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Baran B, Lee EE. Age-Related Changes in Sleep and Its Implications for Cognitive Decline in Aging Persons With Schizophrenia: A Critical Review. Schizophr Bull 2024:sbae059. [PMID: 38713085 DOI: 10.1093/schbul/sbae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive impairment is a core feature of schizophrenia that worsens with aging and interferes with quality of life. Recent work identifies sleep as an actionable target to alleviate cognitive deficits. Cardinal non-rapid eye movement (NREM) sleep oscillations such as sleep spindles and slow oscillations are critical for cognition. People living with schizophrenia (PLWS) and their first-degree relatives have a specific reduction in sleep spindles and an abnormality in their temporal coordination with slow oscillations that predict impaired memory consolidation. While NREM oscillatory activity is reduced in typical aging, it is not known how further disruption in these oscillations contributes to cognitive decline in older PLWS. Another understudied risk factor for cognitive deficits among older PLWS is obstructive sleep apnea (OSA) which may contribute to cognitive decline. STUDY DESIGN We conducted a narrative review to examine the published literature on aging, OSA, and NREM sleep oscillations in PLWS. STUDY RESULTS Spindles are propagated via thalamocortical feedback loops, and this circuitry shows abnormal hyperconnectivity in schizophrenia as revealed by structural and functional MRI studies. While the risk and severity of OSA increase with age, older PLWS are particularly vulnerable to OSA-related cognitive deficits because OSA is often underdiagnosed and undertreated, and OSA adds further damage to the circuitry that generates NREM sleep oscillations. CONCLUSIONS We highlight the critical need to study NREM sleep in older PWLS and propose that identifying and treating OSA in older PLWS will provide an avenue to potentially mitigate and prevent cognitive decline.
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Affiliation(s)
- Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Ricciardiello A, McKinnon AC, Mowszowski L, LaMonica HM, Schrire ZM, Haroutonian C, Lam A, Hickie IB, D'Rozario A, Naismith SL. Assessing sleep architecture and cognition in older adults with depressive symptoms attending a memory clinic. J Affect Disord 2024; 348:35-43. [PMID: 38123073 DOI: 10.1016/j.jad.2023.12.032] [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: 07/13/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While depression is intrinsically and bidirectionally linked with both sleep disturbance and cognition, the inter-relationships between sleep, cognition, and brain integrity in older people with depression, especially those with late-onset depression are undefined. METHODS One hundred and seventy-two older adults (mean age 64.3 ± 6.9 years, Depression: n = 66, Control: n = 106) attending a memory clinic underwent a neuropsychological battery of declarative memory, executive function tasks, cerebral magnetic resonance imaging and overnight polysomnography with quantitative electroencephalography. RESULTS The time spent in slow-wave sleep (SWS) and rapid eye movement (REM) sleep, slow-wave activity, sleep spindles, hippocampal volume and prefrontal cortex thickness did not differ between depression and control and depression onset groups. However, sleep onset latency (p = 0.005) and REM onset latency (p = 0.02) were later in the Depression group compared to controls. Less SWS was associated with poorer memory (r = 0.31, p = 0.023) in the depression group, and less SWS was related to better memory in the control group (r = -0.20, p = 0.043; Fishers r-to-z = -3.19). LIMITATIONS Longitudinal studies are needed to determine if changes in sleep in those with depressive symptoms predict cognitive decline and illness trajectory. CONCLUSION Older participants with depressive symptoms had delayed sleep initiation, suggestive of delayed sleep phase. The association between SWS and memory suggests SWS may be a useful target for cognitive intervention in older adults with depression symptoms. Reduced hippocampal volumes did not mediate this relationship, indicating a broader distributed neural network may underpin these associations.
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Affiliation(s)
- Andrea Ricciardiello
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia.
| | - Andrew C McKinnon
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Loren Mowszowski
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Haley M LaMonica
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Zoe Menczel Schrire
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Carla Haroutonian
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia
| | - Aaron Lam
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ian B Hickie
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Angela D'Rozario
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
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3
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Orlando IF, O'Callaghan C, Lam A, McKinnon AC, Tan JBC, Michaelian JC, Kong SDX, D'Rozario AL, Naismith SL. Sleep spindle architecture associated with distinct clinical phenotypes in older adults at risk for dementia. Mol Psychiatry 2024; 29:402-411. [PMID: 38052981 PMCID: PMC11116104 DOI: 10.1038/s41380-023-02335-1] [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: 07/04/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
Sleep spindles are a hallmark of non-REM sleep and play a fundamental role in memory consolidation. Alterations in these spindles are emerging as sensitive biomarkers for neurodegenerative diseases of ageing. Understanding the clinical presentations associated with spindle alterations may help to elucidate the functional role of these distinct electroencephalographic oscillations and the pathophysiology of sleep and neurodegenerative disorders. Here, we use a data-driven approach to examine the sleep, memory and default mode network connectivity phenotypes associated with sleep spindle architecture in older adults (mean age = 66 years). Participants were recruited from a specialist clinic for early diagnosis and intervention for cognitive decline, with a proportion showing mild cognitive deficits on neuropsychological testing. In a sample of 88 people who underwent memory assessment, overnight polysomnography and resting-state fMRI, a k-means cluster analysis was applied to spindle measures of interest: fast spindle density, spindle duration and spindle amplitude. This resulted in three clusters, characterised by preserved spindle architecture with higher fast spindle density and longer spindle duration (Cluster 1), and alterations in spindle architecture (Clusters 2 and 3). These clusters were further characterised by reduced memory (Clusters 2 and 3) and nocturnal hypoxemia, associated with sleep apnea (Cluster 3). Resting-state fMRI analysis confirmed that default mode connectivity was related to spindle architecture, although directionality of this relationship differed across the cluster groups. Together, these results confirm a diversity in spindle architecture in older adults, associated with clinically meaningful phenotypes, including memory function and sleep apnea. They suggest that resting-state default mode connectivity during the awake state can be associated with sleep spindle architecture; however, this is highly dependent on clinical phenotype. Establishing relationships between clinical and neuroimaging features and sleep spindle alterations will advance our understanding of the bidirectional relationships between sleep changes and neurodegenerative diseases of ageing.
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Affiliation(s)
- Isabella F Orlando
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Aaron Lam
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew C McKinnon
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Joshua B C Tan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Johannes C Michaelian
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Shawn D X Kong
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Angela L D'Rozario
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia.
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia.
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D'Rozario AL, Kao CH, Phillips CL, Mullins AE, Memarian N, Yee BJ, Duffy SL, Cho G, Wong KKH, Kremerskothen K, Chapman J, Haroutonian C, Bartlett DJ, Naismith SL, Grunstein RR. Region-specific changes in brain activity and memory after continuous positive airway pressure therapy in obstructive sleep apnea: a pilot high-density electroencephalography study. Sleep 2023; 46:zsad255. [PMID: 37777337 DOI: 10.1093/sleep/zsad255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/24/2023] [Indexed: 10/02/2023] Open
Abstract
STUDY OBJECTIVES Limited channel electroencephalography (EEG) investigations in obstructive sleep apnea (OSA) have revealed deficits in slow wave activity (SWA) and spindles during sleep and increased EEG slowing during resting wakefulness. High-density EEG (Hd-EEG) has also detected local parietal deficits in SWA (delta power) during NREM. It is unclear whether effective continuous positive airway pressure (CPAP) treatment reverses regional SWA deficits, and other regional sleep and wake EEG abnormalities, and whether any recovery relates to improved overnight memory consolidation. METHODS A clinical sample of men with moderate-severe OSA underwent sleep and resting wake recordings with 256-channel Hd-EEG before and after 3 months of CPAP. Declarative and procedural memory tasks were administered pre- and post-sleep. Topographical spectral power maps and differences between baseline and treatment were compared using t-tests and statistical nonparametric mapping (SnPM). RESULTS In 11 compliant CPAP users (5.2 ± 1.1 hours/night), total sleep time did not differ after CPAP but N1 and N2 sleep were lower and N3 was higher. Centro-parietal gamma power during N3 increased and fronto-central slow spindle activity during N2 decreased (SnPM < 0.05). No other significant differences in EEG power were observed. When averaged specifically within the parietal region, N3 delta power increased after CPAP (p = 0.0029) and was correlated with the change in overnight procedural memory consolidation (rho = 0.79, p = 0.03). During resting wakefulness, there were trends for reduced delta and theta power. CONCLUSIONS Effective CPAP treatment of OSA may correct regional EEG abnormalities, and regional recovery of SWA may relate to procedural memory improvements in the short term.
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Affiliation(s)
- Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Chien-Hui Kao
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Craig L Phillips
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Anna E Mullins
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, New York City, NY, USA
| | - Negar Memarian
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Brendon J Yee
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Shantel L Duffy
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Garry Cho
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Kyle Kremerskothen
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Julia Chapman
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Carla Haroutonian
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ron R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
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5
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Gao J, Cao J, Chen J, Wu D, Luo K, Shen G, Fang Y, Zhang W, Huang G, Su X, Zhao L. Brain morphology and functional connectivity alterations in patients with severe obstructive sleep apnea. Sleep Med 2023; 111:62-69. [PMID: 37722341 DOI: 10.1016/j.sleep.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND It has been demonstrated that widespread structural and functional brain alterations influence the development of cognitive impairment in patients with obstructive sleep apnea (OSA). However, the literature has limited evidence regarding the neuropathophysiological mechanisms behind these impairments. This research aimed to investigate brain morphologic and functional connectivity (FC) abnormalities related to neurocognitive function in OSA. METHODS Fifty treatment-naïve males, newly diagnosed patients with severe OSA, and 50 well-matched healthy controls (HCs) were enrolled prospectively. All subjects underwent an MRI scan, cognitive psychological and sleep scale assessment. The differences of brain morphological and seed-based FC between the two groups were compared. The correlation analysis and receiver operating characteristic curve were performed for further analysis. RESULTS Compared with HCs, the right brainstem, left dorsal-lateral superior frontal gyrus (SFGdor), and superior temporal gyrus (STG) exhibited atrophy in the OSA group. In addition, FC between the left SFGdor and the right postcentral gyrus (PoCG) was increased, which was positively correlated with disease duration (r = 0.312, FDR-corrected P = 0.027). The Jacobian values of the brainstem were negatively correlated with MoCA and recall scores (r = -0.449, FDR-corrected P = 0.0025; r = -0.416, FDR-corrected P = 0.005). Furthermore, the Jacobian values of the left SFGdor demonstrated a relatively high diagnostic performance (sensitivity: 86%, specificity: 56%, AUC: 0.740, 95% CI: 0.643-0.836, P < 0.0001). CONCLUSIONS Structural atrophy in brainstem and frontotemporal lobe and altered FC may be the neurobiological hallmark of brain impairment in OSA. Notably, brainstem atrophy has been associated with cognitive impairment, which may provide new insights into understanding the neuropathophysiological mechanisms of cognitive impairment in OSA patients.
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Affiliation(s)
- Jing Gao
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Jiancang Cao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jieyu Chen
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Dan Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Ke Luo
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Guo Shen
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, China
| | - Yanyan Fang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenwen Zhang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Xiaoyan Su
- Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Lianping Zhao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Parker JL, Appleton SL, Adams RJ, Melaku YA, D'Rozario AL, Wittert GA, Martin SA, Catcheside PG, Lechat B, Teare AJ, Toson B, Vakulin A. The association between sleep spindles and cognitive function in middle-aged and older men from a community-based cohort study. Sleep Health 2023; 9:774-785. [PMID: 37268483 DOI: 10.1016/j.sleh.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Previous studies examining associations between sleep spindles and cognitive function attempted to account for obstructive sleep apnea without consideration for potential moderating effects. To elucidate associations between sleep spindles, cognitive function, and obstructive sleep apnea, this study of community-dwelling men examined cross-sectional associations between sleep spindle metrics and daytime cognitive function outcomes following adjustment for obstructive sleep apnea and potential obstructive sleep apnea moderating effects. METHODS Florey Adelaide Male Ageing Study participants (n = 477, 41-87 years) reporting no previous obstructive sleep apnea diagnosis underwent home-based polysomnography (2010-2011). Cognitive testing (2007-2010) included the inspection time task (processing speed), trail-making tests A (TMT-A) (visual attention) and B (trail-making test-B) (executive function), and Fuld object memory evaluation (episodic memory). Frontal spindle metrics (F4-M1) included occurrence (count), average frequency (Hz), amplitude (µV), and overall (11-16 Hz), slow (11-13 Hz), and fast (13-16 Hz) spindle density (number/minute during N2 and N3 sleep). RESULTS In fully adjusted linear regression models, lower N2 sleep spindle occurrence was associated with longer inspection times (milliseconds) (B = -0.43, 95% confidence interval [-0.74, -0.12], p = .006), whereas higher N3 sleep fast spindle density was associated with worse TMT-B performance (seconds) (B = 18.4, 95% confidence interval [1.62, 35.2], p = .032). Effect moderator analysis revealed that in men with severe obstructive sleep apnea (apnea-hypopnea index ≥30/hour), slower N2 sleep spindle frequency was associated with worse TMT-A performance (χ2 = 12.5, p = .006). CONCLUSIONS Specific sleep spindle metrics were associated with cognitive function, and obstructive sleep apnea severity moderated these associations. These observations support the utility of sleep spindles as useful cognitive function markers in obstructive sleep apnea, which warrants further longitudinal investigation.
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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.
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia; Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.
| | - Gary A Wittert
- Australian Institute of Family Studies, Melbourne, Victoria, Australia; Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Sean A Martin
- Australian Institute of Family Studies, Melbourne, Victoria, Australia; Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.
| | - Alison J Teare
- 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.
| | - 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.
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7
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Matorina N, Tseng J, Ladyka-Wojcik N, Olsen R, Mabbott DJ, Barense MD. Sleep Differentially and Profoundly Impairs Recall Memory in a Patient with Fornix Damage. J Cogn Neurosci 2023; 35:1635-1655. [PMID: 37584584 DOI: 10.1162/jocn_a_02038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
In March 2020, C.T., a kind, bright, and friendly young woman underwent surgery for a midline tumor involving her septum pellucidum and extending down into her fornices bilaterally. Following tumor diagnosis and surgery, C.T. experienced significant memory deficits: C.T.'s family reported that she could remember things throughout the day, but when she woke up in the morning or following a nap, she would expect to be in the hospital, forgetting all the information that she had learned before sleep. The current study aimed to empirically validate C.T.'s pattern of memory loss and explore its neurological underpinnings. On two successive days, C.T. and age-matched controls watched an episode of a TV show and took a nap or stayed awake before completing a memory test. Although C.T. performed numerically worse than controls in both conditions, sleep profoundly exacerbated her memory impairment, such that she could not recall any details following a nap. This effect was replicated in a second testing session. High-resolution MRI scans showed evidence of the trans-callosal surgical approach's impact on the mid-anterior corpus callosum, indicated that C.T. had perturbed white matter particularly in the right fornix column, and demonstrated that C.T.'s hippocampal volumes did not differ from controls. These findings suggest that the fornix is important for processing episodic memories during sleep. As a key output pathway of the hippocampus, the fornix may ensure that specific memories are replayed during sleep, maintain the balance of sleep stages, or allow for the retrieval of memories following sleep.
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Affiliation(s)
| | - Julie Tseng
- Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Donald J Mabbott
- University of Toronto, Ontario, Canada
- Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Morgan D Barense
- University of Toronto, Ontario, Canada
- Rotman Research Institute, Toronto, Ontario, Canada
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8
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Teh JZ, Grummitt L, Haroutonian C, Cross NE, Skinner B, Bartlett DJ, Yee B, Grunstein RR, Naismith SL, D’Rozario AL. Overnight declarative memory consolidation and non-rapid eye movement sleep electroencephalographic oscillations in older adults with obstructive sleep apnea. Sleep 2023; 46:zsad087. [PMID: 37052122 PMCID: PMC10666962 DOI: 10.1093/sleep/zsad087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/01/2023] [Indexed: 04/14/2023] Open
Abstract
STUDY OBJECTIVES To compare overnight declarative memory consolidation and non-rapid eye movement (NREM) sleep electroencephalogram (EEG) oscillations in older adults with obstructive sleep apnea (OSA) to a control group and assess slow-wave activity (SWA) and sleep spindles as correlates of memory consolidation. METHODS Forty-six older adults (24 without OSA and 22 with OSA) completed a word-pair associate's declarative memory task before and after polysomnography. Recall and recognition were expressed as a percentage of the morning relative to evening scores. Power spectral analysis was performed on EEG recorded at frontal (F3-M2, F4-M1) and central (C3-M2, C4-M1) sites. We calculated NREM absolute slow oscillation (0.25-1 Hz) and delta (0.5-4.5 Hz) EEG power, and slow (11-13 Hz) spindle density (number of events per minute of N2 sleep) and fast (13-16 Hz) spindle density. RESULTS There were no significant differences in overnight recall and recognition between OSA (mean age 58.7 ± 7.1 years, apnea-hypopnea index (AHI) 41.9 ± 29.7 events/hour) and non-OSA (age 61.1 ± 10.3 years, AHI 6.6 ± 4.2 events/hour) groups. The OSA group had lower fast spindle density in the frontal region (p = 0.007). No between-group differences in SWA were observed. In the Control group, overnight recognition positively correlated with slow spindle density in frontal (rho = 0.555, p = 0.020) and central regions (rho = 0.490, p = 0.046). Overnight recall was not related to SWA or spindle measures in either group. CONCLUSIONS Older adults with OSA had deficits in fast sleep spindles but showed preserved overnight declarative memory consolidation. It is possible that compensatory mechanisms are being recruited by OSA patients to preserve declarative memory consolidation despite the presence of sleep spindle deficits.
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Affiliation(s)
- Jun Z Teh
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Lucinda Grummitt
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Carla Haroutonian
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Nathan E Cross
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Bradley Skinner
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Brendon Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Angela L D’Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
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9
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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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10
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Associations between objectively measured sleep parameters and cognition in healthy older adults: A meta-analysis. Sleep Med Rev 2023; 67:101734. [PMID: 36577339 DOI: 10.1016/j.smrv.2022.101734] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Multiple studies have examined associations between sleep and cognition in older adults, but a majority of these depend on self-reports on sleep and utilize cognitive tests that assess overall cognitive function. The current meta-analysis involved 72 independent studies and sought to quantify associations between objectively measured sleep parameters and cognitive performance in healthy older adults. Both sleep macrostructure (e.g., sleep duration, continuity, and stages) and microstructure (e.g., slow wave activity and spindle activity) were evaluated. For macrostructure, lower restlessness at night was associated with better memory performance (r = 0.43, p = 0.02), while lower sleep onset latency was associated with better executive functioning (r = 0.28, p = 0.03). Greater relative amount of N2 and REM sleep, but not N3, positively correlated with cognitive performance. The association between microstructure and cognition in older adults was marginally significant. This relationship was moderated by age (z = 0.07, p < 0.01), education (z = 0.26, p = 0.03), and percentage of female participants (z = 0.01, p < 0.01). The current meta-analysis emphasizes the importance of considering objective sleep measures to understand the relationship between sleep and cognition in healthy older adults. These results also form a base from which researchers using wearable sleep technology and measuring behavior through computerized testing tools can evaluate their findings.
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11
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Lafrenière A, Lina JM, Hernandez J, Bouchard M, Gosselin N, Carrier J. Sleep slow waves' negative-to-positive-phase transition: a marker of cognitive and apneic status in aging. Sleep 2023; 46:zsac246. [PMID: 36219687 PMCID: PMC9832517 DOI: 10.1093/sleep/zsac246] [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: 04/08/2022] [Revised: 08/12/2022] [Indexed: 11/07/2022] Open
Abstract
The sleep slow-wave (SW) transition between negative and positive phases is thought to mirror synaptic strength and likely depends on brain health. This transition shows significant age-related changes but has not been investigated in pathological aging. The present study aimed at comparing the transition speed and other characteristics of SW between older adults with amnestic mild cognitive impairment (aMCI) and cognitively normal (CN) controls with and without obstructive sleep apnea (OSA). We also examined the association of SW characteristics with the longitudinal changes of episodic memory and executive functions and the degree of subjective cognitive complaints. aMCI (no/mild OSA = 17; OSA = 15) and CN (no/mild OSA = 20; OSA = 17) participants underwent a night of polysomnography and a neuropsychological evaluation at baseline and 18 months later. Participants with aMCI had a significantly slower SW negative-to-positive-phase transition speed and a higher proportion of SW that are "slow-switchers" than CN participants. These SW measures in the frontal region were significantly correlated with memory decline and cognitive complaints in aMCI and cognitive improvements in CN participants. The transition speed of the SW that are "fast-switchers" was significantly slower in OSA compared to no or mild obstructive sleep apnea participants. The SW transition-related metrics showed opposite correlations with the longitudinal episodic memory changes depending on the participants' cognitive status. These relationships were particularly strong in participants with aMCI. As the changes of the SW transition-related metrics in pathological aging might reflect synaptic alterations, future studies should investigate whether these new metrics covary with biomarker levels of synaptic integrity in this population.
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Affiliation(s)
- Alexandre Lafrenière
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Electrical Engineering, École de Technologie Supérieure, Montreal, Canada
- Centre de Recherches Mathématiques, Université de Montréal, Montreal, Canada
| | - Jimmy Hernandez
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Neurosciences, Université de Montréal, Montreal, Canada
| | - Maude Bouchard
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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12
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Herberts M, Kolla B, Paul T, Mekala P, Mansukhani MP. Sleep apnea and autonomic dysfunction in patients with dementia. Front Neurosci 2022; 16:951147. [PMID: 36408398 PMCID: PMC9669746 DOI: 10.3389/fnins.2022.951147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Sleep apnea is common sleep disorder that is associated with an is an increase in risk of many health conditions, including systemic hypertension, stroke, atrial fibrillation, and heart failure. The predominant underlying pathophysiological mechanism for elevated risk of these conditions in patients with sleep apnea is thought to involve autonomic dysfunction in the form of sympathetic overactivity. Autonomic dysfunction is also associated with several neurodegenerative disorders and sleep apnea, in turn, has been shown to be associated with an increased risk of development of mild cognitive impairment and various types of dementia. Rapid eye movement sleep behavior disorder, which is also associated with an increased risk of alpha synucleiopathy-related dementia, is also linked with autonomic dysfunction. In this article we explore the relationship between sleep apnea, autonomic dysfunction, rapid eye movement sleep behavior disorder and dementia. This article describes the various autonomic dysfunction that are thought to occur in the context of sleep apnea. And illustrate the mechanisms by which sleep apnea, through its impact on autonomic dysfunction could potentially result in dementia. We also review the evidence examining the impact of treatment of sleep apnea on autonomic dysfunction and cognitive outcomes.
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Affiliation(s)
- Michelle Herberts
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Travis Paul
- Mayo Clinic Health System, Southwest Minnesota, Mankato, MN, United States
| | - Praveen Mekala
- Mayo Clinic Health System, Southwest Minnesota, Mankato, MN, United States
| | - Meghna P. Mansukhani
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Meghna P. Mansukhani,
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13
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Mander BA, Dave A, Lui KK, Sprecher KE, Berisha D, Chappel-Farley MG, Chen IY, Riedner BA, Heston M, Suridjan I, Kollmorgen G, Zetterberg H, Blennow K, Carlsson CM, Okonkwo OC, Asthana S, Johnson SC, Bendlin BB, Benca RM. Inflammation, tau pathology, and synaptic integrity associated with sleep spindles and memory prior to β-amyloid positivity. Sleep 2022; 45:6603598. [PMID: 35670275 PMCID: PMC9758508 DOI: 10.1093/sleep/zsac135] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 05/17/2022] [Indexed: 01/25/2023] Open
Abstract
STUDY OBJECTIVES Fast frequency sleep spindles are reduced in aging and Alzheimer's disease (AD), but the mechanisms and functional relevance of these deficits remain unclear. The study objective was to identify AD biomarkers associated with fast sleep spindle deficits in cognitively unimpaired older adults at risk for AD. METHODS Fifty-eight cognitively unimpaired, β-amyloid-negative, older adults (mean ± SD; 61.4 ± 6.3 years, 38 female) enriched with parental history of AD (77.6%) and apolipoprotein E (APOE) ε4 positivity (25.9%) completed the study. Cerebrospinal fluid (CSF) biomarkers of central nervous system inflammation, β-amyloid and tau proteins, and neurodegeneration were combined with polysomnography (PSG) using high-density electroencephalography and assessment of overnight memory retention. Parallelized serial mediation models were used to assess indirect effects of age on fast frequency (13 to <16Hz) sleep spindle measures through these AD biomarkers. RESULTS Glial activation was associated with prefrontal fast frequency sleep spindle expression deficits. While adjusting for sex, APOE ε4 genotype, apnea-hypopnea index, and time between CSF sampling and sleep study, serial mediation models detected indirect effects of age on fast sleep spindle expression through microglial activation markers and then tau phosphorylation and synaptic degeneration markers. Sleep spindle expression at these electrodes was also associated with overnight memory retention in multiple regression models adjusting for covariates. CONCLUSIONS These findings point toward microglia dysfunction as associated with tau phosphorylation, synaptic loss, sleep spindle deficits, and memory impairment even prior to β-amyloid positivity, thus offering a promising candidate therapeutic target to arrest cognitive decline associated with aging and AD.
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Affiliation(s)
- Bryce A Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.,Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA.,Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Abhishek Dave
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.,Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Kitty K Lui
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.,San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine E Sprecher
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Destiny Berisha
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - Miranda G Chappel-Farley
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA.,Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - Ivy Y Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Brady A Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Margo Heston
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal, Sweden
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.,Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA.,Department of Neurobiology and Behavior, University of California, Irvine, CA, USA.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, USA
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14
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The Link between Obstructive Sleep Apnea and Neurocognitive Impairment: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2022; 19:1245-1256. [PMID: 35913462 PMCID: PMC9353960 DOI: 10.1513/annalsats.202205-380st] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer's disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
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15
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Rubega M, Ciringione L, Bertuccelli M, Paramento M, Sparacino G, Vianello A, Masiero S, Vallesi A, Formaggio E, Del Felice A. High-density EEG sleep correlates of cognitive and affective impairment at 12-month follow-up after COVID-19. Clin Neurophysiol 2022; 140:126-135. [PMID: 35763985 PMCID: PMC9292469 DOI: 10.1016/j.clinph.2022.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Objective To disentangle the pathophysiology of cognitive/affective impairment in Coronavirus Disease-2019 (COVID-19), we studied long-term cognitive and affective sequelae and sleep high-density electroencephalography (EEG) at 12-month follow-up in people with a previous hospital admission for acute COVID-19. Methods People discharged from an intensive care unit (ICU) and a sub-intensive ward (nonICU) between March and May 2020 were contacted between March and June 2021. Participants underwent cognitive, psychological, and sleep assessment. High-density EEG recording was acquired during a nap. Slow and fast spindles density/amplitude/frequency and source reconstruction in brain gray matter were extracted. The relationship between psychological and cognitive findings was explored with Pearson correlation. Results We enrolled 33 participants ( 17 nonICU) and 12 controls. We observed a lower Physical Quality of Life index, higher post-traumatic stress disorder (PTSD) score, and a worse executive function performance in nonICU participants. Higher PTSD and Beck Depression Inventory scores correlated with lower executive performance. The same group showed a reorganization of spindle cortical generators. Conclusions Our results show executive and psycho-affective deficits and spindle alterations in COVID-19 survivors – especially in nonICU participants – after 12 months from discharge. Significance These findings may be suggestive of a crucial contribution of stress experienced during hospital admission on long-term cognitive functioning.
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Affiliation(s)
- Maria Rubega
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy.
| | - Luciana Ciringione
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy.
| | - Margherita Bertuccelli
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy; Padova Neuroscience Center, University of Padova, via Orus 2/B, Padova 35129, Italy.
| | - Matilde Paramento
- Department of Information Engineering, University of Padova, via Gradenigo 6/B, Padova 35131, Italy.
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, via Gradenigo 6/B, Padova 35131, Italy.
| | - Andrea Vianello
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, via Giustiniani, 2, Padova 35128, Italy.
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy; Padova Neuroscience Center, University of Padova, via Orus 2/B, Padova 35129, Italy.
| | - Antonino Vallesi
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy; Padova Neuroscience Center, University of Padova, via Orus 2/B, Padova 35129, Italy.
| | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy; Padova Neuroscience Center, University of Padova, via Orus 2/B, Padova 35129, Italy.
| | - Alessandra Del Felice
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani, 3, Padova 35128, Italy; Padova Neuroscience Center, University of Padova, via Orus 2/B, Padova 35129, Italy.
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16
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Zawar I, Mattos MK, Manning C, Quigg M. Sleep Disturbances, Cognitive Status, and Biomarkers of Dementia. J Alzheimers Dis 2022; 89:1367-1374. [PMID: 36031904 DOI: 10.3233/jad-220664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND While sleep disturbances appear to be risk factors in Alzheimer's disease (AD) progression, information such as the prevalence across dementia severity and the influence on the trajectory of cognitive decline is unclear. OBJECTIVE We evaluate the hypotheses that the prevalence of insomnia differs by cognitive impairment, that sleep disturbances track with AD biomarkers, and that longitudinal changes in sleep disorders affect cognition. METHODS We used the National Alzheimer's Coordinating Center Database to determine the prevalence of clinician-identified insomnia and nighttime behaviors in normal, mild cognitive impairment (MCI), and demented individuals. We evaluated mean Montreal Cognitive Assessment (MoCA) scores, hippocampal volumes (HV), and CSF phosphorylated tau:amyloid-β ratios at first visit using analysis of variance with age as a covariate. In longitudinal evaluations, we assessed changes in MoCA scores and HV in insomnia and nighttime behaviors between the first and last visits. RESULTS Prevalence of insomnia was 14%, 16%, and 11% for normal, MCI, and dementia groups. Prevalence of nighttime behaviors was 14%, 21%, and 29% respectively. Insomnia patients had higher MoCA scores, larger HV, and lower pTauBeta than individuals without insomnia, indicating less neurodegeneration. In contrast, nighttime behaviors were associated with worse cognition, smaller HV, and higher pTauBeta. Similar findings were seen between longitudinal associations of sleep disorders and cognition and HV. CONCLUSION Our findings suggest that insomnia is unreliably recognized in patients with cognitive impairment. Nighttime behaviors may better indicate the presence of sleep disturbances and have diagnostic specificity in AD over insomnia.
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Affiliation(s)
- Ifrah Zawar
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Meghan K Mattos
- UVA Section of Geriatrics, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Carol Manning
- Memory Disorders Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Mark Quigg
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA
- UVA Section of Geriatrics, School of Nursing, University of Virginia, Charlottesville, VA, USA
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Parker JL, Melaku YA, D'Rozario AL, Wittert GA, Martin SA, Catcheside PG, Lechat B, Teare AJ, Adams RJ, Appleton SL, Vakulin A. The association between obstructive sleep apnea and sleep spindles in middle-aged and older men: A community-based cohort study. Sleep 2021; 45:6446158. [PMID: 34850237 DOI: 10.1093/sleep/zsab282] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/01/2021] [Indexed: 01/25/2023] Open
Abstract
STUDY OBJECTIVES Sleep spindles show morphological changes in obstructive sleep apnea (OSA). However, previous small studies have limited generalisability, leaving associations between OSA severity measures and spindle metrics uncertain. This study examined cross-sectional associations between OSA severity measures and spindle metrics among a large population-based sample of men. METHODS Community-dwelling men with no previous OSA diagnosis underwent home-based polysomnography. All-night EEG (F4-M1) recordings were processed for artefacts and spindle events identified using previously validated algorithms. Spindle metrics of interest included frequency (Hz), amplitude (µV 2), overall density (11-16 Hz), slow density (11-13 Hz), and fast density (13-16 Hz) (number/minute). Multivariable linear regression models controlling for demographic, biomedical, and behavioural confounders were used to examine cross-sectional associations between OSA severity measures and spindle metrics. RESULTS In adjusted analyses, higher apnea-hypopnea index (AHI/h, as a continuous variable) and percentage total sleep time with oxygen saturation <90% (TST90) were associated with decreased slow spindle density (AHI, B= -0.003, p=0.032; TST90, B= -0.004, p=0.047) but increased frequency (AHI, B=0.002, p=0.009; TST90, B=0.002, p=0.043). Higher TST90 was also associated with greater spindle amplitude (N2 sleep, B=0.04, p=0.011; N3 sleep, B=0.11, p<0.001). Furthermore, higher arousal index was associated with greater spindle amplitude during N2 sleep (B=0.31, p<0.001) but decreased overall density (B= -1.27, p=0.030) and fast density (B= -4.36, p=0.028) during N3 sleep. CONCLUSIONS Among this large population-based sample of men, OSA severity measures were independently associated with spindle abnormalities. Further population studies are needed to determine associations between spindle metrics and functional outcomes.
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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
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, 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.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Alison J Teare
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- 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
| | - 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
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Abstract
To date, our understanding of the role of abnormal hippocampal volume in imaging studies of insomnia disorders (ID) has remained in apparent contradiction. Given that hippocampal function can be mapped to anatomically defined substructures, the hippocampal substructure volume can be examined in detail at present. In this study, we examined the volumes of hippocampal substructures between IDs and healthy controls (HC) to accurately find hippocampal markers of ID. First, we used the automated hippocampal substructure module in FreeSurfer6.0 to inspect T1-weighted magnetic resonance images between 22 IDs and 30 HC. Then, 12 hippocampal substructures were computed. Volumetric assessment was performed at the hippocampal substructure level between groups. Our study revealed significant reduced volume of the bilateral fimbria in IDs compared with HC (p < 0.05/12, Bonferroni corrected), although there was no difference in the total volume of hippocampus. In addition, the correlation analysis showed that the total hippocampal volume of the left hemisphere was negatively correlated with Pittsburgh Sleep Quality Index (PSQI) scores. With regard to hippocampal substructure results, negative correlations were detected between bilateral fimbria volume and clinical variables (i.e., PSQI, SDS, and SAS) in all subjects. Taken together, we revealed marked differences in the volume of the hippocampal substructure between IDs and HC, which provided a more accurate structural imaging marker for the pathological of ID.
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