1
|
Marchi NA, Berger M, Solelhac G, Bayon V, Haba-Rubio J, Legault J, Thompson C, Gosselin N, Vollenweider P, Marques-Vidal P, von Gunten A, Strippoli MPF, Preisig M, Draganski B, Heinzer R. Obstructive sleep apnea and cognitive functioning in the older general population: The moderating effect of age, sex, ApoE4, and obesity. J Sleep Res 2024; 33:e13938. [PMID: 37309703 DOI: 10.1111/jsr.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
Research on the relationship between obstructive sleep apnea and cognitive functioning has yielded conflicting results, particularly in the older population, and moderators of this association have rarely been studied. Here we investigated the cross-sectional association between obstructive sleep apnea and cognitive functioning as well as the moderating effect of age, sex, apolipoprotein E4, and obesity on this association among community-dwelling older people. We analysed data from 496 participants (71.4 ± 4.4 years; 45.6% men) of the HypnoLaus study who underwent polysomnography and a battery of neuropsychological tests. The sample was categorised as no-to-mild obstructive sleep apnea (apnea-hypopnea index 0-14.9/h; reference), moderate obstructive sleep apnea (apnea-hypopnea index 15.0-29.9/h), or severe obstructive sleep apnea (apnea-hypopnea index ≥30/h). Regression and moderation analyses were performed with adjustment for confounders. Apolipoprotein E4 and obesity moderated the association between severe obstructive sleep apnea and processing speed, whereas no moderating effects were found for age and sex. In apolipoprotein E4 carriers only, severe obstructive sleep apnea was associated with lower performance in Stroop condition 1 (B = 3.13, p = 0.024). In obese participants only, severe obstructive sleep apnea was associated with lower performance in Stroop condition 1 (B = 3.02, p = 0.025) and Stroop condition 2 (B = 3.30, p = 0.034). Severe obstructive sleep apnea was also associated with lower executive function in the whole sample according to Stroop condition 3 (B = 3.44, p = 0.020) and Stroop interference score (B = 0.24, p = 0.006). Our findings support associations of severe obstructive sleep apnea (but not moderate obstructive sleep apnea) with lower performance in processing speed and executive function in the older general population. Apolipoprotein E4 and obesity appear to be vulnerability factors that strengthen the association between severe obstructive sleep apnea and lower performance in processing speed.
Collapse
Affiliation(s)
- Nicola Andrea Marchi
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montréal, Quebec, Canada
| | - Mathieu Berger
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Sainbiose Laboratory, Inserm U1059, University of Saint-Etienne, Saint-Étienne, France
| | - Geoffroy Solelhac
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Virginie Bayon
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julie Legault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montréal, Quebec, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montréal, Quebec, Canada
| | - Peter Vollenweider
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Pierre Françoise Strippoli
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Legault J, Thompson C, Moullec G, Baril AA, Martineau-Dussault MÈ, André C, Marchi NA, Cross N, Dang-Vu TT, Carrier J, Gosselin N. Age- and sex-specific associations between obstructive sleep apnea risk and cognitive decline in middle-aged and older adults: A 3-year longitudinal analysis of the Canadian longitudinal study on aging. Sleep Med 2023; 112:77-87. [PMID: 37832163 DOI: 10.1016/j.sleep.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Whether obstructive sleep apnea (OSA) increases the risk of cognitive decline and how sex and age influence this association is not clear. Here, we characterized the sex- and age-specific associations between OSA risk and 3-year cognitive change in middle-aged and older adults. METHODS We included 24,819 participants aged 45-85 (52% women) from the Canadian Longitudinal Study on Aging. OSA risk was measured at baseline using the STOP combined to body mass index (STOP-B). Neuropsychological tests assessed memory, executive functioning, and psychomotor speed at baseline and at 3-year follow-up. We conducted age- and sex-specific linear mixed models to estimate the predictive role of baseline STOP-B score on 3-year cognitive change. RESULTS Men at high-risk for OSA aged 45-59 years showed a steeper decline in psychomotor speed (+13.2 [95% CI: -1.6, 27.9]) compared to men at low-risk. Men at high-risk for OSA aged 60-69 showed a steeper decline in mental flexibility (-1.2 [-1.9, -0.5]) and processing speed (+0.6 [0.3, 0.9]) than those at low-risk. Women at high-risk for OSA aged 45-59 showed a steeper decline in processing speed (+0.1 [-0.2, 0.4]) than women at low-risk, while women at high-risk ≥70 years had a steeper decline in memory (-0.2 [-0.6, 0.1]) and processing speed (+1.0 [0.4, 1.5]). CONCLUSIONS Associations between OSA risk and cognitive decline over 3 years depend on age and sex. Being at high-risk for OSA is associated with a generalized cognitive decline in attention and processing speed, while a memory decline is specific to older women (≥70 years).
Collapse
Affiliation(s)
- Julie Legault
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Cynthia Thompson
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Gregory Moullec
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, QC, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Claire André
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Nicola Andrea Marchi
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada; Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nathan Cross
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada; Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Thien Thanh Dang-Vu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada; Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Julie Carrier
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Nadia Gosselin
- Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
3
|
Suemoto CK, Santos RB, Giatti S, Aielo AN, Silva WA, Parise BK, Cunha LF, Souza SP, Griep RH, Brunoni AR, Lotufo PA, Bensenor IM, Drager LF. Association between objective sleep measures and cognitive performance: a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study. J Sleep Res 2023; 32:e13659. [PMID: 35644479 DOI: 10.1111/jsr.13659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
Sleep disturbances often co-exist, which challenges our understanding of their potential impact on cognition. We explored the cross-sectional associations of insomnia and objective measures of sleep with cognitive performance in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study stratified by middle-aged and older adults. Participants aged ≥55 years underwent cognitive evaluations, polygraphy for 1 night, and actigraphy for 7 days. Insomnia was evaluated using the Clinical Interview Scheduled Revised. Obstructive sleep apnea (OSA) and short sleep duration (SSD) were defined by an apnea-hypopnea index (AHI) of ≥15 events/h and <6 h/ night, respectively. In 703 participants (mean [SD] age 62 [6] years, 44% men), cognition was evaluated using a 10-word list, verbal fluency, and trail-making tests. The frequencies of insomnia, SSD, and OSA were 11%, 24%, and 33%, respectively. In all, 4% had comorbid OSA and insomnia, and 11% had both OSA and SSD. Higher wake after sleep onset (β = -0.004, 95% confidence interval [CI] -0.008, -0.001) and the number of awakenings (β = -0.006, 95% CI -0.012, -0.001) were associated with worse verbal fluency performance. Compared to those without insomnia, older participants with insomnia had worse global performance (β = -0.354, 95% CI -0.671, -0.038). Insomnia was an effect modifier in the associations between AHI and executive function performance (p for the interaction between insomnia and AHI = 0.004) and between oxygen saturation <90% and memory performance (p for the interaction between insomnia and oxygen saturation = 0.02). Although some associations between sleep measures and cognition were significant, they should be considered with caution due to the large sample size and multiple testing performed in this study.
Collapse
Affiliation(s)
- Claudia K Suemoto
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Ronaldo B Santos
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil
| | - Soraya Giatti
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aline N Aielo
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wagner A Silva
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil
| | - Barbara K Parise
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lorenna F Cunha
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvana P Souza
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andre R Brunoni
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo A Lotufo
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil
| | - Luciano F Drager
- Center of Clinical and Epidemiologic Research (CPCE), University of São Paulo, São Paulo, Brazil.,Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
4
|
Short-Term Benefits of Continuous Positive Airway Pressure Treatment on Cognition in the Obstructive Sleep Apnea Syndrome: A Retrospective Study. Brain Sci 2023; 13:brainsci13010124. [PMID: 36672105 PMCID: PMC9856474 DOI: 10.3390/brainsci13010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
The Obstructive Sleep Apnea Syndrome (OSAS) significantly impacts cognitive functioning. The prolonged use (more than 3 months) of ventilotherapy with continuous positive airway pressure (CPAP) seems to have positive effects in restoring cognitive difficulties. However, there is poor evidence about its possible short-term effect. We investigated whether the short use (less than 15 days at testing) of CPAP improved the cognitive functioning in fifty individuals with OSAS by collecting retrospective neuropsychological measures about verbal memory and learning, information processing speed, attention (i.e., alerting, orienting, and executive system), and executive functions (i.e., strategic reasoning, problem-solving, and mental planning). The predictive role of days of CPAP use on the neuropsychological scores was assessed by hierarchical multiple linear regression analyses, over and above the possible role of demographics, body mass index, level of OSAS severity, and the level of anxiety and depression. The average number of days since CPAP adaptation was 4.70 (SD = 3.90; range = 0-15). As the days of CPAP adaptation increased, verbal learning and long-term memory significantly improved, contrary to the other assessed domains. Our results show a significant improvement in some cognitive functions even after a short treatment with CPAP, pointing to the importance of the early use of ventilotherapy to rapidly improve cognitive functioning. Identifying which cognitive functions can or cannot be restored with CPAP use may enable the design of complementary neuropsychological interventions focused on those residual difficulties, possibly enhancing patients' compliance to the treatment.
Collapse
|
5
|
Mahanna-Gabrielli E, Kuwayama S, Tarraf W, Kaur S, DeBuc DC, Cai J, Daviglus ML, Joslin CE, Lee DJ, Mendoza-Santiesteban C, Stickel AM, Zheng D, González HM, Ramos AR. The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos. J Alzheimers Dis 2023; 92:1257-1267. [PMID: 36872780 PMCID: PMC10792435 DOI: 10.3233/jad-221073] [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: 03/06/2023]
Abstract
BACKGROUND Visual impairment could worsen sleep/wake disorders and cognitive decline. OBJECTIVE To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. METHOD HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. RESULT Sleepiness (β= 0.04; p < 0.01) and insomnia (β= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (β= -0.16; p < 0.001) and on average 7-years later (β= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (β= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. CONCLUSION Self-reported visual impairment was independently associated with worse cognitive function and decline.
Collapse
Affiliation(s)
| | | | | | - Sonya Kaur
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jianwen Cai
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | - David J Lee
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Diane Zheng
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alberto R Ramos
- University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Zhang Y, Elgart M, Granot-Hershkovitz E, Wang H, Tarraf W, Ramos AR, Stickel AM, Zeng D, Garcia TP, Testai FD, Wassertheil-Smoller S, Isasi CR, Daviglus ML, Kaplan R, Fornage M, DeCarli C, Redline S, González HM, Sofer T. Genetic associations between sleep traits and cognitive ageing outcomes in the Hispanic Community Health Study/Study of Latinos. EBioMedicine 2023; 87:104393. [PMID: 36493726 PMCID: PMC9732133 DOI: 10.1016/j.ebiom.2022.104393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sleep phenotypes have been reported to be associated with cognitive ageing outcomes. However, there is limited research using genetic variants as proxies for sleep traits to study their associations. We estimated associations between Polygenic Risk Scores (PRSs) for sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnoea (OSA) and measures of cogntive ageing in Hispanic/Latino adults. METHODS We used summary statistics from published genome-wide association studies to construct PRSs representing the genetic basis of each sleep trait, then we studied the association of the PRSs of the sleep phenotypes with cognitive outcomes in the Hispanic Community Healthy Study/Study of Latinos. The primary model adjusted for age, sex, study centre, and measures of genetic ancestry. Associations are highlighted if their p-value <0.05. FINDINGS Higher PRS for insomnia was associated with lower global cognitive function and higher risk of mild cognitive impairment (MCI) (OR = 1.20, 95% CI [1.06, 1.36]). Higher PRS for daytime sleepiness was also associated with increased MCI risk (OR = 1.14, 95% CI [1.02, 1.28]). Sleep duration PRS was associated with reduced MCI risk among short and normal sleepers, while among long sleepers it was associated with reduced global cognitive function and with increased MCI risk (OR = 1.40, 95% CI [1.10, 1.78]). Furthermore, adjustment of analyses for the measured sleep phenotypes and APOE-ε4 allele had minor effects on the PRS associations with the cognitive outcomes. INTERPRETATION Genetic measures underlying insomnia, daytime sleepiness, and sleep duration are associated with MCI risk. Genetic and self-reported sleep duration interact in their effect on MCI. FUNDING Described in Acknowledgments.
Collapse
Affiliation(s)
- Yuan Zhang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Michael Elgart
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Einat Granot-Hershkovitz
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ariana M Stickel
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Tanya P Garcia
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | | | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles DeCarli
- Department of Neurology, Alzheimer's Disease Center, University of California, Davis, Sacramento, CA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Center, University of California, San Diego, La Jolla, CA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
7
|
Morrison HW, White MM, Rothers JL, Taylor-Piliae RE. Examining the Associations between Post-Stroke Cognitive Function and Common Comorbid Conditions among Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13445. [PMID: 36294026 PMCID: PMC9603222 DOI: 10.3390/ijerph192013445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
A considerable complication for stroke survivors is the subsequent development of cognitive decline or dementia. In this study, the relationship between the inflammation-centered comorbidity burden on post-stroke cognitive function among community-dwelling stroke survivors capable of independent living was examined. Data for this secondary analysis were collected from stroke survivors (n = 97) participating in a randomized clinical trial. Participants provided baseline responses, regarding cognitive function (mini-mental status exam, MMSE; Montreal cognitive assessment, MoCA), history of stroke comorbid conditions, and the Stroke Prognosis Instrument-II (SPI-II), an index of stroke comorbidity and recurrent stroke risk within the next two years. Relationships and differences between groups were tested for significance using Spearman's correlation, Kruskal-Wallis, or Mann-Whitney U tests. Most stroke survivors (69%) had multiple comorbidities. Total SPI-II scores were negatively correlated to both MoCA and MMSE scores (r = -0.25, p = 0.01; r = -0.22, p = 0.03, respectively), and differences in MoCA scores among SPI-II risk groups (low, medium, high) were evident (p = 0.05). In contrast, there were no differences in MoCA or MMSE scores when comorbid conditions were examined individually. Lastly, no gender differences were evident in cognitive assessments. Our data support the premise that comorbidity's burden impacts post-stroke cognitive decline, more than a single comorbid condition. Inflammation may be an important component of this comorbidity burden. Future studies that operationalize this concept will better illuminate the complex phenomenon of post-stroke cognitive decline for improved clinical rehabilitation modalities.
Collapse
Affiliation(s)
| | - Melissa M. White
- El Paso Veteran’s Administration Healthcare System, El Paso, TX 79930, USA
| | - Janet L. Rothers
- BIO5 Institute Statistics Consulting Lab, The University of Arizona, Tucson, AZ 85721, USA
| | | |
Collapse
|
8
|
Zhang Y, Elgart M, Kurniansyah N, Spitzer BW, Wang H, Kim D, Shah N, Daviglus M, Zee PC, Cai J, Gottlieb DJ, Cade BE, Redline S, Sofer T. Genetic determinants of cardiometabolic and pulmonary phenotypes and obstructive sleep apnoea in HCHS/SOL. EBioMedicine 2022; 84:104288. [PMID: 36174398 PMCID: PMC9515437 DOI: 10.1016/j.ebiom.2022.104288] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obstructive Sleep Apnoea (OSA) often co-occurs with cardiometabolic and pulmonary diseases. This study is to apply genetic analysis methods to explain the associations between OSA and related phenotypes. METHODS In the Hispanic Community Healthy Study/Study of Latinos, we estimated genetic correlations ρg between the respiratory event index (REI) and 54 anthropometric, glycemic, cardiometabolic, and pulmonary phenotypes. We used summary statistics from published genome-wide association studies to construct Polygenic Risk Scores (PRSs) representing the genetic basis of each correlated phenotype (ρg>0.2 and p-value<0.05), and of OSA. We studied the association of the PRSs of the correlated phenotypes with both REI and OSA (REI≥5), and the association of OSA PRS with the correlated phenotypes. Causal relationships were tested using Mendelian Randomization (MR) analysis. FINDINGS The dataset included 11,155 participants, 31.03% with OSA. 22 phenotypes were genetically correlated with REI. 10 PRSs covering obesity and fat distribution (BMI, WHR, WHRadjBMI), blood pressure (DBP, PP, MAP), glycaemic control (fasting insulin, HbA1c, HOMA-B) and insomnia were associated with REI and/or OSA. OSA PRS was associated with BMI, WHR, DBP and glycaemic traits (fasting insulin, HbA1c, HOMA-B and HOMA-IR). MR analysis identified robust causal effects of BMI and WHR on OSA, and probable causal effects of DBP, PP, and HbA1c on OSA/REI. INTERPRETATION There are shared genetic underpinnings of anthropometric, blood pressure, and glycaemic phenotypes with OSA, with evidence for causal relationships between some phenotypes. FUNDING Described in Acknowledgments.
Collapse
Affiliation(s)
- Yuan Zhang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Michael Elgart
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nuzulul Kurniansyah
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian W. Spitzer
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Doyoon Kim
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Neomi Shah
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel J. Gottlieb
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian E. Cade
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Corresponding author at: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
9
|
Gharsalli H, Harizi C, Zaouche R, Sahnoun I, Saffar F, Maalej S, Douik El Gharbi L. Prevalence of depression and anxiety in obstructive sleep apnea. LA TUNISIE MEDICALE 2022; 100:525-533. [PMID: 36571741 PMCID: PMC9703910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Organic comorbidities of obstructive sleep apnea (OSA) have been widely studied. However, psychiatric disorders, especially depression and anxiety, have not attracted so much attention. AIM The primary aim was to determine the prevalence and the predictive factors of depression and anxiety in OSA patients. The secondary aim was to investigate the association between OSA severity and these psychiatric disorders. METHODS A cross-sectional study including untreated OSA patients without mental illness history was conducted. Patients were administered the Hospital Anxiety (HADS-A) and Depression Scale (HADS-D). Depression and anxiety were diagnosed for HAD-D and HAD-A scores ≥ 8. RESULTS Eighty patients were included (mean age: 54.83 ± 13.12 yr; female: 52 (65%); mean Body mass index (BMI) :34.7±6.14 kg/m2). The prevalence of depression and anxiety was 35 % and 43.8% of patients respectively. Both depressive and anxious OSA patients had more libido disorder ( p=0.011, p=0.0007 ;respectively), anhedonia (p= 10-4, p= 10-4respectively ) and suicidal ideas(p= 0.002 ,p=0.019 respectively). Moreover, depressed OSA patients had lower socio-economic condition (p= 0.019), more coronary artery diseases (CAD) (p=0.019) and less cognitive disorder (p= 0.005). The HADS-D (r=0,095; p=0,404) and the HADS-A (r=0,212; p=0,059) were not correlated with the Apnea/Hyponea Index. The determinants of depressive and anxious mood were female-sex (p= 0.035, p=0.004 respectively) and libido disorder (p=0.040, p=0.02 respectively). Anhedonia (p=10-4) and CAD (p=0.010) were also identified as a predictive factors of depression. CONCLUSIONS In our study, the high prevalence of depression and axiety in apneic patients demonstrates the importance of the psychiatric component in the management of this disease. A collaboration between pneumologists and psychiatrists is necessary in order to improve the quality of life of these patients.
Collapse
Affiliation(s)
- Houda Gharsalli
- 1. Department of Pulmonology, A. Mami Hospital, Ariana, University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Chahida Harizi
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Rania Zaouche
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia,3. El Razi Hospital for psychiatric disorders , Manouba, Tunisia
| | - Imen Sahnoun
- 1. Department of Pulmonology, A. Mami Hospital, Ariana, University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Farah Saffar
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Sonia Maalej
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Leila Douik El Gharbi
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| |
Collapse
|
10
|
Xiaojin L, Licong C, Fei W, Schulz PE, Zhang GQ. Identifying Sleep-Related Factors Associated with Cognitive Function in a Hispanics/Latinos Cohort: A Dual Random Forest Approach. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:744-753. [PMID: 35308908 PMCID: PMC8861662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Disordered sleep is associated with poor cognitive function and cognitive decline. However, little is known regarding the association of sleep-related factors with cognitive function in underrepresented cohorts such as the Hispanic/Latino population. Leveraging the National Sleep Research Resource, one of the most comprehensive collections of sleep studies, we identified a Hispanic/Latino cohort of 1,031 lower cognitive function cases and 2,062 normal controls. We developed a novel dual random forest (DRF) approach to discriminate cases against controls for estimating the potential impact of sleep-related variables related to the decline of cognitive function. Several important sleep-related factors were identified which may be associated with cognitive function in the Hispanics/Latinos cohort, such as heart rate, sleep duration, trouble falling asleep, and apnea/hypopnea index, which are consistent with existing research findings. Our DRF approach is effective in validating the association between disordered sleep and cognitive decline in this unique minority population.
Collapse
Affiliation(s)
- Li Xiaojin
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| | - Cui Licong
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| | - Wang Fei
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065
| | - Paul E Schulz
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| | - Guo-Qiang Zhang
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| |
Collapse
|
11
|
Association between risk of obstructive sleep apnea, inflammation and cognition after 45 years old in the Canadian Longitudinal Study on Aging. Sleep Med 2022; 91:21-30. [DOI: 10.1016/j.sleep.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/23/2022]
|
12
|
González KA, Tarraf W, Wallace DM, Stickel AM, Schneiderman N, Redline S, Patel SR, Gallo LC, Mossavar-Rahmani Y, Daviglus ML, Zee PC, Talavera GA, Sotres-Alvarez D, González HM, Ramos A. Phenotypes of obstructive sleep apnea in the Hispanic Community Health Study/Study of Latinos. Sleep 2021; 44:zsab181. [PMID: 34272952 PMCID: PMC8664595 DOI: 10.1093/sleep/zsab181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Recent work on US Whites from clinical samples used obstructive sleep apnea (OSA) symptoms to generate phenotypes for individuals with moderate-severe OSA which suggested 3 to 5 symptom classes. However, it is unknown whether similar classes generalize to diverse Hispanics/Latino adults. Therefore, we sought to fill this gap by empirically deriving sleep phenotypes among a large sample of diverse Hispanics/Latinos. METHODS We used data from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL; 2008-2011), a prospective cohort study designed using a multisite multistage probability sample of adults 18-74 years old. The subpopulation of interest included participants with moderate-severe OSA symptoms (≥15 respiratory event index (REI) events per hour; n = 1,605). We performed latent class analysis for complex survey data using 15 common OSA symptoms (e.g. Epworth Sleepiness Scale) and 4 comorbidities to identify phenotype classes. RESULTS Average age was 52.4 ± 13.9 years and 34.0% were female. Mean REI was 33.8 ± 22.5 events per hour. Fit statistics and clinical significance suggested that a three-class solution provided the best fit to the data. The three phenotypes were: (1) Minimally Symptomatic (47.7%), (2) Excessive sleepiness (37.1%), and (3) Disturbed Sleep (15.2%). Sensitivity models were consistent with the main proposed solution. CONCLUSIONS Derived sleep phenotypes among diverse Hispanic/Latinos were consistent with recent findings from the Sleep Apnea Global Interdisciplinary Consortium, but we found notable differences in class prevalence relative to Whites. Further research is needed to link derived sleep phenotypes to health comorbidities in diverse populations.
Collapse
Affiliation(s)
- Kevin A González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Wassim Tarraf
- Department of Healthcare Sciences and Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Douglas M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ariana M Stickel
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Linda C Gallo
- Department of Psychology and South Bay Latino Research Center, San Diego State University, San Diego, CA, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Alberto Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
13
|
West NA, Johnson DA, Lutsey PL, Mosley TH, Redline S. Cognition and 20-year subsequent sleep disturbances. Sleep Health 2021; 7:631-637. [PMID: 33750660 PMCID: PMC9829416 DOI: 10.1016/j.sleh.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There is a paucity of data exploring the extent that preclinical cognitive changes are predictive of subsequent sleep outcomes. METHODS Logistic regression models were used to evaluate data from a cohort of 196 African American adults who had measures of cognitive function assessed at 2 time points during a 20-year period across the mid- to late-life transition. Cognitive testing included the Delayed Word Recall, the Digit Symbol Substitution, and the Word Fluency tests, which were summarized as a composite cognitive z-score. Sleep apnea was measured by in-home sleep apnea testing and sleep duration and quality were derived from 7-day wrist actigraphy at the end of the study period. RESULTS A one standard deviation (SD) lower composite cognitive z-score at baseline was significantly associated with greater odds of low sleep efficiency (<85%) (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.13, 3.04) and greater odds of increased wakefulness after sleep onset time (WASO; >60 minutes) (OR = 1.65, 95% CI = 1.05, 2.60) in adjusted models. A one SD faster rate of cognitive decline over the study period was significantly associated with greater odds of low sleep efficiency (OR = 1.68, 95% CI = 1.04, 2.73), greater odds of sleep fragmentation (>35%); (OR = 1.73, 95% CI = 1.05, 2.85), and greater odds of increased WASO (OR = 1.85, 95% CI = 1.15, 2.95) in adjusted models. Neither baseline cognitive z-score nor rate of cognitive decline was associated with sleep apnea or the total average sleep duration. CONCLUSION Cognition at baseline and change over time predicts sleep quality and may reflect common neural mechanisms and vulnerabilities.
Collapse
Affiliation(s)
- Nancy A. West
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA,Corresponding author: Nancy A. West, Division of Epidemiology, University of Utah, 383 Colorow Way, Suite 203, Salt Lake City, UT 84112, USA, (N.A. West)
| | - Dayna A. Johnson
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas H. Mosley
- Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Abstract
There is a strong association between obstructive sleep apnea (OSA) and cognitive dysfunction. Executive function, attention, verbal/visual long-term memory, visuospatial/constructional ability, and information processing are more likely to be affected, whereas language, psychomotor function, and short-term memory are less likely to be affected. Increased accumulation of Aß2-amyloid in the brain, episodic hypoxemia, oxidative stress, vascular inflammation, and systemic comorbidities may contribute to the pathogenesis. Patients with OSA should have cognitive screening or formal testing, and patients with cognitive decline should have testing for OSA. Treatment with continuous positive airway pressure may improve cognitive symptoms in the patient with OSA.
Collapse
Affiliation(s)
- Arpan Patel
- Department of Neurology, Donald and Barbara Zucker School of Medicine, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | - Derek J Chong
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell Health, Lenox Hill Hospital, 130 East 77th Street, 8 Black Hall, New York, NY 10075, USA.
| |
Collapse
|
15
|
Legault J, Thompson C, Martineau-Dussault MÈ, André C, Baril AA, Martinez Villar G, Carrier J, Gosselin N. Obstructive Sleep Apnea and Cognitive Decline: A Review of Potential Vulnerability and Protective Factors. Brain Sci 2021; 11:706. [PMID: 34071739 PMCID: PMC8226698 DOI: 10.3390/brainsci11060706] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
Around 40% of dementia risk is attributable to modifiable risk factors such as physical inactivity, hypertension, diabetes and obesity. Recently, sleep disorders, including obstructive sleep apnea (OSA), have also been considered among these factors. However, despite several epidemiological studies investigating the link between OSA and cognitive decline, there is still no consensus on whether OSA increases the risk of dementia or not. Part of the heterogeneity observed in previous studies might be related to some individual characteristics that modulate the association between OSA and cognitive decline. In this narrative review, we present these individual characteristics, namely, age, sex, menopause, obesity, diabetes mellitus, hypertension, cardiovascular diseases, smoking, excessive alcohol consumption, depression, air pollution, Apolipoprotein E ε4 allele, physical activity, and cognitive reserve. To date, large cohort studies of OSA and cognitive decline tended to statistically control for the effects of these variables, but whether they interact with OSA to predict cognitive decline remains to be elucidated. Being able to better predict who is at risk of cognitive decline when they have OSA would improve clinical management and treatment decisions, particularly when patients present relatively mild OSA.
Collapse
Affiliation(s)
- Julie Legault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada;
| | - Guillermo Martinez Villar
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Recherche CIUSSS NIM, Montreal, QC H4J 1C5, Canada; (J.L.); (C.T.); (M.-È.M.-D.); (C.A.); (G.M.V.); (J.C.)
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| |
Collapse
|
16
|
Polesel DN, Nozoe KT, Bittencourt L, Tufik S, Andersen ML, Fernandes MTB, Hachul H. Waist-to-height ratio and waist circumference as the main measures to evaluate obstructive sleep apnea in the woman's reproductive life stages. Women Health 2021; 61:277-288. [PMID: 33390097 DOI: 10.1080/03630242.2020.1862386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder. In women, the frequency of OSA increases substantially during and after the menopause, as does the prevalence of obesity in this reproductive life stage. This cross-sectional study uses data from the Sao Paulo Epidemiologic Sleep Study (EPISONO, 2007), and comprises a sample of 500 women aged 20-80 years. Multiple logistic regression analysis was used to assess the factors associated with OSA in premenopausal and postmenopausal women. All participants underwent polysomnography, and obesity was assessed using the waist-to-height ratio (WHtR), body mass index, neck and waist circumference, measured using standard methods. WHtR was the factor most associated with a significant increase in risk of OSA in premenopausal women. Waist circumference was the factor most associated with OSA in postmenopausal women, for all severities of the disease. Anthropometric factors presented a high rate of accuracy in the classification of women with OSA. The study found that different obesity-related anthropometric measures should be considered in the diagnosis of OSA, according to the woman's reproductive stage.
Collapse
Affiliation(s)
| | - Karen Tieme Nozoe
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Lia Bittencourt
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Monica Levy Andersen
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | | | - Helena Hachul
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
17
|
Jackson CL, Powell-Wiley TM, Gaston SA, Andrews MR, Tamura K, Ramos A. Racial/Ethnic Disparities in Sleep Health and Potential Interventions Among Women in the United States. J Womens Health (Larchmt) 2020; 29:435-442. [PMID: 32096683 PMCID: PMC7097680 DOI: 10.1089/jwh.2020.8329] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
While essential for health and wellness, the various dimensions of sleep health are generally not equitably distributed across the population, and reasons for racial/ethnic sleep disparities are not fully understood. In this review, we describe racial/ethnic sleep disparities and subsequent implications for health from prior and recently conducted epidemiological and clinical studies as well as the potential sleep interventions presented at the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health. Given the clear connection between sleep and poor health outcomes such as cardiovascular disease, we concluded that future studies are needed to focus on sleep health in general, sleep disorders such as insomnia and obstructive sleep apnea in particular, and disparities in both sleep health and sleep disorders among women using an intersectional framework. Future research should also integrate sleep into interventional research focused on women's health as these results could address health disparities by informing, for example, future mobile health (mHealth) interventions prioritizing women beyond the clinical setting.
Collapse
Affiliation(s)
- Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, North Carolina
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Sciences, Bethesda, Maryland
| | - Tiffany M. Powell-Wiley
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Sciences, Bethesda, Maryland
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Symielle A. Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, North Carolina
| | - Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Alberto Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
| |
Collapse
|
18
|
Ramos AR, Tarraf W, Wu B, Redline S, Cai J, Daviglus ML, Gallo L, Mossavar-Rahmani Y, Perreira KM, Zee P, Zeng D, Gonzalez HM. Sleep and neurocognitive decline in the Hispanic Community Health Study/Study of Latinos. Alzheimers Dement 2020; 16:305-315. [PMID: 31606367 DOI: 10.1016/j.jalz.2019.08.191] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To determine if sleep-disordered breathing (SDB), daytime sleepiness, insomnia, and sleep duration predict seven-year neurocognitive decline in US Hispanics/Latinos (N = 5247). METHODS The exposures were baseline SDB, daytime sleepiness, insomnia, and sleep duration. The outcomes were change in episodic learning and memory (B-SEVLT-Sum and SEVLT-Recall), language (word fluency [WF]), processing speed (Digit Symbol Substitution), and a cognitive impairment screener (Six-item Screener [SIS]). RESULTS Mean age was 63 ± 8 years, with 55% of the population being female with 7.0% Central American, 24.5% Cuban, 9.3% Dominican, 35.9% Mexican, 14.4% Puerto Rican, and 5.1% South American background. Long sleep (>9 hours), but not short sleep (<6 hours), was associated with decline (standard deviation units) in episodic learning and memory (βSEVLT-Sum = -0.22 [se = 0.06]; P < .001; βSEVLT-Recall = -0.13 [se = 0.06]; P < .05), WF (Pwf = -0.20 [se 5 0.06]; P < .01), and SIS (βSIS = -0.16 [se = 0.06]; P < .01), but not processing speed, after adjusting for covariates. SDB, sleepiness, and insomnia were not associated with neurocognitive decline. CONCLUSION Long sleep duration predicted seven-year cognitive decline.
Collapse
Affiliation(s)
- Alberto R Ramos
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Benson Wu
- University of California San Diego, San Diego, CA, USA
| | | | - Jianwen Cai
- University of North Carolina, Chapel Hill, NC, USA
| | | | - Linda Gallo
- San Diego State University, San Diego, CA, USA
| | | | | | - Phyllis Zee
- Feinberg School of Medicine, Chicago, IL, USA
| | - Donglin Zeng
- University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
19
|
Barletta P, Abreu AR, Ramos AR, Dib SI, Torre C, Chediak AD. Role of Obstructive Sleep Apnea in Cognitive Impairment. INTERNATIONAL JOURNAL OF HEAD AND NECK SURGERY 2019; 10:57-61. [PMID: 34305353 PMCID: PMC8302067 DOI: 10.5005/jp-journals-10001-1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggest that untreated and undertreated OSA increases the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders, like Alzheimer’s disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.
Collapse
Affiliation(s)
- Pamela Barletta
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alexandre R Abreu
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto R Ramos
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Salim I Dib
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Carlos Torre
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alejandro D Chediak
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
20
|
Lee JE, Yang SW, Ju YJ, Ki SK, Chun KH. Sleep-disordered breathing and Alzheimer's disease: A nationwide cohort study. Psychiatry Res 2019; 273:624-630. [PMID: 30735921 DOI: 10.1016/j.psychres.2019.01.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/01/2023]
Abstract
Sleep-disordered breathing (SDB) is common and can lead to significant cognitive decline, such as Alzheimer's disease (AD). Therefore, the present study was conducted to investigate whether SDB is associated with AD onset. This study used the nationwide health check-up cohort data between 2002 and 2015. The study population comprised individuals who were diagnosed with SDB and those without SDB who were matched by using propensity score. The matched cohort was followed up until the onset of AD, death, or end of 2015. A multivariate Cox proportional hazard model was used in the analysis. There were 727 (16.7%) patients in the SDB group between 2002 and 2005 and 3635 subjects (83.3%) in the propensity score-matched non-SDB group. After adjusting for the possible confounding variables, patients with SDB were almost 1.58 times more likely to develop AD than those without SDB (hazard ratio [HR] = 1.575, 95% confidence interval [CI] = 1.013-2.448). The present study showed that SDB was associated with an onset of AD. The findings of this study highlight the importance of the interventions to raise awareness of SDB and the need for the government's support to reduce the barrier in accessing appropriate SDB treatment.
Collapse
Affiliation(s)
- Joo Eun Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Republic of Korea
| | - Seong Wu Yang
- Department of Internal Medicine, Jesaeng Hospital, Seongnam, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Republic of Korea
| | - Seung Kuk Ki
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Hong Chun
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.
| |
Collapse
|
21
|
Gouveris H, Eckert DJ. Editorial: Obstructive Sleep Apnea and the Brain. Front Surg 2018; 5:78. [PMID: 30631767 PMCID: PMC6315176 DOI: 10.3389/fsurg.2018.00078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Haralampos Gouveris
- Department of Otorhinolaryngology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA) and the University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
22
|
Tarraf W, Criqui MH, Allison MA, Wright CB, Fornage M, Daviglus M, Kaplan RC, Davis S, Conceicao AS, González HM. Ankle brachial index and cognitive function among Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos. Atherosclerosis 2018; 271:61-69. [PMID: 29459267 DOI: 10.1016/j.atherosclerosis.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/17/2018] [Accepted: 02/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS The Ankle-Brachial index (ABI) is a well-accepted measure of peripheral artery disease (arterial stenosis and stiffness) and has been shown to be associated with cognitive function and disorders; however, these associations have not been examined in Hispanics/Latinos. Therefore, we sought to examine relationships between ABI and cognitive function among diverse middle-age and older Hispanics/Latinos. METHODS We used cross-sectional data on n = 7991 participants aged 45-74 years, without stroke or coronary heart disease, from the Hispanic Community Health Study/Study of Latinos. Our primary outcome, global cognition (GC), was a continuous composite score of four cognitive domains (verbal learning and memory, verbal fluency, executive function, and mental status). Secondary outcomes were the individual tests representing these domains. The ABI was analyzed continuously and categorically with standard clinical cut-points. We tested associations using generalized survey regression models incrementally adjusting for confounding factors. Age, sex, hypertension, diabetes, and dyslipidemia moderations were examined through interactions with the primary exposure. RESULTS In age, sex, and education adjusted models, continuous ABI had an inverse u-shape association with worse GC. We found similar associations with measures of verbal learning and memory, verbal fluency, executive function, but not with low mental status. The associations were attenuated, but not completely explained, by accounting for the confounders and not modified by age, sex, education, and vascular disease risks. CONCLUSIONS In addition to being a robust indicator of arterial compromise, our study suggests that abnormal ABI readings may also be useful for early signaling of subtle cognitive deficits.
Collapse
Affiliation(s)
- Wassim Tarraf
- Institute of Gerontology & Department of Health Care Sciences, Wayne State University, 87 East Ferry St., 240 Knapp Building, Detroit, MI, 48202, USA
| | - Michael H Criqui
- Family and Preventative Medicine, University of California San Diego, 9500 Gilman Drive, MC 0607, SCRB 352, La Jolla, CA, 92093-0607, USA
| | - Matthew A Allison
- Family and Preventative Medicine, University of California San Diego, 9500 Gilman Drive, MC 0965, La Jolla, CA, 92093-0607, USA
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 6001 Executive Boulevard Suite 3309, Bethesda, MD, 20892-9531, USA
| | - Myriam Fornage
- University of Texas Health Science Center at Houston, 1825 Pressler Street, Building SRB-530G, Houston, TX, 77030, USA
| | - Martha Daviglus
- Department of Preventative Medicine, University of Illinois-Chicago, Feinberg School of Medicine, 1819 W. Polk Street, MC 764, Suite 246, Chicago, IL, 60612, USA
| | - Robert C Kaplan
- Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Belfer Building Room 1306C, Bronx, NY, 10461, USA
| | - Sonia Davis
- Department of Biostatistics, University of North Carolina at Chapel Hill, 137 East Franklin St, Suite 203, Chapel Hill, NC, 27514, USA
| | - Alan S Conceicao
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Hector M González
- UC San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, 92093-0949, USA.
| |
Collapse
|
23
|
Labarca G, Cruz R, Jorquera J. Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Non-Alcoholic Steatohepatitis: A Systematic Review and Meta-Analysis. J Clin Sleep Med 2018; 14:133-139. [PMID: 29151428 DOI: 10.5664/jcsm.6900] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES Several studies have reported an association between obstructive sleep apnea (OSA) and several extra-pulmonary issues, such as arterial hypertension and insulin resistance. In recent years, the associations between OSA, non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis (NASH) have been published; however, there is a gap between experimental and clinical studies regarding the efficacy of continuous positive airway pressure (CPAP) treatment in patient populations with these conditions. This issue should be considered when deciding on CPAP treatment in patients with OSA, especially in patients with moderate OSA. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) using the following databases: MEDLINE, Lilacs, and CENTRAL. Two independent reviewers performed the search, analysis, data extraction, and critical analysis. RESULTS From 622 identified studies, we included 5 RCTs that involved patients with OSA and NASH and who were treated with a CPAP device. After CPAP treatment, no changes in liver steatosis, liver fibrosis, and aminotransferase levels (alanine aminotransferase and aspartate aminotransferase) were found. Finally, the quality of evidence using the GRADE approach was low and very low for several outcomes. CONCLUSIONS According to the current analysis, no data regarding the efficacy of CPAP in patients with NASH are available to make recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO; ID: CRD42015027981; URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015027981.
Collapse
Affiliation(s)
- Gonzalo Labarca
- Universidad San Sebastián, Concepción, Chile.,Departamento de Medicina Interna, Complejo Asistencial Víctor Ríos Ruiz, Los Ángeles, Chile
| | - Rodrigo Cruz
- Gastroenterology, Hospital Dipreca, Santiago, Chile
| | - Jorge Jorquera
- Sleep Center and Respiratory Disease, Clinica Las Condes, Santiago, Chile
| |
Collapse
|
24
|
Tamayo Martínez N, Rosselli Cock D. [Obstructive sleep apnea syndrome in patients attending a psychiatry outpatient service: a case series]. ACTA ACUST UNITED AC 2017; 46:243-246. [PMID: 29122232 DOI: 10.1016/j.rcp.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 07/03/2016] [Accepted: 08/15/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a condition associated with multiple negative outcomes. People with mental illness might be at increased risk of having it, given that medication given has adverse effects on weight and there are alterations in sleep associated with them; however, there are few studies in this population. OBJECTIVE Describe the patients and the results of polysomnography ordered based on clinical symptoms in a psychiatric outpatient clinic between 2012 and 2014. METHODS A case series in which medical records were evaluated. RESULTS 58 patients who underwent polysomnography, 89% of them had OSAS, 16% were obese and 19% were been treated with benzodiazepines. CONCLUSIONS This is a condition that must be considered during the clinical evaluation of patients with mental illness, since its presence should make clinicians think about drug treatment and follow up.
Collapse
Affiliation(s)
- Nathalie Tamayo Martínez
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Diego Rosselli Cock
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
25
|
Kim H, Thomas RJ, Yun CH, Au R, Lee SK, Lee S, Shin C. Association of Mild Obstructive Sleep Apnea With Cognitive Performance, Excessive Daytime Sleepiness, and Quality of Life in the General Population: The Korean Genome and Epidemiology Study (KoGES). Sleep 2017; 40:2962428. [PMID: 28329071 DOI: 10.1093/sleep/zsx012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Study Objectives Research points to impaired cognitive performance in sleep clinic patients with obstructive sleep apnea (OSA). However, inconsistent findings from various epidemiologic studies make this relationship less generalizable. The current study investigated the association between OSA and functional outcome measures, such as cognition, daytime sleepiness, and quality of life, in a Korean general population sample. Methods A total of 1492 participants from the Korean Genome and Epidemiology Study (KoGES) were included in the analyses. The presence of OSA measured by overnight polysomnography (PSG) was defined by apnea-hypopnea index (AHI) >5. Cognitive performance was determined with scores from a comprehensive neuropsychological battery. Excessive daytime sleepiness and quality of life were additionally measured through subjective reports. Results After adjusting for various demographic and medical characteristics, OSA was independently associated with lower performance in the Digit Symbol Test (52.73 ± 17.08 vs. 58.72 ± 18.03, OSA vs. not, p = .02). Hypoxia measures were not related to cognitive performance. OSA was associated with higher odds of displaying excessive daytime sleepiness (odds ratio = 1.72, 95% CI: 1.05-2.80), but there was no significant relationship between OSA and quality of life. Conclusions Cognition was unexpectedly unaffected overall. However, OSA was associated with impairment in a multidomain test that taps skills generally associated with frontal lobe function. The results suggest that research on protective and adaptive brain mechanisms to OSA stress can provide unique insights into the brain-sleep interface. As the study runs longitudinally, it will enable future studies on the impact of OSA on cognitive decline.
Collapse
Affiliation(s)
- Hyun Kim
- Department of Psychological and Brain Sciences, Boston University.,Institute of Human Genomic Study, Korea University Ansan Hospital.,Framingham Heart Study, Boston University School of Medicine
| | - Robert J Thomas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital
| | - Sunghee Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital.,Department of Respiratory Internal Medicine, Korea University Ansan Hospital
| |
Collapse
|
26
|
Age- and gender-related differences of CPAP acceptance for obstructive sleep apnea syndrome in Taiwan. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0132-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Vásquez E, Strizich G, Isasi CR, Echeverria SE, Sotres-Alvarez D, Evenson KR, Gellman MD, Palta P, Qi Q, Lamar M, Tarraf W, González HM, Kaplan R. Is there a relationship between accelerometer-assessed physical activity and sedentary behavior and cognitive function in US Hispanic/Latino adults? The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med 2017; 103:43-48. [PMID: 28765082 PMCID: PMC5798874 DOI: 10.1016/j.ypmed.2017.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/01/2017] [Accepted: 07/24/2017] [Indexed: 01/08/2023]
Abstract
Normative changes in cognitive function are expected with increasing age. Research on the relationship between normative cognitive decline and moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SED) needs further investigation in Hispanic/Latinos adults. We assessed the cross-sectional association between accelerometer assessed MVPA and SED with cognitive function in 7,478 adults aged 45-74years from the Hispanic Community Health Study/Study of Latinos. At baseline, cognitive tests included two executive function tests (Digit Symbol Substitution Test (DSST), a test of language (Word Fluency), and a test of memory (Spanish English Verbal Learning Test). Multiple regression models were used to examine associations of time spent in MVPA and SED with cognitive function by age groups, adjusted for age, education, sex, acculturation, and field center. Mean time spent in sedentary behaviors was 12.3h/day in females and 11.9 h/day in males (75% and 77% of accelerometer wear time, respectively). Higher SED, but not MVPA, was associated with lower DSST raw scores (β -0.03 with each 10-min increment in SED; P<0.05), indicating lower performance in executive function in all age groups. No associations were observed for MVPA and SED with tests of language or memory tests. Our findings suggest a distinct association of SED but not MVPA on executive functioning in middle-aged and older Latino adults. Longitudinal studies are needed to more conclusively determine causal links.
Collapse
Affiliation(s)
- Elizabeth Vásquez
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States.
| | - Garrett Strizich
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Carmen R Isasi
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Sandra E Echeverria
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Daniela Sotres-Alvarez
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Kelly R Evenson
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Marc D Gellman
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Priya Palta
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Qibin Qi
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Melissa Lamar
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Wassim Tarraf
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Hector M González
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| | - Robert Kaplan
- University at Albany (SUNY), Epidemiology and Biostatistics, 1 University place, 12144 Rensselaer, United States
| |
Collapse
|
28
|
Leng Y, McEvoy CT, Allen IE, Yaffe K. Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA Neurol 2017; 74:1237-1245. [PMID: 28846764 PMCID: PMC5710301 DOI: 10.1001/jamaneurol.2017.2180] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/15/2017] [Indexed: 11/14/2022]
Abstract
Importance Growing evidence suggests an association between sleep-disordered breathing (SDB) and cognitive decline in elderly persons. However, results from population-based studies have been conflicting, possibly owing to different methods to assess SDB or cognitive domains, making it difficult to draw conclusions on this association. Objective To provide a quantitative synthesis of population-based studies on the relationship between SDB and risk of cognitive impairment. Data Sources PubMed, EMBASE, and PsychINFO were systematically searched to identify peer-reviewed articles published in English before January 2017 that reported on the association between SDB and cognitive function. Study Selection We included cross-sectional and prospective studies with at least 200 participants with a mean participant age of 40 years or older. Data Extraction and Synthesis Data were extracted independently by 2 investigators. We extracted and pooled adjusted risk ratios from prospective studies and standard mean differences from cross-sectional studies, using random-effect models. This meta-analysis followed the PRISMA guidelines and also adhered to the MOOSE guidelines. Main Outcomes and Measures Cognitive outcomes were based on standard tests or diagnosis of cognitive impairment. Sleep-disordered breathing was ascertained by apnea-hypopnea index or clinical diagnosis. Results We included 14 studies, 6 of which were prospective, covering a total of 4 288 419 men and women. Pooled analysis of the 6 prospective studies indicated that those with SDB were 26% (risk ratio, 1.26; 95% CI, 1.05-1.50) more likely to develop cognitive impairment, with no evidence of publication bias but significant heterogeneity between studies. After removing 1 study that introduced significant heterogeneity, the pooled risk ratio was 1.35 (95% CI, 1.11-1.65). Pooled analysis of the 7 cross-sectional studies suggested that those with SDB had slightly worse executive function (standard mean difference, -0.05; 95% CI, -0.09 to 0.00), with no evidence of heterogeneity or publication bias. Sleep-disordered breathing was not associated with global cognition or memory. Conclusions and Relevance Sleep-disordered breathing is associated with an increased risk of cognitive impairment and a small worsening in executive function. Further studies are required to determine the mechanisms linking these common conditions and whether treatment of SDB might reduce risk of cognitive impairment.
Collapse
Affiliation(s)
- Yue Leng
- Department of Psychiatry, University of California,
San Francisco
| | - Claire T. McEvoy
- Department of Psychiatry, University of California,
San Francisco
- School of Medicine, Dentistry, and Biomedical
Sciences, Queen’s University, Belfast, United Kingdom
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics,
University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry, University of California,
San Francisco
- Department of Neurology, University of California, San
Francisco
- Department of Epidemiology, University of California,
San Francisco
- San Francisco VA Medical Center, San Francisco,
California
| |
Collapse
|
29
|
Lam EWK, Chung F, Wong J. Sleep-Disordered Breathing, Postoperative Delirium, and Cognitive Impairment. Anesth Analg 2017; 124:1626-1635. [DOI: 10.1213/ane.0000000000001914] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
30
|
Latshang TD, Furian M, Aeschbacher SS, Ulrich S, Osmonov B, Mirrakhimov EM, Isakova J, Aldashev AA, Sooronbaev TM, Bloch KE. Association between sleep apnoea and pulmonary hypertension in Kyrgyz highlanders. Eur Respir J 2017; 49:13993003.01530-2016. [PMID: 28007792 DOI: 10.1183/13993003.01530-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/21/2016] [Indexed: 02/03/2023]
Abstract
This case-control study evaluates a possible association between high altitude pulmonary hypertension (HAPH) and sleep apnoea in people living at high altitude.Ninety highlanders living at altitudes >2500 m without excessive erythrocytosis and with normal spirometry were studied at 3250 m (Aksay, Kyrgyzstan); 34 healthy lowlanders living below 800 m were studied at 760 m (Bishkek, Kyrgyzstan). Echocardiography, polysomnography and other outcomes were assessed. Thirty-six highlanders with elevated mean pulmonary artery pressure (mPAP) >30 mmHg (31-42 mmHg by echocardiography) were designated as HAPH+. Their data were compared to that of 54 healthy highlanders (HH, mPAP 13-28 mmHg) and 34 healthy lowlanders (LL, mPAP 8-24 mmHg).The HAPH+ group (median age 52 years (interquartile range 47-59) had a higher apnoea-hypopnoea index (AHI) of 33.8 events·h-1 (26.9-54.6) and spent a greater percentage of the night-time with an oxygen saturation <90% (T<90; 78% (61-89)) than the HH group (median age 39 years (32-48), AHI 9.0 events·h-1 (3.6-16), T<90 33% (10-69)) and the LL group (median age 40 years (30-47), AHI 4.3 events·h-1 (1.4-12.6), T<90 0% (0-0)); p<0.007 for AHI and T<90, respectively, in HAPH+ versus others. In highlanders, multivariable regression analysis confirmed an independent association between mPAP and both AHI and T<90, when controlled for age, gender and body mass index.Pulmonary hypertension in highlanders is associated with sleep apnoea and hypoxaemia even when adjusted for age, gender and body mass index, suggesting pathophysiologic interactions between pulmonary haemodynamics and sleep apnoea.
Collapse
Affiliation(s)
- Tsogyal D Latshang
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Furian
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Sayaka S Aeschbacher
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Batyr Osmonov
- Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Erkin M Mirrakhimov
- Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic.,Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
| | - Jainagul Isakova
- Research Institute for Molecular Biology and Medicine, Bishkek, Kyrgyz Republic
| | - Almaz A Aldashev
- Research Institute for Molecular Biology and Medicine, Bishkek, Kyrgyz Republic
| | - Talant M Sooronbaev
- Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Konrad E Bloch
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
31
|
Haba-Rubio J, Marti-Soler H, Tobback N, Andries D, Marques-Vidal P, Waeber G, Vollenweider P, von Gunten A, Preisig M, Castelao E, Tafti M, Heinzer R, Popp J. Sleep characteristics and cognitive impairment in the general population: The HypnoLaus study. Neurology 2016; 88:463-469. [PMID: 28039311 DOI: 10.1212/wnl.0000000000003557] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/03/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess the association between sleep structure and cognitive impairment in the general population. METHODS Data stemmed from 580 participants aged >65 years of the population-based CoLaus/PsyCoLaus study (Lausanne, Switzerland) who underwent complete sleep evaluation (HypnoLaus). Evaluations included demographic characteristics, personal and treatment history, sleep complaints and habits (using validated questionnaires), and a complete polysomnography at home. Cognitive function was evaluated using a comprehensive neuropsychological test battery and a questionnaire on the participant's everyday activities. Participants with cognitive impairment (global Clinical Dementia Rating [CDR] scale score > 0) were compared with participants with no cognitive impairment (global CDR score = 0). RESULTS The 291 participants with a CDR score > 0 (72.5 ± 4.6 years), compared to the 289 controls with CDR = 0 (72.1 ± 4.6 years), had significantly more light (stage N1) and less deep (stage N3) and REM sleep, as well as lower sleep efficiency, higher intrasleep wake, and higher sleepiness scores (all p < 0.05). Sleep-disordered breathing was more severe in participants with cognitive impairment with an apnea/hypopnea index (AHI) of 18.0 (7.8-35.5)/h (p50 [p25-p75]) (vs 12.9 [7.2-24.5]/h, p < 0.001), and higher oxygen desaturation index (ODI). In the multivariate analysis after adjustments for confounding variables, the AHI and the ODI ≥4% and ≥6% were independently associated with cognitive impairment. CONCLUSIONS Participants aged >65 years with cognitive impairment have higher sleepiness scores and a more disrupted sleep. This seems to be related to the occurrence of sleep-disordered breathing and the associated intermittent hypoxia.
Collapse
Affiliation(s)
- José Haba-Rubio
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland.
| | - Helena Marti-Soler
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Nadia Tobback
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Daniela Andries
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Gérard Waeber
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Peter Vollenweider
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Armin von Gunten
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Martin Preisig
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Enrique Castelao
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Mehdi Tafti
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Raphaël Heinzer
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Julius Popp
- From the Center for Investigation and Research in Sleep (J.H.-R., N.T., D.A., M.T., R.H.), Institute of Social and Preventive Medicine (H.M.-S), Department of Medicine, Service of Internal Medicine (P.M.-V., G.W., P.V.), Department of Psychiatry, Service of Old-Age Psychiatry (A.v.G., J.P.), Department of Psychiatry (M.P., E.C.), Center for Integrative Genomics (M.T.), Department of Clinical Neuroscience, and Leenaards Memory Center (J.P.), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland.
| |
Collapse
|
32
|
Ramos AR, Gardener H, Rundek T, Elkind MSV, Boden-Albala B, Dong C, Cheung YK, Stern Y, Sacco RL, Wright CB. Sleep disturbances and cognitive decline in the Northern Manhattan Study. Neurology 2016; 87:1511-1516. [PMID: 27590286 DOI: 10.1212/wnl.0000000000003168] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/16/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. METHODS The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 ± 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 ± 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis-derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain. RESULTS In the cross-sectional analysis, adjusting for demographics and the NOMAS vascular risk score, participants with frequent snoring had worse executive function (β = -12; p = 0.04) and processing speed (β = -13; p = 0.02), but no difference in with episodic memory or language. Those with severe daytime sleepiness (β = -26; p = 0.009) had worse executive function, but no changes in the other NP domains. There was no cross-sectional association between sleep duration and NP performance. Frequent snoring (β = -29; p = 0.0007), severe daytime sleepiness (β = -29; p = 0.05), and long sleep duration (β = -29; p = 0.04) predicted decline in executive function, adjusting for demographic characteristics and NOMAS vascular risk score. Sleep symptoms did not explain change in episodic memory, language, or processing speed. CONCLUSIONS In this race-ethnically diverse community-based cohort, sleep symptoms led to worse cognitive performance and predicted decline in executive function.
Collapse
Affiliation(s)
- Alberto R Ramos
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Hannah Gardener
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Tatjana Rundek
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Mitchell S V Elkind
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Bernadette Boden-Albala
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Chuanhui Dong
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Ying Kuen Cheung
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Yaakov Stern
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Ralph L Sacco
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York
| | - Clinton B Wright
- From the Department of Neurology, The Evelyn F. McKnight Brain Institute (A.R.R., H.G., T.R., C.D., R.L.S., C.B.W.), University of Miami Miller School of Medicine, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E., Y.S.), and Departments of Epidemiology (M.S.V.E.) and Biostatistics (Y.K.C.), Mailman School of Public Health, Columbia University; and New York University (B.B.-A.), New York.
| |
Collapse
|
33
|
Davies CR, Harrington JJ. Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure. Sleep Med Clin 2016; 11:287-98. [PMID: 27542875 DOI: 10.1016/j.jsmc.2016.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is evidence that obstructive sleep apnea (OSA) can negatively impact attention, memory, learning, executive function, and overall intellectual function in adults and children. Imaging techniques, including MRI, MR diffusion tensor imaging, MR spectroscopy, and fMRI, have provided additional insight into the anatomic and functional underpinnings of OSA-related cognitive impairment. Both animal and human studies have looked to elucidate the separate effects of oxygen desaturation and sleep fragmentation on independent aspects of cognition. Data from animal models point to neuro-inflammation and oxidative stress as driving factors of cognitive impairment.
Collapse
Affiliation(s)
- Charles R Davies
- Carle Neuroscience Institute, Carle Foundation Hospital, College of Medicine, University of Illinois at Urbana-Champaign, 602 West University Avenue, Urbana, IL 61801, USA.
| | - John J Harrington
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, 985990 Nebraska Medical Center, Omaha, NE 68159-5990, USA
| |
Collapse
|
34
|
Wang D, Thomas RJ, Yee BJ, Grunstein RR. Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J Appl Physiol (1985) 2016; 120:1484. [DOI: 10.1152/japplphysiol.01008.2015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- David Wang
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
- NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia; and
| | - Robert J. Thomas
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brendon J. Yee
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
- NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia; and
| | - Ronald R. Grunstein
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
- NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia; and
| |
Collapse
|
35
|
Kerner NA, Roose SP. Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms. Am J Geriatr Psychiatry 2016; 24:496-508. [PMID: 27139243 PMCID: PMC5381386 DOI: 10.1016/j.jagp.2016.01.134] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/17/2015] [Accepted: 01/12/2016] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent but very frequently undiagnosed. OSA is an independent risk factor for depression and cognitive impairment/dementia. Herein the authors review studies in the literature pertinent to the effects of OSA on the cerebral microvascular and neurovascular systems and present a model to describe the key pathophysiologic mechanisms that may underlie the associations, including hypoperfusion, endothelial dysfunction, and neuroinflammation. Intermittent hypoxia plays a critical role in initiating and amplifying these pathologic processes. Hypoperfusion and impaired cerebral vasomotor reactivity lead to the development or progression of cerebral small vessel disease (C-SVD). Hypoxemia exacerbates these processes, resulting in white matter lesions, white matter integrity abnormalities, and gray matter loss. Blood-brain barrier (BBB) hyperpermeability and neuroinflammation lead to altered synaptic plasticity, neuronal damage, and worsening C-SVD. Thus, OSA may initiate or amplify the pathologic processes of C-SVD and BBB dysfunction, resulting in the development or exacerbation of depressive symptoms and cognitive deficits. Given the evidence that adequate treatment of OSA with continuous positive airway pressure improves depression and neurocognitive functions, it is important to identify OSA when assessing patients with depression or cognitive impairment. Whether treatment of OSA changes the deteriorating trajectory of elderly patients with already-diagnosed vascular depression and cognitive impairment/dementia remains to be determined in randomized controlled trials.
Collapse
|
36
|
Tsapanou A, Gu Y, O’Shea D, Eich T, Tang MX, Schupf N, Manly J, Zimmerman M, Scarmeas N, Stern Y. Daytime somnolence as an early sign of cognitive decline in a community-based study of older people. Int J Geriatr Psychiatry 2016; 31:247-55. [PMID: 26081795 PMCID: PMC5381157 DOI: 10.1002/gps.4318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to examine the association between self-reported sleep problems and cognitive decline in community-dwelling older people. We hypothesized that daytime somnolence predicts subsequent cognitive decline. METHODS This is a longitudinal study in a 3.2-year follow-up, with 18-month intervals. The setting is the Washington Heights-Inwood Community Aging Project. There were 1098 participants, who were over 65 years old and recruited from the community. Sleep problems were estimated using five sleep categories derived from the RAND Medical Outcome Study Sleep Scale: sleep disturbance, snoring, awaken short of breath/with a headache, sleep adequacy, and daytime somnolence. Four distinct cognitive composite scores were calculated: memory, language, speed of processing, and executive functioning. We used generalized estimating equations analyses with cognitive scores as the outcome, and time, sleep categories and their interactions as the main predictors. Models were initially unadjusted and then adjusted for age, gender, education, ethnicity, depression, and apolipoprotein E-ε4 genotype. RESULTS Increased daytime somnolence (including feeling drowsy/sleepy, having trouble staying awake, and taking naps during the day) was linked to slower speed of processing both cross-sectionally (B = -0.143, p = 0.047) and longitudinally (B = -0.003, p = 0.027). After excluding the demented participants at baseline, the results remained significant (B = -0.003, p = 0.021). CONCLUSIONS Our findings suggest that daytime somnolence may be an early sign of cognitive decline in the older population.
Collapse
Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Deirdre O’Shea
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Teal Eich
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ming-Xin Tang
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicole Schupf
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer Manly
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Molly Zimmerman
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA,National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
37
|
Brockmann PE, Damiani F, Gozal D. Sleep-Disordered Breathing in Adolescents and Younger Adults: A Representative Population-Based Survey in Chile. Chest 2016; 149:981-90. [PMID: 26539784 DOI: 10.1378/chest.15-2112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/06/2015] [Accepted: 10/15/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Prevalence and potential risk contributors of sleep-disordered breathing (SDB) in adolescents and younger adults remain unclear. We hypothesized that SDB prevalence in younger Hispanic adults is higher than the limited evidence indicates. METHODS This is a population-based study of Hispanic subjects surveyed as part of the Chilean National Health Survey database. For this study, only subjects aged 15 to 40 years were included. Sleep and demographic questionnaires were used to assess SDB prevalence and its risk factors. Anthropometric measurements were performed in each subject. Prevalence was calculated for each SDB-related symptom. A regression model was constructed to investigate demographic risk factors of SDB. RESULTS A total of 2,147 subjects were included. Mean age (± SD) was 27.2 ± 7.2 years, n = 899 (42%) were men. Habitual snoring was highly prevalent, with an average of 53.8% in men and 38.3% in women. Snoring, witnessed apneas, and daytime somnolence increased continuously with age, with an abnormal SDB questionnaire score detected in 2.5%. Reported sleep duration was 7.61 ± 1.67 hours during weekdays and 8.27 ± 2.11 hours during weekends. Snoring frequency was significantly higher in men than women at nearly all age groups, and an adjusted regression model (OR [95% CI]) identified male sex (2 [1.6-2.5]; P < .001) and BMI (1.08 [1.03-1.12]; P < .001) as independent risk factors for snoring. CONCLUSION The risk of SDB is highly prevalent in younger adults, even in females, and increases with age and BMI. The high prevalence and low awareness justify active screening and treatment of SDB in this population.
Collapse
Affiliation(s)
- Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics and Sleep Medicine Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Felipe Damiani
- Department of Pediatric Cardiology and Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| |
Collapse
|
38
|
Ramos AR, Seixas A, Dib SI. Obstructive sleep apnea and stroke: links to health disparities. Sleep Health 2015; 1:244-248. [PMID: 29073399 DOI: 10.1016/j.sleh.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 12/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a novel cardiovascular and cerebrovascular risk factor that presents unique opportunities to understand and reduce seemingly intractable stroke disparity among non-Hispanic blacks and Hispanic/Latinos. Individuals from these 2 groups have up to a 2-fold risk of stroke and greater burden of OSA. Obstructive sleep apnea directly and indirectly increases risk of stroke through a variety of autonomic, chemical, and inflammatory mechanisms and vascular risk factors such as hypertension, obesity, and diabetes mellitus. Untreated OSA exacerbates poststroke prognosis, as it may also influence rehabilitation efforts and functional outcomes such as cognitive function after a stroke. Conversely, treatment of OSA may reduce the risk of stroke and may yield better poststroke prognosis. Unfortunately, in racial/ethnic minority groups, there are limited awareness, knowledge, and screening opportunities for OSA. Increasing awareness and improving screening strategies for OSA in minorities may alleviate stroke risk burden and improve stroke outcomes in these populations. This review article is intended to highlight the epidemiology, clinical characteristics, pathophysiology, diagnosis, and treatment of OSA in relation to stroke risk, with an emphasis on race-ethnic disparities.
Collapse
Affiliation(s)
- Alberto R Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL; Sleep Disorders Program, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL.
| | - Azizi Seixas
- Center for Healthful Behavior Change, Department of Population Health, New York University, School of Medicine, New York, NY
| | - Salim I Dib
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL; Sleep Disorders Program, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL
| |
Collapse
|