Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population

Tsai, Cheng-Yu; Hsu, Wen-Hua; Lin, Yi; Liu, Yi-Shin; Lo, Kang; Lin, Shang‐Yang; Majumdar, Arnab; Cheng, Wun-Hao; Lee, Kang‐Yun; Wu, Dean; Lee, Hsin Chien; Hsu, Shin-Mei; Ho, Shu-Chuan; Lin, Feng-Ching; Liu, Wen‐Te; Kuan, Yi‐Chun

doi:10.5664/jcsm.9786

Cited by 10 publications

(10 citation statements)

References 48 publications

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“…These traits interact with each other and contribute to the periodic repetition of respiratory or frequent arousal events in patients with OSA. Recent studies have demonstrated that one of the endophenotypic traits, namely low-ArTH OSA, which may contribute to the highly frequent arousal response, may be associated with or even aggravate other related diseases (e.g., periodic limb movements, cognitive impairment, Alzheimer’s disease) [ 28 , 29 , 30 ]. Therefore, understanding the mechanisms underlying these endophenotypic OSA traits could help to prevent the disease presentation or allow for precise OSA treatment based on the specific pathophysiological condition of each individual.…”

Section: Discussionmentioning

confidence: 99%

Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution

Hsu

Yang

Tsai

et al. 2023

Life

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Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E–I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E–I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA.

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Section: Discussionmentioning

confidence: 99%

Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution

Hsu

Yang

Tsai

et al. 2023

Life

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“…Another major finding of this pilot study is the positive associations between the respiratory arousal frequency and neuron biomarker levels. Previous studies have investigated the associations between arousal responses and cognitive impairment or different neuron biomarker plasma levels in children ( 40 , 41 ). The results of this study demonstrated that respiratory arousal events were associated with elevated neuron biomarker levels and thus increased AD risk in adult patients without cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Associations between risk of Alzheimer's disease and obstructive sleep apnea, intermittent hypoxia, and arousal responses: A pilot study

Tsai

Kuan

et al. 2022

Front. Neurol.

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ObjectivesObstructive sleep apnea (OSA) may increase the risk of Alzheimer's disease (AD). However, potential associations among sleep-disordered breathing, hypoxia, and OSA-induced arousal responses should be investigated. This study determined differences in sleep parameters and investigated the relationship between such parameters and the risk of AD.MethodsPatients with suspected OSA were recruited and underwent in-lab polysomnography (PSG). Subsequently, blood samples were collected from participants. Patients' plasma levels of total tau (T-Tau) and amyloid beta-peptide 42 (Aβ42) were measured using an ultrasensitive immunomagnetic reduction assay. Next, the participants were categorized into low- and high-risk groups on the basis of the computed product (Aβ42 × T-Tau, the cutoff for AD risk). PSG parameters were analyzed and compared.ResultsWe included 36 patients in this study, of whom 18 and 18 were assigned to the low- and high-risk groups, respectively. The average apnea–hypopnea index (AHI), apnea, hypopnea index [during rapid eye movement (REM) and non-REM (NREM) sleep], and oxygen desaturation index (≥3%, ODI-3%) values of the high-risk group were significantly higher than those of the low-risk group. Similarly, the mean arousal index and respiratory arousal index (R-ArI) of the high-risk group were significantly higher than those of the low-risk group. Sleep-disordered breathing indices, oxygen desaturation, and arousal responses were significantly associated with an increased risk of AD. Positive associations were observed among the AHI, ODI-3%, R-ArI, and computed product.ConclusionsRecurrent sleep-disordered breathing, intermittent hypoxia, and arousal responses, including those occurring during the NREM stage, were associated with AD risk. However, a longitudinal study should be conducted to investigate the causal relationships among these factors.

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“…Prior work shows links with bilateral temporal atrophy [30], disconnection in functional brain networks, and with brain oedema [31] and Aβ deposition [32]. Of the recent studies in this field, however, two cross-sectional studies in older adults with and without MCI had mixed findings, with one linking OSA to AD biomarkers [33], and the other not finding an association [34]. Two longitudinal studies are noteworthy.…”

Section: Obstructive Sleep Apnoeamentioning

confidence: 99%

Recent advances in understanding of sleep disorders and disturbances for dementia risk and prevention

Lam,

Kong,

Naismith

2023

Current Opinion in Psychiatry

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Purpose of review To synthesise the recent work examining the relationship between sleep disturbances and dementia, emphasising studies involving individuals with mild cognitive impairment (MCI) or Alzheimer's disease (AD) and/or those investigating AD biomarkers. Additionally, we provide an update on recent interventions targeting sleep-related issues in older adults with MCI or AD. Recent findings Various studies have examined obstructive sleep apnoea, sleep duration, and circadian alterations in relation to Alzheimer's pathology and dementia risk, with an emerging body of evidence suggesting that cardiovascular disease, hypertension, glymphatic function, and inflammation might serve as plausible pathophysiological mechanisms contributing to dementia during critical brain periods. Conversely, recent studies investigating insomnia have produced disparate results. Regarding intervention studies, the scarcity of prospective randomised control trials poses a challenge in establishing the benefits of addressing sleep disorders and disturbances. Summary Recent work examining the pathophysiological links between sleep and dementia is strongest for obstructive sleep apnoea and sleep duration, while findings in insomnia studies exhibit inconsistency, possibly due to varied associations with dementia among different insomnia subtypes. It is apparent that more longitudinal studies examining the underlying pathophysiological mechanisms are necessary, alongside more rigorous clinical trials. Although some trials are underway in this field, there is still scarcity in trials examining interventions for circadian disturbances.

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Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population

Cited by 10 publications

References 48 publications

Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution

Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution

Associations between risk of Alzheimer's disease and obstructive sleep apnea, intermittent hypoxia, and arousal responses: A pilot study

Recent advances in understanding of sleep disorders and disturbances for dementia risk and prevention

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