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Ann Am Thorac Soc. 2017 Nov;14(11):1697-1705. doi: 10.1513/AnnalsATS.201701-052OC.

Greater Cognitive Deficits with Sleep-disordered Breathing among Individuals with Genetic Susceptibility to Alzheimer Disease. The Multi-Ethnic Study of Atherosclerosis.

Author information

1
1 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts.
2
2 Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.
3
3 Division Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
4
4 Departmentof Epidemiology, University of Washington, Seattle, Washington.
5
5 Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
6
6 U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, Georgia; and.
7
7 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.

Abstract

RATIONALE:

There are conflicting findings regarding the link between sleep apnea and cognitive dysfunction.

OBJECTIVES:

Investigate associations between indicators of sleep-disordered breathing (SDB) and cognitive function in the Multi-Ethnic Study of Atherosclerosis and assess effect modification by the apolipoprotein ε-4 (APOE-ε4) allele.

METHODS:

A diverse population (N = 1,752) underwent type 2 in-home polysomnography, which included measurement of percentage sleep time less than 90% oxyhemoglobin saturation (%Sat < 90%) and apnea-hypopnea index (AHI). Epworth Sleepiness Scale score (ESS) and sleep apnea syndrome (SAS; AHI ≥ 5 and ESS > 10) were also analyzed. Cognitive outcomes included the Cognitive Abilities Screening Instrument; Digit Symbol Coding (DSC) test; and Digit Span Tests (DST) Forward and Backward.

RESULTS:

Participants were 45.4% men, aged 68.1 years (SD, 9.1 yr) with a median AHI of 9.0 and mean ESS of 6.0. Approximately 9.7% had SAS, and 26.8% had at least one copy of the APOE-ε4 allele. In adjusted analyses, a 1-SD increase in %Sat < 90% and ESS score were associated with a poorer attention and memory assessed by the DST Forward score (β = -0.12 [SE, 0.06] and β = -0.13 [SE, 0.06], respectively; P ≤ 0.05). SAS and higher ESS scores were also associated with poorer attention and processing speed as measured by the DSC (β = -0.69 [SE, 0.35] and β = -1.42 [SE, 0.35], respectively; P < 0.05). The presence of APOE-ε4 allele modified the associations of %Sat < 90% with DST forward and of ESS with DSC (Pinteraction ≤ 0.05).

CONCLUSIONS:

Overnight hypoxemia and sleepiness were associated with cognition. The average effect estimates were small, similar to effect estimates for several other individual dementia risk factors. Associations were strongest in APOE-ε4 risk allele carriers. Our results (1) suggest that SDB be considered among a group of modifiable dementia risk factors, and (2) highlight the potential vulnerability of APOE-ε4 risk allele carriers with SDB.

KEYWORDS:

apolipoprotein ε-4; cognition; hypoxemia; sleep apnea; sleepiness

PMID:
28731362
PMCID:
PMC5711280
DOI:
10.1513/AnnalsATS.201701-052OC
[Indexed for MEDLINE]
Free PMC Article

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