Poor sleep quality is associated with increased cortical atrophy in community-dwelling adults

Abstract

Objective: To examine the relationship between sleep quality and cortical and hippocampal volume and atrophy within a community-based sample, explore the influence of age on results, and assess the possible confounding effects of physical activity levels, body mass index (BMI), and blood pressure. Methods:In 147 community-dwelling adults (92 female; age 53.9 6 15.5 years), sleep quality was measured using the Pittsburgh Sleep Quality Index and correlated with cross-sectional measures of volume and longitudinal measures of atrophy derived from MRI scans separated by an average of 3.5 years. Exploratory post hoc analysis compared correlations between different age groups and included physical activity, BMI, and blood pressure as additional covariates.Results: Poor sleep quality was associated with reduced volume within the right superior frontal cortex in cross-sectional analyses, and an increased rate of atrophy within widespread frontal, temporal, and parietal regions in longitudinal analyses. Results were largely driven by correlations within adults over the age of 60, and could not be explained by variation in physical activity, BMI, or blood pressure. Sleep quality was not associated with hippocampal volume or atrophy. Conclusions:We found that longitudinal measures of cortical atrophy were widely correlated with sleep quality. Poor sleep quality may be a cause or a consequence of brain atrophy, and future studies examining the effect of interventions that improve sleep quality on rates of atrophy may hold key insights into the direction of this relationship. Poor sleep quality, characterized by difficulties in initiating or maintaining sleep or nonrestorative sleep, has been linked to cognitive deficits 1,2 and increased risk of Alzheimer disease and cognitive decline 3 within community-based samples. MRI is an ideal tool to address whether variations in brain structure underlie these relationships, and MRI studies have linked primary insomnia with reduced volume of the orbitofrontal cortex (OFC), 4,5 hippocampus, 6,7 and precuneus, 4 and increased volume of the rostral anterior cingulate. 5 Although few studies have explored the relationship between sleep and brain structure in healthy individuals, crosssectional correlations have been reported between the volume of the OFC and early-morning awakening 8 and daytime sleepiness. 9 Furthermore, reduction in non-REM (NREM) slow wave activity (SWA) in older adults has been associated with age-related decreases in gray matter density within the medial prefrontal cortex (mPFC).10 To our knowledge, no studies have assessed the relationship between sleep quality and longitudinal change in brain structure.We investigated the relationship between sleep quality and cross-sectional measurements of cortical and hippocampal volume as well as longitudinal measures of atrophy in communitydwelling adults. We expected that poor sleep quality would be associated with reduced volume and increased atrophy within the OFC and mPFC. Furthermore, we hypothesized that correla...

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