Associations between sleep-disordered breathing, nocturnal hypoxemia, and subsequent cognitive decline in older community-dwelling men

The osteoporotic fractures in men sleep study

Terri Blackwell, Kristine Yaffe, Alison Laffan, Susan Redline, Sonia Ancoli-Israel, Kristine E. Ensrud, Yeonsu Song, Katie L. Stone

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objectives To determine whether sleep-disordered breathing (SDB), a group of disorders common in older adults characterized by breathing pauses during sleep often accompanied by hypoxemia, is associated with cognitive decline. Design Population-based longitudinal study. Setting Six centers in the United States. Participants Community-dwelling older men (N = 2,636; aged 76.0 ± 5.3) without probable mild cognitive impairment or dementia followed for 3.4 ± 0.5 years. Measurements SDB was measured using in-home polysomnography: nocturnal hypoxemia (≥1% of sleep time with oxygen saturation (SaO2) <90%, oxygen desaturation index (ODI: number of oxygen desaturations of ≥3% per hour of sleep)) and apnea-hypopnea index (AHI, number of apneas and hypopneas at ≥3% desaturation per hour of sleep). Cognitive decline was measured using the Modified Mini-Mental State Examination (3MS) and the Trail-Making Test Part B (Trails B) at baseline and two follow-up points. Associations between predictors and cognitive decline were examined using linear mixed models adjusted for multiple confounders. Models were further adjusted for potential mediators (sleep duration, sleep fragmentation, resting SaO2). Results Nocturnal hypoxemia was related to greater decline on the 3MS. Men with 1% or more of sleep time with SaO2 less than 90% had an adjusted annualized decline of 0.43 points, compared with 0.25 for men in the reference group (P =.003). For each 5-point increase in ODI, there was an average annualized decline of 0.36 points (P =.01). Results were robust to further adjustment for potential mediators. The association between AHI and cognitive decline did not reach significance. No associations were seen with SDB and decline on the Trails B. Conclusion In older community-dwelling men, there was a modest association between nocturnal hypoxemia and global cognitive decline, suggesting the importance of overnight oxygenation for cognitive function.

Original languageEnglish (US)
Pages (from-to)453-461
Number of pages9
JournalJournal of the American Geriatrics Society
Volume63
Issue number3
DOIs
StatePublished - Mar 1 2015

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Independent Living
Osteoporotic Fractures
Sleep Apnea Syndromes
Sleep
Oxygen
Trail Making Test
Sleep Deprivation
Polysomnography
Apnea
Cognition
Longitudinal Studies
Dementia
Cognitive Dysfunction
Hypoxia
Linear Models
Respiration
Population

Keywords

  • cognitive decline
  • nocturnal hypoxemia
  • sleep-disordered breathing

Cite this

Associations between sleep-disordered breathing, nocturnal hypoxemia, and subsequent cognitive decline in older community-dwelling men : The osteoporotic fractures in men sleep study. / Blackwell, Terri; Yaffe, Kristine; Laffan, Alison; Redline, Susan; Ancoli-Israel, Sonia; Ensrud, Kristine E.; Song, Yeonsu; Stone, Katie L.

In: Journal of the American Geriatrics Society, Vol. 63, No. 3, 01.03.2015, p. 453-461.

Research output: Contribution to journalArticle

Blackwell, Terri ; Yaffe, Kristine ; Laffan, Alison ; Redline, Susan ; Ancoli-Israel, Sonia ; Ensrud, Kristine E. ; Song, Yeonsu ; Stone, Katie L. / Associations between sleep-disordered breathing, nocturnal hypoxemia, and subsequent cognitive decline in older community-dwelling men : The osteoporotic fractures in men sleep study. In: Journal of the American Geriatrics Society. 2015 ; Vol. 63, No. 3. pp. 453-461.
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abstract = "Objectives To determine whether sleep-disordered breathing (SDB), a group of disorders common in older adults characterized by breathing pauses during sleep often accompanied by hypoxemia, is associated with cognitive decline. Design Population-based longitudinal study. Setting Six centers in the United States. Participants Community-dwelling older men (N = 2,636; aged 76.0 ± 5.3) without probable mild cognitive impairment or dementia followed for 3.4 ± 0.5 years. Measurements SDB was measured using in-home polysomnography: nocturnal hypoxemia (≥1{\%} of sleep time with oxygen saturation (SaO2) <90{\%}, oxygen desaturation index (ODI: number of oxygen desaturations of ≥3{\%} per hour of sleep)) and apnea-hypopnea index (AHI, number of apneas and hypopneas at ≥3{\%} desaturation per hour of sleep). Cognitive decline was measured using the Modified Mini-Mental State Examination (3MS) and the Trail-Making Test Part B (Trails B) at baseline and two follow-up points. Associations between predictors and cognitive decline were examined using linear mixed models adjusted for multiple confounders. Models were further adjusted for potential mediators (sleep duration, sleep fragmentation, resting SaO2). Results Nocturnal hypoxemia was related to greater decline on the 3MS. Men with 1{\%} or more of sleep time with SaO2 less than 90{\%} had an adjusted annualized decline of 0.43 points, compared with 0.25 for men in the reference group (P =.003). For each 5-point increase in ODI, there was an average annualized decline of 0.36 points (P =.01). Results were robust to further adjustment for potential mediators. The association between AHI and cognitive decline did not reach significance. No associations were seen with SDB and decline on the Trails B. Conclusion In older community-dwelling men, there was a modest association between nocturnal hypoxemia and global cognitive decline, suggesting the importance of overnight oxygenation for cognitive function.",
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