Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women

Kristine Yaffe, Alison M. Laffan, Stephanie Litwack Harrison, Susan Redline, Adam P Spira, Kristine E. Ensrud, Sonia Ancoli-Israel, Katie L. Stone

Research output: Contribution to journalArticle

Abstract

Context: Sleep-disordered breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-disordered breathing to poor cognition; however, it remains unclear whether sleep-disordered breathing precedes cognitive impairment in older adults. Objectives: To determine the prospective relationship between sleep-disordered breathing and cognitive impairment and to investigate potential mechanisms of this association. Design, Setting, and Participants: Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-disordered breathing was defined as an apneahypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-disordered breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Main Outcome Measures: Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008. Results: Compared with the 193 women without sleep-disordered breathing, the 105 women (35.2%) with sleep-disordered breathing were more likely to develop mild cognitive impairment or dementia (31.1% [n=60] vs 44.8% [n=47]; adjusted odds ratio [AOR], 1.85; 95% confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (>7%) in apnea or hypopnea (both measures of disordered breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95% CI, 1.04-2.83] and AOR, 2.04 [95% CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Conclusion: Among older women, those with sleep-disordered breathing compared with those without sleep-disordered breathing had an increased risk of developing cognitive impairment.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalJournal of the American Medical Association
Volume306
Issue number6
DOIs
StatePublished - Aug 10 2011

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Sleep Apnea Syndromes
Dementia
Sleep
Sleep Deprivation
Odds Ratio
Confidence Intervals
Arousal
Cognition
Cognitive Dysfunction
Hypoxia
Osteoporotic Fractures
Polysomnography
Anti-Anxiety Agents
Apnea
Benzodiazepines
Antidepressive Agents
Respiration
Body Mass Index
Cross-Sectional Studies
Logistic Models

ASJC Scopus subject areas

  • Medicine(all)

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Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. / Yaffe, Kristine; Laffan, Alison M.; Harrison, Stephanie Litwack; Redline, Susan; Spira, Adam P; Ensrud, Kristine E.; Ancoli-Israel, Sonia; Stone, Katie L.

In: Journal of the American Medical Association, Vol. 306, No. 6, 10.08.2011, p. 613-619.

Research output: Contribution to journalArticle

Yaffe, K, Laffan, AM, Harrison, SL, Redline, S, Spira, AP, Ensrud, KE, Ancoli-Israel, S & Stone, KL 2011, 'Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women', Journal of the American Medical Association, vol. 306, no. 6, pp. 613-619. https://doi.org/10.1001/jama.2011.1115
Yaffe, Kristine ; Laffan, Alison M. ; Harrison, Stephanie Litwack ; Redline, Susan ; Spira, Adam P ; Ensrud, Kristine E. ; Ancoli-Israel, Sonia ; Stone, Katie L. / Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. In: Journal of the American Medical Association. 2011 ; Vol. 306, No. 6. pp. 613-619.
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abstract = "Context: Sleep-disordered breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-disordered breathing to poor cognition; however, it remains unclear whether sleep-disordered breathing precedes cognitive impairment in older adults. Objectives: To determine the prospective relationship between sleep-disordered breathing and cognitive impairment and to investigate potential mechanisms of this association. Design, Setting, and Participants: Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-disordered breathing was defined as an apneahypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-disordered breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Main Outcome Measures: Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008. Results: Compared with the 193 women without sleep-disordered breathing, the 105 women (35.2{\%}) with sleep-disordered breathing were more likely to develop mild cognitive impairment or dementia (31.1{\%} [n=60] vs 44.8{\%} [n=47]; adjusted odds ratio [AOR], 1.85; 95{\%} confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (>7{\%}) in apnea or hypopnea (both measures of disordered breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95{\%} CI, 1.04-2.83] and AOR, 2.04 [95{\%} CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Conclusion: Among older women, those with sleep-disordered breathing compared with those without sleep-disordered breathing had an increased risk of developing cognitive impairment.",
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AU - Laffan, Alison M.

AU - Harrison, Stephanie Litwack

AU - Redline, Susan

AU - Spira, Adam P

AU - Ensrud, Kristine E.

AU - Ancoli-Israel, Sonia

AU - Stone, Katie L.

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N2 - Context: Sleep-disordered breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-disordered breathing to poor cognition; however, it remains unclear whether sleep-disordered breathing precedes cognitive impairment in older adults. Objectives: To determine the prospective relationship between sleep-disordered breathing and cognitive impairment and to investigate potential mechanisms of this association. Design, Setting, and Participants: Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-disordered breathing was defined as an apneahypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-disordered breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Main Outcome Measures: Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008. Results: Compared with the 193 women without sleep-disordered breathing, the 105 women (35.2%) with sleep-disordered breathing were more likely to develop mild cognitive impairment or dementia (31.1% [n=60] vs 44.8% [n=47]; adjusted odds ratio [AOR], 1.85; 95% confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (>7%) in apnea or hypopnea (both measures of disordered breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95% CI, 1.04-2.83] and AOR, 2.04 [95% CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Conclusion: Among older women, those with sleep-disordered breathing compared with those without sleep-disordered breathing had an increased risk of developing cognitive impairment.

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