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Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study.

ABSTRACT: STUDY OBJECTIVES:Sleep related breathing disorders (SRBD) are risk factors for cognitive dysfunction in middle-aged subjects, but this association has not been observed in the elderly. We assess the impact of SRBD on cognitive performance in a large cohort of healthy elderly subjects. DESIGN:Cross-sectional study examining the association between subjective memory test, neuropsychological battery testing and SRBD in the elderly. SETTING:Community-based sample in home and research clinical settings. PARTICIPANTS:827 subjects, 58.5% women, aged 68 y at study entry, participated in the study. All were free of previously diagnosed SRBD, coronary heart disease, and neurological disorders, including stroke and dementia. Clinical interview, neurological assessment, polygraphy, and extensive cognitive testing were conducted for all participants. INTERVENTION:N/A. MEASUREMENT AND RESULTS:SRBD (apnea-hypopnea index [AHI] > 15 events/h) was diagnosed in 445 (53%) subjects, 167 (37%) of them with AHI > 30. Minimal daytime sleepiness was found in the group; 9.2% of the population had an Epworth Sleepiness Scale score > 10. No significant association was found between AHI, nocturnal hypoxemia, and cognitive scores. Comparison of mild vs severe cases showed a trend toward lower cognitive scores with AHI > 30, affecting delayed recall and Stroop test. CONCLUSIONS:The impact of undiagnosed SRBD on cognitive function appeared quite limited in a generally older healthy population, and only slightly affected severe cases. The implication of undiagnosed SRBD on the cognitive impairment in elderly subjects remains hypothetical and needs to be prospectively studied.

SUBMITTER: Sforza E

PROVIDER: S-EPMC2849791 | biostudies-literature | 2010 Apr

REPOSITORIES: biostudies-literature

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Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study.

Sforza Emilia E Roche Frédéric F Thomas-Anterion Catherine C Kerleroux Judith J Beauchet Olivier O Celle Sébastien S Maudoux Delphine D Pichot Vincent V Laurent Bernard B Barthélémy Jean Claude JC

Sleep 20100401 4

<h4>Study objectives</h4>Sleep related breathing disorders (SRBD) are risk factors for cognitive dysfunction in middle-aged subjects, but this association has not been observed in the elderly. We assess the impact of SRBD on cognitive performance in a large cohort of healthy elderly subjects.<h4>Design</h4>Cross-sectional study examining the association between subjective memory test, neuropsychological battery testing and SRBD in the elderly.<h4>Setting</h4>Community-based sample in home and re ...[more]

PMID: 20394321

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Project description:IntroductionSleep related breathing disorders (SRBD) are associated with both obesity and systemic inflammation. While the relationship between obesity and SRBD is established, the causality between inflammation and SRBD remains unclear. In this study we investigated the relation between SRBD and C-reactive protein (CRP) as a parameter of inflammation and the influence of SRBD treatment on CRP with additional regard to changes in metabolic and cardiovascular parameters.MethodsPolysomnography (PSG) and laboratory data of patients diagnosed with SRBD over a period of 5 years were prospectively collected in a database and retrospectively analysed regarding the association of SRBD (according to apnoea-hypopnoea- index (AHI), duration of events and extent of desaturation) to CRP, blood pressure, cholesterol, fasting plasma glucose, HbA1c, quality of life measured via a visual analogue scale (VAS 0-100%), and the effects of SRBD therapy on these parameters.Results716 patients were included in the study, 171 with mild SRBD (AHI ≥5 to <15/h), 209 with moderate SRBD (AHI 15 to <30/h), 336 with severe SRBD (AHI ≥30/h). Results according to severity of SRBD. Severe SRBD was significantly associated with elevated levels of CRP (3.7 [1.8-7.0] mg/l, vs. moderate (p = 0.001), and mild SRBD (p<0.001), and higher prevalence of hypertension as compared to moderate and mild SRBD (p<0.001, respectively). Results in highly successful treatment. If SRBD treatment was highly successful (AHI <5/h), CRP and quality of life improved significantly (p = 0.001 and p = 0.002), as did blood pressure (p<0.001 for systolic and diastolic values), although BMI increased (p<0.001). Results in partially successful treatment. If success was defined as reduction of AHI of ≥50%, CRP also decreased (p<0.001), as did blood pressure (p<0.001). Again, BMI increased (p<0.001).ConclusionThis is the first study to show an association of SRBD and CRP independently of BMI in a large cohort. The SRBD therapy-induced CRP decrease was not associated with BMI changes or metabolic changes but rather with the magnitude of AHI improvement.

Project description:Importance:Evidence shows that sleep dysfunction and ?-amyloid (A?) deposition work synergistically to impair brain function in individuals with normal cognition, increasing the risk of developing dementia later in life. However, whether A? continues to play an integral role in sleep dysfunction after the onset of cognitive decline in individuals with dementia is unclear. Objective:To determine whether A? deposition in the brain is associated with subjective measures of sleep quality and cognition in elderly individuals with cognitive disorders. Design, Setting, and Participants:A nested survey study was conducted at the Cognitive Disorders and Comprehensive Alzheimer Disease Center of Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Participants included patients aged 65 years and older with cognitive disorders verified by neuropsychological testing. Eligible participants were identified from a referral center-based sample of patients who underwent fluorine 18-labeled florbetaben positron emission tomography imaging at Thomas Jefferson University Hospital as part of the multicenter Imaging Dementia-Evidence for Amyloid Scanning study. Data collection and analysis occurred between November 2018 and March 2019. Main Outcomes and Measures:Sleep quality was measured via responses to sleep questionnaires, A? deposition was measured via fluorine 18-labeled florbetaben positron emission tomography, and cognition was measured via Mini-Mental State Examination (MMSE) performance. Results:Of the 67 eligible participants, 52 (77.6%) gave informed consent to participate in the study. Of the 52 enrolled participants (mean [SD] age, 76.6 [7.4] years), 27 (51.9%) were women. Daytime sleepiness was associated with A? deposition in the brainstem (B?=?0.0063; 95% CI, 0.001 to 0.012; P?=?.02), but not MMSE performance (B?=?-0.01; 95% CI, -0.39 to 0.37; P?=?.96). The number of nocturnal awakenings was associated with A? deposition in the precuneus (B?=?0.11; 95% CI, 0.06 to 0.17; P?<?.001) and poor MMSE performance (B?=?-2.13; 95% CI, -3.13 to -1.13; P?<?.001). Mediation analysis demonstrated an indirect association between A? deposition and poor MMSE performance that relied on nocturnal awakenings as an intermediary (B?=?-3.99; 95% CI, -7.88 to -0.83; P?=?.01). Conclusions and Relevance:Nighttime sleep disruption may mediate the association between A? and cognitive impairment, suggesting that there is an underlying sleep-dependent mechanism that links A? burden in the brain to cognitive decline. Further elucidation of this mechanism may improve understanding of disease processes associated with A? accumulation.

Project description:ImportanceGrowing 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.ObjectiveTo provide a quantitative synthesis of population-based studies on the relationship between SDB and risk of cognitive impairment.Data sourcesPubMed, 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 selectionWe included cross-sectional and prospective studies with at least 200 participants with a mean participant age of 40 years or older.Data extraction and synthesisData 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 measuresCognitive outcomes were based on standard tests or diagnosis of cognitive impairment. Sleep-disordered breathing was ascertained by apnea-hypopnea index or clinical diagnosis.ResultsWe 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 relevanceSleep-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.

Dataset Information

Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study.

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Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study.

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