5
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Pase MP, Harrison S, Misialek JR, Kline CE, Cavuoto M, Baril AA, Yiallourou S, Bisson A, Himali D, Leng Y, Yang Q, Seshadri S, Beiser A, Gottesman RF, Redline S, Lopez O, Lutsey PL, Yaffe K, Stone KL, Purcell SM, Himali JJ. Sleep Architecture, Obstructive Sleep Apnea, and Cognitive Function in Adults. JAMA Netw Open 2023; 6:e2325152. [PMID: 37462968 PMCID: PMC10354680 DOI: 10.1001/jamanetworkopen.2023.25152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Good sleep is essential for health, yet associations between sleep and dementia risk remain incompletely understood. The Sleep and Dementia Consortium was established to study associations between polysomnography (PSG)-derived sleep and the risk of dementia and related cognitive and brain magnetic resonance imaging endophenotypes. Objective To investigate association of sleep architecture and obstructive sleep apnea (OSA) with cognitive function in the Sleep and Dementia Consortium. Design, Setting, and Participants The Sleep and Dementia Consortium curated data from 5 population-based cohorts across the US with methodologically consistent, overnight, home-based type II PSG and neuropsychological assessments over 5 years of follow-up: the Atherosclerosis Risk in Communities study, Cardiovascular Health Study, Framingham Heart Study (FHS), Osteoporotic Fractures in Men Study, and Study of Osteoporotic Fractures. Sleep metrics were harmonized centrally and then distributed to participating cohorts for cohort-specific analysis using linear regression; study-level estimates were pooled in random effects meta-analyses. Results were adjusted for demographic variables, the time between PSG and neuropsychological assessment (0-5 years), body mass index, antidepressant use, and sedative use. There were 5946 participants included in the pooled analyses without stroke or dementia. Data were analyzed from March 2020 to June 2023. Exposures Measures of sleep architecture and OSA derived from in-home PSG. Main Outcomes and Measures The main outcomes were global cognitive composite z scores derived from principal component analysis, with cognitive domains investigated as secondary outcomes. Higher scores indicated better performance. Results Across cohorts, 5946 adults (1875 females [31.5%]; mean age range, 58-89 years) were included. The median (IQR) wake after sleep onset time ranged from 44 (27-73) to 101 (66-147) minutes, and the prevalence of moderate to severe OSA ranged from 16.9% to 28.9%. Across cohorts, higher sleep maintenance efficiency (pooled β per 1% increase, 0.08; 95% CI, 0.03 to 0.14; P < .01) and lower wake after sleep onset (pooled β per 1-min increase, -0.07; 95% CI, -0.13 to -0.01 per 1-min increase; P = .02) were associated with better global cognition. Mild to severe OSA (apnea-hypopnea index [AHI] ≥5) was associated with poorer global cognition (pooled β, -0.06; 95% CI, -0.11 to -0.01; P = .01) vs AHI less than 5; comparable results were found for moderate to severe OSA (pooled β, -0.06; 95% CI, -0.11 to -0.01; P = .02) vs AHI less than 5. Differences in sleep stages were not associated with cognition. Conclusions and Relevance This study found that better sleep consolidation and the absence of OSA were associated with better global cognition over 5 years of follow-up. These findings suggest that the role of interventions to improve sleep for maintaining cognitive function requires investigation.
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Affiliation(s)
- Matthew P. Pase
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Harvard T.H. Chan School of Public Health, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
| | | | - Jeffrey R. Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Christopher E. Kline
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marina Cavuoto
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Andree-Ann Baril
- Framingham Heart Study, Framingham, Massachusetts
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Stephanie Yiallourou
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Alycia Bisson
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dibya Himali
- Framingham Heart Study, Framingham, Massachusetts
| | - Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California
| | - Qiong Yang
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio
| | - Alexa Beiser
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oscar Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
- Department of Epidemiology, University of California, San Francisco
| | - Katie L. Stone
- California Pacific Medical Center, Research Institute, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Shaun M. Purcell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jayandra J. Himali
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
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14
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Rodrigues NB, McIntyre RS, Lipsitz O, Cha DS, Cao B, Lee Y, Gill H, Lui LMW, Cubała WJ, Ho R, Shekotikhina M, Teopiz KM, Subramaniapillai M, Kratiuk K, Mansur RB, Rosenblat JD. Do sleep changes mediate the anti-depressive and anti-suicidal response of intravenous ketamine in treatment-resistant depression? J Sleep Res 2021; 31:e13400. [PMID: 34137095 DOI: 10.1111/jsr.13400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 12/28/2022]
Abstract
Sleep disturbances are commonly reported in patients with treatment-resistant depression (TRD). Available data have shown that intravenous (IV) ketamine is an effective treatment for patients with TRD and growing data suggest ketamine may improve overall sleep architecture. In the present study, we evaluated whether changes in sleep symptoms mediated the anti-depressive and/or anti-suicidal effects of IV ketamine and whether improvement in sleep correlated with a higher likelihood of achieving response or remission. Adults with TRD received four infusions of IV ketamine at a community-based clinic. Total depressive symptom severity was measured with the Quick Inventory Depressive Symptoms Self-Report 16-Item (QIDS-SR16 ) at baseline and was repeated across four infusions. Suicidal ideation (SI) and four sleep symptoms were measured using the SI item and the five sleep items on the QIDS-SR16 . A total of 323 patients with TRD received IV ketamine. Self-reported improvements in insomnia, night-time restlessness, hypersomnia, early morning waking, and total sleep were significant partial mediators to the improvements observed in depression severity. Similarly, insomnia, night-time restlessness, early morning waking and total sleep improvements mediated the reduction of IV ketamine on SI. All sleep items, except for hypersomnia, were associated with an increased likelihood of achieving response or remission. Notably, each point improvement in total sleep score was significantly associated with achieving responder/remitter status (odds ratio 3.29, 95% confidence interval 2.00-5.41). Insomnia, sleep restlessness, early morning waking and total sleep improvements were significant mediators of antidepressant and anti-suicidal improvements in patients with TRD receiving IV ketamine.
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Affiliation(s)
- Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Brain and Cognition Discovery Foundation, Canada, University of Toronto, Toronto, ON, Canada
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University (SWU), Chongqing, China
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wiesław J Cubała
- Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland
| | - Roger Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | | | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Department of Physical Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,Brain and Cognition Discovery Foundation, Canada, University of Toronto, Toronto, ON, Canada
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15
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Baril AA, Beiser AS, Mysliwiec V, Sanchez E, DeCarli CS, Redline S, Gottlieb DJ, Maillard P, Romero JR, Satizabal CL, Zucker JM, Seshadri S, Pase MP, Himali JJ. Slow-Wave Sleep and MRI Markers of Brain Aging in a Community-Based Sample. Neurology 2020; 96:e1462-e1469. [PMID: 33361258 DOI: 10.1212/wnl.0000000000011377] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/02/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To test the hypothesis that reduced slow-wave sleep, or N3 sleep, which is thought to underlie the restorative functions of sleep, is associated with MRI markers of brain aging, we evaluated this relationship in the community-based Framingham Heart Study Offspring cohort using polysomnography and brain MRI. METHODS We studied 492 participants (age 58.8 ± 8.8 years, 49.4% male) free of neurological diseases who completed a brain MRI scan and in-home overnight polysomnography to assess slow-wave sleep (absolute duration and percentage of total sleep). Volumes of total brain, total cortical, frontal cortical, subcortical gray matter, hippocampus, and white matter hyperintensities were investigated as a percentage of intracranial volume, and the presence of covert brain infarcts was evaluated. Linear and logistic regression models were adjusted for age, age squared, sex, time interval between polysomnography and MRI (3.3 ± 1.0 years), APOE ε4 carrier status, stroke risk factors, sleeping pill use, body mass index, and depression. RESULTS Less slow-wave sleep was associated with lower cortical brain volume (absolute duration, β [standard error] = 0.20 [0.08], p = 0.015; percentage, 0.16 [0.08], p = 0.044), lower subcortical brain volume (percentage, 0.03 [0.02], p = 0.034), and higher white matter hyperintensities volume (absolute duration, -0.12 [0.05], p = 0.010; percentage, -0.10 [0.04], p = 0.033). Slow-wave sleep duration was not associated with hippocampal volume or the presence of covert brain infarcts. CONCLUSION Loss of slow-wave sleep might facilitate accelerated brain aging, as evidence by its association with MRI markers suggestive of brain atrophy and injury. Alternatively, subtle injuries and accelerated aging might reduce the ability of the brain to produce slow-wave sleep.
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Affiliation(s)
- Andrée-Ann Baril
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA.
| | - Alexa S Beiser
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Vincent Mysliwiec
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Erlan Sanchez
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Charles S DeCarli
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Susan Redline
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Daniel J Gottlieb
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Pauline Maillard
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Jose Rafael Romero
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Claudia L Satizabal
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Jared M Zucker
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Sudha Seshadri
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Matthew P Pase
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Jayandra J Himali
- From the Framingham Heart Study (A.-A.B., A.S.B., J.R.R., C.L.S., J.M.Z., S.S., M.P.P. J.J.H.); Department of Neurology (A.-A.B., A.S.B., C.L.S., S.S., J.J.H.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H. ), Boston University School of Public Health, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (V.M., C.L.S., S.S., J.J.H.), and Department of Population Health Sciences (J.J.H.), University of Texas Health Sciences Center, San Antonio; Centre for Advanced Research in Sleep Medicine (E.S.), Hôpital du Sacré-Coeur de Montréal, CIUSSS-NIM; Department of Neuroscience (E.S.), Université de Montréal, Quebec, Canada; Department of Neurology (C.D., P.M.), and School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience (P.M.), University of California, Davis, Sacramento; Division of Sleep and Circadian Disorders (S.R., D.J.G.), Brigham & Women's Hospital; Beth Israel Deaconess Medical Center (S.R., D.J.G.); Division of Sleep Medicine Harvard Medical School, Boston, MA; VA Boston Healthcare System (D.J.G.), Boston, MA; Turner Institute for Brain and Mental Health (M.P.P.), School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
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