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Astara K, Tsimpolis A, Kalafatakis K, Vavougios GD, Xiromerisiou G, Dardiotis E, Christodoulou NG, Samara MT, Lappas AS. Sleep disorders and Alzheimer's disease pathophysiology: The role of the Glymphatic System. A scoping review. Mech Ageing Dev 2024; 217:111899. [PMID: 38163471 DOI: 10.1016/j.mad.2023.111899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Alzheimer's disease (AD) is highly intertwined with sleep disturbances throughout its whole natural history. Sleep consists of a major compound of the functionality of the glymphatic system, as the synchronized slow-wave activity during NREM facilitates cerebrospinal and interstitial long-distance mixing. OBJECTIVE The present study undertakes a scoping review of research on the involvement of the glymphatic system in AD-related sleep disturbances. DESIGN we searched Medline, Embase, PsychInfo and HEAL-link databases, without limitations on date and language, along with reference lists of relevant reviews and all included studies. We included in vivo, in vitro and post-mortem studies examining glymphatic implications of sleep disturbances in human populations with AD spectrum pathology. A thematic synthesis of evidence based on the extracted content was applied and presented in a narrative way. RESULTS In total, 70 original research articles were included and were grouped as following: a) Protein aggregation and toxicity, after sleep deprivation, along with its effects on sleep architecture, b) Glymphatic Sequalae in SDB, yielding potential glymphatic markers c) Circadian Dysregulation, d) Possible Interventions. CONCLUSIONS this review sought to provide insight into the role of sleep disturbances in AD pathogenesis, in the context of the glymphatic disruption.
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Affiliation(s)
- Kyriaki Astara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Neurology, 417 Army Equity Fund Hospital (NIMTS), Athens, Greece
| | - Alexandros Tsimpolis
- Department of Pharmacology, Medical School, University of Crete & Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology Hellas, Heraklion, Crete, Greece
| | - Konstantinos Kalafatakis
- Faculty of Medicine & Dentistry (Malta campus), Queen Mary University of London, VCT 2520, Victoria, Gozo, Malta.
| | - George D Vavougios
- Department of Neurology, Faculty of Medicine, University of Cyprus, Lefkosia, Cyprus; Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Neurology, Athens Naval Hospital, Athens, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Nikos G Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece; Medical School, University of Nottingham, Lenton, Nottingham, UK
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece; Aneurin Bevan University Health Board, Wales, UK
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Orlando IF, O'Callaghan C, Lam A, McKinnon AC, Tan JBC, Michaelian JC, Kong SDX, D'Rozario AL, Naismith SL. Sleep spindle architecture associated with distinct clinical phenotypes in older adults at risk for dementia. Mol Psychiatry 2024; 29:402-411. [PMID: 38052981 PMCID: PMC11116104 DOI: 10.1038/s41380-023-02335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
Sleep spindles are a hallmark of non-REM sleep and play a fundamental role in memory consolidation. Alterations in these spindles are emerging as sensitive biomarkers for neurodegenerative diseases of ageing. Understanding the clinical presentations associated with spindle alterations may help to elucidate the functional role of these distinct electroencephalographic oscillations and the pathophysiology of sleep and neurodegenerative disorders. Here, we use a data-driven approach to examine the sleep, memory and default mode network connectivity phenotypes associated with sleep spindle architecture in older adults (mean age = 66 years). Participants were recruited from a specialist clinic for early diagnosis and intervention for cognitive decline, with a proportion showing mild cognitive deficits on neuropsychological testing. In a sample of 88 people who underwent memory assessment, overnight polysomnography and resting-state fMRI, a k-means cluster analysis was applied to spindle measures of interest: fast spindle density, spindle duration and spindle amplitude. This resulted in three clusters, characterised by preserved spindle architecture with higher fast spindle density and longer spindle duration (Cluster 1), and alterations in spindle architecture (Clusters 2 and 3). These clusters were further characterised by reduced memory (Clusters 2 and 3) and nocturnal hypoxemia, associated with sleep apnea (Cluster 3). Resting-state fMRI analysis confirmed that default mode connectivity was related to spindle architecture, although directionality of this relationship differed across the cluster groups. Together, these results confirm a diversity in spindle architecture in older adults, associated with clinically meaningful phenotypes, including memory function and sleep apnea. They suggest that resting-state default mode connectivity during the awake state can be associated with sleep spindle architecture; however, this is highly dependent on clinical phenotype. Establishing relationships between clinical and neuroimaging features and sleep spindle alterations will advance our understanding of the bidirectional relationships between sleep changes and neurodegenerative diseases of ageing.
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Affiliation(s)
- Isabella F Orlando
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Aaron Lam
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew C McKinnon
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Joshua B C Tan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Johannes C Michaelian
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Shawn D X Kong
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Angela L D'Rozario
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia.
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia.
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Hoyos CM, Phillips CL, Marshall NS, Yaffe K, Martins R, Lagopoulos J, Jackson ML, Mowszowski L, Grunstein RR, Naismith SL. REducing Sleep Apnoea for the PrEvention of Dementia (REShAPED): Protocol for a multi-site feasibility randomised controlled trial. Contemp Clin Trials 2024; 137:107424. [PMID: 38145713 DOI: 10.1016/j.cct.2023.107424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
There is accumulating evidence that has linked OSA with increased risk of cognitive decline and dementia. Here we present the protocol for an Australian, multi-site randomised controlled, parallel open-label trial which will evaluate the feasibility for a full-scale trial investigating the effects of treating OSA on cognitive decline in older adults at risk of dementia within memory clinic settings. We will randomise 180 older adults to either the treatment intervention group or control group for 2 years. Inclusion criteria include: 50-85 years; mild-severe OSA (defined average ODI ≥ 10 with 3% oxygen desaturation determined by wrist oximetry over two nights); and subjective cognitive complaints or mild cognitive impairment. The treatment intervention arm aims to achieve an optimal treatment response based on reducing hypoxic burden with either CPAP, mandibular advancement splint, positional therapy, or oxygen therapy. Furthermore, participants will receive up to 8 sessions which involve motivational interviewing, collaborative goal setting, and behavioural sleep management. The control arm will not receive OSA treatment as part of this trial, however there will be no OSA treatment restrictions, and any treatment will be documented. Primary outcomes are 1) acceptability based upon willingness of participants to be randomised; 2) alleviating hypoxic burden by reducing OSA severity; 3) tolerability of the trial burden based upon collection of outcomes over the 2-year follow-up. Secondary outcomes include safety and cognitive function. Outcomes will be collected at 0, 6 and 24-months. This feasibility study aims to will provide the basis for a larger longer-term trial of dementia prevention.
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Affiliation(s)
- Camilla M Hoyos
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia.
| | - Craig L Phillips
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Nathaniel S Marshall
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia
| | - Kristine Yaffe
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Ralph Martins
- Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia; Centre for Ageing, Cognition and Wellbeing, Macquarie University, North Ryde, Sydney, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of Sunshine Coast, Queensland, Australia
| | - Melinda L Jackson
- Turner Institute of Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Camperdown, Sydney, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; CPC-RPA Clinic, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Camperdown, Sydney, Australia; Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, Australia
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Martinez Villar G, Daneault V, Martineau-Dussault MÈ, Baril AA, Gagnon K, Lafond C, Gilbert D, Thompson C, Marchi NA, Lina JM, Montplaisir J, Carrier J, Gosselin N, André C. Altered resting-state functional connectivity patterns in late middle-aged and older adults with obstructive sleep apnea. Front Neurol 2023; 14:1215882. [PMID: 37470008 PMCID: PMC10353887 DOI: 10.3389/fneur.2023.1215882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for cognitive decline, and has been associated with structural brain alterations in regions relevant to memory processes and Alzheimer's disease. However, it is unclear whether OSA is associated with disrupted functional connectivity (FC) patterns between these regions in late middle-aged and older populations. Thus, we characterized the associations between OSA severity and resting-state FC between the default mode network (DMN) and medial temporal lobe (MTL) regions. Second, we explored whether significant FC changes differed depending on cognitive status and were associated with cognitive performance. Methods Ninety-four participants [24 women, 65.7 ± 6.9 years old, 41% with Mild Cognitive Impairment (MCI)] underwent a polysomnography, a comprehensive neuropsychological assessment and a resting-state functional magnetic resonance imaging (MRI). General linear models were conducted between OSA severity markers (i.e., the apnea-hypopnea, oxygen desaturation and microarousal indices) and FC values between DMN and MTL regions using CONN toolbox. Partial correlations were then performed between OSA-related FC patterns and (i) OSA severity markers in subgroups stratified by cognitive status (i.e., cognitively unimpaired versus MCI) and (ii) cognitive scores in the whole sample. All analyzes were controlled for age, sex and education, and considered significant at a p < 0.05 threshold corrected for false discovery rate. Results In the whole sample, a higher apnea-hypopnea index was significantly associated with lower FC between (i) the medial prefrontal cortex and bilateral hippocampi, and (ii) the left hippocampus and both the posterior cingulate cortex and precuneus. FC patterns were not associated with the oxygen desaturation index, or micro-arousal index. When stratifying the sample according to cognitive status, all associations remained significant in cognitively unimpaired individuals but not in the MCI group. No significant associations were observed between cognition and OSA severity or OSA-related FC patterns. Discussion OSA severity was associated with patterns of lower FC in regions relevant to memory processes and Alzheimer's disease. Since no associations were found with cognitive performance, these FC changes could precede detectable cognitive deficits. Whether these FC patterns predict future cognitive decline over the long-term needs to be investigated.
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Affiliation(s)
- Guillermo Martinez Villar
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health Institute, McGill University, Montréal, QC, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Laboratory and Sleep Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Chantal Lafond
- Department of Pulmonology, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Danielle Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, QC, Canada
- Department of Radiology, Hopital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de, Montréal, QC, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Nicola Andrea Marchi
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, 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
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Département de Génie Electrique, École de Technologie Supérieure, Montréal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
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Liu Z, Zhang L, Wu J, Zheng Z, Gao J, Lin Y, Liu Y, Xu H, Zhou Y. Machine learning-based classification of circadian rhythm characteristics for mild cognitive impairment in the elderly. Front Public Health 2022; 10:1036886. [PMID: 36388285 PMCID: PMC9650188 DOI: 10.3389/fpubh.2022.1036886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction Using wrist-wearable sensors to ecological transient assessment may provide a more valid assessment of physical activity, sedentary time, sleep and circadian rhythm than self-reported questionnaires, but has not been used widely to study the association with mild cognitive impairment and their characteristics. Methods 31 normal cognitive ability participants and 68 MCI participants were monitored with tri-axial accelerometer and nocturnal photo volumetric pulse wave signals for 14 days. Two machine learning algorithms: gradient boosting decision tree and eXtreme gradient boosting were constructed using data on daytime physical activity, sedentary time and nighttime physiological functions, including heart rate, heart rate variability, respiratory rate and oxygen saturation, combined with subjective scale features. The accuracy, precision, recall, F1 value, and AUC of the different models are compared, and the training and model effectiveness are validated by the subject-based leave-one-out method. Results The low physical activity state was higher in the MCI group than in the cognitively normal group between 8:00 and 11:00 (P < 0.05), the daily rhythm trend of the high physical activity state was generally lower in the MCI group than in the cognitively normal group (P < 0.05). The peak rhythms in the sedentary state appeared at 12:00-15:00 and 20:00. The peak rhythms of rMSSD, HRV high frequency output power, and HRV low frequency output power in the 6h HRV parameters at night in the MCI group disappeared at 3:00 a.m., and the amplitude of fluctuations decreased; the amplitude of fluctuations of LHratio nocturnal rhythm increased and the phase was disturbed; the oxygen saturation was between 90 and 95% and less than 90% were increased in all time periods (P < 0.05). The F1 value of the two machine learning algorithms for MCI classification of multi-feature data combined with subjective scales were XGBoost (78.02) and GBDT (84.04). Conclusion By collecting PSQI Scale data combined with circadian rhythm characteristics monitored by wrist-wearable sensors, we are able to construct XGBoost and GBDT machine learning models with good discrimination, thus providing an early warning solution for identifying family and community members with high risk of MCI.
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Affiliation(s)
- Zhizhen Liu
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Zhizhen Liu
| | - Lin Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jingsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhicheng Zheng
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Jiahui Gao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yongsheng Lin
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yinghua Liu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Haihua Xu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yongjin Zhou
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China,Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen, China,*Correspondence: Yongjin Zhou
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The Link between Obstructive Sleep Apnea and Neurocognitive Impairment: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2022; 19:1245-1256. [PMID: 35913462 PMCID: PMC9353960 DOI: 10.1513/annalsats.202205-380st] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer's disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
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Lam A, Haroutonian C, Grummitt L, Ireland C, Grunstein RR, Duffy S, D'Rozario A, Naismith SL. Sleep-Dependent Memory in Older People With and Without MCI: The Relevance of Sleep Microarchitecture, OSA, Hippocampal Subfields, and Episodic Memory. Cereb Cortex 2021; 31:2993-3005. [PMID: 33565576 DOI: 10.1093/cercor/bhaa406] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
This study aimed to determine if, relative to cognitively healthy controls, sleep-dependent memory consolidation (SDMC) is diminished in mild cognitive impairment (MCI), a group at high risk of conversion to dementia. We also sought to determine whether SDMC is associated with sleep characteristics, daytime episodic memory, and hippocampal integrity. Participants with MCI (n = 43) and controls (n = 20) underwent clinical and neuropsychological profiling. From polysomnography, apnea hypopnea index (AHI) and non-REM sleep spindle characteristics were derived. From magnetic resonance imaging, hippocampal subfield volumes were computed. Participants learned a novel 32-item word-pair prior to sleep; morning retention of the word-pairs was used to determine SDMC. Results showed that SDMC did not differ between MCI and controls, but there was a large effect size decrement in SDMC in those with multiple domain MCI (Hedge's g = 0.85). In MCI, poorer SDMC was correlated with CA1 and CA3 hippocampal atrophy, shorter spindle duration, and worse daytime episodic memory. In controls, poorer SDMC was associated with higher AHI. Impaired daytime memory consolidation, reduced hippocampal volumes, shorter sleep spindles, and greater sleep apnea severity are indicators of diminished SDMC in older adults and should be explored in future studies.
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Affiliation(s)
- Aaron Lam
- School of Psychology, University of Sydney, Sydney, New South Wales, 2000, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, 2050, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, 2000, Australia
| | - Carla Haroutonian
- School of Psychology, University of Sydney, Sydney, New South Wales, 2000, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, 2050, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, 2000, Australia
| | - Lucy Grummitt
- School of Psychology, University of Sydney, Sydney, New South Wales, 2000, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, 2000, Australia
| | - Catriona Ireland
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, 2050, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, 2000, Australia.,Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, New South Wales, 2000, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, 2000, Australia
| | - Shantel Duffy
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, 2050, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, 2000, Australia
| | - Angela D'Rozario
- School of Psychology, University of Sydney, Sydney, New South Wales, 2000, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, 2050, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, 2000, Australia.,Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, New South Wales, 2000, Australia
| | - Sharon L Naismith
- School of Psychology, University of Sydney, Sydney, New South Wales, 2000, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, 2050, Australia.,Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, New South Wales, 2000, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2000, Australia
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Shen H, Meng Y, Liu D, Qin Z, Huang H, Pan L, Wang W, Kang J. α7 Nicotinic Acetylcholine Receptor Agonist PNU-282987 Ameliorates Cognitive Impairment Induced by Chronic Intermittent Hypoxia. Nat Sci Sleep 2021; 13:579-590. [PMID: 34007230 PMCID: PMC8123952 DOI: 10.2147/nss.s296701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/13/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Cognitive impairment is an important complication of obstructive sleep apnea (OSA). Chronic intermittent hypoxia (CIH), the main pathophysiological characteristics of OSA, is closely related to cognitive dysfunction and may be mediated by alpha-7 nicotinic acetylcholine receptors (α7nAChR). This study investigated the effects and clarified the mechanisms of α7nAChR on the cognitive function of mice with CIH. METHODS Thirty CD-1 mice were randomly divided into room air (RA), CIH-2 weeks (CIH2W), and CIH-4 weeks (CIH4W) groups. Cognitive function was evaluated by novel object recognition (NOR) and Morris water maze (MWM) tests after exposure. Then, 104 CD-1 mice were exposed to CIH for 4 weeks and randomly divided into four groups: CIH4W (control), with dimethyl sulfoxide (DMSO) (sham), with α7nAChR-specific agonist PNU-282987 (PNU), and with α7nAChR-specific inhibitor methyllycaconitine and PNU-282987 (MLA+PNU). In addition to the evaluation of cognitive function, apoptotic bodies in the hippocampus were detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, changes in p-CREB and BDNF were detected by immunohistochemistry, while those of ERK1/2, CREB, PGC-1α, FNDC5, and BDNF were detected by Western blotting in the hippocampal tissues of the mice. RESULTS Compared to the CIH2W and RA groups, the CIH4W group showed cognitive dysfunction in the NOR and MWM tests. The changes in cognitive dysfunction were alleviated by PNU-282987; furthermore, MLA pretreatment offset the effect. In hippocampal tissues, TUNEL assays showed decreased apoptotic cells, immunohistochemical staining showed increased expressions of p-CREB and BDNF. The expression levels of p-ERK1/2/t-ERK1/2, p-CREB/t-CREB, PGC-1α, FNDC5, and BDNF were increased after PNU-282987 injection. CONCLUSION Four weeks of CIH caused cognitive dysfunction in mice. Activating α7nAChR might ameliorate this dysfunction by upregulating the ERK1/2/CREB signaling pathway; enhancing PGC-1α, FNDC5, and BDNF expression levels; and reducing cell apoptosis in the hippocampal tissue of mice.
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Affiliation(s)
- Hui Shen
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yanling Meng
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Dan Liu
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zheng Qin
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Hong Huang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lei Pan
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jian Kang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Pini L, Wennberg A, Mitolo M, Meneghello F, Burgio F, Semenza C, Venneri A, Mantini D, Vallesi A. Quality of sleep predicts increased frontoparietal network connectivity in patients with mild cognitive impairment. Neurobiol Aging 2020; 95:205-213. [DOI: 10.1016/j.neurobiolaging.2020.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022]
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