Sleep characteristics and risk of dementia and Alzheimer's disease: The Atherosclerosis Risk in Communities Study

Pamela L. Lutsey, Jeffrey R. Misialek, Thomas H. Mosley, Rebecca F. Gottesman, Naresh M. Punjabi, Eyal Shahar, Richard MacLehose, Rachel P. Ogilvie, David Knopman, Alvaro Alonso

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


Introduction This study tested the hypotheses that late-midlife obstructive sleep apnea (OSA) and short and long sleep duration are associated with dementia over 15 years of follow-up. Methods A total of 1667 Atherosclerosis Risk in Communities Study participants underwent in-home polysomnography (1996–1998) and were followed for dementia. Dementia was defined by (1) hospitalization diagnosis codes (1996–2012) and (2) a comprehensive neurocognitive examination (2011–2013) with adjudication. Results OSA and sleep duration were not associated with risk of incident dementia. When using adjudicated outcomes, severe OSA (≥30 vs. <5 apnea-hypopnea events/hour) was associated with higher risk of all-cause dementia (risk ratio [95% confidence interval], 2.35 [1.06–5.18]) and Alzheimer's disease dementia (1.66 [1.03–2.68]); associations were attenuated with cardiovascular risk factor adjustment. Sleeping <7 versus 8 to ≤9 hours was associated with higher risk of all-cause dementia (2.00 [1.03–3.86]). Discussion When adjudicated outcome definitions were used, late-midlife OSA and short sleep duration were associated with all-cause and Alzheimer's disease dementia in later life.

Original languageEnglish (US)
Pages (from-to)157-166
Number of pages10
JournalAlzheimer's and Dementia
Issue number2
StatePublished - Feb 2018

Bibliographical note

Funding Information:
Funding Sources: This was not an industry supported study. The ARIC portion of the Sleep Heart Health Study (SHHS) was supported by National Heart, Lung, and Blood Institute (NHLBI) cooperative agreements U01HL53934 (University of Minnesota) and U01HL64360 (Johns Hopkins University). The ARIC is carried out as a collaborative study supported by NHLBI contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Neurocognitive data are collected by U01 HL096812, HL096814, HL096899, HL096902, HL096917 from the NHLBI and the National Institute of Neurological Disorders and Stroke, and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. This study was additionally supported by grant R21 HL121412 to P.L.L. R.P.O was supported by a National Heart Lung and Blood Training Grant (T32 HL007779). The authors have indicated no financial conflicts of interest. Statistical analyses took place at the University of Minnesota. All authors reviewed the manuscript at their respective institutions.

Funding Information:
Conflicts of Interest: D.K. serves on a Data Safety Monitoring Board for Lundbeck Pharmaceuticals and for the DIAN study; he is an investigator in clinical trials sponsored by Biogen, TauRX Pharmaceuticals, Lilly Pharmaceuticals, and the Alzheimer's Disease Cooperative Study. Numerous authors receive research support from the National Institutes of Health (NIH). R.F.G is an Associate Editor for Neurology .

Publisher Copyright:
© 2017 the Alzheimer's Association


  • Alzheimer's disease
  • Atherosclerosis Risk in Communities (ARIC) Study
  • Dementia
  • Mild cognitive impairment
  • Obstructive sleep apnea
  • Sleep Heart Health Study (SHHS)
  • Sleep duration


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