Subjectively and Objectively Measured Sleep Predict Differing Aspects of Cognitive Functioning in Adults

Subjective sleep more predictive of global cognitive function than objective sleep in older adults: A specification curve analysis

OBJECTIVES

Sleep is associated with cognitive function in older adults. In the current study, we examined this relationship from subjective and objective perspectives, and determined the robustness and dimensional specificity of the associations using a comprehensive modelling approach.

METHODS

Multiple dimensions of subjective (sleep quality and daytime sleepiness) and objective sleep (sleep stages, sleep parameters, sleep spindles, and slow oscillations), as well as subjectively reported and objectively measured cognitive function were collected from 55 older adults. Specification curve analysis was used to examine the robustness of correlations for the effects of sleep on cognitive function.

RESULTS

Robust associations were found between sleep and objectively measured cognitive function, but not with subjective cognitive complaints. In addition, subjective sleep showed robust and consistent associations with global cognitive function, whereas objective sleep showed a more domain-specific association with episodic memory. Specifically, subjective sleep quality and daytime sleepiness correlated with global cognitive function, and objective sleep parameters correlated with episodic memory.

CONCLUSIONS

Overall, associations between sleep and cognitive function in older adults depend on how they are measured and which specific dimensions of sleep and domains of cognitive function are considered. It highlights the importance of focusing on specific associations to ameliorate the detrimental effects of sleep disturbance on cognitive function in later life.

Sleep disturbances and change in multiple cognitive domains among older adults: a multicenter study of five Nordic cohorts

STUDY OBJECTIVES

We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years).

METHODS

Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies.

RESULTS

While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates.

CONCLUSION

This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.

Association between sleep hours and changes in cognitive function according to the morningness-eveningness type: A population-based study

OBJECTIVE

The aim of this study was to investigate proper sleep hours to reduce the risk of cognitive decrease considering morningness-eveningness type.

METHODS

The Korean Community Health Survey was used, which includes adults aged over 19 years old. These data were obtained from a cross-sectional study and assessed sleep hours using questionnaire of Pittsburgh Sleep Quality Index. Based on the wake-up time of each participant, they were classified into the morningness, intermediate, eveningness, and none groups. The change in cognitive function was determined by a single question about memory loss experience.

RESULTS

A total of 224,714 participants were included in the analysis. Of the participants, 55.6 % and 5.0 % of whom had morningness and eveningness, respectively. The risk of cognitive decline was significantly different by sleep hours and morningness-eveningness type. Without considering sleep quality, the intermediate and eveningness groups showed a higher risk of cognitive decline than the morningness group, and the risk was lowest in those with 7-9 sleep hours. However, when sleep quality showing significant effect was included in the analysis, sleep hours showing the lowest risk were different among morningness, intermediate, eveningness groups, and it was the shortest in the morningness type at 5-6 h and the longest in the eveningness type at 7-8 h.

CONCLUSION

Proper sleep hours to decrease the risk of cognitive decline may be different by morningness-eveningness types. However, when considering sleep quality, sleep duration had little influence on cognitive decline. Future studies investigating healthy sleep hours need to consider sleep quality as well as the habitual sleep schedules.

LIMITATIONS

The morningness-eveningness types were classified based on wake-up time not morningness-eveningness types. The morningness-eveningness types in this study would be interpreted as habitual sleep schedule rather than chronotype.

Long-term associations between objective sleep quality and quantity and verbal memory performance in normal cognition and mild cognitive impairment

Introduction

Although the link between sleep and memory function is well established, associations between sleep macrostructure and memory function in normal cognition and Mild Cognitive Impairment remain unclear. We aimed to investigate the longitudinal associations of baseline objectively assessed sleep quality and duration, as well as time in bed, with verbal memory capacity over a 7-9 year period. Participants are a well-characterized subsample of 148 persons (mean age at baseline: 72.8 ± 6.7 years) from the Cretan Aging Cohort. Based on comprehensive neuropsychiatric and neuropsychological evaluation at baseline, participants were diagnosed with Mild Cognitive Impairment (MCI; n = 79) or found to be cognitively unimpaired (CNI; n = 69). Sleep quality/quantity was estimated from a 3-day consecutive actigraphy recording, whereas verbal memory capacity was examined using the Rey Auditory Verbal Learning Test (RAVLT) and the Greek Passage Memory Test at baseline and follow-up. Panel models were applied to the data using AMOS including several sociodemographic and clinical covariates.

Results

Sleep efficiency at baseline directly predicted subsequent memory performance in the total group (immediate passage recall: β = 0.266, p = 0.001; immediate word list recall: β = 0.172, p = 0.01; delayed passage retrieval: β = 0.214, p = 0.002) with the effects in Passage Memory reaching significance in both clinical groups. Wake after sleep onset time directly predicted follow-up immediate passage recall in the total sample (β = -0.211, p = 0.001) and in the MCI group (β = -0.235, p = 0.02). In the total sample, longer 24-h sleep duration was associated with reduced memory performance indirectly through increased sleep duration at follow-up (immediate passage recall: β = -0.045, p = 0.01; passage retention index: β = -0.051, p = 0.01; RAVLT-delayed recall: β = -0.048, p = 0.009; RAVLT-retention index:β = -0.066, p = 0.004). Similar indirect effects were found for baseline 24-h time in bed. Indirect effects of sleep duration/time in bed were found predominantly in the MCI group.

Discussion

Findings corroborate and expand previous work suggesting that poor sleep quality and long sleep duration predict worse memory function in elderly. Timely interventions to improve sleep could help prevent or delay age-related memory decline among non-demented elderly.

Executive function and episodic memory composite scores in older adults: relations with sex, mood, and subjective sleep quality

Executive function and episodic memory processes are particularly vulnerable to aging. We sought to learn the degree to which sex, mood, and subjective sleep quality might be related to executive function and episodic memory composite scores in community-dwelling older adults. We replicated Glisky and colleagues' two-factor (i.e., executive function [N=263] versus episodic memory [N=151]) structure, and found that it did not significantly differ between males and females. Moderation analyses revealed no interactions between sex, mood, and sleep in predicting either composite score. However, females significantly outperformed males on the episodic memory composite, and on all the individual tests comprising it. Ours is the first study to look at sex differences in this battery's factor structure and its potential relations with mood and sleep. Future longitudinal studies in both healthy and clinical populations will help us further probe the possible influence of these variables on executive function and episodic memory in aging.

Chronotype and Time of Day Effects on a Famous Face Recognition Task with Dynamic Stimuli

Chronotype and Time of Day (ToD) can modulate several aspects of cognitive performance. However, there is limited evidence about the effect of these variables on face recognition performance, so the aim of the present study is to investigate this influence. For this, 274 participants (82.5% females; age 18-49 years old, mean = 27.2, SD = 1.82) were shown 20 short videoclips, each gradually morphing from a general identity unfamiliar face to a famous face. Participants should press the spacebar to stop each video as soon as they could identify the famous face, and then provide the name or an unequivocal description of the person. Analysis of response times (RT) showed that evening-types recognised the faces faster than morning-types. Considering different ToD windows, the effect of chronotype was only significant in the 13h-17h and in the 21h-6h time-windows. Altogether, results suggest an advantage of evening-types on famous face recognition using dynamic stimuli with morning-types, being particularly slower during their non-optimal period.

Discrepancies between self-report and objective sleep outcomes are associated with cognitive impairment and fatigue in people with multiple sclerosis and insomnia

OBJECTIVES

The primary aim of this study was to assess the degree to which discrepancies between self-reported and actigraphy-based measures of sleep are associated with specific demographic, disease characteristics, and clinical features in a sample of individuals with multiple sclerosis (MS) reporting clinically significant insomnia symptoms.

METHODS

Participants were 90 community-based participants with MS and insomnia. Measures included the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-Fast Screen (BDI-FS), Modified Fatigue Impact Scale (MFIS), and MS Neuropsychological Screening Questionnaire (MSNQ), and wrist actigraphy-derived sleep parameters. Discrepancy scores were calculated by subtracting actigraphy-derived values from PSQI-derived values for sleep latency (SL), total sleep time (TST), and sleep efficiency (SE).

RESULTS

Correlations between PSQI and actigraphy-derived values were weak. Significant discrepancies, with moderate-to-large effect sizes, were observed between PSQI and actigraphy for SL, TST, and SE, whereby the PSQI yielded longer SL, shorter TST, and less SE than actigraphy. MSNQ elevations correlated with greater PSQI-actigraphy discrepancies in SL and TST. MFIS elevations correlated with greater discrepancies in TST. Discrepancies were not significantly related to BDI-FS, gender, race, education level, or MS type.

CONCLUSIONS

Results emphasize the importance of assessing fatigue with sleep, and when feasible, inclusion of both self-report and actigraphy measures.

Specific Sleep Health Domains as Predictors of Executive Function in Older Adults

OBJECTIVES

Sleep health and executive function are multifaceted constructs that decline with age. Some evidence suggests that poor sleep health may underlie declines in executive function, but this relationship is not consistently found in cognitively normal older adults. The authors systematically investigated distinct sleep health domain associations with specific aspects of executive function.

METHODS

Community-dwelling older adults completed clinical interviews, comprehensive neuropsychological assessments, and subjective sleep measures. Four sleep health domains were investigated: satisfaction/quality, sleep efficiency, sleep duration, and daytime sleepiness/fatigue. Hierarchical multiple regression analyses, adjusting for significant covariates, examined whether the sleep health domains differentially predicted executive function.

RESULTS

Separate analyses found that greater sleep efficiency was associated with better response inhibition, while greater daytime sleepiness/fatigue was associated with worse cognitive flexibility. Categorical differences in sleep duration indicated that average durations, compared with short and long durations, had better executive function performance across measures. Sleep satisfaction/quality was not statistically associated with executive function.

CONCLUSIONS

These findings have implications for sleep assessment and its intervention. Routine screening of sleep duration, efficiency, and daytime fatigue may be particularly useful in identifying those at greater risk of executive dysfunction. Targeting specific problems in sleep may serve to improve cognitive control and efficiency in older adults. Future research is warranted to establish the optimal hours of sleep duration for cognitive health.

Unobtrusive, in-home assessment of older adults' everyday activities and health events: associations with cognitive performance over a brief observation period

In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.

Cross-sectional and prospective associations between self-reported sleep characteristics and cognitive function in men and women: The Midlife in the United States study

Sleep behaviour is an important contributing factor in healthy human ageing and cognitive function. Previous studies have linked sleep deficiency with cognitive decline in older adults. However, there is need for more prospective investigations that focus on specific domains of cognitive function. The present study analysed cross-sectional and prospective associations between self-reported sleep and cognitive function in the Midlife in the United States (MIDUS) study. Weekday and weekend sleep duration and habitual sleep quality were obtained via questionnaire data. Brief Test of Adult Cognition by Telephone was conducted to assess overall cognitive function, as well as episodic memory and executive function. We found significant trend for both long weekday and weekend sleep (>8 hr) and lower episodic memory scores in the overall sample. Sex-specific cross-sectional analysis demonstrated men with longer weekend sleep duration have lower overall cognitive function scores, and a negative association between weekend sleep and episodic memory scores. Women demonstrated a positive association between weekend sleep duration and executive function scores. There was no prospective significance for overall or sex-specific analysis. Our present results suggest that sleep duration may contribute to cognitive function, and future studies should include objective sleep measurements and focus on the potential cognitive benefits of improving sleep to further elucidate this association.

The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis

PURPOSE

While studies indicate cognitive behavioral therapy for insomnia (CBT-I) improves self-report sleep outcomes from questionnaires in people with multiple sclerosis (MS), it is unclear if CBT-I improves outcomes from a sleep log or sleep assessed objectively via actigraphy in people with MS. This study aimed to determine if CBT-I improves sleep log and actigraphy outcomes in individuals with MS.

PATIENTS AND METHODS

Twenty-five participants (Mage = 53.04, SD= 10.90) were included in this secondary analysis of data from a pilot randomized control study to assess the feasibility and treatment effect of CBT-I in individuals with MS. Participants were asked to maintain a sleep log and wear an actigraph for a week at baseline and post-intervention. Participants were randomized into one of three groups (CBT-I, active control, or one-time brief education control group). One-way ANOVAs were used to assess for group differences and within group change in sleep latency, sleep efficiency (SE), time in bed, total sleep time (TST), wake after sleep onset, variability of SE, and variability of TST.

RESULTS

CBT-I resulted in an increase in sleep efficiency (SE) and decrease in time in bed (TIB) and variability of SE from the sleep log. The CBT-I group also experienced a decrease in TIB and total sleep time (TST) from actigraphy. The active control group demonstrated an increase in variability of SE from actigraphy.

CONCLUSION

This study indicates that individuals with MS may experience an improvement in sleep log and actigraphy sleep outcomes following CBT-I, but findings need to be replicated in a larger prospective study. The decrease in TST from actigraphy mirrors results from prior studies.

Sleep health and cognitive function among people with and without HIV: the use of different machine learning approaches

STUDY OBJECTIVES

We investigated associations between actigraphy-assessed sleep measures and cognitive function in people with and without HIV using different analytical approaches to better understand these associations and highlight differences in results obtained by these approaches.

METHODS

Cognitive and 7-day/night actigraphy data were collected from people with HIV (PWH) and lifestyle-similar HIV-negative individuals from HIV and sexual health clinics in the United Kingdom/Ireland. A global cognitive T-score was obtained averaging the standardized individual cognitive test scores accounting for sociodemographics. Average and SD of 11 sleep measures over 7 days/nights were obtained. Rank regression, partial least-squares (PLS) regression, random forest, sleep dimension construct, and latent class analysis (LCA) were applied to evaluate associations between global T-scores and sleep measures.

RESULTS

In 344 PWH (median age 57 years, 86% males), average sleep duration, efficiency, and wake after sleep onset were not associated with global T-scores according to rank regression (p = 0.51, p = 0.09, p = 0.16, respectively). In contrast, global T-scores were associated with average and SD of length of nocturnal awakenings, SD of maintenance efficiency, and average out-of-bed time when analyzed by PLS regression and random forest. No associations were found when using sleep dimensions or LCA. Overall, findings observed in PWH were similar to those seen in HIV-negative individuals (median age 61 years, 67% males).

CONCLUSIONS

Using multivariable analytical approaches, measures of sleep continuity, timing, and regularity were associated with cognitive performance in PWH, supporting the utility of newer methods of incorporating multiple standard and novel measures of sleep-wake patterns in the assessment of health and functioning.

Efficacy of Triprolidine in the Treatment of Temporary Sleep Disturbance

Triprolidine, a first-generation antihistamine for allergic rhinitis, has a shorter half-life and fewer persistent effects relative to other antihistamines and may be useful in the treatment of temporary sleep disturbance. Patients aged ≥18 years old were randomized 1:1:1 to receive either triprolidine 2.5 mg (n = 65), triprolidine 5 mg (n = 66), or placebo (n = 67) on 3 consecutive nights. Sleep disturbance index was monitored via wrist actimeter. Subjective measures were assessed via diary card. Triprolidine 2.5 mg had a significantly lower sleep disturbance index versus placebo on night 1 (P = .02); however, when adjusted for outliers, sleep disturbance index did not significantly differ between either dose of triprolidine versus placebo on night 1. Adjusted sleep disturbance index was significantly lower with triprolidine 2.5 and 5 mg versus placebo on night 3 (P = .0017 and P = .011, respectively) and for the mean of all 3 nights (P = .01 and P = .015, respectively). Sleep latency was significantly improved for triprolidine 2.5 mg versus placebo on nights 2 and 3 and for the mean of all 3 nights and for triprolidine 5 mg versus placebo for the mean of all 3 nights. Subjective measures showed those on both doses of triprolidine felt more refreshed on awakening versus placebo for the mean of all 3 nights, with no increase in daytime sleepiness. The frequency of adverse events was similar across groups. The optimum dose of triprolidine for treatment of temporary sleep disturbance was 2.5 mg. There were improvements in both objective and subjective measures of sleep quality versus placebo, with no safety concerns raised.

Test Anxiety and Poor Sleep: A Vicious Cycle

BACKGROUND

Test anxiety may be better thought of as a biopsychosocial process affecting academic performance during the days leading up to an exam, rather than a static appraisal of attitudes related to test taking. This was a passive observational study following students 2 days before a midterm exam and was designed to test the Sleep Anxiety Performance Process (SAPP) model in the context of a psychology statistics exam.

METHODS

Undergraduates (N = 167) enrolled in a statistics class, January-November 2015. Participants completed an electronic battery of measures and Sleep Mood Study Diaries (SMS) during the mornings, 2 days before a statistics exam. Instructors confirmed exam scores.

RESULTS

A path model showed a reciprocal bi-directional relationship between Sleep Quality and restfulness (Q&R) and test anxiety 2 days before a scheduled exam, with test anxiety measured in the morning, before the exam predicting exam performance. Prior exam performance, being a non-native English speaker (ESL), and class performance motivation also predicted exam performance.

CONCLUSIONS

These data support the SAPP model's premise that that sleep and anxiety feed one another, as a reciprocal process, that collectively impairs academic performance, with direct effects on academic performance, but with implications for overall student health.

Racial discrimination, depressive symptoms, and sleep problems among Blacks in the rural South

OBJECTIVES

Experiences of racial discrimination are common for Black Americans and have been associated with depression and sleep disturbance, factors likely involved in the insidious development of health disparities. The current study replicates these associations and examines longitudinal linkages.

METHOD

Black American couples (men: N = 248, Mage = 40, SD = 9; women: N = 277, Mage = 37, SD = 7) and their children, aged 9 to 14 (N = 276, Mage = 11, SD = 1), completed measures of experiences of racial discrimination, depressive symptoms, and sleep problems at baseline and 8-month follow-up. In separate analyses for men, women, and youth, we examined concurrent and prospective associations of racial discrimination with depressive symptoms and sleep problems, then used longitudinal indirect effect models to examine whether depressive symptoms in response to racial discrimination led to increased sleep problems, or vice versa.

RESULTS

Racial discrimination was associated concurrently with depressive symptoms and sleep problems for all family members. Prospective associations were also found with depressive symptoms and sleep problems in fathers and youth, and sleep problems in mothers. Longitudinal models showed significant indirect effects of racial discrimination on change in sleep problems through depressive symptoms for fathers and mothers, and a similar, but nonsignificant, pattern in youth. There were no indirect effects on change in depressive symptoms through sleep problems.

CONCLUSIONS

Persistent associations of racial discrimination with depressive symptoms and sleep problems reflect a lasting impact of racial discrimination. Because discrimination's effects on depression may contribute to increased sleep problems over time, interventions that buffer the effects of discrimination on depressive symptoms may also reduce sleep problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Actigraphic sleep patterns and cognitive decline in the Hispanic Community Health Study/Study of Latinos

INTRODUCTION

We determined if actigraphy-derived sleep patterns led to 7-year cognitive decline in middle-aged to older Hispanic/Latino adults.

METHODS

We examined 1035 adults, 45 to 64 years of age, from the Hispanic Community Health Study/Study of Latinos. Participants had repeated measures of cognitive function 7 years apart, home sleep apnea studies, and 1 week of actigraphy. Survey linear regression evaluated prospective associations between sleep and cognitive change, adjusting for main covariates.

RESULTS

Longer sleep-onset latency was associated with declines in global cognitive function, verbal learning, and verbal memory. Longer sleep-onset latency was also cross-sectionally associated with verbal learning, verbal memory, and word fluency. Sleep fragmentation was not associated with cognitive change.

CONCLUSION

In a cohort of mostly middle-aged Hispanic/Latinos, actigraphy-derived sleep-onset latency predicted 7-year cognitive change. These findings may serve as targets for sleep interventions of cognitive decline.

Self-reported prior night's sleep quantity on baseline symptom factors and computerized neurocognitive testing in high school athletes

Little is known regarding sleep and baseline concussion performance and symptoms in athletes. We explored the effects of self-reported prior night's sleep quantity on baseline symptoms and computerized neurocognitive testing in high school athletes. A retrospective analysis of 958 high school athletes between the ages of 13-19 years was completed on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance. Participants were categorized into two groups based on self-reported prior night's sleep quantity: <8 h (n = 524; 55%) and ≥8 h (n = 434; 45%). Measures consisted of baseline total symptom score, symptom factors (vestibular-somatic, sleep-arousal, affective, and cognitive-sensory), and ImPACT composite scores (verbal and visual memory, visual-motor speed, reaction time, and impulse control). Significant differences were found on all baseline symptom factors (ps < .02) and total symptom scores (p < .001) with greater symptom reporting in the <8 h prior night's sleep group. No group differences were observed between duration and composite scores of verbal memory (p = .49), visual memory (p = .94), visual-motor speed (p = .38), reaction time (p = .50), or impulse control (p = .81). High school athletes who report <8 h of sleep the night prior to baseline concussion testing reported greater symptoms across all symptom factors. Clinicians should consider inadequate sleep the night prior to concussion testing to ensure accurate, valid assessments, especially on symptom reporting scales.