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Marchi NA, Daneault V, André C, Martineau‐Dussault M, Baril A, Thompson C, Montplaisir JY, Gilbert D, Lorrain D, Boré A, Descoteaux M, Carrier J, Gosselin N. Altered fornix integrity is associated with sleep apnea-related hypoxemia in mild cognitive impairment. Alzheimers Dement 2024; 20:4092-4105. [PMID: 38716833 PMCID: PMC11180866 DOI: 10.1002/alz.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/13/2024] [Accepted: 03/18/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The limbic system is critical for memory function and degenerates early in the Alzheimer's disease continuum. Whether obstructive sleep apnea (OSA) is associated with alterations in the limbic white matter tracts remains understudied. METHODS Polysomnography, neurocognitive assessment, and brain magnetic resonance imaging (MRI) were performed in 126 individuals aged 55-86 years, including 70 cognitively unimpaired participants and 56 participants with mild cognitive impairment (MCI). OSA measures of interest were the apnea-hypopnea index and composite variables of sleep fragmentation and hypoxemia. Microstructural properties of the cingulum, fornix, and uncinate fasciculus were estimated using free water-corrected diffusion tensor imaging. RESULTS Higher levels of OSA-related hypoxemia were associated with higher left fornix diffusivities only in participants with MCI. Microstructure of the other white matter tracts was not associated with OSA measures. Higher left fornix diffusivities correlated with poorer episodic verbal memory. DISCUSSION OSA may contribute to fornix damage and memory dysfunction in MCI. HIGHLIGHTS Sleep apnea-related hypoxemia was associated with altered fornix integrity in MCI. Altered fornix integrity correlated with poorer memory function. Sleep apnea may contribute to fornix damage and memory dysfunction in MCI.
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Affiliation(s)
- Nicola Andrea Marchi
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
- Center for Investigation and Research in SleepDepartment of MedicineLausanne University Hospital and University of LausanneLausanneVaudSwitzerland
- Laboratory for Research in NeuroimagingDepartment of Clinical NeurosciencesLausanne University Hospital and University of LausanneLausanneVaudSwitzerland
| | - Véronique Daneault
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre‐Sud‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
| | - Claire André
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| | - Marie‐Ève Martineau‐Dussault
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| | - Andrée‐Ann Baril
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of MedicineFaculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
| | - Jacques Yves Montplaisir
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychiatryUniversité de MontréalMontrealQuebecCanada
| | - Danielle Gilbert
- Department of RadiologyRadio‐oncology and Nuclear Medicine, Université de MontréalMontrealQuebecCanada
- Department of RadiologyHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
| | - Dominique Lorrain
- Research Center on AgingInstitut Universitaire de Gériatrie de Sherbrooke, CIUSSS de l'EstrieSherbrookeQuebecCanada
- Department of PsychologyUniversité de SherbrookeSherbrookeQuebecCanada
| | - Arnaud Boré
- Sherbrooke Connectivity Imaging LabUniversité de SherbrookeSherbrookeQuebecCanada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging LabUniversité de SherbrookeSherbrookeQuebecCanada
| | - Julie Carrier
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
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Tian Q, Sun J, Li X, Liu J, Zhou H, Deng J, Li J. Association between sleep apnoea and risk of cognitive impairment and Alzheimer's disease: a meta-analysis of cohort-based studies. Sleep Breath 2024; 28:585-595. [PMID: 37857768 DOI: 10.1007/s11325-023-02934-w] [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: 05/12/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To provide updated evidence on the association of obstructive sleep apnoea (OSA)/sleep-disordered breathing (SDB) with risk of all-cause cognitive impairment/dementia and Alzheimer's disease (AD). METHODS A systematic literature search was done in PubMed, EMBASE and Scopus databases for cohort studies (retrospective or prospective) that documented the association of SDB/OSA with the risk of cognitive impairment or all-cause dementia or AD. Only studies that were published in the year 2000 and onwards were included. The random-effects model was used for all the analyses and effect sizes were reported as hazards ratio (HR) with 95% confidence intervals. RESULTS Of 15 studies were included in the meta-analysis, SDB/OSA was diagnosed with at-home polysomnography in six studies, while five studies relied on self-report or questionnaires. In the remaining studies, International Classification of Diseases (ICD) codes determined the diagnosis of SDB. The overall pooled analysis showed that patients with SDB/OSA had higher risk of cognitive impairment and/or all-cause dementia (HR 1.52, 95% CI: 1.32, 1.74), when compared to patients without SDB/OSA. However, when studies with diagnosis of SDB based on polysomnography were pooled together, the strength of association for all-cause cognitive impairment was weaker (HR 1.32, 95% CI: 1.00, 1.74). CONCLUSION Findings suggest a possible association of SDB/OSA with risk of all-cause cognitive impairment and/or dementia. However, careful interpretation is warranted as the majority of the studies did not rely on objective assessment based on polysomnography.
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Affiliation(s)
- Qianqian Tian
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Jiadong Sun
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Xuemei Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Junling Liu
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Hao Zhou
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Jian Deng
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Jie Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China.
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Parker JL, Vakulin A, Naik G, Melaku YA, Stevens D, Wittert GA, Martin SA, Catcheside PG, Toson B, Appleton SL, Adams RJ. Associations of baseline obstructive sleep apnea and sleep macroarchitecture with cognitive function after 8 years in middle-aged and older men from a community-based cohort study. J Sleep Res 2024; 33:e14078. [PMID: 37859564 DOI: 10.1111/jsr.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Previous prospective studies examining associations of obstructive sleep apnea and sleep macroarchitecture with future cognitive function recruited older participants, many demonstrating baseline cognitive impairment. This study examined obstructive sleep apnea and sleep macroarchitecture predictors of visual attention, processing speed, and executive function after 8 years among younger community-dwelling men. Florey Adelaide Male Ageing Study participants (n = 477) underwent home-based polysomnography, with 157 completing Trail-Making Tests A and B and the Mini-Mental State Examination. Associations of obstructive sleep apnea (apnea-hypopnea index, oxygen desaturation index, and hypoxic burden index) and sleep macroarchitecture (sleep stage percentages and total sleep time) parameters with future cognitive function were examined using regression models adjusted for baseline demographic, biomedical, and behavioural factors, and cognitive task performance. The mean (standard deviation) age of the men at baseline was 58.9 (8.9) years, with severe obstructive sleep apnea (apnea-hypopnea index ≥30 events/h) in 9.6%. The median (interquartile range) follow-up was 8.3 (7.9-8.6) years. A minority of men (14.6%) were cognitively impaired at baseline (Mini-Mental State Examination score <28/30). A higher percentage of light sleep was associated with better Trail-Making Test A performance (B = -0.04, 95% confidence interval [CI] -0.06, -0.01; p = 0.003), whereas higher mean oxygen saturation was associated with worse performance (B = 0.11, 95% CI 0.02, 0.19; p = 0.012). While obstructive sleep apnea and sleep macroarchitecture might predict cognitive decline, future studies should consider arousal events and non-routine hypoxaemia measures, which may show associations with cognitive decline.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ganesh Naik
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - David Stevens
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute of Family Studies, Melbourne, Victoria, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Barbara Toson
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Marchi NA, Berger M, Solelhac G, Bayon V, Haba-Rubio J, Legault J, Thompson C, Gosselin N, Vollenweider P, Marques-Vidal P, von Gunten A, Strippoli MPF, Preisig M, Draganski B, Heinzer R. Obstructive sleep apnea and cognitive functioning in the older general population: The moderating effect of age, sex, ApoE4, and obesity. J Sleep Res 2024; 33:e13938. [PMID: 37309703 DOI: 10.1111/jsr.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
Research on the relationship between obstructive sleep apnea and cognitive functioning has yielded conflicting results, particularly in the older population, and moderators of this association have rarely been studied. Here we investigated the cross-sectional association between obstructive sleep apnea and cognitive functioning as well as the moderating effect of age, sex, apolipoprotein E4, and obesity on this association among community-dwelling older people. We analysed data from 496 participants (71.4 ± 4.4 years; 45.6% men) of the HypnoLaus study who underwent polysomnography and a battery of neuropsychological tests. The sample was categorised as no-to-mild obstructive sleep apnea (apnea-hypopnea index 0-14.9/h; reference), moderate obstructive sleep apnea (apnea-hypopnea index 15.0-29.9/h), or severe obstructive sleep apnea (apnea-hypopnea index ≥30/h). Regression and moderation analyses were performed with adjustment for confounders. Apolipoprotein E4 and obesity moderated the association between severe obstructive sleep apnea and processing speed, whereas no moderating effects were found for age and sex. In apolipoprotein E4 carriers only, severe obstructive sleep apnea was associated with lower performance in Stroop condition 1 (B = 3.13, p = 0.024). In obese participants only, severe obstructive sleep apnea was associated with lower performance in Stroop condition 1 (B = 3.02, p = 0.025) and Stroop condition 2 (B = 3.30, p = 0.034). Severe obstructive sleep apnea was also associated with lower executive function in the whole sample according to Stroop condition 3 (B = 3.44, p = 0.020) and Stroop interference score (B = 0.24, p = 0.006). Our findings support associations of severe obstructive sleep apnea (but not moderate obstructive sleep apnea) with lower performance in processing speed and executive function in the older general population. Apolipoprotein E4 and obesity appear to be vulnerability factors that strengthen the association between severe obstructive sleep apnea and lower performance in processing speed.
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Affiliation(s)
- Nicola Andrea Marchi
- 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
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montréal, Quebec, Canada
| | - Mathieu Berger
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Sainbiose Laboratory, Inserm U1059, University of Saint-Etienne, Saint-Étienne, France
| | - Geoffroy Solelhac
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Virginie Bayon
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julie Legault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montréal, Quebec, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montréal, Quebec, Canada
| | - Peter Vollenweider
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Pierre Françoise Strippoli
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Carpi M, Fernandes M, Mercuri NB, Liguori C. Sleep Biomarkers for Predicting Cognitive Decline and Alzheimer's Disease: A Systematic Review of Longitudinal Studies. J Alzheimers Dis 2024; 97:121-143. [PMID: 38043016 DOI: 10.3233/jad-230933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND Sleep disturbances are considered a hallmark of dementia, and strong evidence supports the association between alterations in sleep parameters and cognitive decline in patients with mild cognitive impairment and Alzheimer's disease (AD). OBJECTIVE This systematic review aims to summarize the existing evidence on the longitudinal association between sleep parameters and cognitive decline, with the goal of identifying potential sleep biomarkers of AD-related neurodegeneration. METHODS Literature search was conducted in PubMed, Web of Science, and Scopus databases from inception to 28 March 2023. Longitudinal studies investigating the association between baseline objectively-measured sleep parameters and cognitive decline were assessed for eligibility. RESULTS Seventeen studies were included in the qualitative synthesis. Sleep fragmentation, reduced sleep efficiency, reduced REM sleep, increased light sleep, and sleep-disordered breathing were identified as predictors of cognitive decline. Sleep duration exhibited a U-shaped relation with subsequent neurodegeneration. Additionally, several sleep microstructural parameters were associated with cognitive decline, although inconsistencies were observed across studies. CONCLUSIONS These findings suggest that sleep alterations hold promise as early biomarker of cognitive decline, but the current evidence is limited due to substantial methodological heterogeneity among studies. Further research is necessary to identify the most reliable sleep parameters for predicting cognitive impairment and AD, and to investigate interventions targeting sleep that can assist clinicians in the early recognition and treatment of cognitive decline. Standardized procedures for longitudinal studies evaluating sleep and cognition should be developed and the use of continuous sleep monitoring techniques, such as actigraphy or EEG headband, might be encouraged.
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Affiliation(s)
- Matteo Carpi
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Liguori
- Sleep Medicine Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Legault J, Thompson C, Moullec G, Baril AA, Martineau-Dussault MÈ, André C, Marchi NA, Cross N, Dang-Vu TT, Carrier J, Gosselin N. Age- and sex-specific associations between obstructive sleep apnea risk and cognitive decline in middle-aged and older adults: A 3-year longitudinal analysis of the Canadian longitudinal study on aging. Sleep Med 2023; 112:77-87. [PMID: 37832163 DOI: 10.1016/j.sleep.2023.09.029] [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: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Whether obstructive sleep apnea (OSA) increases the risk of cognitive decline and how sex and age influence this association is not clear. Here, we characterized the sex- and age-specific associations between OSA risk and 3-year cognitive change in middle-aged and older adults. METHODS We included 24,819 participants aged 45-85 (52% women) from the Canadian Longitudinal Study on Aging. OSA risk was measured at baseline using the STOP combined to body mass index (STOP-B). Neuropsychological tests assessed memory, executive functioning, and psychomotor speed at baseline and at 3-year follow-up. We conducted age- and sex-specific linear mixed models to estimate the predictive role of baseline STOP-B score on 3-year cognitive change. RESULTS Men at high-risk for OSA aged 45-59 years showed a steeper decline in psychomotor speed (+13.2 [95% CI: -1.6, 27.9]) compared to men at low-risk. Men at high-risk for OSA aged 60-69 showed a steeper decline in mental flexibility (-1.2 [-1.9, -0.5]) and processing speed (+0.6 [0.3, 0.9]) than those at low-risk. Women at high-risk for OSA aged 45-59 showed a steeper decline in processing speed (+0.1 [-0.2, 0.4]) than women at low-risk, while women at high-risk ≥70 years had a steeper decline in memory (-0.2 [-0.6, 0.1]) and processing speed (+1.0 [0.4, 1.5]). CONCLUSIONS Associations between OSA risk and cognitive decline over 3 years depend on age and sex. Being at high-risk for OSA is associated with a generalized cognitive decline in attention and processing speed, while a memory decline is specific to older women (≥70 years).
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Affiliation(s)
- Julie Legault
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Cynthia Thompson
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Gregory Moullec
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, QC, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Claire André
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Nicola Andrea Marchi
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, 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
| | - Nathan Cross
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada; Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Thien Thanh Dang-Vu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada; Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Julie Carrier
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Nadia Gosselin
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada.
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Sawyer RP, Bennett A, Blair J, Molano J, Timmerman E, Foster F, Karkoska K, Hyacinth HI, Manly JJ, Howard VJ, Petrov ME, Hoffmann CM, Yu F, Demel SL, Aziz Y, Hooper D, Hill EJ, Johnson J, Pounders J, Shatz R. History of obstructive sleep apnea associated with incident cognitive impairment in white but not black individuals in a US national cohort study. Sleep Med 2023; 112:1-8. [PMID: 37801859 PMCID: PMC11071160 DOI: 10.1016/j.sleep.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND We sought to determine if risk for obstructive sleep apnea (OSA), a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals. METHODS To determine whether the risk for OSA, a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals; data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) was used. Participants that completed the sleep questionnaire module, had baseline cognitive assessment, and at least one cognitive assessment during follow-up were included. Risk of OSA was determined based on Berlin Sleep Questionnaire. History of sleep apnea was determined based on structured interview questions. Optimally treated OSA was defined as treated sleep apnea as at least 4 h of continuous positive airway pressure use per night for ≥5 nights per week. RESULTS In 19,017 participants stratified by race, White participants with history of OSA were 1.62 times more likely to have incident cognitive impairment compared to White participants without history of OSA after adjusting for demographic characteristics, history, and lifestyle factors (OR = 1.62, 95% CI = 1.05-2.50, p-value = 0.03). This relationship was not seen in Black participants (OR = 0.92, 95% CI = 0.60-1.43, p-value = 0.72). DISCUSSION A previous diagnosis of OSA is associated with incident cognitive impairment in White Americans but not Black Americans. Further investigations are required to determine the mechanism for this difference.
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Affiliation(s)
- Russell P Sawyer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA.
| | - Aleena Bennett
- Biostatistics Department, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jessica Blair
- Biostatistics Department, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jennifer Molano
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Emerlee Timmerman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Forrest Foster
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Kristine Karkoska
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Hyacinth I Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Jennifer J Manly
- Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York City, NY, 10032, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Megan E Petrov
- Center for Innovation in Healthy & Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Coles M Hoffmann
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Fang Yu
- Center for Innovation in Healthy & Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Stacie L Demel
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Destiny Hooper
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Emily J Hill
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Jamelle Johnson
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Johnson Pounders
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
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Ghavami T, Kazeminia M, Ahmadi N, Rajati F. Global Prevalence of Obstructive Sleep Apnea in the Elderly and Related Factors: A Systematic Review and Meta-Analysis Study. J Perianesth Nurs 2023; 38:865-875. [PMID: 37318436 DOI: 10.1016/j.jopan.2023.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/21/2022] [Accepted: 01/21/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The aims of current meta-analysis was to combine data and statistics on the global prevalence of OSA and related factors in older adults. DESIGN A systematic review and meta-analysis. METHODS To find related studies, various databases were searched including Embase, PubMed, Scopus, Web of Science (WoS), MagIran, and SID (two local databases) using appropriate keywords, MeSH and controlled vocabulary, with no time limitation up to June, 2021. Heterogeneity of studies was evaluated using I2, and Egger's regression intercept was used to detect publication bias. FINDINGS 39 studies with a total sample size of 33,353 people were included. The pooled prevalence of OSA in older adults was 35.9% (95% confidence interval: 28.7%-43.8%; I2 = 98.81%). Considering the high heterogeneity of included studies, subgroup analysis was conducted and yielded the most prevalent in Asia continent with 37.0% (95% CI: 22.4%-54.5%; I2 = 97.32%). However, heterogeneity was remained at high level. In the majority of studies, OSA was significantly and positively related to obesity, increased BMI, age, cardiovascular diseases, diabetes, and daytime sleepiness. CONCLUSIONS Results of this study showed that global prevalence of OSA in older adults is high and is significantly related to obesity, increased BMI, age, cardiovascular diseases, diabetes, and daytime sleepiness. These findings can be used by experts working on the diagnosis and management of OSA in the geriatric population. These findings can be used by experts on the diagnosis and treatment of OSA in the older adults. Due to high heterogeneity, findings should be interpreted with great caution.
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Affiliation(s)
- Tina Ghavami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nassim Ahmadi
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Delaware, Newark, DE
| | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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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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10
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Gu Y, Gagnon JF, Kaminska M. Sleep electroencephalography biomarkers of cognition in obstructive sleep apnea. J Sleep Res 2023; 32:e13831. [PMID: 36941194 DOI: 10.1111/jsr.13831] [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: 09/26/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 03/23/2023]
Abstract
Obstructive sleep apnea has been associated with cognitive impairment and may be linked to disorders of cognitive function. These associations may be a result of intermittent hypoxaemia, sleep fragmentation and changes in sleep microstructure in obstructive sleep apnea. Current clinical metrics of obstructive sleep apnea, such as the apnea-hypopnea index, are poor predictors of cognitive outcomes in obstructive sleep apnea. Sleep microstructure features, which can be identified on sleep electroencephalography of traditional overnight polysomnography, are increasingly being characterized in obstructive sleep apnea and may better predict cognitive outcomes. Here, we summarize the literature on several major sleep electroencephalography features (slow-wave activity, sleep spindles, K-complexes, cyclic alternating patterns, rapid eye movement sleep quantitative electroencephalography, odds ratio product) identified in obstructive sleep apnea. We will review the associations between these sleep electroencephalography features and cognition in obstructive sleep apnea, and examine how treatment of obstructive sleep apnea affects these associations. Lastly, evolving technologies in sleep electroencephalography analyses will also be discussed (e.g. high-density electroencephalography, machine learning) as potential predictors of cognitive function in obstructive sleep apnea.
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Affiliation(s)
- Yusing Gu
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean-François Gagnon
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Respiratory Division & Sleep Laboratory, McGill University Health Centre, Montreal, Québec, Canada
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Targa ADS, Benítez ID, Moncusí-Moix A, Dakterzada F, Minguez O, Vaca R, Dalmases M, Sanchez-de-la-Torre M, Barbé F, Piñol-Ripoll G. Breathing cessation events that compose the apnea-hypopnea index are distinctively associated with the adverse outcomes in Alzheimer's disease. Alzheimers Res Ther 2023; 15:123. [PMID: 37452339 PMCID: PMC10347810 DOI: 10.1186/s13195-023-01266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Previous studies challenge the impact of obstructive sleep apnea (OSA) once patients are diagnosed with Alzheimer's disease (AD). Nevertheless, OSA recognizably disrupts sleep, and relevant associations between sleep, AD pathological markers, and cognition have been demonstrated. We aimed to further explore this, evaluating the associations between each breathing cessation event that compose the apnea-hypopnea index (AHI) and the sleep structure to finally investigate whether this was related to increased levels of AD markers and higher cognitive decline. METHODS Observational, prospective study, including consecutive patients diagnosed with mild-moderate AD. The participants were submitted to overnight polysomnography followed by a cerebrospinal fluid collection for AD pathological markers levels determination. Neuropsychological assessment was performed at baseline and after 12 months of follow-up. RESULTS The cohort was composed of 116 patients (55.2% females) with a median [p25;p75] age of 76.0 [72.0;80.0] years and an AHI of 25.9 [15.1;48.5], which was mainly defined by the presence of hypopneas and obstructive apneas. These were distinctively associated with the sleep structure, with obstructive apneas being related to arousals and sleep lightening and hypopneas being related to an increased number of arousals only. Despite having a lower frequency, mixed and central apneas also presented associations with the sleep structure, particularly increasing the time spent in the lighter sleep stages. In relation to AD pathological markers, obstructive and mixed apneas were related to an augment in neurofilament light levels while hypopneas were associated with a higher phosphorylated-tau/amyloid-beta protein ratio. Hypopneas were the most important event for an increased cognitive decline at the 12-month follow-up. CONCLUSIONS Our findings highlight the importance of a patient-centered approach, with a comprehensive and detailed analysis of the AHI to effectively predict the different outcomes and tailor the appropriate therapeutic strategies.
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Affiliation(s)
- Adriano D S Targa
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Iván D Benítez
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Farida Dakterzada
- Cognitive Disorders Unit, Clinical Neuroscience Research, Hospital Universitari Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Olga Minguez
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafaela Vaca
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mireia Dalmases
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Sanchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine (TRRM), Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerard Piñol-Ripoll
- Cognitive Disorders Unit, Clinical Neuroscience Research, Hospital Universitari Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain.
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Parker JL, Vakulin A, Melaku YA, Wittert GA, Martin SA, D’Rozario AL, Catcheside PG, Lechat B, Toson B, Teare AJ, Appleton SL, Adams RJ. Associations of Baseline Sleep Microarchitecture with Cognitive Function After 8 Years in Middle-Aged and Older Men from a Community-Based Cohort Study. Nat Sci Sleep 2023; 15:389-406. [PMID: 37252206 PMCID: PMC10225127 DOI: 10.2147/nss.s401655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Prospective studies examining associations between baseline sleep microarchitecture and future cognitive function recruited from small samples with predominantly short follow-up. This study examined sleep microarchitecture predictors of cognitive function (visual attention, processing speed, and executive function) after 8 years in community-dwelling men. Patients and Methods Florey Adelaide Male Ageing Study participants (n=477) underwent home-based polysomnography (2010-2011), with 157 completing baseline (2007-2010) and follow-up (2018-2019) cognitive assessments (trail-making tests A [TMT-A] and B [TMT-B] and the standardized mini-mental state examination [SMMSE]). Whole-night F4-M1 sleep EEG recordings were processed following artifact exclusion, and quantitative EEG characteristics were obtained using validated algorithms. Associations between baseline sleep microarchitecture and future cognitive function (visual attention, processing speed, and executive function) were examined using linear regression models adjusted for baseline obstructive sleep apnoea, other risk factors, and cognition. Results The final sample included men aged (mean [SD]) 58.9 (8.9) years at baseline, overweight (BMI 28.5 [4.2] kg/m2), and well educated (75.2% ≥Bachelor, Certificate, or Trade), with majorly normal baseline cognition. Median (IQR) follow-up was 8.3 (7.9, 8.6) years. In adjusted analyses, NREM and REM sleep EEG spectral power was not associated with TMT-A, TMT-B, or SMMSE performance (all p>0.05). A significant association of higher N3 sleep fast spindle density with worse TMT-B performance (B=1.06, 95% CI [0.13, 2.00], p=0.026) did not persist following adjustment for baseline TMT-B performance. Conclusion In this sample of community-dwelling men, sleep microarchitecture was not independently associated with visual attention, processing speed, or executive function after 8 years.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Angela L D’Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Alison J Teare
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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13
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Wu HM, Wang ZJ, Cheng CH, Su T, Wang J, Li YZ, Wang QJ, Han F, Chen R. Daytime Hypercapnia Impairs Working Memory in Young and Middle-Aged Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Nat Sci Sleep 2023; 15:363-373. [PMID: 37220426 PMCID: PMC10200120 DOI: 10.2147/nss.s398440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Obstructive sleep apnea hypopnea syndrome (OSAHS) can lead to cognitive impairment, though few studies have so far examined hypercapnia as its causal mechanism, due to the invasive nature of conventional arterial CO2 measurement. The study aims to investigate the effects of daytime hypercapnia on working memory in young and middle-aged patients with OSAHS. Patients and Methods This prospective study screened 218 patients and eventually recruited 131 patients (aged 25-60 years) with polysomnography (PSG)-diagnosed OSAHS. Using a cut-off of 45mmHg daytime transcutaneous partial pressure of carbon dioxide (PtcCO2), 86 patients were assigned into the normocapnic group and 45 patients into the hypercapnic group. Working memory was evaluated using the Digit Span Backward Test (DSB) and the Cambridge Neuropsychological Test Automated Battery. Results Compared with the normocapnic group, the hypercapnic group performed worse in verbal, visual, and spatial working memory tasks. PtcCO2≥45mmHg was an independent predictor for lower DSB scores (OR=4.057), lower accuracy in the immediate Pattern Recognition Memory (OR=2.600), delayed Pattern Recognition Memory (OR=2.766) and Spatial Recognition Memory (OR=2.722) tasks, lower Spatial Span scores (OR=4.795), and more between errors in the Spatial Working Memory task (OR=2.734 and 2.558, respectively). Notably, PSG indicators of hypoxia and sleep fragmentation did not predict task performance. Conclusion Hypercapnia may be plays an important role in working memory impairment in patients with OSAHS, perhaps more so than hypoxia and sleep fragmentation. Routine CO2 monitoring in these patients could prove of utility in clinical practices.
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Affiliation(s)
- Hua-Man Wu
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Zigong First People’s Hospital, Zigong, Sichuan, People’s Republic of China
| | - Zhi-Jun Wang
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Chao-Hong Cheng
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Tong Su
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jing Wang
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ye-Zhou Li
- School of Medicine, the University of Manchester, Manchester, UK
| | - Qiao-Jun Wang
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Fei Han
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Rui Chen
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Gnoni V, Mesquita M, O’Regan D, Delogu A, Chakalov I, Antal A, Young AH, Bucks RS, Jackson ML, Rosenzweig I. Distinct cognitive changes in male patients with obstructive sleep apnoea without co-morbidities. FRONTIERS IN SLEEP 2023; 2:1097946. [PMID: 38213473 PMCID: PMC7615516 DOI: 10.3389/frsle.2023.1097946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Introduction Obstructive sleep apnoea (OSA) is a multisystem, debilitating, chronic disorder of breathing during sleep, resulting in a relatively consistent pattern of cognitive deficits. More recently, it has been argued that those cognitive deficits, especially in middle-aged patients, may be driven by cardiovascular and metabolic comorbidities, rather than by distinct OSA-processes, such as are for example ensuing nocturnal intermittent hypoxaemia, oxidative stress, neuroinflammation, and sleep fragmentation. Methods Thus, we undertook to define cognitive performance in a group of 27 middle-aged male patients with untreated OSA, who had no concomitant comorbidities, compared with seven matched controls (AHI mean ± S.D.: 1.9 ± 1.4 events/h; mean age 34.0 ± 9.3 years; mean BMI 23.8 ± 2.3 kg/m2). Of the 27 patients, 16 had mild OSA (AHI mean ± S.D.:11.7 ± 4.0 events/h; mean age 42.6 ± 8.2 years; mean BMI 26.7 ± 4.1 kg/m2), and 11 severe OSA (AHI 41.8 ± 20.7 events/h; age: 46.9 ± 10.9 years, BMI: 28.0 ± 3.2 kg/m2). Results In our patient cohort, we demonstrate poorer executive-functioning, visuospatial memory, and deficits in vigilance sustained attention, psychomotor and impulse control. Remarkably, we also report, for the first time, effects on social cognition in this group of male, middle-aged OSA patients. Conclusion Our findings suggest that distinct, OSA-driven processes may be sufficient for cognitive changes to occur as early as in middle age, in otherwise healthy individuals.
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Affiliation(s)
- Valentina Gnoni
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | | | - David O’Regan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Alessio Delogu
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ivan Chakalov
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Romola S. Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- The Raine Study, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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15
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Sabil A, Gagnadoux F. Obstructive sleep apnoea, nocturnal hypoxaemia, and cognitive decline in elderly patients. Eur Respir J 2023; 61:61/4/2300300. [PMID: 37105589 DOI: 10.1183/13993003.00300-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 04/29/2023]
Affiliation(s)
| | - Frédéric Gagnadoux
- University of Angers and Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
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16
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Qiu K, Mao M, Hu Y, Yi X, Zheng Y, Ying Z, Cheng D, Rao Y, Zhang J, Mu X, Ren C, Xu Y, Zhang W, Xu W, Zhao Y, Ren J. Gender-specific association between obstructive sleep apnea and cognitive impairment among adults. Sleep Med 2022; 98:158-166. [PMID: 35870305 DOI: 10.1016/j.sleep.2022.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/29/2022] [Accepted: 07/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aims to explore the gender-specific association between obstructive sleep apnea (OSA) and cognitive impairment. METHODS Participants from UK biobank who have completed at least one of the five baseline cognitive tests (visuospatial memory, prospective memory, fluid intelligence, short numeric memory and reaction time) were included, which were initially divided into two groups based on gender and were further categorized into three subgroups: (1) OSA, (2) self-reported snoring but without OSA, and (3) healthy controls (without OSA or snoring). Multivariable regression analysis was performed to examine the associations among snoring, OSA and performance of each of the five cognitive domains. RESULTS A total of 267,889 participants (47% male, mean age: 57 years old) were included in our study. In the multivariable regression analysis, female participants in the OSA group had a higher risk of having poor prospective memory (OR: 1.24, 95% CI: 1.02~1.50, p = 0.03). Meanwhile, among female participants, OSA were inversely associated with the performances of fluid intelligence (β: 0.29, 95% CI: 0.46~-0.13, p < 0.001) and short-numeric memory (β: 0.14, 95% CI: 0.35~0.08, p = 0.02). Besides, age-related subgroup analyses showed that these associations were largely reserved in younger (<65 years old) female participants rather than older (≥65 years old) female participants. In contrast, among male participants, no significant association was observed between OSA and impairment of the five cognitive domains. CONCLUSIONS OSA was significantly associated with cognitive impairment at certain dimensions in female participants rather than in male participants, indicating that more special attention and timely interventions should be given to younger female OSA patients to prevent further cognitive impairment.
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Affiliation(s)
- Ke Qiu
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.
| | - Minzi Mao
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaowei Yi
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yongbo Zheng
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yufang Rao
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhang
- Lang Zhong People's Hospital, Lang Zhong, Sichuan, China
| | - Xiaosong Mu
- Lang Zhong People's Hospital, Lang Zhong, Sichuan, China
| | - Chuanming Ren
- Affiliated Hospital of Traditional Chinese Medicine of Chongqing Three Gorges Medical College, Chongqing, China
| | - Yanhong Xu
- Department of Oto-Rhino-Laryngology, Yaan People's Hospital, Yaan, Sichuan, China
| | - Wei Zhang
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Ontario, Canada.
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
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17
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Lal C, Ayappa I, Ayas N, Beaudin AE, Hoyos C, Kushida CA, Kaminska M, Mullins A, Naismith SL, Osorio RS, Phillips CL, Parekh A, Stone KL, Turner AD, Varga AW. 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] [MESH Headings] [Grants] [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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18
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Kim DK, Lee IH, Lee BC, Lee CY. Effect of Sleep Disturbance on Cognitive Function in Elderly Individuals: A Prospective Cohort Study. J Pers Med 2022; 12:jpm12071036. [PMID: 35887533 PMCID: PMC9319469 DOI: 10.3390/jpm12071036] [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: 06/02/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Many epidemiologic and clinical studies have shown significant links between the degree of sleep disturbance and severity of impairment of selective cognitive functions, including the risk of neurodegenerative diseases. However, the sleep parameters that affect cognitive function in old age are unclear. Therefore, we investigated the association between sleep parameters and cognitive function in older patients. Patients aged above 65 years who complained of sleep-disordered breathing were enrolled consecutively. The Mini-Mental-State Examination tool was used to evaluate cognitive function. Eighty patients (normal cognitive function, n = 32 and cognitive impairment, n = 42) were included in this study. Multiple linear regression and binary logistic regression analyses were performed to explain the relationship between sleep parameters and cognitive function. We found that the body mass index (BMI) was significantly lower in the cognitive impairment group than in the normal cognitive function group. Additionally, the cognitive impairment group showed significantly decreased sleep efficiency and an increased apnea index compared with normal subjects. Moreover, lower BMI, reduced sleep efficiency, and high frequency of apnea events during sleep were associated with an increased risk of cognitive impairment.
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Affiliation(s)
- Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (D.-K.K.); (I.H.L.); (B.C.L.)
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Il Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (D.-K.K.); (I.H.L.); (B.C.L.)
| | - Byeong Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea; (D.-K.K.); (I.H.L.); (B.C.L.)
| | - Chang Youl Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
- Correspondence: ; Tel.: +82-33-240-5482; Fax: +82-33-255-4291
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19
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Dzierzewski JM, Perez E, Ravyts SG, Dautovich N. Sleep and Cognition: A Narrative Review Focused on Older Adults. Sleep Med Clin 2022; 17:205-222. [PMID: 35659074 PMCID: PMC9177059 DOI: 10.1016/j.jsmc.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Little is known regarding sleep's association with the traditional developmental course of late-life cognitive functioning. As the number of older adults increases worldwide, an enhanced understanding of age-related changes in sleep and cognition is necessary to slow decline and promote optimal aging. This review synthesizes the extant literature on sleep and cognitive function in healthy older adults, older adults with insomnia, and older adults with sleep apnea, incorporating information on the potential promising effects of treating poor sleep on cognitive outcomes in older adults. Unifying theories of the sleep-cognition association, possible mechanisms of action, and important unanswered questions are identified.
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Affiliation(s)
- Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Room 306, Box 842018, Richmond, VA 23284-2018, USA.
| | - Elliottnell Perez
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284-2018, USA
| | - Scott G Ravyts
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284-2018, USA
| | - Natalie Dautovich
- Department of Psychology, Virginia Commonwealth University, 800 West Franklin Street, Room 203, Box 842018, Richmond, VA 23284-2018, USA
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20
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De Nunzio G, Conte L, Lupo R, Vitale E, Calabrò A, Ercolani M, Carvello M, Arigliani M, Toraldo DM, De Benedetto L. A New Berlin Questionnaire Simplified by Machine Learning Techniques in a Population of Italian Healthcare Workers to Highlight the Suspicion of Obstructive Sleep Apnea. Front Med (Lausanne) 2022; 9:866822. [PMID: 35692545 PMCID: PMC9174983 DOI: 10.3389/fmed.2022.866822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is a condition characterized by the presence of repeated complete or partial collapse of the upper airways during sleep associated with episodes of intermittent hypoxia, leading to fragmentation of sleep, sympathetic nervous system activation, and oxidative stress. To date, one of the major aims of research is to find out a simplified non-invasive screening system for this still underdiagnosed disease. The Berlin questionnaire (BQ) is the most widely used questionnaire for OSA and is a beneficial screening tool devised to select subjects with a high likelihood of having OSA. We administered the original ten-question Berlin questionnaire, enriched with a set of questions purposely prepared by our team and completing the socio-demographic, clinical, and anamnestic picture, to a sample of Italian professional nurses in order to investigate the possible impact of OSA disease on healthcare systems. According to the Berlin questionnaire, respondents were categorized as high-risk and low-risk of having OSA. For both risk groups, baseline characteristics, work information, clinical factors, and symptoms were assessed. Anthropometric data, work information, health status, and symptoms were significantly different between OSA high-risk and low-risk groups. Through supervised feature selection and Machine Learning, we also reduced the original BQ to a very limited set of items which seem capable of reproducing the outcome of the full BQ: this reduced group of questions may be useful to determine the risk of sleep apnea in screening cases where questionnaire compilation time must be kept as short as possible.
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Affiliation(s)
- Giorgio De Nunzio
- Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics “E. De Giorgi”, University of Salento, Lecce, Italy
- Laboratory of Interdisciplinary Research Applied to Medicine, University of Salento, Local Health Authority, Lecce, Italy
- *Correspondence: Giorgio De Nunzio
| | - Luana Conte
- Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics “E. De Giorgi”, University of Salento, Lecce, Italy
- Laboratory of Interdisciplinary Research Applied to Medicine, University of Salento, Local Health Authority, Lecce, Italy
| | - Roberto Lupo
- “San Giuseppe da Copertino” Hospital, Local Health Authority, Lecce, Italy
| | - Elsa Vitale
- Department of Mental Health, Local Health Authority, Bari, Italy
| | - Antonino Calabrò
- “Nuovo Ospedale degli Infermi” Hospital, Local Health Authority, Biella, Italy
| | - Maurizio Ercolani
- Local Health Authority Marche Area Vasta 2 Health Department, Ancona, Italy
| | - Maicol Carvello
- Brisighella Community Hospital, Local Health Authority, Romagna, Italy
| | - Michele Arigliani
- Ear, Nose, and Throat Unit, “Vito Fazzi” Hospital, Local Health Authority, Lecce, Italy
| | - Domenico Maurizio Toraldo
- Cardio-Respiratory Unit Care, Department of Rehabilitation, “Vito Fazzi” Hospital, Local Health Authority, Lecce, Italy
| | - Luigi De Benedetto
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
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21
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Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2021; 59:13993003.01649-2021. [PMID: 34561285 DOI: 10.1183/13993003.01649-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate aging and aging related processes; aging may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms (e.g. excessive daytime somnolence, defects in memory and cognition), possible physiological consequences of OSA (e.g. accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in aging. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the above make it essential to review the interaction of OSA and aging, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
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Affiliation(s)
- Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA.,Clinical Research Division, Nathan Kline Institute (NKI), Orangeburg, New York, USA
| | - Miguel Ángel Martínez-García
- Respirology Department, University and Politechnic la Fe Hospital, Valencia, Valencian Community, Spain .,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Zolotoff C, Bertoletti L, Gozal D, Mismetti V, Flandrin P, Roche F, Perek N. Obstructive Sleep Apnea, Hypercoagulability, and the Blood-Brain Barrier. J Clin Med 2021; 10:jcm10143099. [PMID: 34300265 PMCID: PMC8304023 DOI: 10.3390/jcm10143099] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated episodes of intermittent hypoxia (IH) and is recognized as an independent risk factor for vascular diseases that are mediated by a multitude of mechanistic pathophysiological cascades including procoagulant factors. The pro-coagulant state contributes to the development of blood clots and to the increase in the permeability of the blood-brain barrier (BBB). Such alteration of BBB may alter brain function and increase the risk of neurodegenerative diseases. We aim to provide a narrative review of the relationship between the hypercoagulable state, observed in OSA and characterized by increased coagulation factor activity, as well as platelet activation, and the underlying neural dysfunction, as related to disruption of the BBB. We aim to provide a critical overview of the existing evidence about the effect of OSA on the coagulation balance (characterized by increased coagulation factor activity and platelet activation) as on the BBB. Then, we will present the emerging data on the effect of BBB disruption on the risk of underlying neural dysfunction. Finally, we will discuss the potential of OSA therapy on the coagulation balance and the improvement of BBB.
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Affiliation(s)
- Cindy Zolotoff
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
- Correspondence: ; Tel.: +33-477-421-452
| | - Laurent Bertoletti
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, MU Women’s and Children’s Hospital, University of Missouri, Columbia, MO 65201, USA;
| | - Valentine Mismetti
- Service de Pneumologie et d’Oncologie Thoracique, CHU Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France;
| | - Pascale Flandrin
- Laboratoire d’Hématologie, Hôpital Nord, CHU Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France;
| | - Frédéric Roche
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
- Service de Physiologie Clinique et de l’Exercice, Centre VISAS, CHU Saint Etienne, F-42270 Saint-Priest-en-Jarez, France
| | - Nathalie Perek
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
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23
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Colelli DR, Black SE, Masellis M, Lam B, Lim ASP, Boulos MI. Feasibility of unattended home sleep apnea testing in a cognitively impaired clinic population. J Clin Sleep Med 2021; 17:435-444. [PMID: 33094723 DOI: 10.5664/jcsm.8918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) increases the risk of developing dementia. Home sleep apnea testing (HSAT) is a convenient and validated method to screen for OSA among cognitively well individuals; however, it is unknown if it is a clinically feasible and practical approach in clinic patients with cognitive impairment. We evaluated if HSAT was a feasible and practical approach to screen for OSA in clinic patients with cognitive impairment. METHODS Patients with cognitive impairment due to neurodegenerative and/or vascular etiologies completed OSA screening using HSAT. HSAT was considered a feasible technique if ≥ 80% of those who attempted HSAT obtained analyzable data (ie, ≥ 4 hours of flow, effort, and oxygen evaluation), and a practical technique if ≥ 50% of all patients approached for study inclusion obtained analyzable data. RESULTS Of the 119 patients who were approached for participation, 83 were enrolled and offered HSAT; 5 did not complete HSAT screening, and the remaining 78 patients attempted HSAT; mean age (± standard deviation) of 72.86 (± 9.89) years and 46% were male. In those that attempted HSAT, 85.9% (67/78) obtained analyzable data and 56.3% (67/119) of eligible patients approached for study inclusion obtained analyzable data. CONCLUSIONS HSAT is a feasible and practical technique in a clinic population with cognitive impairment. As OSA is a modifiable risk factor for patients with dementia, HSAT has the potential to lead to expedited treatment for OSA, which may potentially improve health-related outcomes such as cognition.
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Affiliation(s)
- David R Colelli
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Benjamin Lam
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Andrew S P Lim
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Mark I Boulos
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Canada
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24
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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: 30] [Impact Index Per Article: 10.0] [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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25
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Sanz-Rubio D, Khalyfa A, Qiao Z, Ullate J, Marin JM, Kheirandish-Gozal L, Gozal D. Cell-Selective Altered Cargo Properties of Extracellular Vesicles Following In Vitro Exposures to Intermittent Hypoxia. Int J Mol Sci 2021; 22:ijms22115604. [PMID: 34070558 PMCID: PMC8198838 DOI: 10.3390/ijms22115604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 01/09/2023] Open
Abstract
Intermittent hypoxia (IH), a hallmark of obstructive sleep apnea (OSA), is associated with cardiovascular and metabolic dysfunction. However, the mechanisms underlying these morbidities remain poorly delineated. Extracellular vesicles (EVs) mediate intercellular communications, play pivotal roles in a multitude of physiological and pathological processes, and could mediate IH-induced cellular effects. Here, the effects of IH on human primary cells and the release of EVs were examined. Microvascular endothelial cells (HMVEC-d), THP1 monocytes, THP1 macrophages M0, THP1 macrophages M1, THP1 macrophages M2, pre-adipocytes, and differentiated adipocytes (HAd) were exposed to either room air (RA) or IH for 24 h. Secreted EVs were isolated and characterized using transmission electron microscopy, nanoparticle tracking analysis, and Western blotting. The effects of each of the cell-derived EVs on endothelial cell (EC) monolayer barrier integrity, on naïve THP1 macrophage polarity, and on adipocyte insulin sensitivity were also evaluated. IH did not alter EVs cell quantal release, but IH-EVs derived from HMVEC-d (p < 0.01), THP1 M0 (p < 0.01) and HAd (p < 0.05) significantly disrupted HMVEC-d monolayer integrity, particularly after H2O2 pre-conditioning. IH-EVs from HMVEC-d and THP1 M0 elicited M2-polarity changes did not alter insulin sensitivity responses. IH induces cell-selective changes in EVs cargo, which primarily seem to target the emergence of endothelial dysfunction. Thus, changes in EVs cargo from selected cell sources in vivo may play causal roles in some of the adverse outcomes associated with OSA.
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Affiliation(s)
- David Sanz-Rubio
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
- Translational Research Unit, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISAragón), 50009 Zaragoza, Spain;
| | - Abdelnaby Khalyfa
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
- Correspondence: ; Tel.: +1-573-884-7685
| | - Zhuanhong Qiao
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - Jorge Ullate
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - José M. Marin
- Translational Research Unit, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISAragón), 50009 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), 28029 Madrid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
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Etindele Sosso FA, Matos E. Socioeconomic disparities in obstructive sleep apnea: a systematic review of empirical research. Sleep Breath 2021; 25:1729-1739. [PMID: 33452999 DOI: 10.1007/s11325-020-02274-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Considering socioeconomic status (SES) in the diagnosis of obstructive sleep apnea (OSA) will enhance our understanding of socioeconomic disparities in clinical practice of sleep medicine. This systematic review analyzes the relations between SES and OSA measures. METHODOLOGY Eleven articles were identified through the Pubmed database. The National Institute of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to rate the quality of these studies. RESULTS This systematic review revealed that associations between socioeconomic status and OSA measures are similar for both adults, children, and adolescents. Our findings showed that: (1) A lower SES is associated with an increased risk of OSA, both in adults and children/adolescents as well as for men and women. (2) Several studies assessed sleep outcomes with a single question, an approach that is unable to capture the multi-dimensionality and day-to-day variability of sleep in general or OSA in particular, (3) Low SES has detrimental effects on sleep health. (4) Sleep questionnaires are more commonly used than objective measure to assess OSA. CONCLUSIONS Interaction between SES and OSA must be better understood to improve current clinical guidelines. Living conditions influence the trajectory of OSA with unknown speed and for an, undetermined period, pointing to the need for more studies on this topic. Future work should identify the effect of SES on the development and progression of OSA, determine the effect of behavioral intervention and local public health programs to reduce social inequalities associated with OSA.
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Affiliation(s)
- F A Etindele Sosso
- Department on Global Health and Ecoepidemiology, Redavi Institute, Montréal, Canada.
| | - E Matos
- Sleep Laboratory of Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro - Vila Real, Vila Real, Portugal
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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: 51] [Impact Index Per Article: 12.8] [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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Abstract
PURPOSE OF REVIEW This review provides a contemporary review of sleep apnea with emphasis on definitions, epidemiology, and consequences. RECENT FINDINGS Amyloid β-42 is one of the main peptides forming amyloid plaques in the brains of Alzheimer patients. Poorer sleep quality and shorter sleep duration have been associated with a higher amyloid burden. Decreased sleep time in the elderly is a precipitating factor in amyloid retention. Studies have shown that the dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of gamma-aminobutyric acid (GABA) and glutamate play a role in sleep disordered breathing (SDB). SUMMARY Untreated sleep disordered breathing (obstructive sleep apnea and/or central sleep apnea) are an important cause of medical mortality and morbidity. OSA is characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep followed by hypoxia and sympathetic activation. Apneic events are terminated by arousal, followed by increases in pulse and blood pressure, and re-oxygenation and the release of inflammatory factors. Individuals with OSA have an increased risk of developing atrial fibrillation. Hypoxemia and poor sleep quality because of OSA increase the risk of cognitive decline in the elderly.
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Berger M, Hirotsu C, Haba-Rubio J, Betta M, Bernardi G, Siclari F, Waeber G, Vollenweider P, Marques-Vidal P, Heinzer R. Risk factors of excessive daytime sleepiness in a prospective population-based cohort. J Sleep Res 2020; 30:e13069. [PMID: 32412149 DOI: 10.1111/jsr.13069] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/01/2023]
Abstract
Although excessive daytime sleepiness is commonly evaluated in clinical and research settings using the Epworth Sleepiness Scale, few studies have assessed the factors associated with its incidence in the general population. We prospectively investigated the predictors of incident and persistent excessive daytime sleepiness in 2,751 subjects (46.1% men, mean age 56.0 ± 9.8 years) from the CoLaus-PsyCoLaus population-based cohort (Lausanne, Switzerland) over 5 years. Participants completed the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, and underwent a full clinical evaluation at baseline and 5 years afterwards. Ambulatory polysomnography was performed at baseline in a sub-sample of 1,404 subjects. Among the 2,438 subjects without excessive daytime sleepiness (Epworth Sleepiness Scale ≤ 10) at baseline, the 5-year incidence of excessive daytime sleepiness was 5.1% (n = 124). Multivariate logistic regression revealed that male sex, depressive symptoms, reported poor sleep quality and moderate to severe obstructive sleep apnea were independent predictors of incident excessive daytime sleepiness, while older age, moderate coffee consumption, periodic leg movement during sleep and hypertension were independent protective factors. Stratified analysis according to sex and age showed some distinctive associations. Among the 313 patients with excessive daytime sleepiness at baseline, 137 (43.8%) had persistent excessive daytime sleepiness 5 years later. Our findings provide new insights into the predictors of incident excessive daytime sleepiness, but interventional studies are needed to understand the impact of treating these risk factors on the incidence of excessive daytime sleepiness.
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Affiliation(s)
- Mathieu Berger
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Gerard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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30
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Carvalho DZ, St Louis EK, Schwarz CG, Lowe VJ, Boeve BF, Przybelski SA, Reddy A, Mielke MM, Knopman DS, Petersen RC, Jack CR, Vemuri P. Witnessed apneas are associated with elevated tau-PET levels in cognitively unimpaired elderly. Neurology 2020; 94:e1793-e1802. [PMID: 32217775 DOI: 10.1212/wnl.0000000000009315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/13/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To assess whether informant-reported apneas during sleep (witnessed apneas) in cognitively unimpaired (CU) elderly persons are associated with higher levels of brain tau. METHODS From the population-based Mayo Clinic Study of Aging, we identified 292 CU elderly ≥65 years of age with both AV-1451 tau-PET and Pittsburgh compound B (PiB)-PET scans and whose bed partners and close relatives had completed a questionnaire that assessed whether participants had witnessed apneas during sleep. For this cross-sectional analysis, we selected the entorhinal and inferior temporal cortices as our regions of interest (ROIs) because they are highly susceptible to tau accumulation. PET signal was scaled to the cerebellum crus to calculate standardized uptake value ratio (SUVR). We fit linear models to assess the association between regional tau and witnessed apneas while controlling for age, sex, years of education, body mass index, hypertension, hyperlipidemia, diabetes, reduced sleep, excessive daytime sleepiness, and global PiB. RESULTS Forty-three participants (14.7%) were found to have witnessed apneas during sleep. The report of witnessed apneas was associated with higher tau-PET SUVR elevation in our ROIs: 0.049 SUVR (95% confidence interval [CI] 0.010-0.087, p = 0.015) in the entorhinal cortex and 0.037 SUVR (95% CI 0.006-0.067, p = 0.019) in the inferior temporal cortex after controlling for confounders. CONCLUSION We identified a significant association between witnessed apneas in CU elderly and elevated tau-PET signal in tau-susceptible brain regions. These results suggest a plausible mechanism that could contribute to cognitive impairment and the development of Alzheimer disease. Longitudinal observations are necessary to determine direction of causality.
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Affiliation(s)
- Diego Z Carvalho
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN.
| | - Erik K St Louis
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Christopher G Schwarz
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Val J Lowe
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Ashritha Reddy
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Departments of Neurology (D.Z.C., E.K.S.L., B.F.B., M.M.M., D.S.K., R.C.P.), Radiology (C.G.S., V.J.L., A.R., C.R.J., P.V.), and Health Sciences Research (S.A.P., M.M.M.), Mayo Clinic, Rochester, MN
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Attier-Zmudka J, Sérot JM, Valluy J, Saffarini M, Douadi Y, Malinowski KP, Balédent O. Sleep Apnea Syndrome in an Elderly Population Admitted to a Geriatric Unit: Prevalence and Effect on Cognitive Function. Front Aging Neurosci 2020; 11:361. [PMID: 31998116 PMCID: PMC6966603 DOI: 10.3389/fnagi.2019.00361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background Sleep apnea leads to cognitive impairment in older patients, but its association with neurodegeneration remains controversial, and most studies do not distinguish between the more common obstructive form (OSAS) and the rarer central form (CSAS). Objective The purpose of this study was to assess the prevalence of the different forms of sleep apnea in a cohort of cognitively impaired elderly patients (>70 years) and to investigate their associations with cognitive deficit, weighted against known risk factors for neurodegeneration. Methods Overnight polygraphy was performed for 76 consecutive patients admitted to our geriatric unit. Their cognitive function was assessed using the Mini Mental-State Exam (MMSE), Mattis Dementia Rating Scale (MDRS) and Stroop test. Multivariable analyses were performed to determine associations between cognitive function and independent variables describing demographics, sleep apnea measures, and cardiovascular risk factors. Results The cohort comprised 58 women and 18 men aged a mean of 84 years (range, 73-96). Sleep apnea syndrome (SAS) was diagnosed in 48 patients (63%), of which 31 (41%) with OSAS and 17 (22%) with CSAS. Multivariable regression analysis revealed that MDRS was lower in patients with OSAS (β = -10.03, p = 0.018), that Stroop Colors and Words delays increased with AHI (β = 0.17, p = 0.030 and β = 0.31, p = 0.047) and that that Stroop Interference delay was higher in patients with CSAS (β = 24.45, p = 0.002). Conclusion Sleep apnea is thus highly prevalent in elderly patients with cognitive impairment. OSAS was associated with lower general cognitive function, while CSAS was only associated with increased Stroop Interference delays. Elderly patients with cognitive deficit could benefit from sleep apnea screening and treatment.
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Affiliation(s)
- Jadwiga Attier-Zmudka
- Department of Gerontology, Saint-Quentin Hospital, Saint-Quentin, France.,CHIMERE, EA 7516 Head & Neck Research Group, University of Picardy Jules Verne, Amiens, France
| | - Jean-Marie Sérot
- Department of Gerontology, Saint-Quentin Hospital, Saint-Quentin, France
| | | | | | - Youcef Douadi
- Department of Pulmonology, Saint-Quentin Hospital, Saint-Quentin, France
| | - Krzysztof Piotr Malinowski
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Olivier Balédent
- CHIMERE, EA 7516 Head & Neck Research Group, University of Picardy Jules Verne, Amiens, France.,BioFlowImage, Image Processing Unit, University Hospital of Amiens, Amiens, France
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32
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Liu W, Cao C, Hu B, Li D, Sun Y, Wu J, Zhang Q. Topological Regularization of Networks in Adult Patients with Moderate-to-Severe Obstructive Sleep Apnea-Hypopnea Syndrome: A Structural MRI Study. Nat Sci Sleep 2020; 12:333-345. [PMID: 32607033 PMCID: PMC7293417 DOI: 10.2147/nss.s248643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) exhibit neurocognitive impairments; however, the neuroimaging mechanism of neurocognitive impairments remains unclear. The aim of this study was to understand the neuroimaging mechanism in adult patients with moderate-to-severe OSAHS, from the perspective of the connectome. PATIENTS AND METHODS Thirty-one untreated patients with moderate-to-severe OSAHS (mean age: 41.23±8.22) were compared with 26 good sleepers (GS) (mean age: 39.50±7.92) matched according to age, gender, handedness, and education level. All subjects underwent thin-slice T1WI scanning of the skull using a 3.0T MRI. Then, a large-scale structural covariance network was constructed based on the gray matter volume extracted from the structural MRI. Graph theory was then used to determine the topological changes in the structural covariance network of OSAHS patients. RESULTS Although small-world networks were retained,the structural covariance network exhibited topological irregularities in regular architecture as evidenced by an increase in the clustering coefficient (p=0.009), transfer coefficient (p=0.029) and local efficiency (p=0.031), and a local increase in the shortest path length (p<0.05) compared with the GS group. Locally, OSAHS patients showed a decrease in nodal betweenness and degree in the left inferior parietal gyrus, left angular gyrus and right anterior cingulate cortex compared with the GS group (p<0.05, uncorrected). In addition, the resistance of structural covariance networks in OSAHS patients to random fault is significantly lower than that of the GS group (p=0.044). CONCLUSION Structural covariance networks are abnormal in terms of multiple network parameters, which provide network-level insight into the neuroimaging mechanism of cognitive impairments in adult OSAHS patients.
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Affiliation(s)
- Wanqing Liu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, People's Republic of China
| | - Chuanlong Cao
- Department of Radiology, Affiliated Xinhua Hospital of Dalian University, Dalian 116001, People's Republic of China
| | - Bing Hu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, People's Republic of China
| | - Danyang Li
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, People's Republic of China
| | - Yumei Sun
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, People's Republic of China
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, People's Republic of China
| | - Qing Zhang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, People's Republic of China
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Bubu OM, Andrade AG, Umasabor-Bubu OQ, Hogan MM, Turner AD, de Leon MJ, Ogedegbe G, Ayappa I, Jean-Louis G G, Jackson ML, Varga AW, Osorio RS. Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 2019; 50:101250. [PMID: 31881487 DOI: 10.1016/j.smrv.2019.101250] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Increasing evidence links cognitive-decline and Alzheimer's disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). With increasing age, there are substantial differences in OSA's prevalence, associated comorbidities and phenotypic presentation. An important question for sleep and AD researchers is whether OSA's heterogeneity results in varying cognitive-outcomes in older-adults compared to middle-aged adults. In this review, we systematically integrated research examining OSA and cognition, mild cognitive-impairment (MCI) and AD/AD biomarkers; including the effects of continuous positive airway pressure (CPAP) treatment, particularly focusing on characterizing the heterogeneity of OSA and its cognitive-outcomes. Broadly, in middle-aged adults, OSA is often associated with mild impairment in attention, memory and executive function. In older-adults, OSA is not associated with any particular pattern of cognitive-impairment at cross-section; however, OSA is associated with the development of MCI or AD with symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment driving these findings. CPAP treatment may be effective in improving cognition in OSA patients with AD. Recent trends demonstrate links between OSA and AD-biomarkers of neurodegeneration across all age-groups. These distinct patterns provide the foundation for envisioning better characterization of OSA and the need for more sensitive/novel sleep-dependent cognitive assessments to assess OSA-related cognitive-impairment.
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Affiliation(s)
- Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Arlener D Turner
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Human Services and Psychology, National Louis University, Chicago, IL, USA
| | - Mony J de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, 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
| | - Girardin Jean-Louis G
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - 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 Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA.
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Gosselin N, Baril AA, Osorio RS, Kaminska M, Carrier J. Obstructive Sleep Apnea and the Risk of Cognitive Decline in Older Adults. Am J Respir Crit Care Med 2019; 199:142-148. [PMID: 30113864 DOI: 10.1164/rccm.201801-0204pp] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Nadia Gosselin
- 1 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,2 Université de Montréal, Montreal, Canada.,3 Canadian Sleep and Circadian Network, Canada
| | - Andrée-Ann Baril
- 1 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,2 Université de Montréal, Montreal, Canada.,3 Canadian Sleep and Circadian Network, Canada
| | - Ricardo S Osorio
- 4 Center for Brain Health, New York University Langone Medical Center, Manhattan, New York.,5 Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York; and
| | - Marta Kaminska
- 3 Canadian Sleep and Circadian Network, Canada.,6 Respiratory Epidemiology and Clinical Research Unit, Respiratory Division and Sleep Laboratory, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Julie Carrier
- 1 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,2 Université de Montréal, Montreal, Canada.,3 Canadian Sleep and Circadian Network, Canada
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Toledo C, Lucero C, Andrade DC, Díaz HS, Schwarz KG, Pereyra KV, Arce-Álvarez A, López NA, Martinez M, Inestrosa NC, Del Rio R. Cognitive impairment in heart failure is associated with altered Wnt signaling in the hippocampus. Aging (Albany NY) 2019; 11:5924-5942. [PMID: 31447429 PMCID: PMC6738419 DOI: 10.18632/aging.102150] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022]
Abstract
Age represents the highest risk factor for death due to cardiovascular disease. Heart failure (HF) is the most common cardiovascular disease in elder population and it is associated with cognitive impairment (CI), diminishing learning and memory process affecting life quality and mortality in these patients. In HF, CI has been associated with inadequate O2 supply to the brain; however, an important subset of HF patients displays CI with almost no alteration in cerebral blood flow. Importantly, nothing is known about the pathophysiological mechanisms underpinning CI in HF with no change in brain tissue perfusion. Here, we aimed to study memory performance and learning function in a rodent model of HF that shows no change in blood flow going to the brain. We found that HF rats presented learning impairments and memory loss. In addition, HF rats displayed a decreased level of Wnt/β-catenin signaling downstream elements in the hippocampus, one pathway implicated largely in aging diseases. Taken together, our results suggest that in HF rats CI is associated with dysfunction of the Wnt/β-catenin signaling pathway. The mechanisms involved in the alterations of Wnt/β-catenin signaling in HF and its contribution to the development/maintenance of CI deserves future investigations.
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Affiliation(s)
- Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Claudia Lucero
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Universidad Mayor, Santiago, Chile
| | - Hugo S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis Arce-Álvarez
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás A López
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milka Martinez
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nibaldo C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
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Yoshimura N, Yonemitsu F, Marmolejo-Ramos F, Ariga A, Yamada Y. Task Difficulty Modulates the Disrupting Effects of Oral Respiration on Visual Search Performance. J Cogn 2019; 2:21. [PMID: 31517239 PMCID: PMC6676927 DOI: 10.5334/joc.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 07/05/2019] [Indexed: 01/11/2023] Open
Abstract
Previous research has suggested that oral respiration may disturb cognitive function and health. The present study investigated whether oral respiration negatively affects visual attentional processing during a visual search task. Participants performed a visual search task in the following three breathing conditions: wearing a nasal plug, wearing surgical tape over their mouths, or no modification (oral vs. nasal vs. control). The participants searched for a target stimulus within different set sizes of distractors in three search conditions (orientation vs colour vs conjunction). Experiment 1 did not show any effect due to respiration. Experiment 2 rigorously manipulated the search efficiency and found that participants required more time to find a poorly discriminable target during oral breathing compared with other breathing styles, which was due to the heightened intercept under this condition. Because the intercept is an index of pre-search sensory processing or motor response in visual search, such cognitive processing was likely disrupted by oral respiration. These results suggest that oral respiration and attentional processing during inefficient visual search share a common cognitive resource.
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Affiliation(s)
- Naoto Yoshimura
- Graduate School of Human-Environment Studies, Kyushu University, JP
- Japan Society for the Promotion of Science, Tokyo, JP
| | - Fumiya Yonemitsu
- Graduate School of Human-Environment Studies, Kyushu University, JP
- Japan Society for the Promotion of Science, Tokyo, JP
| | | | - Atsunori Ariga
- Graduate School of Integrated Arts and Sciences, Hiroshima University, JP
| | - Yuki Yamada
- Faculty of Arts and Science, Kyushu University, JP
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Barletta P, Abreu AR, Ramos AR, Dib SI, Torre C, Chediak AD. Role of Obstructive Sleep Apnea in Cognitive Impairment. INTERNATIONAL JOURNAL OF HEAD AND NECK SURGERY 2019; 10:57-61. [PMID: 34305353 PMCID: PMC8302067 DOI: 10.5005/jp-journals-10001-1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggest that untreated and undertreated OSA increases the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders, like Alzheimer’s disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.
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Affiliation(s)
- Pamela Barletta
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alexandre R Abreu
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto R Ramos
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Salim I Dib
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Carlos Torre
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alejandro D Chediak
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Syndrome d’apnées du sommeil : caractéristiques cliniques des patients atteints dans la population hospitalière de Château-Thierry. Rev Mal Respir 2019; 36:326-332. [DOI: 10.1016/j.rmr.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
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Lee JE, Yang SW, Ju YJ, Ki SK, Chun KH. Sleep-disordered breathing and Alzheimer's disease: A nationwide cohort study. Psychiatry Res 2019; 273:624-630. [PMID: 30735921 DOI: 10.1016/j.psychres.2019.01.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/01/2023]
Abstract
Sleep-disordered breathing (SDB) is common and can lead to significant cognitive decline, such as Alzheimer's disease (AD). Therefore, the present study was conducted to investigate whether SDB is associated with AD onset. This study used the nationwide health check-up cohort data between 2002 and 2015. The study population comprised individuals who were diagnosed with SDB and those without SDB who were matched by using propensity score. The matched cohort was followed up until the onset of AD, death, or end of 2015. A multivariate Cox proportional hazard model was used in the analysis. There were 727 (16.7%) patients in the SDB group between 2002 and 2005 and 3635 subjects (83.3%) in the propensity score-matched non-SDB group. After adjusting for the possible confounding variables, patients with SDB were almost 1.58 times more likely to develop AD than those without SDB (hazard ratio [HR] = 1.575, 95% confidence interval [CI] = 1.013-2.448). The present study showed that SDB was associated with an onset of AD. The findings of this study highlight the importance of the interventions to raise awareness of SDB and the need for the government's support to reduce the barrier in accessing appropriate SDB treatment.
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Affiliation(s)
- Joo Eun Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Republic of Korea
| | - Seong Wu Yang
- Department of Internal Medicine, Jesaeng Hospital, Seongnam, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Republic of Korea
| | - Seung Kuk Ki
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Hong Chun
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.
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Zhao C, Viana A, Ma Y, Capasso R. The effect of aging on drug-induced sleep endoscopy findings. Laryngoscope 2018; 128:2644-2650. [PMID: 30194857 DOI: 10.1002/lary.27265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/03/2018] [Accepted: 04/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the correlation of aging and upper airway collapse characteristics observed by drug-induced sleep endoscopy (DISE), and report the observed differences on obstructive sleep apnea (OSA) subjects, older and younger than 60 years. STUDY DESIGN Case series. METHODS This study analyzed the data of 200 OSA patients who underwent DISE between January 1, 2013 and June 30, 2017. The variables sex, body mass index (BMI), Epworth Sleepiness Scale score, tonsil size, modified Mallampati (MM) classification, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), lowest oxygen saturation, and VOTE (velum, oropharynx, tongue base, epiglottis) classification were compared between two groups: <60 and ≥60 years old. RESULTS Older age had significant correlation with higher AHI, ODI, lower O2 nadir, multisite obstruction, combined upper (palatopharyngeal) + lower (hypopharyngeal) level obstructions, and complete anterior-posterior (AP) velum collapse pattern. Lateral oropharyngeal wall collapse was significantly lower in the older group. Findings remained statistically significant when adjusted for sex, BMI, tonsil size, and MM. CONCLUSIONS Aging was an independent factor that directly correlated with increased AHI and hypoxemia, multisites, combined levels of obstruction, and complete AP velum collapse pattern. Being older than 60 years had higher of complete AP velum collapse and lower incidence of lateral oropharyngeal wall collapse, regardless of OSA severity and tonsil size. LEVEL OF EVIDENCE 4 Laryngoscope, 2644-2650, 2018.
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Affiliation(s)
- Chen Zhao
- Department of Otorhinolaryngology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.,Division of Sleep Surgery, Stanford, California, U.S.A
| | - Alonço Viana
- Division of Sleep Surgery, Stanford, California, U.S.A.,Graduate Program of Neurology, Rio de Janeiro State Federal University, Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A
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Rezaei S, Montazar E, Mousavi SV, Poorabolghasem Hosseini S. Physical Activity and Cognitive Function in the Elderly Population. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2018. [DOI: 10.29252/cjns.4.14.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Greater Cognitive Deficits with Sleep-disordered Breathing among Individuals with Genetic Susceptibility to Alzheimer Disease. The Multi-Ethnic Study of Atherosclerosis. Ann Am Thorac Soc 2018; 14:1697-1705. [PMID: 28731362 DOI: 10.1513/annalsats.201701-052oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE There are conflicting findings regarding the link between sleep apnea and cognitive dysfunction. OBJECTIVES Investigate associations between indicators of sleep-disordered breathing (SDB) and cognitive function in the Multi-Ethnic Study of Atherosclerosis and assess effect modification by the apolipoprotein ε-4 (APOE-ε4) allele. METHODS A diverse population (N = 1,752) underwent type 2 in-home polysomnography, which included measurement of percentage sleep time less than 90% oxyhemoglobin saturation (%Sat < 90%) and apnea-hypopnea index (AHI). Epworth Sleepiness Scale score (ESS) and sleep apnea syndrome (SAS; AHI ≥ 5 and ESS > 10) were also analyzed. Cognitive outcomes included the Cognitive Abilities Screening Instrument; Digit Symbol Coding (DSC) test; and Digit Span Tests (DST) Forward and Backward. RESULTS Participants were 45.4% men, aged 68.1 years (SD, 9.1 yr) with a median AHI of 9.0 and mean ESS of 6.0. Approximately 9.7% had SAS, and 26.8% had at least one copy of the APOE-ε4 allele. In adjusted analyses, a 1-SD increase in %Sat < 90% and ESS score were associated with a poorer attention and memory assessed by the DST Forward score (β = -0.12 [SE, 0.06] and β = -0.13 [SE, 0.06], respectively; P ≤ 0.05). SAS and higher ESS scores were also associated with poorer attention and processing speed as measured by the DSC (β = -0.69 [SE, 0.35] and β = -1.42 [SE, 0.35], respectively; P < 0.05). The presence of APOE-ε4 allele modified the associations of %Sat < 90% with DST forward and of ESS with DSC (Pinteraction ≤ 0.05). CONCLUSIONS Overnight hypoxemia and sleepiness were associated with cognition. The average effect estimates were small, similar to effect estimates for several other individual dementia risk factors. Associations were strongest in APOE-ε4 risk allele carriers. Our results (1) suggest that SDB be considered among a group of modifiable dementia risk factors, and (2) highlight the potential vulnerability of APOE-ε4 risk allele carriers with SDB.
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Moon C, Melah KE, Johnson SC, Bratzke LC. Sleep-disordered breathing, brain volume, and cognition in older individuals with heart failure. Brain Behav 2018; 8:e01029. [PMID: 29920994 PMCID: PMC6043704 DOI: 10.1002/brb3.1029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Sleep-disordered breathing is common in individuals with heart failure and may contribute to changes in the brain and decreased cognition. However, limited research has explored how the apnea-hypopnea index contributes to brain structure and cognition in this population. The aims of this study were to explore how the apnea-hypopnea index is associated with brain volume and cognition in heart failure patients. METHODS Data of 28 heart failure patients (mean age = 67.93; SD = 5.78) were analyzed for this cross-sectional observational study. We evaluated the apnea-hypopnea index using a portable multichannel sleep-monitoring device. All participants were scanned using 3.0 Tesla magnetic resonance imaging and neuropsychological tests. Brain volume was evaluated using a voxel-based morphometry method with T1-weighted images. We used multiple regressions to analyze how the apnea-hypopnea index is associated with brain volume and cognition. RESULTS We found an inverse association between apnea-hypopnea index scores and white matter volume (β = -0.002, p = 0.026), but not in gray matter volume (β = -0.001, p = 0.237). Higher apnea-hypopnea index was associated with reduced regional gray and white matter volume (p < 0.001, uncorrected). Cognitive scores were not associated with the apnea-hypopnea index (p-values were >0.05). CONCLUSION Findings from this study provide exploratory evidence that higher apnea-hypopnea index may be associated with greater brain volume reduction in heart failure patients. Future studies are needed to establish the relationship between sleep-disordered breathing, brain volume, and cognition in heart failure samples.
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Affiliation(s)
- Chooza Moon
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Kelsey E Melah
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
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Sharma RA, Varga AW, Bubu OM, Pirraglia E, Kam K, Parekh A, Wohlleber M, Miller MD, Andrade A, Lewis C, Tweardy S, Buj M, Yau PL, Sadda R, Mosconi L, Li Y, Butler T, Glodzik L, Fieremans E, Babb JS, Blennow K, Zetterberg H, Lu SE, Badia SG, Romero S, Rosenzweig I, Gosselin N, Jean-Louis G, Rapoport DM, de Leon MJ, Ayappa I, Osorio RS. Obstructive Sleep Apnea Severity Affects Amyloid Burden in Cognitively Normal Elderly. A Longitudinal Study. Am J Respir Crit Care Med 2018; 197:933-943. [PMID: 29125327 PMCID: PMC6020410 DOI: 10.1164/rccm.201704-0704oc] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/09/2017] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Recent evidence suggests that obstructive sleep apnea (OSA) may be a risk factor for developing mild cognitive impairment and Alzheimer's disease. However, how sleep apnea affects longitudinal risk for Alzheimer's disease is less well understood. OBJECTIVES To test the hypothesis that there is an association between severity of OSA and longitudinal increase in amyloid burden in cognitively normal elderly. METHODS Data were derived from a 2-year prospective longitudinal study that sampled community-dwelling healthy cognitively normal elderly. Subjects were healthy volunteers between the ages of 55 and 90, were nondepressed, and had a consensus clinical diagnosis of cognitively normal. Cerebrospinal fluid amyloid β was measured using ELISA. Subjects received Pittsburgh compound B positron emission tomography scans following standardized procedures. Monitoring of OSA was completed using a home sleep recording device. MEASUREMENTS AND MAIN RESULTS We found that severity of OSA indices (AHIall [F1,88 = 4.26; P < 0.05] and AHI4% [F1,87 = 4.36; P < 0.05]) were associated with annual rate of change of cerebrospinal fluid amyloid β42 using linear regression after adjusting for age, sex, body mass index, and apolipoprotein E4 status. AHIall and AHI4% were not associated with increases in ADPiB-mask (Alzheimer's disease vulnerable regions of interest Pittsburg compound B positron emission tomography mask) most likely because of the small sample size, although there was a trend for AHIall (F1,28 = 2.96, P = 0.09; and F1,28 = 2.32, not significant, respectively). CONCLUSIONS In a sample of cognitively normal elderly, OSA was associated with markers of increased amyloid burden over the 2-year follow-up. Sleep fragmentation and/or intermittent hypoxia from OSA are likely candidate mechanisms. If confirmed, clinical interventions for OSA may be useful in preventing amyloid build-up in cognitively normal elderly.
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Affiliation(s)
- Ram A. Sharma
- Center for Brain Health, Department of Psychiatry, and
| | - Andrew W. Varga
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Omonigho M. Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
| | | | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ankit Parekh
- College of Engineering, The University of Iowa, Iowa City, Iowa
| | | | | | | | - Clifton Lewis
- Center for Brain Health, Department of Psychiatry, and
| | | | - Maja Buj
- Center for Brain Health, Department of Psychiatry, and
| | - Po L. Yau
- Center for Brain Health, Department of Psychiatry, and
| | - Reem Sadda
- Harlem Hospital–Columbia University Medical Center, New York, New York
| | - Lisa Mosconi
- Center for Brain Health, Department of Psychiatry, and
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, and
| | - Tracy Butler
- Center for Brain Health, Department of Psychiatry, and
| | - Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, and
| | - Els Fieremans
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - James S. Babb
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Kaj Blennow
- Institute of Neuroscience and Psychiatry, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Psychiatry, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Shou E. Lu
- Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey
| | - Sandra G. Badia
- Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institute for Biomedical Research Sant Pau, CIBERSAM, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Sergio Romero
- Biomedical Engineering Research Centre, Department of Automatic Control, Universitat Politècnica de Catalunya, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Barcelona, Spain
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Sleep Disorders Centre, Guy’s and St. Thomas’ Hospital, GSTT NHS Trust, London, United Kingdom
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hospital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; and
- Department of Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York, New York
| | - David M. Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
Increased age is associated with normative declines in both sleep and cognitive functioning. Although there are some inconsistencies in the literature, negative sleep changes are associated with worse cognitive functioning. This negative relationship holds true across normal-sleeping older adults, older adults with insomnia, older adults with sleep disordered breathing, cognitively healthy older adults, and older adults with dementia. There are mixed results regarding potential benefits of sleep treatments on cognitive functions; however, this line of research deserves added attention because the potential mechanisms of action are likely distinct from other interventions to improve cognition.
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Affiliation(s)
- Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Room 306, Box 842018, Richmond, VA 23284-2018, USA.
| | - Natalie Dautovich
- Department of Psychology, Virginia Commonwealth University, 800 West Franklin Street, Room 203, Box 842018, Richmond, VA 23284-2018, USA
| | - Scott Ravyts
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284-2018, USA
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Abstract
Sleep-disordered breathing (SDB) is a highly prevalent chronic disease in older adults. A growing body of evidence demonstrates that SDB in older adults is linked to many adverse cardiovascular, neurocognitive, and metabolic sequelae. However, several unanswered questions remain regarding the diagnosis, consequences, and treatment of SDB in older adults. This review presents the current evidence pertaining to the management of SDB in older adults and identifies crucial gaps in knowledge that need further investigation.
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Affiliation(s)
- Susmita Chowdhuri
- Sleep Medicine Section, John D. Dingell VA Medical Center, Detroit, MI 48201, USA; Department of Medicine, Wayne State University, Detroit, MI 48201, USA.
| | - Pragnesh Patel
- Department of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - M Safwan Badr
- Sleep Medicine Section, John D. Dingell VA Medical Center, Detroit, MI 48201, USA; Department of Medicine, Wayne State University, Detroit, MI 48201, USA
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48
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The Study of Neurocognitive Outcomes, Radiological and Retinal Effects of Aspirin in Sleep Apnoea- rationale and methodology of the SNORE-ASA study. Contemp Clin Trials 2017; 64:101-111. [PMID: 29097299 DOI: 10.1016/j.cct.2017.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Sleep disordered breathing (SDB) is highly prevalent in older adults. Increasing evidence links SDB to the risk of dementia, mediated via a number of pathways, some of which may be attenuated by low-dose aspirin. This study will evaluate, in a healthy older cohort, the prospective relationship between SDB and cognitive function, changes in retinal and cerebral microvasculature, and determine whether low-dose aspirin ameliorates the effects of SDB on these outcomes over 3years. DESIGN SNORE-ASA is a sub-study of the ASPirin in Reducing Events in the Elderly (ASPREE) randomised, multi-centre, placebo-controlled trial evaluating the effect of daily 100mg aspirin on disability-free and dementia-free survival in the healthy older adult aged 70 and over. At baseline, 1400 ASPREE participants successfully underwent a home sleep study with a home sleep study screening device for SDB; and 296 underwent both 1.5 Tesla brain magnetic resonance imaging (MRI) and retinal vascular imaging (RVI). Cognitive testing, brain MRI and RVI is being repeated after 3years. PRIMARY OUTCOME MEASURES Change in the modified mini-mental state examination score. Secondary outcome measures are changes in other cognitive tests, and changes in abnormal parameters on RVI and volume of white matter hyper-intensities on brain MRI. CONCLUSION Identifying preventive therapies for delaying the onset of dementia is of paramount importance. The results of this study will help clarify the impact of the SDB on risk of cognitive decline and cerebral small vessel disease, and whether low-dose aspirin can ameliorate cognitive decline in the setting of SDB. SNORE-ASA TRIAL REGISTRATION ACTRN12612000891820: The Principal ASPREE study is registered with the International Standardized Randomized Controlled Trials Register, ASPirin in Reducing Events in the Elderly, Number: ISRCTN83772183 and clinicaltrials.gov Number NCT01038583.
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49
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Leng Y, McEvoy CT, Allen IE, Yaffe K. Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA Neurol 2017; 74:1237-1245. [PMID: 28846764 PMCID: PMC5710301 DOI: 10.1001/jamaneurol.2017.2180] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/15/2017] [Indexed: 11/14/2022]
Abstract
Importance Growing evidence suggests an association between sleep-disordered breathing (SDB) and cognitive decline in elderly persons. However, results from population-based studies have been conflicting, possibly owing to different methods to assess SDB or cognitive domains, making it difficult to draw conclusions on this association. Objective To provide a quantitative synthesis of population-based studies on the relationship between SDB and risk of cognitive impairment. Data Sources PubMed, EMBASE, and PsychINFO were systematically searched to identify peer-reviewed articles published in English before January 2017 that reported on the association between SDB and cognitive function. Study Selection We included cross-sectional and prospective studies with at least 200 participants with a mean participant age of 40 years or older. Data Extraction and Synthesis Data were extracted independently by 2 investigators. We extracted and pooled adjusted risk ratios from prospective studies and standard mean differences from cross-sectional studies, using random-effect models. This meta-analysis followed the PRISMA guidelines and also adhered to the MOOSE guidelines. Main Outcomes and Measures Cognitive outcomes were based on standard tests or diagnosis of cognitive impairment. Sleep-disordered breathing was ascertained by apnea-hypopnea index or clinical diagnosis. Results We included 14 studies, 6 of which were prospective, covering a total of 4 288 419 men and women. Pooled analysis of the 6 prospective studies indicated that those with SDB were 26% (risk ratio, 1.26; 95% CI, 1.05-1.50) more likely to develop cognitive impairment, with no evidence of publication bias but significant heterogeneity between studies. After removing 1 study that introduced significant heterogeneity, the pooled risk ratio was 1.35 (95% CI, 1.11-1.65). Pooled analysis of the 7 cross-sectional studies suggested that those with SDB had slightly worse executive function (standard mean difference, -0.05; 95% CI, -0.09 to 0.00), with no evidence of heterogeneity or publication bias. Sleep-disordered breathing was not associated with global cognition or memory. Conclusions and Relevance Sleep-disordered breathing is associated with an increased risk of cognitive impairment and a small worsening in executive function. Further studies are required to determine the mechanisms linking these common conditions and whether treatment of SDB might reduce risk of cognitive impairment.
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Affiliation(s)
- Yue Leng
- Department of Psychiatry, University of California,
San Francisco
| | - Claire T. McEvoy
- Department of Psychiatry, University of California,
San Francisco
- School of Medicine, Dentistry, and Biomedical
Sciences, Queen’s University, Belfast, United Kingdom
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics,
University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry, University of California,
San Francisco
- Department of Neurology, University of California, San
Francisco
- Department of Epidemiology, University of California,
San Francisco
- San Francisco VA Medical Center, San Francisco,
California
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50
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Minoves M, Morand J, Perriot F, Chatard M, Gonthier B, Lemarié E, Menut JB, Polak J, Pépin JL, Godin-Ribuot D, Briançon-Marjollet A. An innovative intermittent hypoxia model for cell cultures allowing fast Po2 oscillations with minimal gas consumption. Am J Physiol Cell Physiol 2017; 313:C460-C468. [DOI: 10.1152/ajpcell.00098.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 01/13/2023]
Abstract
Performing hypoxia-reoxygenation cycles in cell culture with a cycle duration accurately reflecting what occurs in obstructive sleep apnea (OSA) patients is a difficult but crucial technical challenge. Our goal was to develop a novel device to expose multiple cell culture dishes to intermittent hypoxia (IH) cycles relevant to OSA with limited gas consumption. With gas flows as low as 200 ml/min, our combination of plate holders with gas-permeable cultureware generates rapid normoxia-hypoxia cycles. Cycles alternating 1 min at 20% O2 followed by 1 min at 2% O2 resulted in Po2 values ranging from 124 to 44 mmHg. Extending hypoxic and normoxic phases to 10 min allowed Po2 variations from 120 to 25 mmHg. The volume of culture medium or the presence of cells only modestly affected the Po2 variations. In contrast, the nadir of the hypoxia phase increased when measured at different heights above the membrane. We validated the physiological relevance of this model by showing that hypoxia inducible factor-1α expression was significantly increased by IH exposure in human aortic endothelial cells, murine breast carcinoma (4T1) cells as well as in a blood-brain barrier model (2.5-, 1.5-, and 6-fold increases, respectively). In conclusion, we have established a new device to perform rapid intermittent hypoxia cycles in cell cultures, with minimal gas consumption and the possibility to expose several culture dishes simultaneously. This device will allow functional studies of the consequences of IH and deciphering of the molecular biology of IH at the cellular level using oxygen cycles that are clinically relevant to OSA.
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Affiliation(s)
- Mélanie Minoves
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
| | - Jessica Morand
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
| | - Frédéric Perriot
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
| | - Morgane Chatard
- Université de Lyon and Université Jean Monnet, Saint-Etienne, France
| | - Brigitte Gonthier
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
| | - Emeline Lemarié
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
| | | | - Jan Polak
- Center for Research on Diabetes, Metabolism and Nutrition Third Faculty of Medicine, Charles University, Prague, Czech Republic; and
| | - Jean-Louis Pépin
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
- Centre Hospitalier Universitaire, Grenoble, France
| | - Diane Godin-Ribuot
- HP2 Laboratory, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042, Grenoble, France
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