Sleep Apnea, Sleep Duration and Brain MRI Markers of Cerebral Vascular Disease and Alzheimer's Disease: The Atherosclerosis Risk in Communities Study (ARIC)

• Authors: Pamela L. Lutsey, University of Minnesota; Faye L. Norby, University of Minnesota; Rebecca F. Gottesman, Johns Hopkins University; Thomas Mosley, University of Mississippi; Richard F. MacLehose, University of Minnesota; Naresh M. Punjabi, Johns Hopkins University; Eyal Shahar, University of Arizona; Clifford R. Jack, Jr., Mayo Clinic; Alvaro Alonso, Emory University
• Journal Title: PLoS ONE
• Volume: Volume 11, Number 7
• Publisher: Public Library of Science | 2016-07-14, Pages e0158758-e0158758
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0158758
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; COGNITIVE-DECLINE; HEART HEALTH; CEREBROVASCULAR-DISEASE; INTERMITTENT HYPOXIA; STRUCTURAL-CHANGES; BLOOD-PRESSURE; OLDER WOMEN; DEMENTIA; IMPAIRMENT; STROKE

Abstract

Background A growing body of literature has suggested that obstructive sleep apnea (OSA) and habitual short sleep duration are linked to poor cognitive function. Neuroimaging studies may provide insight into this relation. Objective We tested the hypotheses that OSA and habitual short sleep duration, measured at ages 54-73 years, would be associated with adverse brain morphology at ages 67-89 years. Methods Included in this analysis are 312 ARIC study participants who underwent in-home overnight polysomnography in 1996-1998 and brain MRI scans about 15 years later (2012-2013). Sleep apnea was quantified by the apnea-hypopnea index and categorized as moderate/ severe (≥15.0 events/hour), mild (5.0-14.9 events/hour), or normal (<5.0 events/hour). Habitual sleep duration was categorized, in hours, as <7, 7 to ≥8, 8. MRI outcomes included number of infarcts (total, subcortical, and cortical) and white matter hyperintensity (WMH) and Alzheimer's disease signature region volumes. Multivariable adjusted logistic and linear regression models were used. All models incorporated inverse probability weighting, to adjust for potential selection bias. Results At the time of the sleep study participants were 61.7 (SD: 5.0) years old and 54% female; 19% had moderate/severe sleep apnea. MRI imaging took place 14.8 (SD: 1.0) years later, when participants were 76.5 (SD: 5.2) years old. In multivariable models which accounted for body mass index, neither OSA nor abnormal sleep duration were statistically significantly associated with odds of cerebral infarcts, WMH brain volumes or regional brain volumes. Conclusions In this community-based sample, mid-life OSA and habitually short sleep duration were not associated with later-life cerebral markers of vascular dementia and Alzheimer's disease. However, selection bias may have influenced our results and the modest sample size led to relatively imprecise associations.