Modifying pathways by age and sex for the association between combined sleep disordered breathing and long sleep duration with neurocognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract

Introduction:We aimed to determine whether obesity or metabolic syndrome (MetS) modify associations between sleep-disordered breathing (SDB), self-reported sleep duration (SD), and phenotypes of combined SDB/SD with 7-year neurocognitive decline (ND) in a community based-cohort of U.S. Hispanic/Latinos (N = 5500) in different age and sex groups. Methods:The exposures were baseline SDB (respiratory event index ≥ 15), sleepiness (Epworth Sleepiness Scale ≥ 10), SD (< 6 hours, 6-9 hours, ≥ 9 hours). The outcome was 7-year ND.Results: Mean age was 56.0 years, 54.8% were females. Obesity modified the association between SDB/SD and ND in memory (F = 21.49, P < 0.001) and global cognition (F = 9.14, P < 0.001) in the oldest age group. Women without MetS with combined long sleep/SDB exhibited most pronounced decline in global cognition (F = 3.07, P = 0.010). Discussion:The association between combined SDB/long sleep and declines in memory and global cognition was most pronounced in obese older adults. Among women, MetS status modified the association between long sleep/SDB and decline in global cognition.

Obstructive sleep apnea and cognitive functioning in the older general population: The moderating effect of age, sex, ApoE4, and obesity

“…The results of the present study are also in contrast to those of a recently published longitudinal study by our group in which only oldest-old participants (aged ≥75 years) with OSA demonstrated a greater longitudinal decline in processing speed over a 5 year period (Marchi et al, 2023). However, the different sample characteristics and methodological approaches make it difficult to compare the present study with those published earlier (Addison-Brown et al, 2014;Kaur et al, 2021;Marchi et al, 2023). In particular, the REGARDS and HCHS/SOL studies included middle-aged and older participants, whereas our study included a sample of older adults with a relatively narrow age distribution.…”

“…The absence of an age‐specific effect contrasts with the results of two previous population‐based studies which showed age modified the association between OSA and cognitive functioning, but in opposite ways. In the REGARDS study (Addison‐Brown et al, 2014) a weaker association between OSA and cognitive dysfunction was found with increasing age, whereas in the HCHS/SOL study (Kaur et al, 2021) a stronger association between OSA and cognitive decline was documented with increasing age particularly in participants of 65 years and older. The results of the present study are also in contrast to those of a recently published longitudinal study by our group in which only oldest‐old participants (aged ≥75 years) with OSA demonstrated a greater longitudinal decline in processing speed over a 5 year period (Marchi et al, 2023).…”

“…The cross‐sectional analysis of stroke‐free participants in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) study revealed that individuals with high risk of OSA (as measured by the Berlin Sleep Questionnaires) had lower performance on semantic fluency task in middle age, but not in older age (Addison‐Brown et al, 2014). In contrast, the longitudinal analysis conducted by Kaur et al in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) showed that association between OSA (as measured by a limited channel device) and cognitive decline was more pronounced in older age than in middle age (Kaur et al, 2021).…”

“…Unfortunately, large cohort studies of OSA and cognitive functioning tended to statistically control for the effect or provided results stratified by these characteristics without assessing the interaction terms. Only a few studies have formally tested whether these features interact with OSA to predict cognitive functioning in the general population (Addison‐Brown et al, 2014; Kaur et al, 2021; Nikodemova et al, 2013; Ramos et al, 2015; Spira et al, 2008). Kaur et al who examined the modifying effect of sex did not find a significant interaction (Kaur et al, 2021), although a previous cross‐sectional analysis of more than 8000 middle‐aged and older participants in the same population‐based cohort (HCHS/SOL) showed an association between OSA and lower cognitive performance in women compared with men (Ramos et al, 2015).…”

Sleep duration and brain MRI measures: Results from the SOL‐INCA MRI study

“…Sleep duration was treated as a categorical and continuous measure. The categorical cutoffs for sleep duration (<6 hours, 6–9 hours, >9 h) were chosen based on previous research on sleep duration and MRI measures, 29 and our own HCHS/SOL data using these categories of sleep 30 …”