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Sleep-Disordered Breathing and Cognition in Older Adults

  • Dementia (KS Marder, Section Editor)
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Abstract

Both sleep-disordered breathing (SDB) and cognitive impairment are common among older adults, yet few studies have examined their relationship within this population to determine whether the effect of SDB on cognition is of a magnitude similar to or greater than that observed in younger and middle-aged adults. Here, we review the extant literature and report that studies are largely supportive of an association between SDB and cognitive impairment in older adults, particularly in the domains of attention/vigilance, executive function, and verbal delayed recall memory. Presence of the APOE4 allele may confer increased vulnerability to SDB-associated cognitive dysfunction among elderly individuals. Although findings are mixed, there is strong evidence to suggest that SDB-related intermittent hypoxemia is the primary mechanism through which SDB exerts its adverse effects on cognition. We propose a microvascular model in which chronic intermittent hypoxemia causes vasculopathy that ultimately is expressed as cognitive impairment in the older adult. However, it remains unclear whether the effects of SDB on cognition are the same regardless of age or whether there is a synergistic interaction between age and SDB.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ancoli-Israel S, Kripke DF, Klauber MR, et al. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14:486–95.

    PubMed  CAS  Google Scholar 

  2. Salthouse TA. Selective review of cognitive aging. J Int Neuropsychol Soc. 2010;16:754–60.

    Article  PubMed  Google Scholar 

  3. Jackson ML, Stough C, Howard ME, et al. The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea. Sleep and Breathing. 2011;15:439–45.

    Article  PubMed  Google Scholar 

  4. Beebe DW, Groesz L, Wells C, et al. The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. Sleep. 2003;26:298–307.

    PubMed  Google Scholar 

  5. Aloia MS, Arnedt JT, Davis JD, et al. Neuropsychological sequelae of obstructive sleep apnea–hypopnea syndrome: a critical review. J Int Neuropsychol Soc. 2004;10:772–85.

    Article  PubMed  Google Scholar 

  6. He W, Sengupta M, Velkoff VA, DeBarros KA. 65+ in the United States. In: US census bureau current population reports. Washington, D.C: U.S. Government Printing Office; 2005. p. 23–209.

    Google Scholar 

  7. Medicine AAoS. International classification of sleep disorders, edition 2: diagnostic and coding manual. Westchester: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  8. De Backer WA. Central sleep apnoea, pathogenesis and treatment: an overview and perspective. Eur Respir J. 1995;8:1372–83.

    Article  PubMed  Google Scholar 

  9. Norman D, Loredo JS. Obstructive sleep apnea in older adults. Clin Geriatr Med. 2008;24:151–65. ix.

    Article  PubMed  Google Scholar 

  10. McMahon JP, Foresman BH, Chisholm RC. The influence of CPAP on the neurobehavioral performance of patients with obstructive sleep apnea hypopnea syndrome: a systematic review. WMJ. 2003;102:36–43.

    PubMed  Google Scholar 

  11. Mazza S, Pepin JL, Naegele B. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J. 2006;28:1020–8.

    Article  PubMed  CAS  Google Scholar 

  12. Zimmerman ME, Arnedt JT, Stanchina M, et al. Normalization of memory performance and positive airway pressure adherence in memory-impaired patients with obstructive sleep apnea. Chest. 2006;130:1772–8.

    Article  PubMed  Google Scholar 

  13. Aloia MS, Arnedt JT, Stepnowsky C, et al. Predicting treatment adherence in obstructive sleep apnea using principles of behavior change. J Clin Sleep Med. 2005;1:346–53.

    PubMed  Google Scholar 

  14. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  PubMed  CAS  Google Scholar 

  15. Carskadon MA, Dement WC. Respiration during sleep in the aged human. J Gerontol. 1981;36:420–3.

    PubMed  CAS  Google Scholar 

  16. Launois SH, Pepin JL, Levy P. Sleep apnea in the elderly: a specific entity? Sleep Med Rev. 2007;11:87–97.

    Article  PubMed  Google Scholar 

  17. Berry DT, Webb WB, Block AJ. Sleep apnea syndrome. A critical review of the apnea index as a diagnostic criterion. Chest. 1984;86:529–31.

    Article  PubMed  CAS  Google Scholar 

  18. Ancoli-Israel S, Palmer BW, Cooke JR, et al. Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J Am Geriatr Soc. 2008;56:2076–81.

    Article  PubMed  Google Scholar 

  19. Shochat T, Pillar G. Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management. Drugs Aging. 2003;20:551–60.

    Article  PubMed  Google Scholar 

  20. Beaulieu-Bonneau S, Hudon C. Sleep disturbances in older adults with mild cognitive impairment. Int Psychogeriatr. 2009;21:654–66.

    Article  PubMed  Google Scholar 

  21. Naismith SL, Rogers NL, Hickie IB, et al. Sleep well, think well: sleep–wake disturbance in mild cognitive impairment. J Geriatr Psychiatr Neurol. 2010;23:123–30.

    Article  Google Scholar 

  22. McCurry SM, Ancoli-Israel S. Sleep dysfunction in Alzheimer’s disease and other dementias. Curr Treat Options Neurol. 2003;5:261–72.

    Article  PubMed  Google Scholar 

  23. Neikrug AB, Ancoli-Israel S. Sleep disorders in the older adult—a mini-review. Gerontology. 2010;56:181–9.

    Article  PubMed  Google Scholar 

  24. Yesavage J, Bliwise D, Guilleminault C, et al. Preliminary communication: intellectual deficit and sleep-related respiratory disturbance in the elderly. Sleep. 1985;8:30–3.

    PubMed  CAS  Google Scholar 

  25. Berry DT, Phillips BA, Cook YR, et al. Geriatric sleep apnea syndrome: a preliminary description. J Gerontol. 1990;45:M169–74.

    PubMed  CAS  Google Scholar 

  26. Aloia MS, Ilniczky N, Di Dio P, et al. Neuropsychological changes and treatment compliance in older adults with sleep apnea. J Psychosom Res. 2003;54:71–6.

    Article  PubMed  Google Scholar 

  27. Mathieu A, Mazza S, Decary A, et al. Effects of obstructive sleep apnea on cognitive function: a comparison between younger and older OSAS patients. Sleep Med. 2008;9:112–20.

    Article  PubMed  CAS  Google Scholar 

  28. Alchanatis M, Zias N, Deligiorgis N, et al. Comparison of cognitive performance among different age groups in patients with obstructive sleep apnea. Sleep and breathing. 2008;12:17–24.

    Article  PubMed  Google Scholar 

  29. • Kim SJ, Lee JH, Lee DY, et al. Neurocognitive dysfunction associated with sleep quality and sleep apnea in patients with mild cognitive impairment. Am J Geriatr Psychiatr. 2011;19:374–81. This study is notable because it specifically examined SDB in older adults with MCI. Individuals with MCI are at high risk of developing dementia. Although no differences were found between MCI and control groups on measures of AHI and hypoxemia, higher AHI was associated with poorer performance on a language test among individuals with MCI.

    Article  Google Scholar 

  30. Katz MJ, Lipton RB, Hall CB, et al. Age-specific and sex-specific prevalence and incidence of mild cognitive impairment, dementia, and Alzheimer dementia in blacks and whites: a report from the Einstein Aging Study. Alzheimer Dis Assoc Disord. 2011.

  31. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s and Dementia. 2011;7:270–9.

    Article  PubMed  Google Scholar 

  32. Phillips BA, Berry DT, Schmitt FA, et al. Sleep-disordered breathing in the healthy elderly. Clinically significant? Chest. 1992;101:345–9.

    Article  PubMed  CAS  Google Scholar 

  33. Boland LL, Shahar E, Iber C, et al. Measures of cognitive function in persons with varying degrees of sleep-disordered breathing: the Sleep Heart Health Study. J Sleep Res. 2002;11:265–72.

    Article  PubMed  Google Scholar 

  34. Foley DJ, Masaki K, White L, et al. Sleep-disordered breathing and cognitive impairment in elderly Japanese-American men. Sleep. 2003;26:596–9.

    PubMed  Google Scholar 

  35. Sforza E, Roche F, Thomas-Anterion C, et al. Cognitive function and sleep related breathing disorders in a healthy elderly population: the SYNAPSE study. Sleep. 2010;33:515–21.

    PubMed  Google Scholar 

  36. Corder EH, Saunders AM, Strittmatter WJ, et al. Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer’s disease in late onset families. Science. 1993;261:921–3.

    Article  PubMed  CAS  Google Scholar 

  37. Kadotani H, Kadotani T, Young T, et al. Association between apolipoprotein E epsilon4 and sleep-disordered breathing in adults. JAMA. 2001;285:2888–90.

    Article  PubMed  CAS  Google Scholar 

  38. O’Hara R, Schroder CM, Kraemer HC, et al. Nocturnal sleep apnea/hypopnea is associated with lower memory performance in APOE epsilon4 carriers. Neurology. 2005;65:642–4.

    Article  PubMed  Google Scholar 

  39. Spira AP, Blackwell T, Stone KL, et al. Sleep-disordered breathing and cognition in older women. J Am Geriatr Soc. 2008;56:45–50.

    Article  PubMed  Google Scholar 

  40. Kim H, Dinges DF, Young T. Sleep-disordered breathing and psychomotor vigilance in a community-based sample. Sleep. 2007;30:1309–16.

    PubMed  Google Scholar 

  41. Hayward L, Mant A, Eyland A, et al. Sleep disordered breathing and cognitive function in a retirement village population. Age Ageing. 1992;21:121–8.

    Article  PubMed  CAS  Google Scholar 

  42. Dealberto MJ, Pajot N, Courbon D, Alperovitch A. Breathing disorders during sleep and cognitive performance in an older community sample: the EVA Study. J Am Geriatr Soc. 1996;44:1287–94.

    PubMed  CAS  Google Scholar 

  43. Cohen-Zion M, Stepnowsky C, Marler, et al. Changes in cognitive function associated with sleep disordered breathing in older people. J Am Geriatr Soc. 2001;49:1622–7.

    Article  PubMed  CAS  Google Scholar 

  44. •• Yaffe K, Laffan AM, Harrison SL, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306:613–9. This longitudinal study of 298 older women drawn from the community found that women with SDB had a nearly twofold increased risk of developing either mild cognitive impairment or dementia over a 5-year follow-up period. Furthermore, within women with SDB, measures of hypoxemia, but not sleep fragmentation or sleep duration, were associated with mild cognitive impairment or dementia risk.

    Article  PubMed  CAS  Google Scholar 

  45. • Blackwell T, Yaffe K, Ancoli-Israel S, et al. Associations between sleep architecture and sleep-disordered breathing and cognition in older community-dwelling men: the Osteoporotic Fractures in Men Sleep Study. J Am Geriatr Soc. 2011;59:2217–25. This community-based study of 2,909 older men found relationships between severe hypoxemia and performance on a vigilance test. No relationships were found between cognitive performance and mild indicies of SDB, suggesting that there may be a threshold effect at which hypoxemia exerts a negative impact on cognition.

    Article  PubMed  Google Scholar 

  46. Lanfranchi P, Somers VK. Obstructive sleep apnea and vascular disease. Respir Res. 2001;2:315–9.

    Article  PubMed  CAS  Google Scholar 

  47. Kato M, Roberts-Thomson P, Phillips BG, et al. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation. 2000;102:2607–10.

    Article  PubMed  CAS  Google Scholar 

  48. Silverberg DS, Oksenberg A, Iaina A. Sleep-related breathing disorders as a major cause of essential hypertension: fact or fiction? Curr Opin Nephrol Hypertens. 1998;7:353–7.

    Article  PubMed  CAS  Google Scholar 

  49. Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19:2271–7.

    Article  PubMed  CAS  Google Scholar 

  50. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25.

    PubMed  CAS  Google Scholar 

  51. Monahan K, Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol. 2011;26:541–7.

    Article  PubMed  Google Scholar 

  52. Ayalon L, Ancoli-Israel S, Drummond SP. Obstructive sleep apnea and age: a double insult to brain function? Am J Respir Crit Care Med. 2010;182:413–9.

    Article  PubMed  Google Scholar 

  53. Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2011;34:121–6.

    PubMed  Google Scholar 

  54. Tregear S, Reston J, Schoelles K, Phillips B. Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep. 2010;33:1373–80.

    PubMed  Google Scholar 

  55. Barbe F, Duran-Cantolla J, Capote F, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010;181:718–26.

    Article  PubMed  Google Scholar 

  56. Lavie L, Lavie P. Ischemic preconditioning as a possible explanation for the age decline relative mortality in sleep apnea. Med Hypotheses. 2006;66:1069–73.

    Article  PubMed  Google Scholar 

  57. Dinges DI, Powell JW. Microcomputer analysis of performance on a portable, simple visual RT task sustained operations. Behav Res Methods Instrum Comput. 1985;17:652–5.

    Article  Google Scholar 

  58. Lewis RF, Rennick PM. Manual for the repeatable cognitive-perceptual-motor batter. Gross Point Park: Axon; 1979.

    Google Scholar 

  59. Army Individual Test Battery. Manual of directions and scoring. Washington, D.C: War Department, Adjutant General’s Office; 1944.

    Google Scholar 

  60. Wechsler D. Wechsler Adult Intelligence Scale–4th edition. administration and scoring manual. San Antonio: Psychological Corporation; 2008.

    Google Scholar 

  61. Connors K. CPT: Connors’ continuous performance test. Toronto: Multi-Health Systems; 1995.

    Google Scholar 

  62. Golden CJ. Stroop Color and Word Test: a manual for clinical and experimental uses. Chicago, IL: Stoelting; 1978.

    Google Scholar 

  63. Raven JC. Progressive matrices: a perceptual test of intelligence. Individual form. Oxford: Oxford Psychologists Press; 1938.

    Google Scholar 

  64. Spreen O, Benton AL. Neurosensory Center Comprehensive Examination for Aphasia (NCCEA) (revised edition). Victoria: University of Victoria Neuropsychology Labratory; 1977.

    Google Scholar 

  65. Benedict RHB, Schretlen D, Brandt J. Hopkins Verbal Learning Test: revised: instructions for administration and scoring. Odessa: Psychological Assessment Resources; 1997.

    Google Scholar 

  66. Rey A. L’examine clinique en psychologie. Paris: Press Universitaire de France; 1958.

    Google Scholar 

  67. Benedict RHB. Brief visuospatial memory test–revised. Odessa: Psychological Assessment Resources; 1998.

    Google Scholar 

  68. Delis DC, Kramer JH, Kaplan E, Ober BA. California Verbal Learning Test–second edition, adult version. San Antonio: Psychological Corporation; 2000.

    Google Scholar 

  69. Wechsler D. Wechsler Memory Scale–fourth edition. administration and scoring manual. San Antonio: Psychological Corporation; 2009.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Room 338, Bronx, NY, 10461, USA

    Molly E. Zimmerman

  2. Department of Medicine, National Jewish Health, Denver, CO, USA

    Mark S. Aloia

  3. Philips/Respironics, Inc., Murrysville, PA, USA

    Mark S. Aloia

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  1. Molly E. Zimmerman
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  2. Mark S. Aloia
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Correspondence to Molly E. Zimmerman.

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Zimmerman, M.E., Aloia, M.S. Sleep-Disordered Breathing and Cognition in Older Adults. Curr Neurol Neurosci Rep 12, 537–546 (2012). https://doi.org/10.1007/s11910-012-0298-z

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