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Balbim GM, Falck RS, Boa Sorte Silva NC, Kramer AF, Voss M, Liu-Ambrose T. The Association of the 24-Hour Activity Cycle Profiles With Cognition in Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae099. [PMID: 38642387 PMCID: PMC11167489 DOI: 10.1093/gerona/glae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The relationship of cognition and the 24-h activity cycle (24-HAC), encompassing physical activity, sedentary behavior, and sleep, in older adults with mild cognitive impairment (MCI) remains uncertain. Distinct combinations of 24-HAC behaviors can characterize unique activity profiles and influence cognition. We aimed to characterize 24-HAC activity profiles in older adults with MCI and assess whether differences in cognition exist across profiles. METHODS We conducted a cross-sectional analysis utilizing baseline data from 3 randomized controlled trials involving 253 community-dwelling older adults (55 + years) with MCI (no functional impairment, dementia diagnosis, and Montreal Cognitive Assessment score <26/30). Using MotionWatch8© wrist-worn actigraphy (+5 days), we captured the 24-HAC. Cognition was indexed by the Alzheimer's Disease Assessment Scale Cognitive Plus (ADAS-Cog-Plus). Compositional data and latent profile analyses identified distinct 24-HAC activity profiles. Analysis of covariance examined whether 24-HAC activity profiles differed in cognition. RESULTS Four distinct activity profiles were identified. Profile 1 ("Average 24-HAC," n = 103) engaged in all 24-HAC behaviors around the sample average. Profile 2 ("Active Chillers," n = 70) depicted lower-than-average engagement in physical activity and higher-than-average sedentary behavior. Profile 3 ("Physical Activity Masters," n = 54) were the most active and the least sedentary. Profile 4 ("Sedentary Savants," n = 26) were the least active and the most sedentary. Sleep was similar across profiles. There were no significant differences in ADAS-Cog-Plus scores between 24-HAC activity profiles (p > .05). CONCLUSIONS Older adults with MCI exhibited four 24-HAC activity profiles conforming to recommended physical activity and sleep guidelines. Nonetheless, cognition was similar across these profiles.
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Affiliation(s)
- Guilherme Moraes Balbim
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Nárlon Cássio Boa Sorte Silva
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Arthur F Kramer
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Michelle Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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2
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Qin S, Chee MWL. The Emerging Importance of Sleep Regularity on Cardiovascular Health and Cognitive Impairment in Older Adults: A Review of the Literature. Nat Sci Sleep 2024; 16:585-597. [PMID: 38831959 PMCID: PMC11145062 DOI: 10.2147/nss.s452033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/25/2024] [Indexed: 06/05/2024] Open
Abstract
The regularity of sleep/wake patterns across multiple days is emerging as an important determinant of health. However, the association between sleep regularity and health outcomes in the aging population is not well understood. The current systematic review identified 22 publications that examined the relationship between sleep regularity and selected health outcomes: cardiovascular risk, cognitive impairment, and mortality. All studies were published after 2010, reflecting a growing research interest in daily sleep regularity. Low sleep regularity was consistently associated with higher cardiovascular risk and elevated risk of all-cause mortality. Results on cognitive impairment are mixed, with inconsistency likely attributed to small sample sizes and differences in sleep regularity assessment. Overall, regularity in sleep carries important information about health and should be included in future studies that collect daily sleep measures. Gaps in literature and methodological shortcomings are discussed.
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Affiliation(s)
- Shuo Qin
- Centre for Sleep and Cognition, National University of Singapore, Singapore
| | - Michael W L Chee
- Centre for Sleep and Cognition, National University of Singapore, Singapore
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3
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Winer JR. The role of actigraphy in detecting and characterizing the early phases of Alzheimer's disease. Sleep 2024; 47:zsae076. [PMID: 38497688 PMCID: PMC11082468 DOI: 10.1093/sleep/zsae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Joseph R Winer
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA, USA
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4
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Lui KK, Dave A, Sprecher KE, Chappel-Farley MG, Riedner BA, Heston MB, Taylor CE, Carlsson CM, Okonkwo OC, Asthana S, Johnson SC, Bendlin BB, Mander BA, Benca RM. Older adults at greater risk for Alzheimer's disease show stronger associations between sleep apnea severity in REM sleep and verbal memory. Alzheimers Res Ther 2024; 16:102. [PMID: 38725033 PMCID: PMC11080222 DOI: 10.1186/s13195-024-01446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) increases risk for cognitive decline and Alzheimer's disease (AD). While the underlying mechanisms remain unclear, hypoxemia during OSA has been implicated in cognitive impairment. OSA during rapid eye movement (REM) sleep is usually more severe than in non-rapid eye movement (NREM) sleep, but the relative effect of oxyhemoglobin desaturation during REM versus NREM sleep on memory is not completely characterized. Here, we examined the impact of OSA, as well as the moderating effects of AD risk factors, on verbal memory in a sample of middle-aged and older adults with heightened AD risk. METHODS Eighty-one adults (mean age:61.7 ± 6.0 years, 62% females, 32% apolipoprotein E ε4 allele (APOE4) carriers, and 70% with parental history of AD) underwent clinical polysomnography including assessment of OSA. OSA features were derived in total, NREM, and REM sleep. REM-NREM ratios of OSA features were also calculated. Verbal memory was assessed with the Rey Auditory Verbal Learning Test (RAVLT). Multiple regression models evaluated the relationships between OSA features and RAVLT scores while adjusting for sex, age, time between assessments, education years, body mass index (BMI), and APOE4 status or parental history of AD. The significant main effects of OSA features on RAVLT performance and the moderating effects of AD risk factors (i.e., sex, age, APOE4 status, and parental history of AD) were examined. RESULTS Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxyhemoglobin desaturation index (ODI) during REM sleep were negatively associated with RAVLT total learning and long-delay recall. Further, greater REM-NREM ratios of AHI, RDI, and ODI (i.e., more events in REM than NREM) were related to worse total learning and recall. We found specifically that the negative association between REM ODI and total learning was driven by adults 60 + years old. In addition, the negative relationships between REM-NREM ODI ratio and total learning, and REM-NREM RDI ratio and long-delay recall were driven by APOE4 carriers. CONCLUSION Greater OSA severity, particularly during REM sleep, negatively affects verbal memory, especially for people with greater AD risk. These findings underscore the potential importance of proactive screening and treatment of REM OSA even if overall AHI appears low.
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Affiliation(s)
- Kitty K Lui
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Abhishek Dave
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Kate E Sprecher
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Miranda G Chappel-Farley
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - Brady A Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Margo B Heston
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Chase E Taylor
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Cynthia M Carlsson
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Institute, Madison, WI, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Ozioma C Okonkwo
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Institute, Madison, WI, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Institute, Madison, WI, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Institute, Madison, WI, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Barbara B Bendlin
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Institute, Madison, WI, USA
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Bryce A Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.
- Department of Cognitive Sciences, University of California, Irvine, CA, USA.
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA.
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA.
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA.
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, USA.
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Michalowsky B, Engel L, Buchholz M, Weber N, Kohlmann T, Xie F. Health Fluctuations in Dementia and its Impact on the Assessment of Health-Related Quality of Life Using the EQ-5D-5L. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02342-8. [PMID: 38649092 DOI: 10.1016/j.jval.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/21/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To quantify health fluctuations, identify affected health-related quality of life (HRQoL) dimensions, and evaluate if fluctuations affect the HRQoL instruments recall period adherence in people living with dementia (PlwD). METHODS Caregivers of PlwD completed a daily diary for 14 days, documenting if PlwD's health was better or worse than the day before and the affected HRQoL dimensions. Health fluctuation was categorized into low (0-4 fluctuations in 14 days), moderate (5-8), and high (9-14). Also, caregivers and PlwD completed the EQ-5D-5L (proxy- and self-reported) on days 1, 7, and 14. Subsequently, caregivers were interviewed to determine whether recurrent fluctuations were considered in the EQ-5D-5L assessment of today's health (recall period adherence). RESULTS Fluctuations were reported for 96% of PlwD, on average, for 7 of the 14 days. Dimensions most frequently triggering fluctuations included memory, mobility, concentration, sleep, pain, and usual activities. Fluctuations were associated with higher EQ-5D-5L health-states variation and nonadherence to the EQ-5D-5L recall period "today." PlwD with moderate to high fluctuation had the highest EQ-5D-5L utility change between day 1 and 14 (0.157 and 0.134) and recall period nonadherence (31% and 26%) compared with PlwD with low fluctuation (0.010; 17%). Recall period nonadherence was higher in PlwD with improved compared with those with deteriorated health in the diary (37% vs 9%). CONCLUSIONS Health fluctuations frequently occur in dementia and strongly affect HRQoL assessments. Further research is needed to evaluate if more extended recall periods and multiple, consecutive assessments could capture health fluctuations more appropriately in dementia.
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Affiliation(s)
- Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Patient-reported Outcomes & Health Economics Research, Greifswald, Germany.
| | - Lidia Engel
- Deakin University, Faculty of Health, Department School of Health and Social Development, Melbourne, Australia
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Patient-reported Outcomes & Health Economics Research, Greifswald, Germany
| | - Niklas Weber
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Patient-reported Outcomes & Health Economics Research, Greifswald, Germany
| | - Thomas Kohlmann
- University Medicine Greifswald, Section Methods in Community Medicine, Greifswald, Germany
| | - Feng Xie
- McMaster University, Health Research Methods, Evidence and Impact, Hamilton, ON, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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6
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Sakal C, Li T, Li J, Yang C, Li X. Association Between Sleep Efficiency Variability and Cognition Among Older Adults: Cross-Sectional Accelerometer Study. JMIR Aging 2024; 7:e54353. [PMID: 38596863 PMCID: PMC11007383 DOI: 10.2196/54353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/17/2024] [Accepted: 02/18/2024] [Indexed: 04/11/2024] Open
Abstract
Background Sleep efficiency is often used as a measure of sleep quality. Getting sufficiently high-quality sleep has been associated with better cognitive function among older adults; however, the relationship between day-to-day sleep quality variability and cognition has not been well-established. Objective We aimed to determine the relationship between day-to-day sleep efficiency variability and cognitive function among older adults, using accelerometer data and 3 cognitive tests. Methods We included older adults aged >65 years with at least 5 days of accelerometer wear time from the National Health and Nutrition Examination Survey (NHANES) who completed the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Word-Learning subtest (CERAD-WL), and the Animal Fluency Test (AFT). Sleep efficiency was derived using a data-driven machine learning algorithm. We examined associations between sleep efficiency variability and scores on each cognitive test adjusted for age, sex, education, household income, marital status, depressive symptoms, diabetes, smoking habits, alcohol consumption, arthritis, heart disease, prior heart attack, prior stroke, activities of daily living, and instrumental activities of daily living. Associations between average sleep efficiency and each cognitive test score were further examined for comparison purposes. Results A total of 1074 older adults from the NHANES were included in this study. Older adults with low average sleep efficiency exhibited higher levels of sleep efficiency variability (Pearson r=-0.63). After adjusting for confounding factors, greater average sleep efficiency was associated with higher scores on the DSST (per 10% increase, β=2.25, 95% CI 0.61 to 3.90) and AFT (per 10% increase, β=.91, 95% CI 0.27 to 1.56). Greater sleep efficiency variability was univariably associated with worse cognitive function based on the DSST (per 10% increase, β=-3.34, 95% CI -5.33 to -1.34), CERAD-WL (per 10% increase, β=-1.00, 95% CI -1.79 to -0.21), and AFT (per 10% increase, β=-1.02, 95% CI -1.68 to -0.36). In fully adjusted models, greater sleep efficiency variability remained associated with lower DSST (per 10% increase, β=-2.01, 95% CI -3.62 to -0.40) and AFT (per 10% increase, β=-.84, 95% CI -1.47 to -0.21) scores but not CERAD-WL (per 10% increase, β=-.65, 95% CI -1.39 to 0.08) scores. Conclusions Targeting consistency in sleep quality may be useful for interventions seeking to preserve cognitive function among older adults.
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Affiliation(s)
- Collin Sakal
- School of Data Science, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tingyou Li
- School of Data Science, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Juan Li
- Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Can Yang
- Department of Mathematics, The Hong Kong University of Science and Technology, Hong Kong, China (Hong Kong)
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong, China (Hong Kong)
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7
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Lam A, Kong S, Naismith SL. Recent advances in understanding of sleep disorders and disturbances for dementia risk and prevention. Curr Opin Psychiatry 2024; 37:94-100. [PMID: 38226546 DOI: 10.1097/yco.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW To synthesise the recent work examining the relationship between sleep disturbances and dementia, emphasising studies involving individuals with mild cognitive impairment (MCI) or Alzheimer's disease (AD) and/or those investigating AD biomarkers. Additionally, we provide an update on recent interventions targeting sleep-related issues in older adults with MCI or AD. RECENT FINDINGS Various studies have examined obstructive sleep apnoea, sleep duration, and circadian alterations in relation to Alzheimer's pathology and dementia risk, with an emerging body of evidence suggesting that cardiovascular disease, hypertension, glymphatic function, and inflammation might serve as plausible pathophysiological mechanisms contributing to dementia during critical brain periods. Conversely, recent studies investigating insomnia have produced disparate results. Regarding intervention studies, the scarcity of prospective randomised control trials poses a challenge in establishing the benefits of addressing sleep disorders and disturbances. SUMMARY Recent work examining the pathophysiological links between sleep and dementia is strongest for obstructive sleep apnoea and sleep duration, while findings in insomnia studies exhibit inconsistency, possibly due to varied associations with dementia among different insomnia subtypes. It is apparent that more longitudinal studies examining the underlying pathophysiological mechanisms are necessary, alongside more rigorous clinical trials. Although some trials are underway in this field, there is still scarcity in trials examining interventions for circadian disturbances.
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Affiliation(s)
- Aaron Lam
- Healthy Brain Ageing Program, Brain and Mind Centre
- School of Psychology, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Camperdown
- The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Shawn Kong
- Healthy Brain Ageing Program, Brain and Mind Centre
- School of Psychology, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Camperdown
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre
- School of Psychology, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Camperdown
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Lui K, Dave A, Sprecher K, Chappel-Farley M, Riedner B, Heston M, Taylor C, Carlsson C, Okonkwo O, Asthana S, Johnson S, Bendlin B, Mander B, Benca R. Older adults at greater risk for Alzheimer's disease show stronger associations between sleep apnea severity and verbal memory. RESEARCH SQUARE 2023:rs.3.rs-3683218. [PMID: 38076899 PMCID: PMC10705699 DOI: 10.21203/rs.3.rs-3683218/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background Obstructive sleep apnea (OSA) increases risk for cognitive decline and Alzheimer's disease (AD). While the underlying mechanisms remain unclear, hypoxemia during OSA has been implicated in cognitive impairment. OSA during rapid eye movement (REM) sleep is usually more severe than in non-rapid eye movement (NREM) sleep, but the relative effect of oxyhemoglobin desaturation during REM versus NREM sleep on memory is not completely characterized. Here, we examined the impact of OSA, as well as the moderating effects of AD risk factors, on verbal memory in a sample of middle-aged and older adults with heightened AD risk. Methods Eighty-one adults (mean age:61.7±6.0 years, 62% females, 32% apolipoprotein E ε4 allele (APOE4) carriers, and 70% with parental history of AD) underwent clinical polysomnography including assessment of OSA. OSA features were derived in total, NREM, and REM sleep. REM-NREM ratios of OSA features were also calculated. Verbal memory was assessed with the Rey Auditory Verbal Learning Test (RAVLT). Multiple regression models evaluated the relationships between OSA features and RAVLT scores while adjusting for sex, age, time between assessments, education years, body mass index (BMI), and APOE4 status or parental history of AD. The significant main effects of OSA features on RAVLT performance and the moderating effects of AD risk factors (i.e., sex, age, APOE4 status, and parental history of AD) were examined. Results Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxyhemoglobin desaturation index (ODI) during REM sleep were negatively associated with RAVLT total learning and long-delay recall. Further, greater REM-NREM ratios of AHI, RDI, and ODI (i.e., more events in REM than NREM) were related to worse total learning and recall. We found specifically that the negative association between REM ODI and total learning was driven by adults 60+ years old. In addition, the negative relationships between REM-NREM ODI ratio and total learning and REM-NREM RDI ratio and long-delay recall were driven by APOE4 carriers. Conclusion Greater OSA severity, particularly during REM sleep, negatively affects verbal memory, especially for people with greater AD risk. These findings underscore the potential importance of proactive screening and treatment of REM OSA even if overall AHI appears low.
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Affiliation(s)
- Kitty Lui
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Abhishek Dave
- Department of Cognitive Sciences, University of California, Irvine
| | - Kate Sprecher
- Department of Population Health Sciences, University of Wisconsin-Madison
| | | | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison
| | - Margo Heston
- Department of Medicine, University of Wisconsin-Madison
| | - Chase Taylor
- Department of Neuroscience, University of Kentucky
| | - Cynthia Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison
| | - Ozioma Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison
| | - Sterling Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison
| | | | - Bryce Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine
| | - Ruth Benca
- Department of Psychiatry and Behavioral Medicine, Wake Forest University
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Skourti E, Simos P, Zampetakis A, Koutentaki E, Zaganas I, Alexopoulou C, Vgontzas A, Basta M. Long-term associations between objective sleep quality and quantity and verbal memory performance in normal cognition and mild cognitive impairment. Front Neurosci 2023; 17:1265016. [PMID: 37928739 PMCID: PMC10620682 DOI: 10.3389/fnins.2023.1265016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
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.
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Affiliation(s)
- Eleni Skourti
- Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Greece
| | - Panagiotis Simos
- Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Greece
- Computational Biomedicine Lab, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Alexandros Zampetakis
- Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Koutentaki
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Ioannis Zaganas
- Division of Neurology and Sensory Organs, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Alexandros Vgontzas
- Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Greece
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Maria Basta
- Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Greece
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, United States
- Day Care Center for Alzheimer’s Disease “Nefeli”, University Hospital of Heraklion, Crete, Greece
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