與統合分析，整合2024年7月至2025年2月所有發表於電子資料庫（Medline、Cochrane Library 、EMBASE、CINAHL、Web of Science、ProQuest、APA PsycInfo、華藝線上圖書館、萬芳數據庫及中國知識資源總庫）的相關觀察性世代研究。納入條件為（一）研究對象為輕度認知功能障礙患者且合併失眠；（二）研究設計為觀察世代研究（cohort study）且追蹤時長需至少三年；（三）研究結果為進展成阿茲海默氏症。排除條件為（一）臨床指引、導讀文章、研究會議、海報以及不包含全文的研究；（二）由生理、藥理、實驗條件等外在因素導致的失眠；（三）由其他睡眠困擾（如睡眠相關呼吸障礙、晝夜節律障礙、異態睡眠症、睡眠相關運動障礙等）或疾病所引起的失眠症狀（四）額顳葉型失智症、路易氏體失智症、血管型失智或其他原因引起的失智症。本研究使用Newcastle-Ottawa Scale for Cohort Study進行文獻品質評讀，並使用Comprehensive Meta Analysis軟體進行統合分析，以隨機效應模型計算相對風險（Relative Risk）及信賴區間，最後使用GRADE系統評估本研究之證據等級。
研究結果：
本研究共檢索了3,639篇文獻，最終納入7篇觀察世代研究，共2,962名輕度認知功能障礙患者。系統性回顧及統合分析結果顯示，失眠可能並非輕度認知功能障礙進展成阿茲海默氏症的風險因子（RR＝1.02，95％CI：0.83－1.25，I²＝60.4%）；敏感性分析顯示，逐一移除單篇研究後，總體相對風險與統計顯著性均未產生顯著變化，顯示該結果具有穩定性；次群體分析顯示，不同的效應量型態及輕度認知功能障礙診斷方式均無顯著差異；僅失眠評估方式在量表評估與自述失眠間呈現顯著差異（Q-between = 4.469，p = 0.035）；由於納入文獻數量有限，回歸分析與出版偏誤檢測之結果缺乏足夠統計解釋力。整體GRADE證據等級評級為「低」，顯示現有研究尚不足以提供明確的結論，未來仍需更多高品質研究加以驗證。
結論與建議
本研究認為失眠可能並非輕度認知功能進展成阿茲海默氏阿茲海默氏症的風險因子，然而由於目前的研究篇數有限，且納入文獻中輕度認知功能障礙與失眠的診斷標準及評估方式上存在差異，導致結果的解釋力有限，建議未來研究應採用一致且具臨床效度的輕度認知功能障礙診斷標準，並結合客觀失眠測量方式或臨床診斷，同時區分不同失眠亞型進行分析，以更全面評估失眠在疾病進展中的角色。

Mild cognitive impairment (MCI) represents a transitional stage between normal aging and dementia and often precedes Alzheimer’s disease (AD). This study aimed to determine whether insomnia increases the risk of progression from MCI to AD through a systematic review and meta-analysis. Following the PRISMA 2020 guidelines, ten international and regional databases were systematically searched. The quality of included studies was assessed using the Newcastle Ottawa Scale, and a random effects meta-analysis was performed with Comprehensive Meta-Analysis software. Seven cohort studies involving 2,962 participants met the inclusion criteria. The pooled relative risk showed no significant association between insomnia and the progression from MCI to AD (RR = 1.02, 95% CI: 0.83–1.25, I² = 60.4%). Subgroup analyses revealed methodological variability in insomnia assessments, while sensitivity analyses confirmed the robustness of the results. Due to the limited number of studies and existing heterogeneity, the overall quality of evidence was rated as low. In conclusion, current evidence suggests that insomnia may not be a significant risk factor for the progression from MCI to AD; however, further high-quality longitudinal studies using standardized diagnostic criteria and objective insomnia assessments are warranted to clarify this association.

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