Sleep macroarchitecture but not obstructive sleep apnea is independently associated with cognitive function in only older men of a population‐based cohort

Abstract

Summary Evidence linking obstructive sleep apnea with cognitive dysfunction predominantly comes from clinical or select community samples. We investigated the independent cross‐sectional association of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function in unselected community‐dwelling middle‐aged and older men. Four hundred and seventy‐seven Florey Adelaide Male Ageing Study participants underwent successful home‐based polysomnography. They also completed cognitive testing, including the inspection time task, Fuld object memory evaluation, trail‐making test A and B, and mini‐mental state examination. Multivariable regression models examined independent cross‐sectional associations of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function. In univariable analyses, a higher apnea–hypopnea index and percentage of total sleep time with oxygen saturation <90% were associated with worse trail‐making test A performance (both p < .05). A higher apnea–hypopnea index was also associated with worse trail‐making test B performance and slower inspection time (both p < .05). In adjusted analyses, obstructive sleep apnea and sleep macroarchitecture parameters were not associated with cognitive function (all p > .05). In age‐stratified analysis in men ≥65 years, greater stage 1 sleep was independently associated with worse trail‐making test A performance, whereas greater stage 3 sleep was independently associated with better trail‐making test A performance (both p < .05). Our findings suggest that obstructive sleep apnea is not independently associated with cognitive function. In older, but not younger, men, light sleep was associated with worse attention, whereas deep sleep was associated with better attention. Longitudinal population‐based cohort studies are needed to determine if obstructive sleep apnea and disrupted sleep macroarchitecture independently predict prospective cognitive dysfunction and decline.

Association between objective sleep measures and cognitive performance: a cross‐sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil) study

“…WASO and sleep fragmentation were associated with lower baseline scores and 5‐year cognitive decline evaluated by the Montreal Cognitive Assessment (MOCA) in 759 American older adults (McSorley, Bin, & Lauderdale, 2019). Similar to our findings, light sleep was associated with worse attention in older men, while OSA was unrelated to cognitive performance (Parker et al, 2021).…”

Cognition in Patients with Sleep-Disordered Breathing: Can Obstructive and Central Apneic Pauses Play a Different Role in Cognitive Impairment?

“…It could indicate a deterioration in restorative sleep function and possible subsequent negative effects on cognitive function. This hypothesis is supported by the findings of previous studies, where the reduction in REM sleep and increased percentage of N1 NREM phase correlated with attention deficit and executive dysfunction [ 17 , 18 ]. In our study, the proportion of the N1 NREM phase was the only significant factor in the model predicting impaired verbal fluency.…”

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

“…Longitudinal Study of Adult Health study (AHI ≥15/h) (Suemoto et al, 2022), or when they analysed AHI only as a continuous variable (Blackwell et al, 2011;Parker et al, 2021). Second, all observed associations in our study were restricted to processing speed and executive function according to the Stroop test, whereas no significant associations were found with respect to episodic verbal memory, language, or visuospatial function.…”

“…Indeed, our results corroborates those of the Proof‐Synapse Cohort, which revealed reduced cognitive performance among individuals with severe OSA (Sforza et al, 2010). Consequently, it is not surprising that some studies have yielded non‐significant results when they used lower AHI thresholds for defining OSA, such as the Sleep Heart Health Study (AHI >10/h) (Quan et al, 2006) or the Brazilian Longitudinal Study of Adult Health study (AHI ≥15/h) (Suemoto et al, 2022), or when they analysed AHI only as a continuous variable (Blackwell et al, 2011; Parker et al, 2021). Second, all observed associations in our study were restricted to processing speed and executive function according to the Stroop test, whereas no significant associations were found with respect to episodic verbal memory, language, or visuospatial function.…”