Trajectories of daytime sleepiness and their associations with dementia incidence

Enhancing the Management of Hypersomnia: Examining the Role of the Orexin System

Excessive daytime sleepiness (EDS) is common. However, clinical features of excessive sleepiness can have broad and variable presentations. In addition, there can be an increased likelihood of medical or psychiatric comorbidity. Examination of the networks that regulate sleep-wake and circadian control reveals a complex and intricately designed integration system. Dysregulation in the coordination, effectiveness, or efficiency of these systems can contribute to developing EDS, and inform on the endotypes observed and pharmacologic considerations for treatment. The discovery and characterization of the diurnal expression and function of orexin (hypocretin) have led to a transformed understanding of sleep-wake control and EDS, as well as its role beyond sleep. As a result, a novel drug class, orexin agonists, is anticipated to emerge for clinical use in the near future. An understanding of orexin physiology and its transdisciplinary impact is necessary to best prepare for patient selection, use, and anticipated benefit and monitoring of both expected benefits and any other health change. This study provides a review of the range of clinical features and impact of EDS, the relationship between sleep-wake, circadian and other health networks, and an examination of orexin physiology with anticipatory guidance on the potential transdisciplinary role and impact of orexin agonists.

Association of Sleep Disturbances With Prevalent and Incident Motoric Cognitive Risk Syndrome in Community-Residing Older Adults

BACKGROUND AND OBJECTIVES

There is growing evidence that sleep disturbances are associated with cognitive impairment risk, but their association with the incidence of motoric cognitive risk syndrome (MCR)-a predementia syndrome characterized by slow gait speed and cognitive complaints-is unknown. We aimed to examine the association of sleep disturbances, overall and specific subtypes, with (1) incident and (2) prevalent MCR in older adults.

METHODS

Community-residing adults aged 65 years and older without dementia were recruited from population lists and included in Central Control of Mobility and Aging, a prospective cohort study, in Albert Einstein College of Medicine, Bronx, NY. We included participants with available data for MCR and Pittsburgh Sleep Quality Index (PSQI). MCR was defined as cognitive complaints reported on standardized questionnaires and slow gait speed as recorded on an electronic treadmill and was adjudicated at baseline and annual follow-up visits. Participants were divided into "good" sleepers (≤5) and "poor" sleepers (>5) based on an established PSQI cut score. Among participants without MCR at baseline, Cox proportional hazard models adjusted for (1) age, sex, and education and (2) further for comorbidity index, Geriatric Depression Scale score, and global cognitive score were used to examine the association of baseline sleep disturbances with MCR incidence. Association between poor sleep quality and prevalent MCR at baseline in the overall population was explored using multivariate logistic regression analysis.

RESULTS

445 participants were included (56.9% women, mean age: 75.9 years [75.3; 76.5]). In MCR-free participants at baseline (n = 403), 36 developed incident MCR over a mean follow-up of 2.9 years. Poor sleepers had a higher risk of incident MCR (HR = 2.7 [1.2; 5.2]) compared with good sleepers, but this association was not significant after adjustment for depressive symptoms (adjusted hazard ratio [aHR] = 1.6 [0.7-3.4]). Among the 7 PSQI components, only sleep-related daytime dysfunction (excessive sleepiness and lower enthusiasm) showed a significant risk of MCR in fully adjusted models (aHR = 3.3 [1.5-7.4]). Prevalent MCR was not associated with poor sleep quality (OR [95% CI] = 1.1 [0.5-2.3]).

DISCUSSION

Overall poor sleep quality was associated with incident MCR, but not with prevalent MCR. Specifically, older adults with sleep-related daytime dysfunction are at increased risk of developing MCR. Further studies are needed to validate mechanisms of this relationship.

The association between sleep duration trajectories and successful aging: a population-based cohort study

BACKGROUND

Insufficient or excessive sleep duration are associated with increased risk of individual adverse outcomes. However, it remains largely unknown whether sleep duration trajectories are associated with overall health among older adults. This study aimed to examine the association between sleep duration trajectories and successful aging.

METHODS

In the China Health and Retirement Longitudinal Study (CHARLS), 3,306 participants without major chronic diseases at baseline and survived to aged 60 years and older at the end of follow-up were potentially eligible participants. Total sleep duration was assessed in 2011, 2013, and 2015, and successful aging was evaluated in 2020 and was defined as being free of major chronic diseases, no physical impairment, high cognitive function, good mental health, and active engagement with life. Latent class mixed model (LCMM) was used to identify sleep duration trajectories and logistic regression was performed to explore the association between these trajectories and successful aging.

RESULTS

During the 9-year follow-up, 455 individuals (13.8%) met the criteria for successful aging. Five sleep duration trajectories were identified: normal stable, long stable, decreasing, increasing, and short stable. Compared with the normal stable trajectory, the adjusted ORs (95% CI) for achieving successful aging for participants with long stable, decreasing, increasing, and short stable trajectories were 1.00 (0.77, 1.30), 0.64 (0.40, 1.03), 0.64 (0.45, 0.92), and 0.48 (0.35, 0.66), respectively. The stratified and sensitivity analyses were generally consistent with the main results.

CONCLUSIONS

Increasing and short stable trajectories of sleep duration are associated with lower odds of successful aging relative to participants in the normal stable trajectory. The findings underscore the critical importance of monitoring dynamic changes in sleep duration in middle-aged and older Chinese adults.

An exploratory single-arm open-label clinical study to evaluate the combined effect of Vamana and Sarasvata Churna in reducing excessive daytime sleepiness

BACKGROUND

Excessive Daytime Sleepiness (EDS) is inferred as persistent sleepiness and often a general lack of energy during the day even after apparently adequate or even prolonged nighttime sleep. The subjects may not be identifying excessive daytime sleepiness but may present as feeling tired, lack of energy etc. They may seem apparently healthy and without any other systemic illness. In the current health scenario there is a need for alternative interventions to manage this disease.

OBJECTIVE

This study was aimed to assess the combined effect of Vamana (therapeutic vomiting) and Sarasvata Churna in reducing Excessive Daytime Sleepiness.

MATERIALS AND METHODS

This was a single-arm exploratory open-label clinical trial. 10 subjects having EDS diagnosed using Modified Epworth Sleepiness Scale (MESS) with a score of 10-24 with proper exclusion were recruited from OPD and IPD, Department of Kāyacikitsa, Amrita School of Ayurveda. All the participants were clinically examined, sought for medical history and further checked biochemically to exclude any other systemic illness that may lead to this condition. Only healthy subjects with quality night sleep (assessed by PSQI) and without any other systemic illness were selected. The treatment protocol adopted was Vamana Karma followed by 30 days of Sarasvata Churna as Shamana Aushadha (medicine for pacification). Assessment was done using MESS on 0th day and after 30 days of Shamana Aushadha Sevana. After completion of treatment, the results were statistically analysed using Wilcoxon Signed Rank Test and final conclusion was drawn.

RESULTS

On analysis of the symptoms using Modified Epworth Sleepiness Scale, the mean total score reduced from 14.8 to 2.8 with 81.08 % relief in these 10 subjects and a significant p value < 0.05 after Vamana followed by 30 days of Shamana Aushadha Sevana.

DISCUSSION

Sarasvata Churna which was administered as Shamana Aushadha possesses Medhya (Nootropic), Buddhi Smriti Dhriti Vardhaka (intellect, memory and patience promoting) attributes and is being indicated in Vicetas. Most of the drugs in Sarasvata Churna are Rasayana (rejuvenation) that imparts Indriya Bala (strengthening of senses) and Priti (contempt) to Manas by Prinana (nourishing) of Rasa Dhatu.

CONCLUSION

From this study, we could conclude that the combination of Vamana Karma followed by Sarasvata Churna administration is effective in reducing EDS.

Association between dysphagia risk and sleep quality in community-dwelling older adults: A cross-sectional study

Objectives

Exploring the effects of swallowing function on sleep quality could provide valuable insights into the potential impact of reduced swallowing function on sleep. However, pertinent studies are limited. Therefore, this study aimed to investigate the relationship between dysphagia risk and sleep health in community-dwelling older adults.

Methods

Data for this cross-sectional study were obtained from the Shizuoka and Daiko studies conducted as part of the Japan Multi-Institutional Collaborative Cohort Study. Information on demographics, overall lifestyle, dysphagia risk, as well as sleep quality, duration, satisfaction, and regularity, was obtained using a self-administered questionnaire. Dysphagia risk and sleep quality were assessed using the Dysphagia Risk Assessment Questionnaire for the Community-dwelling Elderly and the Japanese version of the Pittsburgh Sleep Questionnaire Index, respectively. Multivariate logistic regression, adjusted for covariates, was employed to assess the association between dysphagia risk and sleep health.

Results

Among the 3058 participants (1633 males, 1425 females) aged ≥60 years, 28.0 % exhibited dysphagia risk, and 19.1 % reported poor sleep quality. Those with dysphagia risk were more likely to experience poor sleep quality than those without dysphagia risk. In male participants, dysphagia was significantly associated with poor sleep quality, unsatisfactory sleep, and sleep irregularity, but was not significantly associated with unsatisfactory or irregular sleep in female participants. The Japanese version of the Pittsburgh Sleep Questionnaire Index components-subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction-were associated with dysphagia risk in both sexes.

Conclusions

Dysphagia risk is associated with sleep quality in older individuals in Japan. Thus, preserving swallowing function may contribute to enhancing sleep quality.

Olfactory Dysfunction and Long-Term Trajectories of Sleep Disorders among early Parkinson's Disease: Findings from a Longitudinal Cohort

BACKGROUND

Previous studies have suggested a connection between impaired olfactory function and an increased risk of rapid eye movement sleep behavior disorder (RBD) in individuals diagnosed with Parkinson's disease (PD). However, there is a gap in knowledge regarding the potential impact of olfactory dysfunction on the long-term patterns of sleep disorders among early PD patients.

METHODS

Data from the Parkinson's Progression Markers Initiative program included 589 participants with assessments of sleep disorders using the Epworth Sleepiness Scale (ESS) and RBD Screening Questionnaire (RBDSQ). Olfactory dysfunction at baseline was measured using the University of Pennsylvania Smell Identification Test. Trajectories of sleep disorders over a 5-year follow-up were identified using group-based trajectory modeling, and the relationship between olfactory dysfunction and sleep disorder trajectories was examined through binomial logistic regression.

RESULTS

Two distinct trajectories of sleep disorders over the 5-year follow-up period were identified, characterized by maintaining a low or high ESS score and a low or high RBDSQ score. An inversion association was observed between olfactory function measures and trajectories of excessive daytime sleepiness (odds ratio [OR] = 0.97, 95% confidence interval [CI] 0.95, 1.00, p = 0.038), after controlling for potential covariates. Similarly, olfactory function showed a significant association with lower trajectories of probable RBD (OR = 0.96, 95% CI 0.94, 0.98, p = 0.001) among early PD individuals. Consistent findings were replicated across alternative analytical models.

CONCLUSIONS

Our findings indicated that olfactory dysfunction was associated with unfavorable long-term trajectories of sleep disorders among early PD.

BACKGROUND

Previous studies have suggested a connection between impaired olfactory function and an increased risk of rapid eye movement sleep behavior disorder (RBD) in individuals diagnosed with Parkinson's disease (PD). However, there is a gap in knowledge regarding the potential impact of olfactory dysfunction on the long-term patterns of sleep disorders among early PD patients.

METHODS

Data from the Parkinson's Progression Markers Initiative program included 589 participants with assessments of sleep disorders using the Epworth Sleepiness Scale (ESS) and RBD Screening Questionnaire (RBDSQ). Olfactory dysfunction at baseline was measured using the University of Pennsylvania Smell Identification Test. Trajectories of sleep disorders over a 5-year follow-up were identified using group-based trajectory modeling, and the relationship between olfactory dysfunction and sleep disorder trajectories was examined through binomial logistic regression.

RESULTS

Two distinct trajectories of sleep disorders over the 5-year follow-up period were identified, characterized by maintaining a low or high ESS score and a low or high RBDSQ score. An inversion association was observed between olfactory function measures and trajectories of excessive daytime sleepiness (odds ratio [OR] = 0.97, 95% confidence interval [CI] 0.95, 1.00, p = 0.038), after controlling for potential covariates. Similarly, olfactory function showed a significant association with lower trajectories of probable RBD (OR = 0.96, 95% CI 0.94, 0.98, p = 0.001) among early PD individuals. Consistent findings were replicated across alternative analytical models.

CONCLUSIONS

Our findings indicated that olfactory dysfunction was associated with unfavorable long-term trajectories of sleep disorders among early PD.

How Modifiable Are Modifiable Dementia Risk Factors? A Framework for Considering the Modifiability of Dementia Risk Factors

Many risk factors for dementia, identified from observational studies, are potentially modifiable. This raises the possibility that targeting key modifiable dementia risk factors may reduce the prevalence of dementia, which has led to the development of dementia risk reduction and prevention strategies, such as intervention trials or dementia prevention guidelines. However, what has rarely been considered in the studies that inform these strategies is the extent to which modifiable dementia risk factors can (1) be identified by individuals, and (2) be readily modified by individuals. Characteristics of modifiable dementia risk factors such as readiness of identification and targeting, as well as when they should be targeted, can influence the design, or success of strategies for reducing dementia risk. This review aims to develop a framework for classifying the degree of modifiability of dementia risk factors for research studies. The extent to which these modifiable dementia risk factors could be modified by an individual seeking to reduce their dementia risk is determined, as well as the resources that might be needed for both risk factor identification and modification, and whether modification may be optimal in early-life (aged <45 years), midlife (aged 45-65 years) or late-life (aged >65 years). Finally, barriers that could influence the ability of an individual to engage in risk factor modification and, ultimately, dementia risk reduction are discussed.

The prevalence of excessive daytime sleepiness and associated factors in older diabetic patients

OBJECTIVES

Sleep disorders are a frequent health problem in older patients with diabetes mellitus (DM). There has been no study investigating the factors associated with excessive daytime sleepiness (EDS) in older diabetic patients. We aimed to investigate the prevalence and associated factors of EDS.

METHODS

We performed a retrospective cross-sectional study in older diabetic patients. The Epworth Sleepiness Scale score of ≥ 11 points indicated EDS. All patients underwent comprehensive geriatric assessment including demographic characteristics, blood pressures, comorbid diseases, cognitive and nutritional states, basic and instrumental daily living activity indexes, lower urinary tract symptoms, and laboratory values.

RESULTS

Of 227 patients, 73.1% were females, with a mean age of 78.8 ± 6.5. The prevalence of EDS was 19.8%. Patients with EDS were mostly males with dementia and used significantly more medication with more anticholinergic drug burden, falls, urge incontinence, and nocturia (p < 0.05). They had higher SARC-F and lower Barthel index, Lawton-Brodie, Tinetti, MMSE scores, and high-density lipoprotein than the patients without EDS (p < 0.05). After adjusting for age, sex, and dementia, all parameters that were significant in univariate analysis remained associated with EDS, except for falls, and MMSE scores.

CONCLUSION

The EDS was found in one in five older diabetic patients. There was a significant relationship between EDS and drug use, anticholinergic drug burden, impaired excretory functions, sarcopenia, decreased functional capacity, falls, gait-balance disorder, and cognitive dysfunction. The recognization of EDS and the implementation of interventions may be helpful in the management of geriatric syndromes.

Social Support and Daytime Sleepiness Among Chinese Medical Students: Mediating Roles of Loneliness and Problematic Smartphone Use

Background

Sleep problems have become a serious threat to public health worldwide. Daytime sleepiness is an important indicator of many sleep problems, which have a significant impact on academic performance, physical and mental health, and wellbeing among medical students. We aimed to explore the factors associated with daytime sleepiness among medical students.

Methods

We conducted a cross-sectional survey of 466 medical students recruited via convenience sampling. Self-rated psychometric scales, including the Social Support Rate Scale, the Epworth Sleepiness Scale, the Chinese version of the UCLA loneliness scale, and the Mobile Phone Addiction Index (MPAI), were utilized to evaluate social support, daytime sleepiness, loneliness, and problematic smartphone use. A sequential mediation model was constructed with daytime sleepiness as the dependent variable, social support as the independent variable, and loneliness and problematic smartphone use as mediating variables. Age, gender, and grade were taken as covariates.

Results

Social support among medical students was negatively associated with loneliness, problematic smartphone use, and daytime sleepiness (p < 0.01). A sequential mediation analysis showed that loneliness (the first mediator) and problematic smartphone use (the second mediator) sequentially mediated the path from social support to daytime sleepiness among medical students (β = -0.008; 95% CI = -0.016, -0.002). Moreover, there were also significant mediating roles observed in the relationship between social support and daytime sleepiness via loneliness only (β = -0.037; 95% CI = -0.062, -0.015) and problematic smartphone use only (β = -0.022; 95% CI = -0.041, -0.008).

Conclusion

Social support, loneliness, and problematic smartphone use among medical students influenced their daytime sleepiness. Interventions targeting medical student loneliness and problematic smartphone use behaviors might attenuate the effects from low levels of social support and further improve daytime sleepiness.

Associations between self-reported sleep quality and cerebrospinal fluid biomarkers in mild cognitive impairment and Alzheimer's disease

Sleep disorders are very common in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Several parameters of polysomnography seem to correlate with cognitive scores and amyloid biomarkers in the different stages of AD. However, there is limited evidence for the relationship between self-reported sleep impairment and disease biomarkers. In this study, we assessed the relationship between self-reported sleep complaints, with the Pittsburgh Sleep Quality Index, and both cognitive function and cerebrospinal fluid biomarkers in 70 patients with MCI and 78 patients with AD. Sleep duration and daytime dysfunction were higher in AD. Daytime dysfunction had a negative correlation with cognitive scores (Mini-Mental-State Examination and Montreal Cognitive Assessment) and with amyloid-beta1-42 protein, and a positive correlation with total tau protein. However, daytime dysfunction was an independent predictor only of t-tau values (F=57.162; 95% CI: [18.118; 96.207], P=0.004). These findings support a relationship between daytime dysfunction, cognitive scores and neurodegeneration, further expanding recent findings that it may signal a risk of dementia.

Sleepiness in neurological disorders

Sleepiness is a frequent and underrecognized symptom in neurological disorders, that impacts functional outcomes and quality of life. Multiple and potentially additive factors might contribute to sleepiness in neurological disorders, including sleep quality alterations, circadian rhythm disorders, drugs, and sleep disorders including sleep apnea or central disorders of hypersomnolence. Physician awareness of the possible symptoms of hypersomnolence, and associated causes is of crucial importance to allow proper identification and treatment of underlying causes. This review first provides a brief overview on clinical aspects of excessive daytime sleepiness, and diagnosis tools, then examines its frequency and mechanisms in various neurological disorders, including neurodegenerative disorders, multiple sclerosis, autoimmune encephalitis, epilepsy, and stroke.

A high propensity for excessive daytime sleepiness independent of lifestyle is associated with cognitive performance in community-dwelling older adults

Objective

The relationship between excessive daytime sleepiness (EDS) and cognitive performance of older adults remains unclear, especially when a healthy lifestyle is considered. The study aimed to explore the association between EDS in passive and active situations and general cognitive function among community-dwelling older adults.

Methods

Two hundred and seventy-one older adults aged 60 and above were recruited from the community cohort in Shangrao. All study participants were free of depression and dementia. The Chinese version of the Epworth Sleepiness Scale (CESS) was used to evaluate EDS. Using the item scores of CESS, the presence of EDS among all study participants were grouped as non-EDS, passive situation-related EDS (PSR-EDS), active situation-related EDS (ASR-EDS), and high sleep propensity (HSP). The Hong Kong Brief Cognitive Test (HKBC) was used to assess cognitive function. Chinese healthy lifestyle metrics were scored based on AHA Life Simple-7. The multivariate logistic regression model was used to estimate the association between the presence of EDS and cognitive function.

Results

The PSR-EDS (n = 29, 20.8 ± 5.3) and the HSP groups (n = 21, 19.8 ± 4.8) scored lower with HKBC than in the non-EDS group (n = 213, 23.2 ± 4.9). The subdomain performance of language in the HSP group was poorer than in the non-EDS group (ps < 0.05). Relative to non-EDS, HSP (OR = 3.848, 95% CI = 1.398-10.591) was associated with an increased risk of poor cognitive performance after adjusting age, sex, education, and healthy lifestyle metrics.

Conclusion

High propensity for excessive daytime sleepiness, irrespective of lifestyle, is associated with poorer cognitive performance among community-dwelling older adults. The findings may provide empirical evidence to support sleepiness intervention for reducing the risk of cognitive decline.

Daytime Sleepiness Is Associated with Lower Cognitive Scores: The Look AHEAD Study

Background

Daytime sleepiness is common in older adults and may result from poor nighttime sleep due to sleep disordered breathing, fragmented sleep, or other sleep disorders. Daytime sleepiness may be associated with cognition in older adults.

Objectives

We investigated the association between self-reported daytime sleepiness and cognitive function in the Look AHEAD clinical trial.

Design

Observational follow-up of a randomized clinical trial of an intensive lifestyle intervention.

Setting

Clinic.

Participants

Participants (n=1,778) aged 45-76 years at baseline with type 2 diabetes and overweight or obesity.

Interventions

Participants were randomized to an intensive lifestyle intervention for weight loss or a control condition of diabetes support and education.

Measurements

Participants provided self-reported levels of daytime sleepiness at baseline and years 12-13. Cognitive function was assessed with a neurocognitive battery at years 12-13 and 18-20.

Results

Participants who reported having frequent daytime sleepiness (often or always) performed significantly worse than others on the cognitive composite (-0.35; p-value=0.014) after controlling for covariates. When stratified by intervention arm, participants assigned to the intensive lifestyle intervention who reported often/always having daytime sleepiness performed worse on Digit Symbol Coding (-0.63; p-value=0.05) and Trail Making Part-B (-0.56; p-value=0.02) after controlling for covariates. Statistical interactions revealed associations between daytime sleepiness and the following covariates: race and ethnicity, APOE ε4 carrier status, baseline history of cardiovascular disease, and depression.

Conclusions

Daytime sleepiness over ~13 years predicted poorer cognitive performance in older individuals who, by virtue of having diabetes and overweight/obesity, are at high risk for sleep disorders and cognitive impairment.

Association of subclinical depressive symptoms and sleep with cognition in the community-dwelling older adults

BACKGROUND

/Purpose: This study aimed to explore the association of subclinical depressive symptoms and sleep with cognition in community-dwelling Taiwanese older adults.

METHODS

This four-year prospective cohort study (2015-2019) included 379 participants aged 65 years or older from the annual senior health checkup program at National Taiwan University Hospital who were followed up two years later. Global and domain cognitive functions were assessed using validated neuropsychological tests. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression (CES-D) Scale. Sleep quality was evaluated using the Pittsburg Sleep Quality Index (PSQI). Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Generalized linear mixed models were used to explore the associations of subclinical depressive symptoms and sleep variables with cognition, adjusting for important covariates. Stratification analyses were performed using the sleep variables.

RESULTS

Over time, depressive symptoms were associated with poor performance of memory (βˆ = 0.24, P = 0.04) and executive function (βˆ = -0.24, P = 0.03). Poor sleep quality (elevated PSQI score) was associated with poor memory performance (βˆ = -0.04 to -0.03, P < 0.05). Excessive daytime sleepiness (elevated ESS score) was associated with poor performance of memory (βˆ = -0.02, P < 0.05) and executive function (βˆ = -0.02, P = 0.001). At baseline, better sleep quality and no excessive daytime sleepiness were associated with better memory performance over time.

CONCLUSION

Subclinical depressive symptoms, worse sleep quality, and excessive daytime sleepiness were differentially associated with impairment of cognitive domains (mainly memory and executive function).

Circadian disruption and sleep disorders in neurodegeneration

Disruptions of circadian rhythms and sleep cycles are common among neurodegenerative diseases and can occur at multiple levels. Accumulating evidence reveals a bidirectional relationship between disruptions of circadian rhythms and sleep cycles and neurodegenerative diseases. Circadian disruption and sleep disorders aggravate neurodegeneration and neurodegenerative diseases can in turn disrupt circadian rhythms and sleep. Importantly, circadian disruption and various sleep disorders can increase the risk of neurodegenerative diseases. Thus, harnessing the circadian biology findings from preclinical and translational research in neurodegenerative diseases is of importance for reducing risk of neurodegeneration and improving symptoms and quality of life of individuals with neurodegenerative disorders via approaches that normalize circadian in the context of precision medicine. In this review, we discuss the implications of circadian disruption and sleep disorders in neurodegenerative diseases by summarizing evidence from both human and animal studies, focusing on the bidirectional links of sleep and circadian rhythms with prevalent forms of neurodegeneration. These findings provide valuable insights into the pathogenesis of neurodegenerative diseases and suggest a promising role of circadian-based interventions.

Self-reported sleepiness associates with greater brain and cortical volume and lower prevalence of ischemic covert brain infarcts in a community sample

STUDY OBJECTIVES

We evaluated if self-reported sleepiness was associated with neuroimaging markers of brain aging and ischemic damage in a large community-based sample.

METHODS

Participants from the Framingham Heart Study Offspring cohort (n = 468, 62.5 ± 8.7 years old, 49.6%M) free of dementia, stroke, and neurological diseases, completed sleep questionnaires and polysomnography followed by magnetic resonance imaging (MRI), 3 years later on average. We used linear and logistic regression models to evaluate the associations between Epworth Sleepiness Scale (ESS) scores and total brain, cortical and subcortical gray matter, and white matter hyperintensities volumes, and the presence of covert brain infarcts.

RESULTS

Higher sleepiness scores were associated with larger total brain volume, greater cortical gray matter volume, and a lower prevalence of covert brain infarcts, even when adjusting for a large array of potential confounders, including demographics, sleep profiles and disorders, organic health diseases, and proxies for daytime cognitive and physical activities. Interactions indicated that more sleepiness was associated with larger cortical gray matter volume in men only and in APOE ε4 noncarriers, whereas a trend for smaller cortical gray matter volume was observed in carriers. In longitudinal analyses, those with stable excessive daytime sleepiness over time had greater total brain and cortical gray matter volumes, whereas baseline sleepiness scores were not associated with subsequent atrophy or cognitive decline.

CONCLUSION

Our findings suggest that sleepiness is not necessarily a marker of poor brain health when not explained by diseases or sleep debt and sleep disorders. Rather, sleepiness could be a marker of preserved sleep-regulatory processes and brain health in some cases.

The Relationship Between Light Exposure before Bedtime and Daytime Sleepiness Among People Living With Cognitive Impairment

While sleep disturbances are common in people living with cognitive impairment, little is known about the influence of evening light exposure on their sleep. The purpose of this study was to examine the relationship between evening light exposure in natural living environment and daytime sleepiness in community residing people living with cognitive impairment. A secondary data analysis was conducted using the baseline data of the Healthy Patterns Clinical Trial. Actiwatch Spectrum Plus was used to collect information on the average white light intensity of 4 hours before sleep for three consecutive days. Multivariate regression analyses were used. Among 173 participants, the average light intensity during evening was 80.25 ± 123.04 lux. After controlling for covariates, greater intensity of light exposure during evening was related to excessive daytime sleepiness (β = 0.211, p = .004). The results of our study suggest exposure to light during evening may disturb sleep and subsequently influence daytime sleepiness the following day.

Disease progression in Parkinson's disease patients with subjective cognitive complaint

Objective

Little is known about the disease progression of Parkinson's disease patients with subjective cognitive complaint (PD‐SCC). This longitudinal cohort study aims to compare the progression of clinical features and quality of life (QoL) in PD patients with normal cognition (NC), SCC, and mild cognitive impairment (MCI).

Methods

A total of 383 PD patients were enrolled, including 189 PD‐NC patients, 59 PD‐SCC patients, and 135 PD‐MCI patients, with 1–7 years of follow‐up. Linear mixed models were applied to evaluate longitudinal changes in motor symptoms, nonmotor features (cognitive impairment, depression, and excessive daytime sleepiness), and QoL in PD.

Results

At baseline, PD‐SCC patients had lower Beck Depression Inventory (BDI) scores and Parkinson's Disease Questionnaire‐39 (PDQ‐39) scores than PD‐NC patients (all p < 0.05). Longitudinal analyses revealed that the PD‐SCC group exhibited faster progression in terms of BDI scores (p = 0.042) and PDQ‐39 scores (p = 0.035) than the PD‐NC group. The PD‐MCI group exhibited faster progression rates in the Epworth Sleepiness Scale scores (p = 0.001) and PDQ‐39 scores (p = 0.005) than the PD‐NC group. In addition, the PD‐SCC group exhibited a greater reduction in attention (Trail Making Test Part A, p = 0.047) and executive function (Stroop Color‐Word Test, p = 0.037) than the PD‐NC group.

Interpretation

PD‐SCC patients exhibited faster deterioration of depression and QoL than PD‐NC patients, and SCC may be an indicator of initial attention and executive function decline in PD. Our findings provided a more accurate prognosis in PD‐SCC patients.

Excessive Daytime Sleepiness is Associated With Malnutrition, Dysphagia, and Vitamin D Deficiency in Older Adults

OBJECTIVES

Both excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included.

METHODS

All patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin B₁₂, vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale score of ≥11 points indicated EDS.

RESULTS

The mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P < .05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted.

CONCLUSIONS AND IMPLICATIONS

There is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively.

Cognitive Functions Predict Trajectories of Sleepiness Over 10 Years: A Population-Based Study

BACKGROUND

Excessive daytime sleepiness is associated with chronic disorders of aging and mortality. Because longitudinal data are limited on the development of sleep disturbances and cognitive changes in older adults, we investigated the demographic, clinical, and cognitive predictors of self-reported daytime sleepiness over a period of 10 years.

METHODS

We jointly modeled latent trajectories over time of sleepiness, cognitive domains, and informative attrition and then fit models to identify cognitive trajectories and baseline characteristics that predicted the trajectories of sleepiness.

RESULTS

Three latent trajectory groups were identified: emerging sleepiness, persistent sleepiness, and consistently low daytime sleepiness accounting for attrition in all groups. Compared with low sleepiness, emerging sleepiness was significantly associated with declining attention and subjective memory complaints; persistent sleepiness was associated with lower baseline scores in all cognitive domains, declining language trajectory, and more subjective memory complaints.

CONCLUSIONS

These findings suggest that persistent sleepiness and emerging daytime sleepiness are associated with cognitive decline and multiple morbidities, albeit more subtly in emerging daytime sleepiness. Furthermore, these data suggest that change in the cognitive domain of attention and subjective memory complaints may be early indicators of future sleep disturbance.

Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States

BACKGROUND

Sleep disturbance and deficiency are common among older adults and have been linked with dementia and all-cause mortality. Using nationally representative data, we examine the relationship between sleep disturbance and deficiency and their risk for incident dementia and all-cause mortality among older adults.

METHODS

The National Health and Aging Trends Study (NHATS) is a nationally-representative longitudinal study of Medicare beneficiaries in the US age 65 and older. Surveys that assessed sleep disturbance and duration were administered at baseline. We examined the relationship between sleep disturbance and deficiency and incident dementia and all-cause mortality over the following 5 years using Cox proportional hazards modeling, controlling for confounders.

RESULTS

Among the sample (n = 2,812), very short sleep duration (≤5 hours: HR = 2.04, 95% CI: 1.26 - 3.33) and sleep latency (>30 minutes: HR = 1.45, 95% CI: 1.03 - 2.03) were associated with incident dementia in adjusted Cox models. Difficulty maintaining alertness ("Some Days": HR = 1.49, 95% CI: 1.13 - 1.94 and "Most/Every Day": HR = 1.65, 95% CI: 1.17 - 2.32), napping ("Some days": HR = 1.38, 95% CI: 1.03 - 1.85; "Most/Every Day": HR = 1.73, 95% CI: 1.29 - 2.32), sleep quality ("Poor/Very Poor": HR = 1.75, 95% CI: 1.17 - 2.61), and very short sleep duration (≤5 hours: HR = 2.38, 95% CI: 1.44 - 3.92) were associated with all-cause mortality in adjusted Cox models.

CONCLUSIONS

Addressing sleep disturbance and deficiency may have a positive impact on risk for incident dementia and all-cause mortality among older adults.