Sleep disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women

By Kristine Yaffe, Alison M Laffan, S. Harrison, S. Redline, A. Spira, K. Ensrud, S. Ancoli-Israel, Katie L. Stone. Journal of the American Medical Association (JAMA), 2011

1,093 citations recorded by the source corpus.

Context Sleep-disordered breathing (SDB), characterized by recurrent arousals from sleep and intermittent hypoxemia, is common among older adults. Cross-sectional studies have linked SDB to poor cognition; however, it remains unclear whether sleep disordered breathing precedes cognitive impairment in older adults. Objectives To determine the prospective relationship between sleep disordered breathing and cognitive impairment and to investigate potential mechanisms of this association. Design, Setting, and Participants Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography (PSG) measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep disordered breathing with risk of mild cognitive impairment or dementia and adjustments were made for age, race, body mass index, education, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or non-benzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Main Outcome Measures Adjudicated cognitive status (normal, dementia, or mild cognitive impairment [MCI]) based on data collected between November 2006 and September 2008 Results Compared with the 193 women without sleep disordered breathing, the 105 women (35.2%) with SDB were more likely to develop MCI/dementia (n=60 (31.1%) vs n=47 (44.8%)) even after multivariate adjustment (adjusted OR=1.85, 95% CI 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage (>7%) of sleep time in apnea or hypopnea, both measures of disordered breathing, were associated with risk of developing MCI/dementia (adjusted OR=1.71, 95% CI 1.04 − 2.83 and adjusted OR=2.04, 95% CI 1.10 − 3.78, respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Conclusions Among older women, those with sleep disordered breathing, compared with those without SDB, were associated with an increased risk of developing cognitive impairment.

Subfields: Endocrine and Autonomic Systems, Experimental and Cognitive Psychology, Physiology

View Paper: https://www.semanticscholar.org/paper/1bdb9e1a4f1775ec55606dae7185c51c0a5b194c

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Endocrine and Autonomic Systems

1. T. Young
2. Paul E. Peppard
3. K. Hla
4. Mari Palta
5. E. Hagen
6. J. Barnet
7. Naresh M. Punjabi
8. Atul Malhotra

In Experimental and Cognitive Psychology

1. T. Young
2. Paul E. Peppard
3. Naresh M. Punjabi
4. D. Gottlieb
5. Atul Malhotra

In Physiology

1. D. Holtzman
2. T. Young
3. J. Long
4. Paul E. Peppard
5. John C. Morris
6. K. Hla
7. Mari Palta
8. E. Hagen

Citations in the corpus

• Increased prevalence of sleep-disordered breathing in adults. (2013, background): “The estimated increases translate to millions of additional afflicted persons in the United States, and, consequently, incidences of sequelae of SDB, such as cardiovascular morbidities and stroke (1, 33, 34), cognitive decline (4), depression (7), and premature death (8, 9), are likely accelerated r”
• Sleep quality and preclinical Alzheimer Disease (2013, positive): “poxia, increased the prospective risk of dementia in a cohort of elderly women.(18) In mouse models of AD, chronic”
• Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population‐based perspective (2015, neutral): “[129] Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, et al.”
• Alzheimer Disease: An Update on Pathobiology and Treatment Strategies (2019, positive): “Women with sleep disordered breathing have a higher risk of developing MCI or dementia relative to non-sleep disordered breathing patients (Yaffe et al., 2011).”