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Long JJ, Chen Y, Kim B, Bae S, Li Y, Orandi BJ, Chu NM, Mathur A, Segev DL, McAdams-DeMarco MA. Sleep Disorders and Dementia Risk in Older Patients with Kidney Failure: A Retrospective Cohort Study. Clin J Am Soc Nephrol 2024:01277230-990000000-00412. [PMID: 38913442 DOI: 10.2215/cjn.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Key Points
Older patients with kidney failure who are newly diagnosed with sleep disorders are at higher risk of developing any type of dementia, vascular dementia, and other/mixed types of dementia.For older patients with kidney failure who are diagnosed with obstructive sleep apnea, positive airway pressure therapy is an intervention that is associated with lower dementia risk.
Background
Community-dwelling older adults with sleep disorders are at higher risk of developing dementia. Greater than 50% of older patients with kidney failure experience sleep disorders, which may explain their high burden of dementia.
Methods
Among 216,158 patients (aged 66 years and older) with kidney failure (United States Renal Data System; 2008–2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional hazards models with propensity score weighting. We tested whether positive airway pressure (PAP) therapy was associated with reduced dementia risk among patients with obstructive sleep apnea (OSA).
Results
26.3% of patients were diagnosed with sleep disorders; these patients had a higher 5-year unadjusted cumulative incidence for any type of dementia (36.2% versus 32.3%; P < 0.001), vascular dementia (4.4% versus 3.7%; P < 0.001), and other/mixed dementia (29.3% versus 25.8%; P < 0.001). Higher risk of any type of dementia was identified in patients with insomnia (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [CI], 1.34 to 1.51), sleep-related breathing disorders (SRBDs) (aHR, 1.20, 95% CI, 1.17 to 1.23), and other sleep disorders (aHR, 1.24; 95% CI, 1.11 to 1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR, 1.43; 95% CI, 1.19 to 1.73) and SRBDs (aHR, 1.15; 95% CI, 1.07 to 1.24). Patients with SRBDs (aHR, 1.07; 95% CI, 1.00 to 1.15) were at higher risk of Alzheimer disease. Among patients with OSA, PAP therapy was associated with lower risk of any type of dementia (aHR, 0.82; 95% CI, 0.76 to 0.90) and vascular dementia (aHR, 0.65; 95% CI, 0.50 to 0.85).
Conclusions
Older patients with kidney failure and sleep disorders are at a higher risk of dementia. Sleep is an important modifiable factor that should be considered for targeted interventions to mitigate dementia risk in patients with kidney failure. For patients with OSA, PAP therapy is associated with lower dementia risk.
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Affiliation(s)
- Jane J Long
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Yusi Chen
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Byoungjun Kim
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Sunjae Bae
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Yiting Li
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Babak J Orandi
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Medicine, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
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Li A, Jaakkola MK, Saaresranta T, Klén R, Li XG. Analysis of sleep apnea research with a special focus on the use of positron emission tomography as a study tool. Sleep Med Rev 2024; 77:101967. [PMID: 38936220 DOI: 10.1016/j.smrv.2024.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
The quality of sleep plays a significant role in determining human well-being, and studying sleep and sleep disorders using various methods can aid in the prevention and treatment of diseases. Positron emission tomography (PET) is a noninvasive and highly sensitive medical imaging technique that has been widely adopted in the clinic. This review article provides data on research activity related to sleep and sleep apnea and discusses the use of PET in investigating sleep apnea and other sleep disorders. We conducted a statistical analysis of the number of original research articles published on sleep and sleep apnea between 1965 and 2021 and found that there has been a dramatic increase in publications since 1990. The distribution of contributing countries and regions has also undergone significant changes. Although there is an extensive body of literature on sleep research (256,399 original research articles during 1965-2021), PET has only been used in 54 of these published studies, indicating a largely untapped area of research. Nonetheless, PET is a useful tool for identifying connections between sleep disorders and pathological changes in various diseases, including neurological, metabolic, and cardiovascular disorders, as well as cancer. To facilitate the broader use of PET in sleep apnea research, further studies are needed in both clinical and preclinical settings.
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Affiliation(s)
- Anting Li
- Turku PET Centre, University of Turku, Turku, Finland; Faculty of Medicine, University of Turku, Turku, Finland
| | - Maria K Jaakkola
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Riku Klén
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Xiang-Guo Li
- Turku PET Centre, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland; InFLAMES Research Flagship, University of Turku, Turku, Finland; Department of Chemistry, University of Turku, Turku, Finland.
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Ourry V, Binette AP, St-Onge F, Strikwerda-Brown C, Chagnot A, Poirier J, Breitner J, Arenaza-Urquijo EM, Rabin JS, Buckley R, Gonneaud J, Marchant NL, Villeneuve S. How Do Modifiable Risk Factors Affect Alzheimer's Disease Pathology or Mitigate Its Effect on Clinical Symptom Expression? Biol Psychiatry 2024; 95:1006-1019. [PMID: 37689129 DOI: 10.1016/j.biopsych.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
Epidemiological studies show that modifiable risk factors account for approximately 40% of the population variability in risk of developing dementia, including sporadic Alzheimer's disease (AD). Recent findings suggest that these factors may also modify disease trajectories of people with autosomal-dominant AD. With positron emission tomography imaging, it is now possible to study the disease many years before its clinical onset. Such studies can provide key knowledge regarding pathways for either the prevention of pathology or the postponement of its clinical expression. The former "resistance pathway" suggests that modifiable risk factors could affect amyloid and tau burden decades before the appearance of cognitive impairment. Alternatively, the resilience pathway suggests that modifiable risk factors may mitigate the symptomatic expression of AD pathology on cognition. These pathways are not mutually exclusive and may appear at different disease stages. Here, in a narrative review, we present neuroimaging evidence that supports both pathways in sporadic AD and autosomal-dominant AD. We then propose mechanisms for their protective effect. Among possible mechanisms, we examine neural and vascular mechanisms for the resistance pathway. We also describe brain maintenance and functional compensation as bases for the resilience pathway. Improved mechanistic understanding of both pathways may suggest new interventions.
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Affiliation(s)
- Valentin Ourry
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Alexa Pichet Binette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Clinical Memory Research Unit, Department of Clinical Sciences, Lunds Universitet, Malmö, Sweden
| | - Frédéric St-Onge
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cherie Strikwerda-Brown
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Audrey Chagnot
- UK Dementia Research Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Judes Poirier
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - John Breitner
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Eider M Arenaza-Urquijo
- Environment and Health over the Lifecourse Programme, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Buckley
- Melbourne School of Psychological Sciences University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julie Gonneaud
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Natalie L Marchant
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sylvia Villeneuve
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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Astara K, Tsimpolis A, Kalafatakis K, Vavougios GD, Xiromerisiou G, Dardiotis E, Christodoulou NG, Samara MT, Lappas AS. Sleep disorders and Alzheimer's disease pathophysiology: The role of the Glymphatic System. A scoping review. Mech Ageing Dev 2024; 217:111899. [PMID: 38163471 DOI: 10.1016/j.mad.2023.111899] [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: 08/25/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Alzheimer's disease (AD) is highly intertwined with sleep disturbances throughout its whole natural history. Sleep consists of a major compound of the functionality of the glymphatic system, as the synchronized slow-wave activity during NREM facilitates cerebrospinal and interstitial long-distance mixing. OBJECTIVE The present study undertakes a scoping review of research on the involvement of the glymphatic system in AD-related sleep disturbances. DESIGN we searched Medline, Embase, PsychInfo and HEAL-link databases, without limitations on date and language, along with reference lists of relevant reviews and all included studies. We included in vivo, in vitro and post-mortem studies examining glymphatic implications of sleep disturbances in human populations with AD spectrum pathology. A thematic synthesis of evidence based on the extracted content was applied and presented in a narrative way. RESULTS In total, 70 original research articles were included and were grouped as following: a) Protein aggregation and toxicity, after sleep deprivation, along with its effects on sleep architecture, b) Glymphatic Sequalae in SDB, yielding potential glymphatic markers c) Circadian Dysregulation, d) Possible Interventions. CONCLUSIONS this review sought to provide insight into the role of sleep disturbances in AD pathogenesis, in the context of the glymphatic disruption.
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Affiliation(s)
- Kyriaki Astara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Neurology, 417 Army Equity Fund Hospital (NIMTS), Athens, Greece
| | - Alexandros Tsimpolis
- Department of Pharmacology, Medical School, University of Crete & Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology Hellas, Heraklion, Crete, Greece
| | - Konstantinos Kalafatakis
- Faculty of Medicine & Dentistry (Malta campus), Queen Mary University of London, VCT 2520, Victoria, Gozo, Malta.
| | - George D Vavougios
- Department of Neurology, Faculty of Medicine, University of Cyprus, Lefkosia, Cyprus; Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Neurology, Athens Naval Hospital, Athens, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Nikos G Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece; Medical School, University of Nottingham, Lenton, Nottingham, UK
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece; Aneurin Bevan University Health Board, Wales, UK
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Gills JL, Bubu OM. Obstructive Sleep Apnea and Alzheimer's Disease Pathology: Is Sleep Architecture the Missing Key? J Alzheimers Dis 2024; 98:69-73. [PMID: 38363613 DOI: 10.3233/jad-231385] [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] [Indexed: 02/17/2024]
Abstract
Impairments of the sleep architecture due to disrupted sleep in individuals with obstructive sleep apnea (OSA) may result in reduced slow wave sleep (SWS), intermittent hypoxemia, and excessive day time sleepiness- all factors that have been shown to impact Alzheimer's disease (AD) risk. In this commentary, we comment on the work by Cavuoto and colleagues in which they examine the associations between nocturnal hypoxemia or sleep disruptions (during SWS) and amyloid-β burden in individuals with OSA. We review the findings in the context of other similar studies and highlight the strengths and weaknesses of these published studies. We note the importance of examining these relationships longitudinally with a large sample size, including considering sleep health disparities, vascular components, and multiple cognitive domain tests.
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Affiliation(s)
- Joshua L Gills
- Department of Psychiatry, Healthy Brain Aging Sleep Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, Institute of Excellence in Health Equity, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, USA
| | - Omonigho M Bubu
- Department of Psychiatry, Healthy Brain Aging Sleep Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, Institute of Excellence in Health Equity, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Alzheimer's Disease Research Center, Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neuroscience and Physiology, NYU Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA
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Mohammadi I, Adibparsa M, Najafi A, Sehat MS, Sadeghi M. A systematic review with meta-analysis to assess Alzheimer's disease biomarkers in adults with or without obstructive sleep apnoea. Int Orthod 2023; 21:100814. [PMID: 37776696 DOI: 10.1016/j.ortho.2023.100814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The aim was to design a meta-analysis evaluating the positron emission tomography (PET) uptake and cerebrospinal fluid (CSF), circulating levels of amyloid-β (Aβ), and tau proteins OSA group versus control group, as well as the association of these biomarkers with the severity of OSA. MATERIAL AND METHODS Four databases were searched until April 17, 2023, without any restrictions. The effect sizes were the standardized mean difference (SMD) along with a 95% confidence interval (CI). RESULTS A total of 21 articles were entered into the meta-analysis. The pooled SMDs of the CSF levels in OSA adults compared to controls were: -0.82 (P=0.004) for Aβ42, -1.13 (P<0.001) for Aβ40, 0.17 (P=0.23) for p-tau, 0.04 (P=0.65) for t-tau, 0.08 (P=0.89) for Aβ42/Aβ40 ratio, and 0.81 (P=0.001) for t-tau/Aβ42 ratio. The pooled SMD for the PET uptake of Aβ burden in OSA adults compared to controls was 0.30 (P=0.03). The pooled SMDs of the circulating levels in OSA adults compared to controls were: 0.67 (P=0.002) for Aβ42, 0.11 (P=0.82) for Aβ40, 0.35 (P=0.06) for p-tau, and 1.41(P=0.005) for t-tau. The pooled SMDs for levels of Aβ42, Aβ40, total Aβ, p-tau, t-tau, and Aβ42/Aβ40 ratio in severe OSA adults compared to mild/moderate OSA adults were -0.15 (P=0.33), 0.25 (P=35), 0.04 (P=87), -2.53 (P=0.24), -0.24 (P=0.52), and -0.28 (P=0.30), respectively. CONCLUSIONS The results indicated that CSF levels of Aβ42 and Aβ40 in OSA adults were significantly lower, but the CSF level of t-tau/Aβ42 ratio and PET Aβ burden uptake in OSA adults significantly were higher than in controls.
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Affiliation(s)
- Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mehrdad Adibparsa
- Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Amir Najafi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mohammad Soroush Sehat
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, 67144-15185 Kermanshah, Iran.
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Gao J, Cao J, Chen J, Wu D, Luo K, Shen G, Fang Y, Zhang W, Huang G, Su X, Zhao L. Brain morphology and functional connectivity alterations in patients with severe obstructive sleep apnea. Sleep Med 2023; 111:62-69. [PMID: 37722341 DOI: 10.1016/j.sleep.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND It has been demonstrated that widespread structural and functional brain alterations influence the development of cognitive impairment in patients with obstructive sleep apnea (OSA). However, the literature has limited evidence regarding the neuropathophysiological mechanisms behind these impairments. This research aimed to investigate brain morphologic and functional connectivity (FC) abnormalities related to neurocognitive function in OSA. METHODS Fifty treatment-naïve males, newly diagnosed patients with severe OSA, and 50 well-matched healthy controls (HCs) were enrolled prospectively. All subjects underwent an MRI scan, cognitive psychological and sleep scale assessment. The differences of brain morphological and seed-based FC between the two groups were compared. The correlation analysis and receiver operating characteristic curve were performed for further analysis. RESULTS Compared with HCs, the right brainstem, left dorsal-lateral superior frontal gyrus (SFGdor), and superior temporal gyrus (STG) exhibited atrophy in the OSA group. In addition, FC between the left SFGdor and the right postcentral gyrus (PoCG) was increased, which was positively correlated with disease duration (r = 0.312, FDR-corrected P = 0.027). The Jacobian values of the brainstem were negatively correlated with MoCA and recall scores (r = -0.449, FDR-corrected P = 0.0025; r = -0.416, FDR-corrected P = 0.005). Furthermore, the Jacobian values of the left SFGdor demonstrated a relatively high diagnostic performance (sensitivity: 86%, specificity: 56%, AUC: 0.740, 95% CI: 0.643-0.836, P < 0.0001). CONCLUSIONS Structural atrophy in brainstem and frontotemporal lobe and altered FC may be the neurobiological hallmark of brain impairment in OSA. Notably, brainstem atrophy has been associated with cognitive impairment, which may provide new insights into understanding the neuropathophysiological mechanisms of cognitive impairment in OSA patients.
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Affiliation(s)
- Jing Gao
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Jiancang Cao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jieyu Chen
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Dan Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Ke Luo
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Guo Shen
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, China
| | - Yanyan Fang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenwen Zhang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Xiaoyan Su
- Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Lianping Zhao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Kinugawa K. Obstructive sleep apnea and dementia: A role to play? Rev Neurol (Paris) 2023; 179:793-803. [PMID: 37633736 DOI: 10.1016/j.neurol.2023.08.006] [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: 06/30/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
A growing number of studies, in animal models and humans, have highlighted the link between sleep and Alzheimer's disease (AD) pathophysiology. Among sleep disorders, obstructive sleep apnea (OSA) appears to be a potentially interesting comorbidity, as it is highly prevalent in the middle-aged and elderly population, often associated with some cognitive impairment, associated with an increased risk of developing cognitive decline and dementia including AD, and indeed treatable. The association between OSA and cognition varies according to the studies, but OSA is more frequent in older people with AD than those who are cognitively normal. People with OSA suffer from daytime sleepiness, impaired cognitive function and an increased risk of developing mild cognitive impairment, dementia and AD than those without OSA. Finally, the literature suggests a link between OSA and AD biomarkers. Whether screening and treating OSA could have positive impact on the levels of AD biomarkers and slow or even prevent incident dementia remain to be investigated. It therefore seems essential to understand the role of OSA in the pathophysiology of AD, as there is still no effective treatment to slow or halt its progression. At present, treating the risk factors that can promote the development and/or worsening of AD represents a promising strategy for delaying or even thwarting the onset of symptoms.
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Affiliation(s)
- K Kinugawa
- Sorbonne University, CNRS, UMR Biological Adaptation and Aging, AP-HP, Paris, France; Charles-Foix Hospital, Functional Exploration Unit for Older Patients, 94200 Ivry-sur-Seine, France.
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9
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André C, Kuhn E, Rehel S, Ourry V, Demeilliez-Servouin S, Palix C, Felisatti F, Champetier P, Dautricourt S, Yushkevich P, Vivien D, de La Sayette V, Chételat G, de Flores R, Rauchs G. Association of Sleep-Disordered Breathing and Medial Temporal Lobe Atrophy in Cognitively Unimpaired Amyloid-Positive Older Adults. Neurology 2023; 101:e370-e385. [PMID: 37258299 PMCID: PMC10435067 DOI: 10.1212/wnl.0000000000207421] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disordered breathing (SDB) has been related to amyloid deposition and an increased dementia risk. However, how SDB relates to medial temporal lobe neurodegeneration and subsequent episodic memory impairment is unclear. Our objective was to investigate the impact of amyloid positivity on the associations between SDB severity, medial temporal lobe subregions, and episodic memory performance in cognitively unimpaired older adults. METHODS Data were acquired between 2016 and 2020 in the context of the Age-Well randomized controlled trial of the Medit-Aging European project. Participants older than 65 years who were free of neurologic, psychiatric, or chronic medical diseases were recruited from the community. They completed a neuropsychological evaluation, in-home polysomnography, a Florbetapir PET, and an MRI, including a specific high-resolution assessment of the medial temporal lobe and hippocampal subfields. Multiple linear regressions were conducted to test interactions between amyloid status and SDB severity on the volume of MTL subregions, controlling for age, sex, education, and the ApoE4 status. Secondary analyses aimed at investigating the links between SDB, MTL subregional atrophy, and episodic memory performance at baseline and at a mean follow-up of 20.66 months in the whole cohort and in subgroups stratified according to amyloid status. RESULTS We included 122 cognitively intact community-dwelling older adults (mean age ± SD: 69.40 ± 3.85 years, 77 women, 26 Aβ+ individuals) in baseline analyses and 111 at follow-up. The apnea-hypopnea index interacted with entorhinal (β = -0.81, p < 0.001, pη2 = 0.19), whole hippocampal (β = -0.61, p < 0.001, pη2 = 0.10), subiculum (β = -0.56, p = 0.002, pη2 = 0.08), CA1 (β = -0.55, p = 0.002, pη2 = 0.08), and DG (β = -0.53, p = 0.003, pη2 = 0.08) volumes such that a higher sleep apnea severity was related to lower MTL subregion volumes in amyloid-positive individuals, but not in those who were amyloid negative. In the whole cohort, lower whole hippocampal (r = 0.27, p = 0.005) and CA1 (r = 0.28, p = 0.003) volumes at baseline were associated with worse episodic memory performance at follow-up. DISCUSSION Overall, we showed that SDB was associated with MTL atrophy in cognitively asymptomatic older adults engaged in the Alzheimer continuum, which may increase the risk of developing memory impairment over time. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02977819.
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Affiliation(s)
- Claire André
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Elizabeth Kuhn
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Stéphane Rehel
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Valentin Ourry
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Solène Demeilliez-Servouin
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Cassandre Palix
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Francesca Felisatti
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Pierre Champetier
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Sophie Dautricourt
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Paul Yushkevich
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Denis Vivien
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Vincent de La Sayette
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Gaël Chételat
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Robin de Flores
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France
| | - Géraldine Rauchs
- From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France.
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Martinez Villar G, Daneault V, Martineau-Dussault MÈ, Baril AA, Gagnon K, Lafond C, Gilbert D, Thompson C, Marchi NA, Lina JM, Montplaisir J, Carrier J, Gosselin N, André C. Altered resting-state functional connectivity patterns in late middle-aged and older adults with obstructive sleep apnea. Front Neurol 2023; 14:1215882. [PMID: 37470008 PMCID: PMC10353887 DOI: 10.3389/fneur.2023.1215882] [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: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for cognitive decline, and has been associated with structural brain alterations in regions relevant to memory processes and Alzheimer's disease. However, it is unclear whether OSA is associated with disrupted functional connectivity (FC) patterns between these regions in late middle-aged and older populations. Thus, we characterized the associations between OSA severity and resting-state FC between the default mode network (DMN) and medial temporal lobe (MTL) regions. Second, we explored whether significant FC changes differed depending on cognitive status and were associated with cognitive performance. Methods Ninety-four participants [24 women, 65.7 ± 6.9 years old, 41% with Mild Cognitive Impairment (MCI)] underwent a polysomnography, a comprehensive neuropsychological assessment and a resting-state functional magnetic resonance imaging (MRI). General linear models were conducted between OSA severity markers (i.e., the apnea-hypopnea, oxygen desaturation and microarousal indices) and FC values between DMN and MTL regions using CONN toolbox. Partial correlations were then performed between OSA-related FC patterns and (i) OSA severity markers in subgroups stratified by cognitive status (i.e., cognitively unimpaired versus MCI) and (ii) cognitive scores in the whole sample. All analyzes were controlled for age, sex and education, and considered significant at a p < 0.05 threshold corrected for false discovery rate. Results In the whole sample, a higher apnea-hypopnea index was significantly associated with lower FC between (i) the medial prefrontal cortex and bilateral hippocampi, and (ii) the left hippocampus and both the posterior cingulate cortex and precuneus. FC patterns were not associated with the oxygen desaturation index, or micro-arousal index. When stratifying the sample according to cognitive status, all associations remained significant in cognitively unimpaired individuals but not in the MCI group. No significant associations were observed between cognition and OSA severity or OSA-related FC patterns. Discussion OSA severity was associated with patterns of lower FC in regions relevant to memory processes and Alzheimer's disease. Since no associations were found with cognitive performance, these FC changes could precede detectable cognitive deficits. Whether these FC patterns predict future cognitive decline over the long-term needs to be investigated.
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Affiliation(s)
- Guillermo Martinez Villar
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health Institute, McGill University, Montréal, QC, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Laboratory and Sleep Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Chantal Lafond
- Department of Pulmonology, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Danielle Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, QC, Canada
- Department of Radiology, Hopital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de, Montréal, QC, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Nicola Andrea Marchi
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Département de Génie Electrique, École de Technologie Supérieure, Montréal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
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Koo DL, Cabeen RP, Yook SH, Cen SY, Joo EY, Kim H. More extensive white matter disruptions present in untreated obstructive sleep apnea than we thought: A large sample diffusion imaging study. Hum Brain Mapp 2023; 44:3045-3056. [PMID: 36896706 PMCID: PMC10171547 DOI: 10.1002/hbm.26261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/22/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
Obstructive sleep apnea (OSA) may lead to white mater (WM) disruptions and cognitive deficits. However, no studies have investigated the full extent of the brain WM, and its associations with cognitive deficits in OSA remain unclear. We thus applied diffusion tensor imaging (DTI) tractography with multi-fiber models and used atlas-based bundle-specific approach to investigate the WM abnormalities for various tracts of the cerebral cortex, thalamus, brainstem, and cerebellum in patients with untreated OSA. We enrolled 100 OSA patients and 63 healthy controls. Fractional anisotropy (FA) and mean diffusivity (MD) values mapped on 33 regions of interest including WM tracts of cortex, thalamus, brainstem, and cerebellum were obtained from tractography-based reconstructions. We compared FA/MD values between groups and correlated FA/MD with clinical data in the OSA group after controlling for age and body mass index. OSA patients showed significantly lower FA values in multiple WM fibers including corpus callosum, inferior fronto-occipital fasciculus, middle/superior longitudinal fasciculi, thalamic radiations, and uncinate (FDR <0.05). Higher FA values were found in medial lemniscus of patients compared to controls (FDR <0.05). Lower FA values of rostrum of corpus callosum correlated with lower visual memory performance in OSA group (p < .005). Our quantitative DTI analysis demonstrated that untreated OSA could negatively impact the integrity of pathways more broadly, including brainstem structures such as medial lemniscus, in comparison to previous findings. Fiber tract abnormalities of the rostral corpus callosum were associated with impaired visual memory in untreated OSA may provide insights into the related pathomechanism.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Ryan P Cabeen
- Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Soon Hyun Yook
- Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven Yong Cen
- Department of Radiology, USC Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Seoul, South Korea
| | - Hosung Kim
- Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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12
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Kong W, Zang Y. Alzheimer's disease biomarkers in patients with obstructive sleep apnea hypopnea syndrome and effects of surgery: A prospective cohort study. Front Aging Neurosci 2023; 14:959472. [PMID: 36733500 PMCID: PMC9887197 DOI: 10.3389/fnagi.2022.959472] [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: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Background Obstructive sleep apnea hypopnea syndrome (OSAHS) may cause Alzheimer's disease (AD), t-tau, p-tau, Aβ42, and Aβ40 are important elements in the process of AD, and changes in the levels of these biomarkers may affect the cognitive functioning of patients. Our objective was to investigate whether uvulopalatopharyngoplasty could reduce the plasma levels of AD biomarkers in OSAHS patients and the potential correlations of AD biomarkers with cognitive impairment and sleepiness, and explore the independent influencing factors of cognitive function. Methods Alzheimer's disease biomarkers were measured in the plasma of 35 patients with severe OSAHS requiring surgical treatment and 16 healthy controls without OSAHS. The cognitive function and sleepiness of OSAHS patients was also evaluated. The case group was given uvulopalatopharyngoplasty and followed at the postoperative sixth month, the follow-up cases were 27, and plasma AD biomarker levels, cognitive function, and sleepiness were re-evaluated. The preoperative and postoperative AD biomarker levels OSAHS patients were compared with each other and those of the control group. Linear stepwise regression and lasso regression were used to explore the relationships of AD biomarkers with cognitive impairment and sleepiness. Results Significantly higher Aβ40, t-tau, p-tau in plasma were observed preoperatively in OSAHS patients comparing to controls (29.24 ± 32.52 vs. 13.18 ± 10.78, p = 0.049; 11.88 ± 7.05 vs. 7.64 ± 4.17, p = 0.037; 26.31 ± 14.41 vs. 17.34 ± 9.12, p = 0.027). The sixth month of postoperation, the plasma AD biomarkers (Aβ42, Aβ40, t-tau, p-tau) in plasma levels decreased significantly (0.23 ± 0.17 vs. 0.20 ± 0.16, p = 0.0001; 29.24 ± 32.52 vs. 23.52 ± 24.46, p = 0.0046; 11.88 ± 7.05 vs. 8.88 ± 6.21, p = 0.0001;26.31 ± 14.41 vs. 20.43 ± 10.50, p = 0.0001). A comparison of MMSE and ESS scores from before to after surgery revealed obvious differences (27.14 ± 1.65 vs. 29.07 ± 1.78, p = 0.0001; 11.91 ± 4.84 vs. 5.89 ± 2.83, p = 0.0001). Changes in cognitive function and sleepiness scores from before to after uvulopalatopharyngoplasty were significantly correlated with AD biomarkers. Body mass index and t-tau were potential influencing factors cognitive function. Conclusion Obstructive sleep apnea hypopnea syndrome can increase plasma AD biomarkers levels. Uvulopalatopharyngoplasty can improve patients' cognition and sleepiness, and the mechanism may be related to changes in plasma AD biomarkers. Higher AHI and higher t-tau level were identified as independent risk factors for cognitive decline.
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Affiliation(s)
- Weili Kong
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zang
- Department of Information Management, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China,*Correspondence: Yi Zang,
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Cavuoto MG, Robinson SR, O'Donoghue FJ, Barnes M, Howard ME, Tolson J, Stevens B, Schembri R, Rosenzweig I, Rowe CC, Jackson ML. Associations Between Amyloid Burden, Hypoxemia, Sleep Architecture, and Cognition in Obstructive Sleep Apnea. J Alzheimers Dis 2023; 96:149-159. [PMID: 37742634 DOI: 10.3233/jad-221049] [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] [Indexed: 09/26/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased risk of amyloid-β (Aβ) burden, the hallmark of Alzheimer's disease, and cognitive decline. OBJECTIVE To determine the differential impacts of hypoxemia and slow-wave sleep disruption on brain amyloid burden, and to explore the effects of hypoxemia, slow-wave sleep disruption, and amyloid burden on cognition in individuals with and without OSA. METHODS Thirty-four individuals with confirmed OSA (mean±SD age 57.5±4.1 years; 19 males) and 12 healthy controls (58.5±4.2 years; 6 males) underwent a clinical polysomnogram, a NAV4694 positron emission tomography (PET) scan for Aβ burden, assessment of APOEɛ status and cognitive assessments. Linear hierarchical regressions were conducted to determine the contributions of demographic and sleep variables on amyloid burden and cognition. RESULTS Aβ burden was associated with nocturnal hypoxemia, and impaired verbal episodic memory, autobiographical memory and set shifting. Hypoxemia was correlated with impaired autobiographical memory, and only set shifting performance remained significantly associated with Aβ burden when controlling for sleep variables. CONCLUSIONS Nocturnal hypoxemia was related to brain Aβ burden in this sample of OSA participants. Aβ burden and hypoxemia had differential impacts on cognition. This study reveals aspects of sleep disturbance in OSA that are most strongly associated with brain Aβ burden and poor cognition, which are markers of early Alzheimer's disease. These findings add weight to the possibility that hypoxemia may be causally related to the development of dementia; however, whether it may be a therapeutic target for dementia prevention in OSA is yet to be determined.
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Affiliation(s)
- Marina G Cavuoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Stephen R Robinson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Julie Tolson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Bronwyn Stevens
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ivana Rosenzweig
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), London, UK
| | - Christopher C Rowe
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
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14
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Gibson M, Yiallourou S, Pase MP. The Association Between 24-Hour Blood Pressure Profiles and Dementia. J Alzheimers Dis 2023; 94:1303-1322. [PMID: 37458039 DOI: 10.3233/jad-230400] [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] [Indexed: 07/18/2023]
Abstract
Midlife hypertension increases risk for dementia. Around one third of adults have diagnosed hypertension; however, many adults are undiagnosed, or remain hypertensive despite diagnosis or treatment. Since blood pressure (BP) follows a circadian rhythm, ambulatory BP monitoring allows for the assessment of BP over a 24-hour period and provides an important tool for improving the diagnosis and management of hypertension. The measurement of 24-hour BP profiles, especially nocturnal BP, demonstrate better predictive ability for cardiovascular disease and mortality than office measurement. However, few studies have examined 24-hour BP profiles with respect to dementia risk. This is an important topic since improvements in BP management could facilitate the primary prevention of vascular cognitive impairment and dementia. Therefore, this review discusses the evidence linking BP to dementia, with a focus on whether the implementation of 24-hour BP measurements can improve risk prediction and prevention strategies. Pathways linking nocturnal BP to dementia are also discussed as are risk reduction strategies. Overall, limited research suggests an association between 24-hour BP elevation and poorer cognition, cerebral small vessel disease, and dementia. However, most studies were cross-sectional. Further evidence is needed to substantiate 24-hour BP profiles, over and above office BP, as predictors of vascular cognitive impairment and incident dementia.
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Affiliation(s)
- Madeline Gibson
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Stephanie Yiallourou
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Matthew P Pase
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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Malone JE, Elkasaby MI, Lerner AJ. Effects of Hypertension on Alzheimer's Disease and Related Disorders. Curr Hypertens Rep 2022; 24:615-625. [PMID: 36125695 DOI: 10.1007/s11906-022-01221-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To review the pathophysiology of hypertension in Alzheimer's disease and related dementias and explore the current landscape of clinical trials involving treatment of hypertension to improve cognition. RECENT FINDINGS Hypertension is increasingly recognized as a contributor to cognitive impairment. Clinical trials that explore blood pressure reductions with cognitive outcomes have been promising. Various antihypertensives have been evaluated in clinical trials, with growing interest in those agents that impact the renin-angiotensin-aldosterone system due to its own association with cognitive impairment. No antihypertensive agent has been found to be superior to others in reducing cognitive impairment risk or conferring neuroprotective benefits. In this review, the pathophysiology of and clinical trial data involving hypertension and dementia will be explored. Hypertension is a significant risk factor for the development of neurodegenerative dementias, and clinical trials have been overall favorable in improving cognition by reductions in blood pressure using antihypertensive agents.
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Affiliation(s)
- Joseph E Malone
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mohamed I Elkasaby
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alan J Lerner
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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16
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Qian L, Rawashdeh O, Kasas L, Milne MR, Garner N, Sankorrakul K, Marks N, Dean MW, Kim PR, Sharma A, Bellingham MC, Coulson EJ. Cholinergic basal forebrain degeneration due to sleep-disordered breathing exacerbates pathology in a mouse model of Alzheimer's disease. Nat Commun 2022; 13:6543. [PMID: 36323689 PMCID: PMC9630433 DOI: 10.1038/s41467-022-33624-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Although epidemiological studies indicate that sleep-disordered breathing (SDB) such as obstructive sleep apnea is a strong risk factor for the development of Alzheimer's disease (AD), the mechanisms of the risk remain unclear. Here we developed a method of modeling SDB in mice that replicates key features of the human condition: altered breathing during sleep, sleep disruption, moderate hypoxemia, and cognitive impairment. When we induced SDB in a familial AD model, the mice displayed exacerbation of cognitive impairment and the pathological features of AD, including increased levels of amyloid-beta and inflammatory markers, as well as selective degeneration of cholinergic basal forebrain neurons. These pathological features were not induced by chronic hypoxia or sleep disruption alone. Our results also revealed that the cholinergic neurodegeneration was mediated by the accumulation of nuclear hypoxia inducible factor 1 alpha. Furthermore, restoring blood oxygen levels during sleep to prevent hypoxia prevented the pathological changes induced by the SDB. These findings suggest a signaling mechanism whereby SDB induces cholinergic basal forebrain degeneration.
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Affiliation(s)
- Lei Qian
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.1003.20000 0000 9320 7537Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Oliver Rawashdeh
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Leda Kasas
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Michael R. Milne
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.1003.20000 0000 9320 7537Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Nicholas Garner
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Kornraviya Sankorrakul
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.10223.320000 0004 1937 0490Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Salaya, Thailand
| | - Nicola Marks
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Matthew W. Dean
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Pu Reum Kim
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Aanchal Sharma
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Mark C. Bellingham
- grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Elizabeth J. Coulson
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.1003.20000 0000 9320 7537Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.1003.20000 0000 9320 7537School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072 Australia
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17
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Cui W, Duan Z, Li Z, Feng J. Assessment of Alzheimer’s disease-related biomarkers in patients with obstructive sleep apnea: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:902408. [PMID: 36313031 PMCID: PMC9606796 DOI: 10.3389/fnagi.2022.902408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Increasing evidence links Alzheimer’s disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). The core AD cerebrospinal fluid (CSF) biomarkers, including amyloid-β 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau), can reflect key elements of AD pathophysiology before the emergence of symptoms. Besides, the amyloid-β (Aβ) and tau burden can also be tested by positron emission tomography (PET) scans. Electronic databases (PubMed, Embase, Web of Science, and The Cochrane Library) were searched until August 2022 to assess the AD-related biomarkers measured by PET scans and CSF in OSA patients. The overall analysis showed significant differences in Aβ42 levels (SMD = −0.93, 95% CI:−1.57 to −0.29, P < 0.001) and total tau (t-tau) levels (SMD = 0.24, 95% CI: 0.01–0.48, P = 0.308) of CSF, and Aβ burden (SMD = 0.37, 95% CI = 0.13–0.61, P = 0.69) tested by PET scans between the OSA and controls. Furthermore, CSF Aβ42 levels showed significant differences in patients with moderate/severe OSA compared with healthy control, and levels of CSF Aβ42 showed differences in OSA patients with normal cognition as well. Besides, age and BMI have influences on heterogeneity. Our meta-analysis indicated abnormal AD-related biomarkers (CSF and PET scans) in patients with OSA, supporting the current hypothesis that OSA, especially moderate/severe OSA, may start the AD neuropathological process.
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Affiliation(s)
- Wenqi Cui
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhenghao Duan
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zijian Li
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Zeng Y, Shu Y, Liu X, Li P, Kong L, Li K, Xie W, Zeng L, Long T, Huang L, Li H, Peng D. Frequency-specific alterations in intrinsic low-frequency oscillations in newly diagnosed male patients with obstructive sleep apnea. Front Neurosci 2022; 16:987015. [PMID: 36248662 PMCID: PMC9561418 DOI: 10.3389/fnins.2022.987015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Previous studies found abnormal low-frequency spontaneous brain activity related to cognitive impairment in patients with obstructive sleep apnea (OSA). However, it is unclear if low-frequency spontaneous brain activity is related to specific frequency bands in OSA patients. In this study, we used the amplitude of low-frequency fluctuation (ALFF) method in patients with OSA to explore characteristics of spontaneous brain activity in the classical (0.01–0.1 Hz) and five sub-frequency bands (slow-2 to slow-6) and analyzed the relationship between spontaneous brain activity and clinical evaluation was analyzed. Patients and methods Resting-state magnetic resonance imaging data and clinical assessments were collected from 52 newly-diagnosed OSA patients and 62 healthy controls (HCs). We calculated the individual group ALFF values in the classical and five different sub-frequency bands. A two-sample t-test compared ALFF differences, and one-way analysis of variance explored interactions in frequency bands between the two groups. Results ALFF values in the OSA group were lower than those in the HC group in the bilateral precuneus/posterior cingulate cortex, bilateral angular gyrus, left inferior parietal lobule, brainstem, and right fusiform gyrus. In contrast, ALFF values in the OSA group were higher than those in the HC group in the bilateral cerebellum posterior lobe, bilateral superior frontal gyrus, bilateral middle frontal gyrus, left inferior frontal gyrus, left inferior temporal gyrus, and left fusiform gyrus. Some ALFF values in altered brain regions were associated with body mass index, apnea-hypopnea index, neck circumference, snoring history, minimum SaO2, average SaO2, arousal index, oxygen reduction index, deep sleep period naming, abstraction, and delayed recall in specific frequency bands. Conclusion Our results indicated the existence of frequency-specific differences in spontaneous brain activity in OSA patients, which were related to cognitive and other clinical symptoms. This study identified frequency-band characteristics related to brain damage, expanded the cognitive neuroimaging mechanism, and provided additional OSA neuroimaging markers.
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Affiliation(s)
- Yaping Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Haijun Li,
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Dechang Peng,
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19
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The Link between Obstructive Sleep Apnea and Neurocognitive Impairment: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2022; 19:1245-1256. [PMID: 35913462 PMCID: PMC9353960 DOI: 10.1513/annalsats.202205-380st] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer's disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
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20
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Liu C, Lee SH, Loewenstein DA, Galvin JE, Camargo CJ, Alperin N. Poor sleep accelerates hippocampal and posterior cingulate volume loss in cognitively normal healthy older adults. J Sleep Res 2022; 31:e13538. [PMID: 34927298 PMCID: PMC10731580 DOI: 10.1111/jsr.13538] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 01/05/2023]
Abstract
Poor sleep quality is a known risk factor for Alzheimer's disease. This longitudinal imaging study aimed to determine the acceleration in the rates of tissue loss in cognitively critical brain regions due to poor sleep in healthy elderly individuals. Cognitively-normal healthy individuals, aged ≥60 years, reported Pittsburgh Sleep Quality Index (PSQI) and underwent baseline and 2-year follow-up magnetic resonance imaging brain scans. The links between self-reported sleep quality, rates of tissue loss in cognitively-critical brain regions, and white matter hyperintensity load were assessed. A total of 48 subjects were classified into normal (n = 23; PSQI score <5) and poor sleepers (n = 25; PSQI score ≥5). The two groups were not significantly different in terms of age, gender, years of education, ethnicity, handedness, body mass index, and cognitive performance. Compared to normal sleepers, poor sleepers exhibited much faster rates of volume loss, over threefold in the right hippocampus and fivefold in the right posterior cingulate over 2 years. In contrast, there were no significant differences in the rates of volume loss in the cerebral and cerebellar grey and white matter between the two groups. Rates of volume loss in the right posterior cingulate were negatively associated with global PSQI scores. Poor sleep significantly accelerates volume loss in the right hippocampus and the right posterior cingulate cortex. These findings demonstrate that self-reported sleep quality explains inter-individual differences in the rates of volume loss in cognitively-critical brain regions in healthy older adults and provide a strong impetus to offer sleep interventions to cognitively normal older adults who are poor sleepers.
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Affiliation(s)
- Che Liu
- Department of Radiology, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | - Sang H. Lee
- Department of Radiology, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David A. Loewenstein
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James E. Galvin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J. Camargo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Noam Alperin
- Department of Radiology, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
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21
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Lee MH, Lee SK, Kim S, Kim REY, Nam HR, Siddiquee AT, Thomas RJ, Hwang I, Yoon JE, Yun CH, Shin C. Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood. JAMA Netw Open 2022; 5:e2222999. [PMID: 35857321 PMCID: PMC9301517 DOI: 10.1001/jamanetworkopen.2022.22999] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Obstructive sleep apnea (OSA) is associated with cognitive impairment and brain structural alterations, but longitudinal outcomes are understudied. OBJECTIVE To examine the associations of OSA with cognition and white matter (WM) integrity over a 4-year period. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted in a community-based adult population among participants who had both baseline (2011-2014) and 4-year follow-up (2015-2018) polysomnography, diffusion tensor imaging, and cognitive assessment data. Participants with neurological disorders, anomalous findings on brain magnetic resonance imaging, or inadequate quality of the evaluations were excluded. Data were analyzed from March to November 2021. EXPOSURES Participants were categorized depending on the presence vs absence of OSA at baseline and follow-up polysomnographic analysis. MAIN OUTCOMES AND MEASURES The main outcomes were proportional changes over a 4-year period in neuropsychological performance and WM integrity. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol-coding, Trail Making Test-A, and Stroop Test. WM integrity was assessed by fractional anisotropy, axial, and radial diffusivity. To examine interactions with age and sex, participants were subgrouped by age older than 60 years vs 60 years or younger and men vs women. RESULTS A total of 1998 individuals were assessed for eligibility, and 888 were excluded based on exclusion criteria, leaving 1110 participants (mean [SD] age, 58.0 [6.0] years; 517 [46.6%] men) for analysis, including 458 participants grouped as OSA-free, 72 participants with resolved OSA, 163 participants with incident OSA, and 417 participants with persistent OSA. Incident OSA was associated with altered WM integrity and with concomitant changes in sustained attention compared with participants without OSA (eg, change in Digit Symbol-coding test score, -3.2% [95% CI, -5.2% to -1.2%]). Participants with resolved OSA showed better visual recall at the follow-up (change in Visual Reproduction-immediate recall test, 17.5% [95% CI, 8.9% to 26.1%]; change in Visual Reproduction-delayed recall test, 33.1% [95% CI, 11.3% to 54.9%]), with concordant changes in diffusion parameters at the relevant anatomic areas. In the older group only (age >60 years), persistent OSA was associated with altered WM integrity and cognition (eg, Visual Reproduction-recognition test: β = -24.2 [95% CI, -40.7 to -7.7]). Sex also was associated with modifying the association of OSA with WM integrity of the left posterior internal capsule, the left genu of corpus callosum, and the right middle cerebellar peduncle only in men and with cognition only in women (eg, Visual Reproduction-immediate recall test: β = 33.4 [95% CI, 19.1 to 47.7]). CONCLUSIONS AND RELEVANCE These findings suggest that dynamic changes in OSA status were significantly associated with WM integrity and cognition, which varied by age and sex. It is possible that adequate interventions for OSA could better preserve brain health in middle to late adulthood.
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Affiliation(s)
- Min-Hee Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Soriul Kim
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Regina E. Y. Kim
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hye Ryeong Nam
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ali T. Siddiquee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Inha Hwang
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jee-Eun Yoon
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea
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22
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Increased Levels of Plasma Alzheimer’s Disease Biomarkers and Their Associations with Brain Structural Changes and Carotid Intima-Media Thickness in Cognitively Normal Obstructive Sleep Apnea Patients. Diagnostics (Basel) 2022; 12:diagnostics12071522. [PMID: 35885428 PMCID: PMC9324500 DOI: 10.3390/diagnostics12071522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) has been linked to Alzheimer’s disease (AD) and amyloid deposition in the brain. OSA is further linked to the development of cardiovascular and cerebrovascular diseases. In this study, we analyzed the plasma levels of AD neuropathology biomarkers and their relationships with structural changes of the brain and atherosclerosis. Thirty OSA patients with normal cognition and 34 normal controls were enrolled. Cognitive functions were assessed by the Wechsler Adult Intelligence Scale third edition and Cognitive Ability Screening Instrument. Plasma Aβ-40, Aβ-42, and T-tau levels were assayed using immunomagnetic reduction. The carotid intima-media thickness was measured to assess the severity of atherosclerosis. Structural MR images of brain were acquired with voxel-based morphometric analysis of T1 structural images. The OSA patients exhibited significantly elevated plasma levels of Aβ-42 and T-tau, as well as increased gray matter volume in the right precuneus. Plasma T-tau level is associated with carotid intima-media thickness and gray matter volume of the precuneus. These findings may indicate early changes that precede clinically apparent cognitive impairment. The measurement of these biomarkers may aid in the early detection of OSA-associated morbidity and possible treatment planning for the prevention of irreversible neuronal damage and cognitive dysfunction.
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Costello MM, Mc Carthy CE, Bosch J, Robinson S, McDermott C, Canavan MD, O'Donnell MJ. Are clinical trials randomising households to lifestyle interventions to delay cognitive decline feasible? A pilot study to determine the beliefs, preferences, and deterrents for households impacted by dementia based on semi-structured interviews. BMC Geriatr 2022; 22:322. [PMID: 35418013 PMCID: PMC9005908 DOI: 10.1186/s12877-022-02941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction While lifestyle risk factors are implicated in the development and progression of cognitive impairment, interventional trials of individual participants have yielded unconvincing evidence. We sought to explore the development of lifestyle interventions targeting the household-unit. Methods Semi-structured interviews were carried out among eight households affected by cognitive impairment (i.e. member of the household had cognitive impairment). Interviews took place online using a secure, web-based video platform recommended for patient clinician interaction. Interview content was analysed, and important themes identified. Results Eighteen participants were interviewed within households, of which eight (one per household) had cognitive impairment and others were spouses or first-degree relatives living in the same home. Several themes emerged; 1) household members without cognitive impairment were more likely to report poor sleep habits, and sleep was perceived to be the hardest behaviour to change; 2) diet generated most interest as a potential lifestyle intervention target as most participants believed there is a strong link with nutrition and cognition; 3) physical activity is challenging to adapt due to lack of motivation and focus when individuals are cognitively impaired. Barriers to study participation, including risk of harm, complexity of intervention and deviation from routine emerged during discussions. Conclusions This study identified beliefs and preferences of households towards lifestyle intervention trials. Findings from this study may be used to inform future clinical trial protocols and future qualitative studies should explore acceptability and feasibility of digital intervention applications.
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Affiliation(s)
- Maria M Costello
- HRB-Clinical Research Facility, National University of Ireland Galway, Galway, H91YR71, Ireland. .,University Hospital Galway, Newcastle Road, Galway, Ireland.
| | - Christine E Mc Carthy
- HRB-Clinical Research Facility, National University of Ireland Galway, Galway, H91YR71, Ireland.,University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Jackie Bosch
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Stephanie Robinson
- HRB-Clinical Research Facility, National University of Ireland Galway, Galway, H91YR71, Ireland.,University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Clodagh McDermott
- HRB-Clinical Research Facility, National University of Ireland Galway, Galway, H91YR71, Ireland.,University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Michelle D Canavan
- HRB-Clinical Research Facility, National University of Ireland Galway, Galway, H91YR71, Ireland.,University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Martin J O'Donnell
- HRB-Clinical Research Facility, National University of Ireland Galway, Galway, H91YR71, Ireland.,University Hospital Galway, Newcastle Road, Galway, Ireland
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Filchenko I, Korostovtseva L, Bochkarev M, Sviryaev Y. Brain damage in sleep-disordered breathing: the role of glia (clinical aspects). Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:32-37. [DOI: 10.17116/jnevro202212203132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Abstract
Obstructive sleep apnea (OSA) is a disease that results from loss of upper airway muscle tone leading to upper airway collapse during sleep in anatomically susceptible persons, leading to recurrent periods of hypoventilation, hypoxia, and arousals from sleep. Significant clinical consequences of the disorder cover a wide spectrum and include daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, respiratory failure, and pulmonary hypertension. With escalating rates of obesity a major risk factor for OSA, the public health burden from OSA and its sequalae are expected to increase, as well. In this chapter, we review the mechanisms responsible for the development of OSA and associated neurocognitive and cardiometabolic comorbidities. Emphasis is placed on the neural control of the striated muscles that control the pharyngeal passages, especially regulation of hypoglossal motoneuron activity throughout the sleep/wake cycle, the neurocognitive complications of OSA, and the therapeutic options available to treat OSA including recent pharmacotherapeutic developments.
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Affiliation(s)
- Luu V Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States.
| | - Jonathan Jun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
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Kim REY, Abbott RD, Kim S, Thomas RJ, Yun CH, Kim H, Johnson H, Shin C. Sleep Duration, Sleep Apnea, and Gray Matter Volume. J Geriatr Psychiatry Neurol 2022; 35:47-56. [PMID: 33511901 DOI: 10.1177/0891988720988918] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aimed to evaluate the effect of sleep duration on brain structures in the presence versus absence of sleep apnea in middle-aged and older individuals. The study investigated a population-based sample of 2,560 individuals, aged 49-80 years. The presence of sleep apnea and self-reported sleep duration were examined in relation to gray matter volume (GMV) in total and lobar brain regions. We identified ranges of sleep duration associated with maximal GMV using quadratic regression and bootstrap sampling. A significant quadratic association between sleep duration and GMV was observed in total and lobar brain regions of men with sleep apnea. In the fully adjusted model, optimal sleep durations associated with peak GMV between brain regions ranged from 6.7 to 7.0 hours. Shorter and longer sleep durations were associated with lower GMV in total and 4 sub-regions of the brain in men with sleep apnea.
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Affiliation(s)
- Regina Eun Young Kim
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea.,Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Robert Douglas Abbott
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea
| | - Soriul Kim
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea
| | - Robert Joseph Thomas
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si Gyeonggi-do, South Korea
| | - Chang-Ho Yun
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Hyun Kim
- Department of Clinical Psychology, Boston University, Boston, MA, USA
| | - Hans Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Chol Shin
- Institute of Human Genomic Study, Korea University College of Medicine, Ansan City, South Korea
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Ulland TK, Ewald AC, Knutson AO, Marino KM, Smith SMC, Watters JJ. Alzheimer's Disease, Sleep Disordered Breathing, and Microglia: Puzzling out a Common Link. Cells 2021; 10:2907. [PMID: 34831129 PMCID: PMC8616348 DOI: 10.3390/cells10112907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 12/14/2022] Open
Abstract
Sleep Disordered Breathing (SDB) and Alzheimer's Disease (AD) are strongly associated clinically, but it is unknown if they are mechanistically associated. Here, we review data covering both the cellular and molecular responses in SDB and AD with an emphasis on the overlapping neuroimmune responses in both diseases. We extensively discuss the use of animal models of both diseases and their relative utilities in modeling human disease. Data presented here from mice exposed to intermittent hypoxia indicate that microglia become more activated following exposure to hypoxia. This also supports the idea that intermittent hypoxia can activate the neuroimmune system in a manner like that seen in AD. Finally, we highlight similarities in the cellular and neuroimmune responses between SDB and AD and propose that these similarities may lead to a pathological synergy between SDB and AD.
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Affiliation(s)
- Tyler K. Ulland
- Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, Madison, WI 53705, USA; (T.K.U.); (K.M.M.)
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI 53705, USA
| | - Andrea C. Ewald
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
| | - Andrew O. Knutson
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
| | - Kaitlyn M. Marino
- Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, Madison, WI 53705, USA; (T.K.U.); (K.M.M.)
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI 53705, USA
| | - Stephanie M. C. Smith
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
| | - Jyoti J. Watters
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI 53705, USA
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
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Liu NY, Sun JH, Jiang XF, Li H. Helicobacter pylori infection and risk for developing dementia: an evidence-based meta-analysis of case-control and cohort studies. Aging (Albany NY) 2021; 13:22571-22587. [PMID: 34559067 PMCID: PMC8507304 DOI: 10.18632/aging.203571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Infection with multiple pathogens may play a key role in the pathogenesis of dementia. Whether Helicobacter pylori (H. pylori) infection is associated causally with dementia is controversial. OBJECTIVE We conduct a meta-analysis of case-control and cohort studies on the association between H. pylori infection and the risk for all-cause and Alzheimer's disease (AD) dementia. METHODS Two independent reviewers searched the PubMed, Cochrane Library, and Embase databases with English language restrictions from the date of conception to September 18, 2020. The primary analysis was as follows: the exposure variable was H. pylori infection, and the outcome was incident all-cause and AD dementia. Pooled odds ratios (OR), relative risk (RR), and corresponding 95% confidence intervals (CI) were obtained using the fixed-or random-effect model. Forest plots were generated to summarize the results. RESULTS Ten studies involving 96,561 participants were included in the meta-analysis: 5 case-control studies and 5 cohort studies. The overall pooled cohort studies showed a significant positive association between H. pylori infection and all-cause dementia with pooled RR of 1.36 (95% CI, 1.11-1.67). There was no association between H. pylori infection and risk for developing AD: RR of 1.33 (95% CI, 0.86-2.05) in cohort studies, and OR of 1.72 (95% CI, 0.97-3.04) in case-control studies. Significant heterogeneity was showed in each comparison group. CONCLUSION This meta-analysis supports a positive association between H. pylori infection and the risk of all-cause dementia, but not AD dementia. Due to the interference of confounding factors, randomized controlled trials are needed to prove their causality.
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Affiliation(s)
- Nan-Yang Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jia-Hui Sun
- Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xue-Fan Jiang
- Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Hao Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Lee MH, Lee SK, Thomas RJ, Yoon JE, Yun CH, Shin C. Deep Learning-Based Assessment of Brain Connectivity Related to Obstructive Sleep Apnea and Daytime Sleepiness. Nat Sci Sleep 2021; 13:1561-1572. [PMID: 34557049 PMCID: PMC8455296 DOI: 10.2147/nss.s327110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/04/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with altered pairwise connections between brain regions, which might explain cognitive impairment and daytime sleepiness. By adopting a deep learning method, we investigated brain connectivity related to the severity of OSA and daytime sleepiness. PATIENTS AND METHODS A cross-sectional design applied a deep learning model on structural brain networks obtained from 553 subjects (age, 59.2 ± 7.4 years; men, 35.6%). The model performance was evaluated with the Pearson's correlation coefficient (R) and probability of absolute error less than standard deviation (PAE RESULTS We achieved a meaningful R (up to 0.74) and PAE CONCLUSION A deep learning method can assess the association of brain network characteristics with OSA severity and daytime sleepiness and specify the relevant brain connectivity.
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Affiliation(s)
- Min-Hee Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Robert J Thomas
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jee-Eun Yoon
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea
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30
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Abstract
There is a strong association between obstructive sleep apnea (OSA) and cognitive dysfunction. Executive function, attention, verbal/visual long-term memory, visuospatial/constructional ability, and information processing are more likely to be affected, whereas language, psychomotor function, and short-term memory are less likely to be affected. Increased accumulation of Aß2-amyloid in the brain, episodic hypoxemia, oxidative stress, vascular inflammation, and systemic comorbidities may contribute to the pathogenesis. Patients with OSA should have cognitive screening or formal testing, and patients with cognitive decline should have testing for OSA. Treatment with continuous positive airway pressure may improve cognitive symptoms in the patient with OSA.
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Affiliation(s)
- Arpan Patel
- Department of Neurology, Donald and Barbara Zucker School of Medicine, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | - Derek J Chong
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell Health, Lenox Hill Hospital, 130 East 77th Street, 8 Black Hall, New York, NY 10075, USA.
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31
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Insel PS, Mohlenhoff BS, Neylan TC, Krystal AD, Mackin RS. Association of Sleep and β-Amyloid Pathology Among Older Cognitively Unimpaired Adults. JAMA Netw Open 2021; 4:e2117573. [PMID: 34297074 PMCID: PMC8303100 DOI: 10.1001/jamanetworkopen.2021.17573] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Disrupted sleep commonly occurs with progressing neurodegenerative disease. Large, well-characterized neuroimaging studies of cognitively unimpaired adults are warranted to clarify the magnitude and onset of the association between sleep and emerging β-amyloid (Aβ) pathology. OBJECTIVE To evaluate the associations between daytime and nighttime sleep duration with regional Aβ pathology in older cognitively unimpaired adults. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, screening data were collected between April 1, 2014, and December 31, 2017, from healthy, cognitively unimpaired adults 65 to 85 years of age who underwent florbetapir F 18 positron emission tomography (PET), had APOE genotype information, scored between 25 and 30 on the Mini-Mental State Examination, and had a Clinical Dementia Rating of 0 for the Anti-Amyloid Treatment in Asymptomatic Alzheimer Disease (A4) Study. Data analysis was performed from December 1, 2019, to May 10, 2021. EXPOSURES Self-reported daytime and nighttime sleep duration. MAIN OUTCOMES AND MEASURES Regional Aβ pathology, measured by florbetapir PET standardized uptake value ratio. RESULTS Amyloid PET and sleep duration information was acquired on 4425 cognitively unimpaired participants (mean [SD] age, 71.3 [4.7] years; 2628 [59.4%] female; 1509 [34.1%] tested Aβ positive). Each additional hour of nighttime sleep was associated with a 0.005 reduction of global Aβ standardized uptake value ratio (F1, 4419 = 5.0; P = .03), a 0.009 reduction of medial orbitofrontal Aβ (F1, 4419 = 17.4; P < .001), and a 0.011 reduction of anterior cingulate Aβ (F1, 4419 = 15.9; P < .001). When restricting analyses to participants who tested Aβ negative, nighttime sleep was associated with a 0.006 reduction of medial orbitofrontal Aβ (F1,2910 = 16.9; P < .001) and a 0.005 reduction of anterior cingulate Aβ (F1,2910 = 7.6; P = .03). Daytime sleep was associated with a 0.013 increase of precuneus Aβ (F1,2910 = 7.3; P = .03) and a 0.024 increase of posterior cingulate Aβ (F1,2910 = 14.2; P = .001) in participants who tested Aβ negative. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the increased risk of Aβ deposition with reduced nighttime sleep duration occurred early, before cognitive impairment or significant Aβ deposition. Daytime sleep may be associated with an increase in risk for early Aβ accumulation and did not appear to be corrective for loss of nighttime sleep, demonstrating a circadian rhythm dependence of sleep in preventing Aβ accumulation. Treatments that improve sleep may reduce early Aβ accumulation and aid in delaying the onset of cognitive dysfunction associated with early Alzheimer disease.
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Affiliation(s)
- Philip S. Insel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Brian S. Mohlenhoff
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California
| | - Thomas C. Neylan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California
| | - Andrew D. Krystal
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - R. Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California
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Skiba V, Novikova M, Suneja A, McLellan B, Schultz L. Use of positive airway pressure in mild cognitive impairment to delay progression to dementia. J Clin Sleep Med 2021; 16:863-870. [PMID: 32039755 DOI: 10.5664/jcsm.8346] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim was to assess the relationship between continuous positive airway pressure (CPAP) therapy and cognitive function in patients with mild cognitive impairment (MCI) and obstructive sleep apnea (OSA). METHODS This was a retrospective chart review of patients with MCI and OSA. CPAP therapy compliance was defined as average use of CPAP therapy for at least 4 hours per night. Kaplan-Meier estimates, log-rank tests, and Cox proportional hazards regression were done to compare the compliance groups in terms of progression to dementia, defined as a Clinical Dementia Rating of 1 or greater. Linear mixed models were used to assess the relationships between CPAP therapy compliance and neurological cognitive function outcomes over time. RESULTS Ninety-six patients were included with mean age at MCI diagnosis of 70.4 years, mean apnea-hypopnea index of 25.9 events/h, and mean duration of neurology follow-up of 2.8 years. Forty-two were CPAP compliant, 30 were noncompliant, and 24 had no CPAP use. No overall difference between the groups was detected for progression to dementia (P = .928, log-rank test). Patients with amnestic MCI had better CPAP use (P = .016) and shorter progression time to dementia (P = .042), but this difference was not significant after adjusting for age, education, and race (P = .32). CONCLUSIONS CPAP use in patients with MCI and OSA was not associated with delay in progression to dementia or cognitive decline.
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Affiliation(s)
- Virginia Skiba
- Division of Sleep Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Marina Novikova
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan
| | - Aarushi Suneja
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan
| | - Beth McLellan
- Division of Sleep Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
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Gao L, Li P, Gaba A, Musiek E, Ju YS, Hu K. Fractal motor activity regulation and sex differences in preclinical Alzheimer's disease pathology. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12211. [PMID: 34189248 PMCID: PMC8220856 DOI: 10.1002/dad2.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Degradation in fractal motor activity regulation (FMAR), a measure of multiscale self-similarity of motor control, occurs in aging and accelerates with clinical progression to Alzheimer's disease (AD). Whether FMAR changes occur during the pre-symptomatic phase of the disease in women and men remains unknown. METHODS FMAR was assessed in cognitively normal participants (n = 178) who underwent 7 to 14 days of home actigraphy. Preclinical AD pathology was determined by amyloid imaging-Pittsburgh compound B (PiB) and cerebrospinal fluid (CSF) phosphorylated-tau181 (p-tau) to amyloid beta 42 (Aβ42) ratio. RESULTS Degradation in daytime FMAR was overall significantly associated with preclinical amyloid plaque pathology via PiB+ imaging (beta coefficient β = 0.217, standard error [SE] = 0.101, P = .034) and increasing CSF tau181-Aβ42 ratio (β = 0.220, SE = 0.084, P = .009). In subset analysis by sex, the effect sizes were significant in women for PiB+ (β = 0.279, SE = 0.112, P = .015) and CSF (β = 0.245, SE = 0.094, P = .011) but not in men (both Ps > .05). These associations remained after inclusion of daily activity level, apolipoprotein E ε4 carrier status, and rest/activity patterns. DISCUSSION Changes in daytime FMAR from actigraphy appear to be present in women early in preclinical AD. This may be a combination of earlier pathology changes in females reflected in daytime FMAR, and a relatively underpowered male group. Further studies are warranted to test FMAR as an early noncognitive physiological biomarker that precedes the onset of cognitive symptoms.
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Affiliation(s)
- Lei Gao
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Peng Li
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Arlen Gaba
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
| | - Erik Musiek
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Knight Alzheimer's Disease Research CenterWashington University School of MedicineSt. LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt. LouisMissouriUSA
| | - Yo‐El S. Ju
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt. LouisMissouriUSA
| | - Kun Hu
- Medical Biodynamics ProgramBrigham and Women's HospitalBostonMassachusettsUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMassachusettsUSA
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Legault J, Thompson C, Martineau-Dussault MÈ, André C, Baril AA, Martinez Villar G, Carrier J, Gosselin N. Obstructive Sleep Apnea and Cognitive Decline: A Review of Potential Vulnerability and Protective Factors. Brain Sci 2021; 11:706. [PMID: 34071739 PMCID: PMC8226698 DOI: 10.3390/brainsci11060706] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
Around 40% of dementia risk is attributable to modifiable risk factors such as physical inactivity, hypertension, diabetes and obesity. Recently, sleep disorders, including obstructive sleep apnea (OSA), have also been considered among these factors. However, despite several epidemiological studies investigating the link between OSA and cognitive decline, there is still no consensus on whether OSA increases the risk of dementia or not. Part of the heterogeneity observed in previous studies might be related to some individual characteristics that modulate the association between OSA and cognitive decline. In this narrative review, we present these individual characteristics, namely, age, sex, menopause, obesity, diabetes mellitus, hypertension, cardiovascular diseases, smoking, excessive alcohol consumption, depression, air pollution, Apolipoprotein E ε4 allele, physical activity, and cognitive reserve. To date, large cohort studies of OSA and cognitive decline tended to statistically control for the effects of these variables, but whether they interact with OSA to predict cognitive decline remains to be elucidated. Being able to better predict who is at risk of cognitive decline when they have OSA would improve clinical management and treatment decisions, particularly when patients present relatively mild OSA.
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Affiliation(s)
- Julie Legault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada;
| | - Guillermo Martinez Villar
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
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Owen JE, Benediktsdottir B, Cook E, Olafsson I, Gislason T, Robinson SR. Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea. Sleep 2021; 44:5909379. [PMID: 32954401 DOI: 10.1093/sleep/zsaa195] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/10/2020] [Indexed: 12/23/2022] Open
Abstract
Obstructive sleep apnea (OSA) involves intermittent cessations of breathing during sleep. People with OSA can experience memory deficits and have reduced hippocampal volume; these features are also characteristic of Alzheimer's disease (AD), where they are accompanied by neurofibrillary tangles (NFTs) and amyloid beta (Aβ) plaques in the hippocampus and brainstem. We have recently shown reduced hippocampal volume to be related to OSA severity, and although OSA may be a risk factor for AD, the hippocampus and brainstems of clinically verified OSA cases have not yet been examined for NFTs and Aβ plaques. The present study used quantitative immunohistochemistry to investigate postmortem hippocampi of 34 people with OSA (18 females, 16 males; mean age 67 years) and brainstems of 24 people with OSA for the presence of NFTs and Aβ plaques. OSA severity was a significant predictor of Aβ plaque burden in the hippocampus after controlling for age, sex, body mass index (BMI), and continuous positive airway pressure (CPAP) use. OSA severity also predicted NFT burden in the hippocampus, but not after controlling for age. Although 71% of brainstems contained NFTs and 21% contained Aβ plaques, their burdens were not correlated with OSA severity. These results indicate that OSA accounts for some of the "cognitively normal" individuals who have been found to have substantial Aβ burdens, and are currently considered to be at a prodromal stage of AD.
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Affiliation(s)
- Jessica E Owen
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Bryndis Benediktsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elizabeth Cook
- Department of Clinical Biochemistry, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Stephen R Robinson
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria, Australia
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36
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André C, Laniepce A, Chételat G, Rauchs G. Brain changes associated with sleep disruption in cognitively unimpaired older adults: A short review of neuroimaging studies. Ageing Res Rev 2021; 66:101252. [PMID: 33418092 DOI: 10.1016/j.arr.2020.101252] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
Ageing is characterized by a progressive decline of sleep quality. Sleep difficulties are increasingly recognized as a risk factor for Alzheimer's disease (AD), and have been associated with cognitive decline. However, the brain substrates underlying this association remain unclear. In this review, our objective was to provide a comprehensive overview of the relationships between sleep changes and brain structural, functional and molecular integrity, including amyloid and tau pathologies in cognitively unimpaired older adults. We especially discuss the topography and causality of these associations, as well as the potential underlying mechanisms. Taken together, current findings converge to a link between several sleep parameters, amyloid and tau levels in the CSF, and neurodegeneration in diffuse frontal, temporal and parietal areas. However, the existing literature remains heterogeneous, and the specific sleep changes associated with early AD pathological changes, in terms of topography and neuroimaging modality, is not clearly established yet. Notably, if slow wave sleep disruption seems to be related to frontal amyloid deposition, the brain correlates of sleep-disordered breathing and REM sleep disruption remain unclear. Moreover, sleep parameters associated with tau- and FDG-PET imaging are largely unexplored. Lastly, whether sleep disruption is a cause or a consequence of brain alterations remains an open question.
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37
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André C, Rehel S, Kuhn E, Landeau B, Moulinet I, Touron E, Ourry V, Le Du G, Mézenge F, Tomadesso C, de Flores R, Bejanin A, Sherif S, Delcroix N, Manrique A, Abbas A, Marchant NL, Lutz A, Klimecki OM, Collette F, Arenaza-Urquijo EM, Poisnel G, Vivien D, Bertran F, de la Sayette V, Chételat G, Rauchs G. Association of Sleep-Disordered Breathing With Alzheimer Disease Biomarkers in Community-Dwelling Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Neurol 2021; 77:716-724. [PMID: 32202593 DOI: 10.1001/jamaneurol.2020.0311] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Increasing evidence suggests that sleep-disordered breathing (SDB) increases the risk of developing Alzheimer clinical syndrome. However, the brain mechanisms underlying the link between SDB and Alzheimer disease are still unclear. Objective To determine which brain changes are associated with the presence of SDB in older individuals who are cognitively unimpaired, including changes in amyloid deposition, gray matter volume, perfusion, and glucose metabolism. Design, Setting, and Participants This cross-sectional study was conducted using data from the Age-Well randomized clinical trial of the Medit-Ageing European project, acquired between 2016 and 2018 at Cyceron Center in Caen, France. Community-dwelling older adults were assessed for eligibility and were enrolled in the Age-Well clinical trial if they did not meet medical or cognitive exclusion criteria and were willing to participate. Participants who completed a detailed neuropsychological assessment, polysomnography, a magnetic resonance imaging, and florbetapir and fluorodeoxyglucose positron emission tomography scans were included in the analyses. Main Outcomes and Measures Based on an apnea-hypopnea index cutoff of 15 events per hour, participants were classified as having SDB or not. Voxelwise between-group comparisons were performed for each neuroimaging modality, and secondary analyses aimed at identifying which SDB parameter (sleep fragmentation, hypoxia severity, or frequency of respiratory disturbances) best explained the observed brain changes and assessing whether SDB severity and/or SDB-associated brain changes are associated with cognitive and behavioral changes. Results Of 157 participants initially assessed, 137 were enrolled in the Age-Well clinical trial, and 127 were analyzed in this study. The mean (SD) age of the 127 participants was 69.1 (3.9) years, and 80 (63.0%) were women. Participants with SDB showed greater amyloid burden (t114 = 4.51; familywise error-corrected P = .04; Cohen d, 0.83), gray matter volume (t119 = 4.12; familywise error-corrected P = .04; Cohen d, 0.75), perfusion (t116 = 4.62; familywise error-corrected P = .001; Cohen d, 0.86), and metabolism (t79 = 4.63; familywise error-corrected P = .001; Cohen d, 1.04), overlapping mainly over the posterior cingulate cortex and precuneus. No association was found with cognition, self-reported cognitive and sleep difficulties, or excessive daytime sleepiness symptoms. Conclusions and Relevance The SDB-associated brain changes in older adults who are cognitively unimpaired include greater amyloid deposition and neuronal activity in Alzheimer disease-sensitive brain regions, notably the posterior cingulate cortex and precuneus. These results support the need to screen and treat for SDB, especially in asymptomatic older populations, to reduce Alzheimer disease risk. Trial Registration ClinicalTrials.gov Identifier: NCT02977819.
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Affiliation(s)
- Claire André
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France.,Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Stéphane Rehel
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France.,Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Elizabeth Kuhn
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Brigitte Landeau
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Inès Moulinet
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Edelweiss Touron
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Valentin Ourry
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Gwendoline Le Du
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Florence Mézenge
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Clémence Tomadesso
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Robin de Flores
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Alexandre Bejanin
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Siya Sherif
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Nicolas Delcroix
- Centre National de la Recherche Scientifique, Unité Mixte de Service 3048, GIP Cyceron, Caen, France
| | - Alain Manrique
- Normandie Université, Université de Caen, EA 4650 "Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique", GIP Cyceron, Caen, France
| | - Ahmed Abbas
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Natalie L Marchant
- Division of Psychiatry, University College London, London, United Kingdom
| | - Antoine Lutz
- Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale Unité 1028, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5292, Lyon University, Lyon, France
| | - Olga M Klimecki
- Swiss Center for Affective Sciences, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Collette
- GIGA-Cyclotron Research Centre, In Vivo Imaging and Psychology and Cognitive Neuroscience Unit, Liège University, Liège, Belgium
| | - Eider M Arenaza-Urquijo
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Géraldine Poisnel
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Denis Vivien
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France.,Département de Recherche Clinique, Centre Hospitalier Universitaire de Caen-Normandie, Caen, France
| | - Françoise Bertran
- Unité d'Exploration et de Traitement des Troubles du Sommeil, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Vincent de la Sayette
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France.,Service de Neurologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Gaël Chételat
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Géraldine Rauchs
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
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Baril AA, Martineau-Dussault MÈ, Sanchez E, André C, Thompson C, Legault J, Gosselin N. Obstructive Sleep Apnea and the Brain: a Focus on Gray and White Matter Structure. Curr Neurol Neurosci Rep 2021; 21:11. [PMID: 33586028 DOI: 10.1007/s11910-021-01094-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea is extremely prevalent in the elderly and may precipitate dementia. We review recent advances on gray and white matter structure in obstructive sleep apnea, the impact of treatment, and potential pathological and neurodegenerative processes underlying brain structural changes. RECENT FINDINGS Two opposite patterns are observed in neuroimaging studies of obstructive sleep apnea. One may indicate cellular damage (gray matter atrophy, higher white matter hyperintensity burden, lower white matter fractional anisotropy, higher water diffusivities), while the other (gray matter hypertrophy, restricted white matter diffusivities) may reflect transitory responses, such as intracellular edema, reactive gliosis or compensatory structural changes. Treating obstructive sleep apnea could partly reverse these structural changes. Structural alterations related to obstructive sleep apnea may follow a multi-determined biphasic pattern depending on numerous factors (e.g. severity, symptomatology, age) that could tip the scale toward neurodegeneration and need to be investigated by longitudinal studies.
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Affiliation(s)
- Andrée-Ann Baril
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, 5400 boul. Gouin Ouest, local J-5135, Montréal, Québec, H4J 1C5, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - Erlan Sanchez
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, 5400 boul. Gouin Ouest, local J-5135, Montréal, Québec, H4J 1C5, Canada.,Department of Neuroscience, Université de Montréal, Montréal, Canada
| | - Claire André
- Physiopathology and Imaging of Neurological Disorders, Institut National de la Santé et de la Recherche Médicale, Institut Blood and Brain, Université de Caen, Normandie Université, GIP Cyceron, Caen, France.,Neuropsychologie et Imagerie de la Mémoire Humain, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Caen, Université de Caen, Normandie Université, Paris Sciences & Lettres Université, École Pratique des Hautes Études, GIP Cyceron, Caen, France
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, 5400 boul. Gouin Ouest, local J-5135, Montréal, Québec, H4J 1C5, Canada
| | - Julie Legault
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, 5400 boul. Gouin Ouest, local J-5135, Montréal, Québec, H4J 1C5, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, 5400 boul. Gouin Ouest, local J-5135, Montréal, Québec, H4J 1C5, Canada. .,Department of Psychology, Université de Montréal, Montréal, Canada.
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Sleep disorders and late-onset epilepsy of unknown origin: Understanding new trajectories to brain amyloidopathy. Mech Ageing Dev 2021; 194:111434. [PMID: 33444630 DOI: 10.1016/j.mad.2021.111434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
The intertwining between epilepsy, sleep disorders and beta amyloid pathology has been progressively highlighted, as early identification and stratification of patients at high risk of cognitive decline is the need of the hour. Modification of the sleep-wake activity, such as sleep impairment or excessive daytime sleepiness, can critically affect cerebral beta amyloid levels. Both mice models and human studies have demonstrated a substantial increase in the burden of beta amyloid pathology after sleep-deprivation, with potential negative effects partially restored by sleep recovery. The accumulation of beta amyloid has been shown to be an early event in the course of Alzheimer's disease dementia. Beta amyloid accumulation has been linked to epileptic seizures epileptic seizures, with beta amyloid being itself pro-epileptogenic in mice models already at oligomeric stage, well before plaque deposition. Further supporting a potential relationship between beta amyloid and epilepsy: i) seizures happen in 1 out of oofut 10 patients with Alzheimer's disease in the prodromal stage, ii) epileptic activity accelerates cognitive decline in Alzheimer's disease, iii) people with late-onset epilepsy present a critically high risk of developing dementia. In this Review we highlight the role of beta amyloid as a potential shared mechanisms between sleep disorders, late-onset epilepsy, and cognitive decline.
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40
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Ylä-Herttuala S, Hakulinen M, Poutiainen P, Laitinen TM, Koivisto AM, Remes AM, Hallikainen M, Lehtola JM, Saari T, Korhonen V, Könönen M, Vanninen R, Mussalo H, Laitinen T, Mervaala E. Severe Obstructive Sleep Apnea and Increased Cortical Amyloid-β Deposition. J Alzheimers Dis 2021; 79:153-161. [PMID: 33216027 DOI: 10.3233/jad-200736] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The suggested association between severe obstructive sleep apnea (OSA) and risk of Alzheimer's disease (AD) needs further study. Only few recent reports exist on associations between brain amyloid-β (Aβ) burden and severe OSA in middle-aged patients. OBJECTIVE Examine the possible presence of cortical Aβ accumulation in middle-aged patients with severe OSA. METHODS We performed detailed multimodal neuroimaging in 19 cognitive intact patients (mean 44.2 years) with severe OSA (Apnea-Hypopnea Index >30 h-1). Known etiological factors for possible Aβ accumulation were used as exclusion criteria. Aβ uptake was studied with [11C]-PiB-PET, glucose metabolism with [18F]-FDG-PET, and structural imaging with 3.0T MRI. RESULTS When analyzed individually, in [11C]-PiB-PET a substantial number (∼32%) of the patients exhibited statistically significant evidence of increased cortical Aβ uptake based on elevated regional Z-score values, mostly seen bilaterally in the precuneus and posterior cingulum regions. Cortical glucose hypometabolism in [18F]-FDG-PET was seen in two patients. MRI did not show structural changes suggestive of AD-related pathology. CONCLUSION Increased [11C]-PiB uptake was seen in middle-aged cognitively intact patients with severe OSA. These findings are similar to those described in cognitive unimpaired older OSA patients. The changes in cortical Aβ uptake suggest that severe OSA itself may predispose to alterations related to AD already in middle-age. Aβ clearance may be compromised without simultaneous evidence of metabolic or structural alterations. The results emphasize the importance of early diagnostics and proper treatment of severe OSA in cognitively intact middle-aged subjects, possibly diminishing the individual risk for later cognitive dysfunction.
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Affiliation(s)
- Salla Ylä-Herttuala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hakulinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pekka Poutiainen
- Department of Cyclotron and Radiopharmacy, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Neurosciences, University of Helsinki, Helsinki, Finland.,Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Merja Hallikainen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha-Matti Lehtola
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Toni Saari
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Educational Sciences and Psychology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Ville Korhonen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Mussalo
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Kuang H, Zhu YG, Zhou ZF, Yang MW, Hong FF, Yang SL. Sleep disorders in Alzheimer's disease: the predictive roles and potential mechanisms. Neural Regen Res 2021; 16:1965-1972. [PMID: 33642368 PMCID: PMC8343328 DOI: 10.4103/1673-5374.308071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sleep disorders are common in patients with Alzheimer's disease, and can even occur in patients with amnestic mild cognitive impairment, which appears before Alzheimer's disease. Sleep disorders further impair cognitive function and accelerate the accumulation of amyloid-β and tau in patients with Alzheimer's disease. At present, sleep disorders are considered as a risk factor for, and may be a predictor of, Alzheimer's disease development. Given that sleep disorders are encountered in other types of dementia and psychiatric conditions, sleep-related biomarkers to predict Alzheimer's disease need to have high specificity and sensitivity. Here, we summarize the major Alzheimer's disease-specific sleep changes, including abnormal non-rapid eye movement sleep, sleep fragmentation, and sleep-disordered breathing, and describe their ability to predict the onset of Alzheimer's disease at its earliest stages. Understanding the mechanisms underlying these sleep changes is also crucial if we are to clarify the role of sleep in Alzheimer's disease. This paper therefore explores some potential mechanisms that may contribute to sleep disorders, including dysregulation of the orexinergic, glutamatergic, and γ-aminobutyric acid systems and the circadian rhythm, together with amyloid-β accumulation. This review could provide a theoretical basis for the development of drugs to treat Alzheimer's disease based on sleep disorders in future work.
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Affiliation(s)
- Huang Kuang
- Department of Physiology, College of Medicine, Nanchang University, Nanchang, Jiangxi Province, China
| | - Yu-Ge Zhu
- Department of Physiology, College of Medicine, Nanchang University, Nanchang, Jiangxi Province, China
| | - Zhi-Feng Zhou
- Department of Physiology, College of Medicine, Nanchang University, Nanchang, Jiangxi Province, China
| | - Mei-Wen Yang
- Department of Nurse, Nanchang University Hospital, Nanchang, Jiangxi Province, China
| | - Fen-Fang Hong
- Department of Experimental Teaching Center, Nanchang University, Nanchang, Jiangxi Province, China
| | - Shu-Long Yang
- Department of Physiology, College of Medicine, Nanchang University, Nanchang, Jiangxi Province, China
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Korte N, Nortley R, Attwell D. Cerebral blood flow decrease as an early pathological mechanism in Alzheimer's disease. Acta Neuropathol 2020; 140:793-810. [PMID: 32865691 PMCID: PMC7666276 DOI: 10.1007/s00401-020-02215-w] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 02/08/2023]
Abstract
Therapies targeting late events in Alzheimer's disease (AD), including aggregation of amyloid beta (Aβ) and hyperphosphorylated tau, have largely failed, probably because they are given after significant neuronal damage has occurred. Biomarkers suggest that the earliest event in AD is a decrease of cerebral blood flow (CBF). This is caused by constriction of capillaries by contractile pericytes, probably evoked by oligomeric Aβ. CBF is also reduced by neutrophil trapping in capillaries and clot formation, perhaps secondary to the capillary constriction. The fall in CBF potentiates neurodegeneration by upregulating the BACE1 enzyme that makes Aβ and by promoting tau hyperphosphorylation. Surprisingly, therefore, CBF reduction may play a crucial role in driving cognitive decline by initiating the amyloid cascade itself, or being caused by and amplifying Aβ production. Here, we review developments in this area that are neglected in current approaches to AD, with the aim of promoting novel mechanism-based therapeutic approaches.
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Affiliation(s)
- Nils Korte
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Ross Nortley
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK
| | - David Attwell
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, WC1E 6BT, UK.
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Jackson ML, Cavuoto M, Schembri R, Doré V, Villemagne VL, Barnes M, O’Donoghue FJ, Rowe CC, Robinson SR. Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study. J Alzheimers Dis 2020; 78:611-617. [DOI: 10.3233/jad-200571] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Obstructive sleep apnea (OSA) has been linked to an increase risk of dementia. Few studies have cross-sectionally examined whether clinically-confirmed OSA is associated with a higher brain amyloid burden. Objective: The aim of this study was to compare brain amyloid burden in individuals with untreated OSA and healthy controls, and explore associations between amyloid burden and polysomnographic and subjective measures of sleep, demographics, and mood. Methods: Thirty-four individuals with OSA (mean age 57.5±4.1 y; 19 males) and 12 controls (mean age 58.5±4.2 y; 6 males) underwent a clinical polysomnogram and a 11C-PiB positron emission tomography (PET) scan to quantify amyloid burden. Results: Amyloid burden was elevated in the OSA group relative to controls, and was significantly higher in those with severe OSA relative to mild/moderate OSA. Correlation analyses indicated that higher amyloid burden was associated with a higher Non-REM apnea hypopnea index, poorer sleep efficiency, and less time spent in stage N3 sleep, when controlling for age. Conclusion: Severe OSA is associated with a modest elevation of brain amyloid, the significance of which should be further investigated to explore the implications for dementia risk.
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Affiliation(s)
- Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Marina Cavuoto
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Vincent Doré
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
- CSIRO Health and Biosecurity Flagship, Melbourne, Australia
| | - Victor L. Villemagne
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Fergal J. O’Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Christopher C. Rowe
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
| | - Stephen R. Robinson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
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Mullins AE, Kam K, Parekh A, Bubu OM, Osorio RS, Varga AW. Obstructive Sleep Apnea and Its Treatment in Aging: Effects on Alzheimer's disease Biomarkers, Cognition, Brain Structure and Neurophysiology. Neurobiol Dis 2020; 145:105054. [PMID: 32860945 PMCID: PMC7572873 DOI: 10.1016/j.nbd.2020.105054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023] Open
Abstract
Here we review the impact of obstructive sleep apnea (OSA) on biomarkers of Alzheimer's disease (AD) pathogenesis, neuroanatomy, cognition and neurophysiology, and present the research investigating the effects of continuous positive airway pressure (CPAP) therapy. OSA is associated with an increase in AD markers amyloid-β and tau measured in cerebrospinal fluid (CSF), by Positron Emission Tomography (PET) and in blood serum. There is some evidence suggesting CPAP therapy normalizes AD biomarkers in CSF but since mechanisms for amyloid-β and tau production/clearance in humans are not completely understood, these findings remain preliminary. Deficits in the cognitive domains of attention, vigilance, memory and executive functioning are observed in OSA patients with the magnitude of impairment appearing stronger in younger people from clinical settings than in older community samples. Cognition improves with varying degrees after CPAP use, with the greatest effect seen for attention in middle age adults with more severe OSA and sleepiness. Paradigms in which encoding and retrieval of information are separated by periods of sleep with or without OSA have been done only rarely, but perhaps offer a better chance to understand cognitive effects of OSA than isolated daytime testing. In cognitively normal individuals, changes in EEG microstructure during sleep, particularly slow oscillations and spindles, are associated with biomarkers of AD, and measures of cognition and memory. Similar changes in EEG activity are reported in AD and OSA, such as "EEG slowing" during wake and REM sleep, and a degradation of NREM EEG microstructure. There is evidence that CPAP therapy partially reverses these changes but large longitudinal studies demonstrating this are lacking. A diagnostic definition of OSA relying solely on the Apnea Hypopnea Index (AHI) does not assist in understanding the high degree of inter-individual variation in daytime impairments related to OSA or response to CPAP therapy. We conclude by discussing conceptual challenges to a clinical trial of OSA treatment for AD prevention, including inclusion criteria for age, OSA severity, and associated symptoms, the need for a potentially long trial, defining relevant primary outcomes, and which treatments to target to optimize treatment adherence.
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Affiliation(s)
- Anna E Mullins
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Korey Kam
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ankit Parekh
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY 10016, USA
| | - Andrew W Varga
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Bubu OM, Umasabor-Bubu OQ, Turner AD, Parekh A, Mullins A, Kam K, Birckbichler M, Fahad M, Mbah AK, Williams NJ, Rapoport DM, de Leon M, Jean-Louis G, Ayappa I, Varga AW, Osorio RS. Self-reported obstructive sleep apnea, amyloid and tau burden, and Alzheimer's disease time-dependent progression. Alzheimers Dement 2020; 17:10.1002/alz.12184. [PMID: 33090679 PMCID: PMC8026765 DOI: 10.1002/alz.12184] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is associated with Alzheimer's disease (AD) biomarkers in cognitively normal (CN) and mild cognitive impaired (MCI) participants. However, independent and combined effects of OSA, amyloid beta (Aβ) and tau-accumulation on AD time-dependent progression risk is unclear. METHODS Study participants grouped by biomarker profile, as described by the A/T/N scheme, where "A" refers to aggregated Aβ, "T" aggregated tau, and "N" to neurodegeneration, included 258 CN (OSA-positive [OSA+] [A+TN+ n = 10, A+/TN- n = 6, A-/TN+ n = 10, A-/TN- n = 6 and OSA-negative [OSA-] [A+TN+ n = 84, A+/TN- n = 11, A-/TN+ n = 96, A-/TN- n = 36]) and 785 MCI (OSA+ [A+TN+ n = 35, A+/TN- n = 15, A-/TN+ n = 25, A-/TN- n = 16] and OSA- [A+TN+ n = 388, A+/TN- n = 28, A-/TN+ n = 164, A-/TN- n = 114]) older-adults from the Alzheimer's Disease Neuroimaging Initiative cohort. Cox proportional hazards regression models estimated the relative hazard of progression from CN-to-MCI and MCI-to-AD, among baseline OSA CN and MCI patients, respectively. Multi-level logistic mixed-effects models with random intercept and slope investigated the synergistic associations of self-reported OSA, Aβ, and tau burden with prospective cognitive decline. RESULTS Independent of TN-status (CN and MCI), OSA+/Aβ+ participants were approximately two to four times more likely to progress to MCI/AD (P < .001) and progressed 6 to 18 months earlier (P < .001), compared to other participants combined (ie, OSA+/Aβ-, OSA-/Aβ+, and OSA-/Aβ-). Notably, OSA+/Aβ- versus OSA-/Aβ- (CN and MCI) and OSA+/TN- versus OSA-/TN- (CN) participants showed no difference in the risk and time-to-MCI/AD progression. Mixed effects models demonstrated OSA synergism with Aβ (CN and MCI [β = 1.13, 95% confidence interval (CI), 0.74 to 1.52, and β = 1.18, 95%CI, 0.82 to 1.54]) respectively, and with tau (MCI [β = 1.31, 95% CI, 0.87 to 1.47]), P < .001 for all. DISCUSSION OSA acts in synergism with Aβ and with tau, and all three acting together result in synergistic neurodegenerative mechanisms especially as Aβ and tau accumulation becomes increasingly abnormal, thus leading to shorter progression time to MCI/AD in CN and MCI-OSA patients, respectively.
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Affiliation(s)
- Omonigho M. Bubu
- Center for Sleep and Brain Health, Department of
Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Center for Healthful Behavior Change, Department of
Population Health, New York Grossman School of Medicine, New York, USA
| | - Ogie Q. Umasabor-Bubu
- Department of Epidemiology and Infection Control, State
University New York Downstate Medical Center, Brooklyn, NY, USA
| | - Arlener D Turner
- Center for Sleep and Brain Health, Department of
Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Mullins
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Mukhtar Fahad
- Department of Epidemiology and Biostatistics, College of
Public Health, University of South Florida, Tampa, FL, USA
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of
Public Health, University of South Florida, Tampa, FL, USA
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Department of
Population Health, New York Grossman School of Medicine, New York, USA
| | - David M. Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology,
Weill Cornell Medicine, New York, NY, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of
Population Health, New York Grossman School of Medicine, New York, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew W. Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S. Osorio
- Center for Sleep and Brain Health, Department of
Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, New York, USA
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Liguori C, Maestri M, Spanetta M, Placidi F, Bonanni E, Mercuri NB, Guarnieri B. Sleep-disordered breathing and the risk of Alzheimer's disease. Sleep Med Rev 2020; 55:101375. [PMID: 33022476 DOI: 10.1016/j.smrv.2020.101375] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022]
Abstract
Sleep-disordered breathing is highly prevalent in the elderly population. Obstructive sleep apnea (OSA) represents the most common sleep disorder among the adult and elderly population. Recently, OSA diagnosis has been associated with an increased risk of developing cognitive decline and dementia, including vascular dementia and Alzheimer's disease (AD). Subsequently, there have been studies on AD biomarkers investigating cerebrospinal fluid, blood, neuroimaging, and nuclear medicine biomarkers in patients with OSA. Furthermore, studies have attempted to assess the possible effects of continuous positive airway pressure (CPAP) treatment on the cognitive trajectory and AD biomarkers in patients with OSA. This review summarizes the findings of studies on each AD biomarker (cognitive, biofluid, neuroimaging, and nuclear medicine imaging) in patients with OSA, also accounting for the related effects of CPAP treatment. In addition, the hypothetical model connecting OSA to AD in a bi-directional interplay is analyzed. Finally, the sex-based differences in prevalence and clinical symptoms of OSA between men and women have been investigated in relation to AD risk. Further studies investigating AD biomarkers changes in patients with OSA and the effect of CPAP treatment should be auspicated in future for identifying strategies to prevent the development of AD.
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Affiliation(s)
- Claudio Liguori
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Michelangelo Maestri
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Matteo Spanetta
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Nicola B Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Santa Lucia Foundation, Rome, Italy
| | - Biancamaria Guarnieri
- Center of Sleep Medicine, Department of Neurology, Villa Serena Hospital, Città S. Angelo, Pescara, Italy; Villa Serena Foundation for the Research, Città S. Angelo, Pescara, Italy
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Mohajer B, Abbasi N, Mohammadi E, Khazaie H, Osorio RS, Rosenzweig I, Eickhoff CR, Zarei M, Tahmasian M, Eickhoff SB. Gray matter volume and estimated brain age gap are not linked with sleep-disordered breathing. Hum Brain Mapp 2020; 41:3034-3044. [PMID: 32239749 PMCID: PMC7336142 DOI: 10.1002/hbm.24995] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/29/2020] [Accepted: 03/09/2020] [Indexed: 12/11/2022] Open
Abstract
Alzheimer's disease (AD) and sleep-disordered breathing (SDB) are prevalent conditions with a rising burden. It is suggested that SDB may contribute to cognitive decline and advanced aging. Here, we assessed the link between self-reported SDB and gray matter volume in patients with AD, mild cognitive impairment (MCI) and healthy controls (HCs). We further investigated whether SDB was associated with advanced brain aging. We included a total of 330 participants, divided based on self-reported history of SDB, and matched across diagnoses for age, sex and presence of the Apolipoprotein E4 allele, from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Gray-matter volume was measured using voxel-wise morphometry and group differences in terms of SDB, cognitive status, and their interaction were assessed. Further, using an age-prediction model fitted on gray-matter data of external datasets, we predicted study participants' age from their structural images. Cognitive decline and advanced age were associated with lower gray matter volume in various regions, particularly in the bilateral temporal lobes. Brains age was well predicted from the morphological data in HCs and, as expected, elevated in MCI and particularly in AD subjects. However, there was neither a significant difference between regional gray matter volume in any diagnostic group related to the SDB status, nor in SDB-by-cognitive status interaction. Moreover, we found no difference in estimated chronological age gap related to SDB, or by-cognitive status interaction. Contrary to our hypothesis, we were not able to find a general or a diagnostic-dependent association of SDB with either gray-matter volumetric or brain aging.
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Affiliation(s)
- Bahram Mohajer
- Institute of Medical Science and Technology, Shahid Beheshti UniversityTehranIran
- Non‐Communicable Diseases Research CenterEndocrinology and Metabolism Population Sciences Institute, Tehran University of Medical SciencesTehranIran
| | - Nooshin Abbasi
- McConnell Brain Imaging CentreMontreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Esmaeil Mohammadi
- Institute of Medical Science and Technology, Shahid Beheshti UniversityTehranIran
- Non‐Communicable Diseases Research CenterEndocrinology and Metabolism Population Sciences Institute, Tehran University of Medical SciencesTehranIran
| | - Habibolah Khazaie
- Sleep Disorders Research CenterKermanshah University of Medical SciencesKermanshahIran
| | - Ricardo S. Osorio
- Department of Psychiatry, Center for Brain Health, NYU Langone Medical CenterNew YorkNew YorkUSA
- Nathan S. Kline Institute for Psychiatric ResearchNew YorkNew YorkUSA
| | - Ivana Rosenzweig
- Sleep Disorders CentreGuy's and St Thomas' Hospital, GSTT NHSLondonUK
- Sleep and Brain Plasticity Centre, Department of NeuroimagingIOPPN, King's College LondonLondonUK
| | - Claudia R. Eickhoff
- Institute of Neuroscience and Medicine (INM‐1; INM‐7), Research Center JülichJülichGermany
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine UniversityDüsseldorfGermany
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti UniversityTehranIran
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti UniversityTehranIran
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM‐1; INM‐7), Research Center JülichJülichGermany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich‐Heine UniversityDüsseldorfGermany
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Lee MH, Yun CH, Min A, Hwang YH, Lee SK, Kim DY, Thomas RJ, Han BS, Shin C. Altered structural brain network resulting from white matter injury in obstructive sleep apnea. Sleep 2020; 42:5526734. [PMID: 31260533 DOI: 10.1093/sleep/zsz120] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/22/2019] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To assess, using fractional anisotropy (FA) analysis, alterations of brain network connectivity in adults with obstructive sleep apnea (OSA). Abnormal networks could mediate clinical functional deficits and reflect brain tissue injury. METHODS Structural brain networks were constructed using diffusion tensor imaging (DTI) from 165 healthy (age 57.99 ± 6.02 years, male 27.9%) and 135 OSA participants (age 59.01 ± 5.91 years, male 28.9%) and global network properties (strength, global efficiency, and local efficiency) and regional efficiency were compared between groups. We examined MRI biomarkers of brain tissue injury using FA analysis and its effect on the network properties. RESULTS Differences between groups of interest were noted in global network properties (p-value < 0.05, corrected), and regional efficiency (p-value < 0.05, corrected) in the left middle cingulate and paracingulate gyri, right posterior cingulate gyrus, and amygdala. In FA analysis, OSA participants showed lower FA values in white matter (WM) of the right transverse temporal, anterior cingulate and paracingulate gyri, and left postcentral, middle frontal and medial frontal gyri, and the putamen. After culling fiber tracts through WM which showed significant differences in FA, we observed no group difference in network properties. CONCLUSIONS Changes in WM integrity and structural connectivity are present in OSA participants. We found that the integrity of WM affected brain network properties. Brain network analysis may improve understanding of neurocognitive deficits in OSA, enable longitudinal tracking, and provides explanations for specific symptoms and recovery kinetics.
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Affiliation(s)
- Min-Hee Lee
- Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI.,Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Areum Min
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Yoon Ho Hwang
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dong Youn Kim
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Robert J Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Bong Soo Han
- Department of Radiological Science, Yonsei University, Wonju, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.,Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea
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Benthem SD, Skelin I, Moseley SC, Stimmell AC, Dixon JR, Melilli AS, Molina L, McNaughton BL, Wilber AA. Impaired Hippocampal-Cortical Interactions during Sleep in a Mouse Model of Alzheimer's Disease. Curr Biol 2020; 30:2588-2601.e5. [PMID: 32470367 PMCID: PMC7356567 DOI: 10.1016/j.cub.2020.04.087] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/11/2020] [Accepted: 04/29/2020] [Indexed: 01/23/2023]
Abstract
Spatial learning is impaired in humans with preclinical Alzheimer's disease (AD). We reported similar impairments in 3xTg-AD mice learning a spatial reorientation task. Memory reactivation during sleep is critical for learning-related plasticity, and memory consolidation is correlated with hippocampal sharp wave ripple (SWR) density, cortical delta waves (DWs), cortical spindles, and the temporal coupling of these events-postulated as physiological substrates for memory consolidation. Further, hippocampal-cortical discoordination is prevalent in individuals with AD. Thus, we hypothesized that impaired memory consolidation mechanisms in hippocampal-cortical networks could account for spatial memory deficits. We assessed sleep architecture, SWR-DW dynamics, and memory reactivation in a mouse model of tauopathy and amyloidosis implanted with a recording array targeting isocortex and hippocampus. Mice underwent daily recording sessions of rest-task-rest while learning the spatial reorientation task. We assessed memory reactivation by matching activity patterns from the approach to the unmarked reward zone to patterns during slow-wave sleep (SWS). AD mice had more SWS, but reduced SWR density. The increased SWS compensated for reduced SWR density so there was no reduction in SWR number. In control mice, spindles were phase-coupled with DWs, and hippocampal SWR-cortical DW coupling was strengthened in post-task sleep and was correlated with performance on the spatial reorientation task the following day. However, in AD mice, SWR-DW and spindle-DW coupling were impaired. Thus, reduced SWR-DW coupling may cause impaired learning in AD, and spindle-DW coupling during short rest-task-rest sessions may serve as a biomarker for early AD-related changes in these brain dynamics.
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Affiliation(s)
- Sarah D Benthem
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA.
| | - Ivan Skelin
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA 92697, USA
| | - Shawn C Moseley
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA
| | - Alina C Stimmell
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA
| | - Jessica R Dixon
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA
| | - Andreza S Melilli
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA
| | - Leonardo Molina
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Bruce L McNaughton
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA 92697, USA; Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Aaron A Wilber
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA.
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Pak VM, Onen SH, Bliwise DL, Kutner NG, Russell KL, Onen F. Sleep Disturbances in MCI and AD: Neuroinflammation as a Possible Mediating Pathway. Front Aging Neurosci 2020; 12:69. [PMID: 32457592 PMCID: PMC7227443 DOI: 10.3389/fnagi.2020.00069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/26/2020] [Indexed: 12/11/2022] Open
Abstract
Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) affect a high proportion of the elderly population with an increasing prevalence. Sleep disturbances are frequent in those with MCI and AD. This review summarizes existing research on sleep disturbances and neuroinflammation in MCI and AD. Although strong evidence supports various pathways linking sleep and AD pathology, the temporal direction of this central relationship is not yet known. Improved understanding of sleep disturbance and neuroinflammation in MCI and AD may aid in the identification of targets for their prevention.
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Affiliation(s)
- Victoria M Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - S-Hakki Onen
- Centre de Sommeil, Hôpital de la Croix-Rousse, Lyon, France.,INSERM U128, Université de Lyon, Lyon, France
| | - Donald L Bliwise
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Nancy G Kutner
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Katherine L Russell
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Fannie Onen
- CHU Bichat-Claude-Bernard, AP-HP, Service de Gériatrie, Paris, France.,CESP & INSERM 1178 Université Paris Sud, Paris, France
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