@article {9417, title = {Sleep Architecture, Obstructive Sleep Apnea, and Cognitive Function in Adults.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, month = {2023 Jul 03}, pages = {e2325152}, abstract = {

IMPORTANCE: Good sleep is essential for health, yet associations between sleep and dementia risk remain incompletely understood. The Sleep and Dementia Consortium was established to study associations between polysomnography (PSG)-derived sleep and the risk of dementia and related cognitive and brain magnetic resonance imaging endophenotypes.

OBJECTIVE: To investigate association of sleep architecture and obstructive sleep apnea (OSA) with cognitive function in the Sleep and Dementia Consortium.

DESIGN, SETTING, AND PARTICIPANTS: The Sleep and Dementia Consortium curated data from 5 population-based cohorts across the US with methodologically consistent, overnight, home-based type II PSG and neuropsychological assessments over 5 years of follow-up: the Atherosclerosis Risk in Communities study, Cardiovascular Health Study, Framingham Heart Study (FHS), Osteoporotic Fractures in Men Study, and Study of Osteoporotic Fractures. Sleep metrics were harmonized centrally and then distributed to participating cohorts for cohort-specific analysis using linear regression; study-level estimates were pooled in random effects meta-analyses. Results were adjusted for demographic variables, the time between PSG and neuropsychological assessment (0-5 years), body mass index, antidepressant use, and sedative use. There were 5946 participants included in the pooled analyses without stroke or dementia. Data were analyzed from March 2020 to June 2023.

EXPOSURES: Measures of sleep architecture and OSA derived from in-home PSG.

MAIN OUTCOMES AND MEASURES: The main outcomes were global cognitive composite z scores derived from principal component analysis, with cognitive domains investigated as secondary outcomes. Higher scores indicated better performance.

RESULTS: Across cohorts, 5946 adults (1875 females [31.5\%]; mean age range, 58-89 years) were included. The median (IQR) wake after sleep onset time ranged from 44 (27-73) to 101 (66-147) minutes, and the prevalence of moderate to severe OSA ranged from 16.9\% to 28.9\%. Across cohorts, higher sleep maintenance efficiency (pooled β per 1\% increase, 0.08; 95\% CI, 0.03 to 0.14; P < .01) and lower wake after sleep onset (pooled β per 1-min increase, -0.07; 95\% CI, -0.13 to -0.01 per 1-min increase; P = .02) were associated with better global cognition. Mild to severe OSA (apnea-hypopnea index [AHI] >=5) was associated with poorer global cognition (pooled β, -0.06; 95\% CI, -0.11 to -0.01; P = .01) vs AHI less than 5; comparable results were found for moderate to severe OSA (pooled β, -0.06; 95\% CI, -0.11 to -0.01; P = .02) vs AHI less than 5. Differences in sleep stages were not associated with cognition.

CONCLUSIONS AND RELEVANCE: This study found that better sleep consolidation and the absence of OSA were associated with better global cognition over 5 years of follow-up. These findings suggest that the role of interventions to improve sleep for maintaining cognitive function requires investigation.

}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.25152}, author = {Pase, Matthew P and Harrison, Stephanie and Misialek, Jeffrey R and Kline, Christopher E and Cavuoto, Marina and Baril, Andree-Ann and Yiallourou, Stephanie and Bisson, Alycia and Himali, Dibya and Leng, Yue and Yang, Qiong and Seshadri, Sudha and Beiser, Alexa and Gottesman, Rebecca F and Redline, Susan and Lopez, Oscar and Lutsey, Pamela L and Yaffe, Kristine and Stone, Katie L and Purcell, Shaun M and Himali, Jayandra J} } @article {9864, title = {Sleep macro-architecture and dementia risk in adults: Meta-analysis of 5 cohorts from the Sleep and Dementia Consortium.}, journal = {medRxiv}, year = {2024}, month = {2024 Nov 05}, abstract = {

STUDY OBJECTIVES: Poor sleep may play a role in the risk of dementia. However, few studies have investigated the association between polysomnography (PSG)-derived sleep architecture and dementia incidence. We examined the relationship between sleep macro-architecture and dementia incidence across five US-based cohort studies from the Sleep and Dementia Consortium (SDC).

METHODS: Percent of time spent in stages of sleep (N1, N2, N3, REM sleep), wake after sleep onset and sleep maintenance efficiency were derived from a single night home-based PSG. Dementia was ascertained in each cohort using its cohort-specific criteria. Each cohort performed Cox proportional hazard regressions for each sleep exposure and incident dementia, adjusting for age, sex, body mass index, anti-depressant use, sedative use, and status. Results were then pooled in random effects meta-analyses.

RESULTS: The pooled sample comprised 4,657 participants (30\% women) aged >=60 years (mean age was 74 years at sleep assessment). There were 998 (21.4\%) dementia cases (median follow-up time of 5 to 19 years). Pooled effects of the five cohorts showed no association between sleep architecture and incident dementia. When meta-analyses were restricted to the three cohorts which had dementia case ascertainment based on DSM-IV/V criteria (n=2,374), higher N3\% was marginally associated with an increased risk of dementia (HR: 1.06; 95\%CI: 1.00-1.12, per percent increase N3, p=0.050).

CONCLUSIONS: There were no consistent associations between sleep macro-architecture measured and the risk of incident dementia. Implementing more nuanced sleep metrics remains an important next step for uncovering more about sleep-dementia associations.

}, doi = {10.1101/2024.11.05.24316677}, author = {Yiallourou, Stephanie and Baril, Andree-Ann and Wiedner, Crystal and Misialek, Jeffrey R and Kline, Christopher E and Harrison, Stephanie and Cannon, Ethan and Yang, Qiong and Bernal, Rebecca and Bisson, Alycia and Himali, Dibya and Cavuoto, Marina and Weihs, Antoine and Beiser, Alexa and Gottesman, Rebecca F and Leng, Yue and Lopez, Oscar and Lutsey, Pamela L and Purcell, Shaun M and Redline, Susan and Seshadri, Sudha and Stone, Katie L and Yaffe, Kristine and Ancoli-Israel, Sonia and Xiao, Qian and Vaou, Eleni Okeanis and Himali, Jayandra J and Pase, Matthew P} }