Actigraphic, but not subjective, sleep measures are associated with cognitive impairment in memory clinic patients

Is poor sleep quality associated with poor neurocognitive outcome in cancer survivors? A systematic review

PURPOSE

Cancer-related neurocognitive impairment and poor sleep are prevalent in cancer survivors and have a negative impact on their quality of life. This systematic review studies the association between sleep disturbance and neurocognitive functioning, as well as the potential positive effects of sleep interventions on neurocognitive functioning in cancer survivors. In addition, we aimed at determining the potential positive effects of sleep interventions on neurocognitive functioning in this population.

METHODS

Following PRISMA guidelines for reporting systematic reviews and meta-analyses, a comprehensive PubMed, Embase, PsycINFO, and CINAHL search was performed. Inclusion criteria were adult cancer survivors, self-reported or objective measures of neurocognitive functioning and sleep quality, or reports on the association between sleep and neurocognitive functioning.

RESULTS

Of the 4,547 records retrieved, 17 studies were retained for this review. Twelve studies were correlational, and five reported on interventions aimed at improving sleep quality. All studies that included self-reported neurocognitive functioning found that poorer sleep was associated with worse neurocognitive functioning. In four out of eight studies, poorer sleep was associated with objective neurocognitive impairment. Three out of five interventional studies showed neurocognitive functioning improved with improved sleep.

CONCLUSIONS

While poor sleep in cancer survivors is associated with self-reported neurocognitive impairment, the association between poor sleep and objective neurocognitive impairment is less evident.

IMPLICATIONS FOR CANCER SURVIVORS

It is important that care providers are aware of the association between sleep and neurocognitive functioning and that improving sleep quality can be a way to decrease neurocognitive impairment in cancer survivors.

Evaluation of racial and ethnic heterogeneity in the associations of sleep quality and sleep apnea risk with cognitive function and cognitive decline

INTRODUCTION

The prevalence of poor sleep quality and sleep apnea differs by race and ethnicity and may contribute to racial disparities in cognitive aging. We investigated whether sleep quality and sleep apnea risk were associated with cognitive function and decline and whether the associations differed by race/ethnicity.

METHODS

Participants from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE; N = 1690; mean age: 75.7 years) study, a cohort of Asian, Black, Latino, and White participants, completed a modified Pittsburgh Sleep Quality Index assessing subjective sleep quality, latency, duration, disturbances, sleep medication use, and daytime dysfunction. Sleep apnea risk was measured by questions about snoring, tiredness, and whether apnea was observed. Executive function and verbal episodic memory were assessed at three time points over an average of 2.7 years with the Spanish and English Neuropsychological Assessment Scale. We fit linear mixed-effect models and stratified analyses by race/ethnicity.

RESULTS

Higher sleep apnea risk was associated with faster declines in verbal episodic memory (β ^ sleep apnea = -0.02, 95% confidence interval [CI], -0.04, -0.001) but not in executive function. Poorer sleep quality was associated with lower levels of and faster decline in executive function but not in verbal episodic memory. Race/ethnicity modified these associations: compared to estimated effects among White participants, poorer global sleep quality (β ^ sleep*time = -0.02, 95% CI, -0.02, -0.01) was associated with larger effects on decline in executive function among Black participants. Estimated effects of some individual sleep quality components were also modified by race/ethnicity; for example, sleep medication use was associated with faster declines in executive function (β ^ sleep*time = -0.05, 95% CI, -0.07, -0.03) and verbal episodic memory β ^ sleep*time = -0.04, 95% CI, -0.07, -0.02) among Black participants compared to White participants.

DISCUSSION

Observational evidence indicates sleep quality is a promising target for addressing racial/ethnic disparities in cognitive aging, especially among Black older adults.

Highlights

Sleep apnea risk was associated with faster declines in verbal episodic memory but not executive function among all participants.Global sleep quality was associated with lower levels of and faster decline in executive function but not verbal episodic memory among all participants.Black older adults were particularly susceptible to the estimated adverse cognitive impacts of global sleep quality, particularly the use of sleep medication.

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.

Better sleep quality and higher physical activity levels predict lower emotion dysregulation among persons with major depression disorder

BACKGROUND

People with Major Depression Disorders (MDD) often complain about sleep problems and experience emotion dysregulation. Prior research suggests physical activity can improve both sleep quality and emotional control. However, there is limited research on emotion regulation and the impact of physical activity and sleep in this population.

OBJECTIVES

The present study examined the relationships between sleep quality, emotion regulation, and physical activity levels among patients with MDD.

METHODS

The sample consisted of 118 patients with MDD (mean age: 31.85 years) who completed questionnaires on sleep quality, physical activity, emotion regulation, and depression.

RESULTS

Results showed that more sleep problems were associated with worse emotion dysregulation, and more physical activity was associated with fewer sleep problems and less emotion dysregulation. Furthermore, physical activity and sleep quality significantly predicted emotion dysregulation, with physical activity being the stronger predictor.

CONCLUSIONS

Results from this study suggest that individuals with MDD who are able to engage in physical activity and get better sleep could experience emotional regulation benefits.

[Sleep in patients of a memory clinic : Clinical characteristics of the discrepancy between subjective and objective assessment]

BACKGROUND

Dementia is often accompanied by sleep disturbances, whereby the diagnostics with subjective procedures and objective methods can produce discrepant results. The frequency and clinical characteristics of patients, whose subjective sleep efficiency was unimpaired and was in contrast to an objectively conspicuous sleep efficiency in the sense of an overestimation, were investigated in a memory consultation.

METHODS

On 2 consecutive days, patients underwent guideline-oriented diagnostics for dementia (including mini-mental status examination, MMSE and clinical dementia rating, CDR), supplemented by a subjective (Pittsburgh sleep quality index, PSQI) and objective (overnight actigraphy) sleep assessment. Overestimation of sleep efficiency was defined as a subjective sleep efficiency (SSE) of ≥85% with an actigraphic sleep efficiency (ASE) of <85%.

RESULTS

Of 45 patients (74.4 ± 7.8 years; 26 f/19 m; CDR < 1: n = 16, CDR = 1: n = 28; diagnostic groups according to ICD-10: F0: n = 39, F3: n = 5, Z03.x: n = 1) 10 showed an overestimation of sleep efficiency, who showed a lower MMSE score and a higher proportion of patients with a dementia syndrome (CDR = 1) when compared with the other three groups of SSE and ASE ≥85% (n = 17), SSE and ASE <85% (n = 9) and SSE <85% with ASE ≥85% (n = 9). Binary regression showed that MMSE remained an important predictor for overestimation of sleep efficiency.

CONCLUSION

Cognitive deficits in memory clinic patients appear to contribute to a poorer perception and/or an underreporting of objectively disturbed sleep. This could promote false negative subjective screening results in a diagnostic process in which a comprehensive sleep assessment is not routinely considered.

Objective and subjective sleep measures are associated with neurocognition in aging adults with and without HIV

Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n = 52, HIV-negative n = 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p's > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p = 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p = 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p = 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p = 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p = 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive disorders as well as neurodegenerative disorders associated with aging. Future studies should evaluate if behavioral sleep interventions can improve neurocognition.

Sensory-Evoked 40-Hz Gamma Oscillation Improves Sleep and Daily Living Activities in Alzheimer's Disease Patients

Pathological proteins contributing to Alzheimer’s disease (AD) are known to disrupt normal neuronal functions in the brain, leading to unbalanced neuronal excitatory-inhibitory tone, distorted neuronal synchrony, and network oscillations. However, it has been proposed that abnormalities in neuronal activity directly contribute to the pathogenesis of the disease, and in fact it has been demonstrated that induction of synchronized 40 Hz gamma oscillation of neuronal networks by sensory stimulation reverses AD-related pathological markers in transgenic mice carrying AD-related human pathological genes. Based on these findings, the current study evaluated whether non-invasive sensory stimulation inducing cortical 40 Hz gamma oscillation is clinically beneficial for AD patients. Patients with mild to moderate AD (n = 22) were randomized to active treatment group (n = 14; gamma sensory stimulation therapy) or to sham group (n = 8). Participants in the active treatment group received precisely timed, 40 Hz visual and auditory stimulations during eye-closed condition to induce cortical 40 Hz steady-state oscillations in 1-h daily sessions over a 6-month period. Participants in the sham group were exposed to similar sensory stimulation designed to not evoke cortical 40 Hz steady-state oscillations that are observed in the active treatment patients. During the trial, nighttime activities of the patients were monitored with continuous actigraphy recordings, and their functional abilities were measured by Alzheimer’s Disease Cooperative Study – Activities of Daily Living (ADCS-ADL) scale. Results of this study demonstrated that 1-h daily therapy was well tolerated throughout the 6-month treatment period by all subjects. Patients receiving gamma sensory stimulation showed significantly reduced nighttime active periods, in contrast, to deterioration in sleep quality in sham group patients. Patients in the sham group also showed the expected, significant decline in ADCS-ADL scores, whereas patients in the gamma sensory stimulation group fully maintained their functional abilities over the 6-month period. These findings confirm the safe application of 40 Hz sensory stimulation in AD patients and demonstrate a high adherence to daily treatment. Furthermore, this is the first time that beneficial clinical effects of the therapy are reported, justifying expanded and longer trials to explore additional clinical benefits and disease-modifying properties of gamma sensory stimulation therapy.

Clinical Trial Registration:clinicaltrials.gov, identifier: NCT03556280.

Low sleep efficiency does not impact upper or lower limb vascular function in young adults

NEW FINDINGS

What is the central question of this study? We sought to investigate whether young adults reporting low sleep quality possessed lower vascular function and altered autonomic nervous system modulation when compared with young adults reporting high sleep quality. What is the main finding and its importance? The study revealed that in young adults reporting low sleep quality, neither vascular nor autonomic function was significantly different when compared with young adults reporting high sleep quality. These findings suggest that young adults are either not substantially impacted by or can adequately adapt to the negative consequences commonly associated with poor sleep.

ABSTRACT

The aim of the study was to investigate whether young adults reporting low sleep quality also possessed lower vascular function, potentially stemming from altered autonomic nervous system modulation, when compared with young adults reporting high sleep quality. Thirty-one healthy young adults (age 24 ± 4 years) underwent a 7 night sleep assessment (Actigraph GT3X accelerometer). After the sleep assessment, subjects meeting specific criteria were separated into high (HSE; ≥85%; n = 11; eight men and three women) and low (LSE; <80%; n = 11; nine men and two women) sleep efficiency groups. Peripheral vascular function was assessed in the upper and lower limb, using the flow-mediated dilatation technique in the arm (brachial artery) and leg (superficial femoral artery). Heart rate variability was evaluated during 5 min of rest and used frequency parameters reflective of parasympathetic and/or sympathetic nervous system modulation (high- and low-frequency parameters). By experimental design, significant differences in sleep quality between groups were reported, with the LSE group exhibiting a longer time awake after sleep onset, higher number of awakenings and longer average time per awakening when compared with the HSE group. Despite these differences in sleep quality, no significant differences in upper and lower limb vascular function and heart rate variability measures were revealed when comparing the LSE and HSE groups. Additionally, in all subjects (n = 31), no correlations between sleep efficiency and vascular function/autonomic modulation were revealed. This study revealed that low sleep quality does not impact upper or lower limb vascular function or autonomic nervous system modulation in young adults.