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  • 1
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    Obstructive sleep apnea risk is associated with decreased executive processing speed in older women but not in men: A longitudinal analysis of the Canadian Longitudinal Study on Aging
    Wiley ; 2022
    In:  Alzheimer's & Dementia Vol. 18, No. S7 ( 2022-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 18, No. S7 ( 2022-12)
    Abstract: Studies investigating the possible links between obstructive sleep apnea (OSA) and cognitive dysfunction have yet led to heterogenous results. Individual characteristics, such as sex and age, could moderate this association and explain part of this heterogeneity. Here, we characterized the sex‐ and age‐specific association between OSA risk and cognitive performance using longitudinal data from the community‐based Canadian Longitudinal Study on Aging (CLSA) comprehensive cohort. Method Our sample included 25,393 participants aged 45 to 85 years at baseline (mean = 63 years; 51% women; 78% with post‐secondary degree), recruited between 2011 and 2015 across Canada. Participants with Alzheimer’s and Parkinson’s diagnosis or with history of stroke and of traumatic brain injury were excluded. Participants’ risk for OSA was measured at baseline using the STOP‐B questionnaire, based on risk factors and symptoms of OSA. Participants scoring ³ 3/5 were classified as being at high‐risk for OSA. Neuropsychological tests assessed memory (Rey Auditory Verbal Learning Test), executive functioning (Mental Alternation, Animal Fluency, Controlled Oral Word Association and Stroop tests) and psychomotor speed (Choice Reaction Time) at baseline and at 3‐year follow‐up. We calculated changes (follow‐up – baseline) in each cognitive continuous score and conducted sex‐specific age‐stratified (45‐59; 60–69; 70–85 years) analyses of covariance (ANCOVAs) to estimate the predictive role of baseline OSA risk, adjusting for socio‐demographic, lifestyle and medical comorbidities. The level of significance was set at p 〈 0.05, after false‐discovery rate correction. Results In the whole sample, results show a decline over time only for executive functioning (Mental Alternation, Animal Fluency and Stroop) at 3‐year follow‐up. When analyses were performed according to age and sex, being at high‐risk for OSA was associated with increased reaction times only in women aged 70–85 years (Stroop word: [F = 12.486; 95%CI ‐5.440 to ‐1.554]; Stroop color: [F = 7,870; 95%CI ‐9.843 to ‐1.738] ). Conclusion Although changes in executive functioning were noted over time in the whole sample, being at high‐risk for OSA only increased the risk of slower processing speed for older women. These findings suggest that the possible detrimental effects of OSA on cognitive health depend on participants’ age and sex.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v18.S7
    DOI: 10.1002/alz.063205
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2201940-6
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  • 2
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    REM sleep is associated with the integrity of the cholinergic basal forebrain in aMCI participants
    Wiley ; 2022
    In:  Alzheimer's & Dementia Vol. 18, No. S7 ( 2022-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 18, No. S7 ( 2022-12)
    Abstract: The basal forebrain cholinergic system (BFCS) degenerates in Alzheimer’s disease (AD) before the onset of dementia. Interestingly, rapid‐eye movement (REM) sleep is highly dependent on cholinergic activity. In AD patients, REM sleep duration is reduced but the underlying brain mechanisms are still unclear. Our objective was to investigate the associations between REM‐sleep quantity and BFCS integrity in participants with amnestic mild cognitive impairment (aMCI) compared to healthy controls. Method Sixty‐two participants (31 cognitively healthy: 66.8 ± 7.2 years old, 13 women; 31 aMCI: 68.3 ± 8.8 years old, 7 women) underwent polysomnography and structural magnetic resonance imaging examinations. REM sleep duration (number of minutes) and proportion (%) were computed. All participants had a REM sleep apnea‐hypopnea index 〈 15. T1‐weighted images were preprocessed using CAT12 and the DARTEL algorithm, and the mean intensity of BFCS subregions (i.e., Ch1‐2‐3, Ch4 and total BFCS) was extracted using the JuBrain Anatomy Toolbox. Multiple regressions were performed between BFCS subregional intensities and REM sleep indices controlling for age, sex and total intracranial volume, in the whole cohort and in the two groups separately. Result In the whole cohort, REM sleep duration and proportion were positively associated with Ch4 intensity (duration: r = 0.31, p = 0.017; proportion: r = 0.35, p = 0.007; Figure 1A and B) and total BFCS intensity (duration: r = 0.31, p = 0.016; proportion: r = 0.29, p = 0.024). Analyses stratified by cognitive status showed the same pattern in aMCI participants: REM sleep duration and proportion were positively associated with both Ch4 intensity (duration: r = 0.44, p = 0.018; proportion: r = 0.49, p = 0.009; Figure 1C and D) and total BFCS intensity (duration: r = 0.46, p = 0.014; proportion: r = 0.46, p = 0.013). No significant association, nor trend, was found in cognitively healthy participants (Figure 1C and D). Conclusion In aMCI participants, lower REM sleep duration and proportion were associated with a decreased integrity of the BFCS, especially the Nucleus Basalis of Meynert. Our results support the notion that REM sleep alterations are an early marker of the degeneration of the BFCS in prodromal AD, before the onset of dementia.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v18.S7
    DOI: 10.1002/alz.067250
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 3
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    Obstructive Sleep Apnea and Cognitive Decline: A Review of Potential Vulnerability and Protective Factors
    MDPI AG ; 2021
    In:  Brain Sciences Vol. 11, No. 6 ( 2021-05-27), p. 706-
    Details
    In: Brain Sciences, MDPI AG, Vol. 11, No. 6 ( 2021-05-27), p. 706-
    Abstract: Around 40% of dementia risk is attributable to modifiable risk factors such as physical inactivity, hypertension, diabetes and obesity. Recently, sleep disorders, including obstructive sleep apnea (OSA), have also been considered among these factors. However, despite several epidemiological studies investigating the link between OSA and cognitive decline, there is still no consensus on whether OSA increases the risk of dementia or not. Part of the heterogeneity observed in previous studies might be related to some individual characteristics that modulate the association between OSA and cognitive decline. In this narrative review, we present these individual characteristics, namely, age, sex, menopause, obesity, diabetes mellitus, hypertension, cardiovascular diseases, smoking, excessive alcohol consumption, depression, air pollution, Apolipoprotein E ε4 allele, physical activity, and cognitive reserve. To date, large cohort studies of OSA and cognitive decline tended to statistically control for the effects of these variables, but whether they interact with OSA to predict cognitive decline remains to be elucidated. Being able to better predict who is at risk of cognitive decline when they have OSA would improve clinical management and treatment decisions, particularly when patients present relatively mild OSA.
    Type of Medium: Online Resource
    ISSN: 2076-3425
    URL: Article
    DOI: 10.3390/brainsci11060706
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2651993-8
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  • 4
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    Age- and sex-specific associations between obstructive sleep apnea risk and cognitive decline in middle-aged and older adults: A 3-year longitudinal analysis of the Canadian longitudinal study on aging
    Elsevier BV ; 2023
    In:  Sleep Medicine ( 2023-10)
    Details
    In: Sleep Medicine, Elsevier BV, ( 2023-10)
    Type of Medium: Online Resource
    ISSN: 1389-9457
    URL: Article
    DOI: 10.1016/j.sleep.2023.09.029
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2041737-8
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  • 5
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    Association between risk of obstructive sleep apnea, inflammation and cognition after 45 years old in the Canadian Longitudinal Study on Aging
    Elsevier BV ; 2022
    In:  Sleep Medicine Vol. 91 ( 2022-03), p. 21-30
    Details
    In: Sleep Medicine, Elsevier BV, Vol. 91 ( 2022-03), p. 21-30
    Type of Medium: Online Resource
    ISSN: 1389-9457
    URL: Article
    DOI: 10.1016/j.sleep.2022.02.006
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 6
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    Data_Sheet_1.docx
    Frontiers Media SA ; 2023
    In:  Frontiers in Neurology Vol. 14 ( 2023-6-19)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 14 ( 2023-6-19)
    Abstract: Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for cognitive decline, and has been associated with structural brain alterations in regions relevant to memory processes and Alzheimer’s disease. However, it is unclear whether OSA is associated with disrupted functional connectivity (FC) patterns between these regions in late middle-aged and older populations. Thus, we characterized the associations between OSA severity and resting-state FC between the default mode network (DMN) and medial temporal lobe (MTL) regions. Second, we explored whether significant FC changes differed depending on cognitive status and were associated with cognitive performance. Methods Ninety-four participants [24 women, 65.7 ± 6.9 years old, 41% with Mild Cognitive Impairment (MCI)] underwent a polysomnography, a comprehensive neuropsychological assessment and a resting-state functional magnetic resonance imaging (MRI). General linear models were conducted between OSA severity markers (i.e., the apnea-hypopnea, oxygen desaturation and microarousal indices) and FC values between DMN and MTL regions using CONN toolbox. Partial correlations were then performed between OSA-related FC patterns and (i) OSA severity markers in subgroups stratified by cognitive status (i.e., cognitively unimpaired versus MCI) and (ii) cognitive scores in the whole sample. All analyzes were controlled for age, sex and education, and considered significant at a p   & lt; 0.05 threshold corrected for false discovery rate. Results In the whole sample, a higher apnea-hypopnea index was significantly associated with lower FC between (i) the medial prefrontal cortex and bilateral hippocampi, and (ii) the left hippocampus and both the posterior cingulate cortex and precuneus. FC patterns were not associated with the oxygen desaturation index, or micro-arousal index. When stratifying the sample according to cognitive status, all associations remained significant in cognitively unimpaired individuals but not in the MCI group. No significant associations were observed between cognition and OSA severity or OSA-related FC patterns. Discussion OSA severity was associated with patterns of lower FC in regions relevant to memory processes and Alzheimer’s disease. Since no associations were found with cognitive performance, these FC changes could precede detectable cognitive deficits. Whether these FC patterns predict future cognitive decline over the long-term needs to be investigated.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    URL: Article
    DOI: 10.3389/fneur.2023.1215882
    DOI: 10.3389/fneur.2023.1215882.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2564214-5
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  • 7
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    REM sleep is associated with the volume of the cholinergic basal forebrain in aMCI individuals
    Springer Science and Business Media LLC ; 2023
    In:  Alzheimer's Research & Therapy Vol. 15, No. 1 ( 2023-09-08)
    Details
    In: Alzheimer's Research & Therapy, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2023-09-08)
    Abstract: Rapid-eye movement (REM) sleep highly depends on the activity of cholinergic basal forebrain (BF) neurons and is reduced in Alzheimer’s disease. Here, we investigated the associations between the volume of BF nuclei and REM sleep characteristics, and the impact of cognitive status on these links, in late middle-aged and older participants. Methods Thirty-one cognitively healthy controls (66.8 ± 7.2 years old, 13 women) and 31 participants with amnestic Mild Cognitive Impairment (aMCI) (68.3 ± 8.8 years old, 7 women) were included in this cross-sectional study. All participants underwent polysomnography, a comprehensive neuropsychological assessment and Magnetic Resonance Imaging examination. REM sleep characteristics (i.e., percentage, latency and efficiency) were derived from polysomnographic recordings. T1-weighted images were preprocessed using CAT12 and the DARTEL algorithm, and we extracted the gray matter volume of BF regions of interest using a probabilistic atlas implemented in the JuBrain Anatomy Toolbox. Multiple linear regressions were performed between the volume of BF nuclei and REM sleep characteristics controlling for age, sex and total intracranial volume, in the whole cohort and in subgroups stratified by cognitive status. Results In the whole sample, lower REM sleep percentage was significantly associated to lower nucleus basalis of Meynert (Ch4) volume (β = 0.32, p  = 0.009). When stratifying the cohort according to cognitive status, lower REM sleep percentage was significantly associated to both lower Ch4 (β = 0.48, p  = 0.012) and total BF volumes (β = 0.44, p  = 0.014) in aMCI individuals, but not in cognitively unimpaired participants. No significant associations were observed between the volume of the BF and wake after sleep onset or non-REM sleep variables. Discussion These results suggest that REM sleep disturbances may be an early manifestation of the degeneration of the BF cholinergic system before the onset of dementia, especially in participants with mild memory deficits.
    Type of Medium: Online Resource
    ISSN: 1758-9193
    URL: Article
    DOI: 10.1186/s13195-023-01265-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2506521-X
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  • 8
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    Age‐stratified, sex‐specific differences in cognitive performance based on risk of obstructive sleep apnea and systemic inflammation: A cross‐sectional analysis of the Canadian Longitudinal Study of Aging
    Wiley ; 2021
    In:  Alzheimer's & Dementia Vol. 17, No. S6 ( 2021-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S6 ( 2021-12)
    Abstract: Growing evidence supports associations between cognitive impairment and obstructive sleep apnea (OSA). Our study aimed at determining the age and sex‐specific, independent relationship between risk of having OSA and cognitive performance, and the influence of systemic inflammation on this relationship. Method Our sample included 25,712 participants from the Canadian Longitudinal Study of Aging (CLSA) comprehensive cohort aged 45 to 85 years ( M = 63 years; 51% women; 78% with post‐secondary degree). Exclusion criteria included Alzheimer’s and Parkinson’s disease and history of stroke and of traumatic brain injury. Participants were classified as high‐ or low‐risk of having OSA based on the STOP questionnaire (high‐risk = ≥ 2/4), considering signs and symptoms associated with OSA including snoring (S), tiredness (T), observation of apneas (O), and high blood pressure (P). Neuropsychological tests assessed memory, executive functioning and psychomotor speed. Levels of high‐sensitivity C‐reactive protein (hs‐CRP) were obtained through blood samples. We conducted sex‐ and age‐specific (45‐59; 60‐69; ≥70) General Linear Models between cognitive scores and risk of OSA, and moderation and mediation analyses with levels of hs‐CRP. Analyses were adjusted for socio‐demographic, lifestyle and medical comorbidities. Result In the fully adjusted model, 45‐59 years old women at high‐risk of OSA presented poorer short‐term memory and learning (Rey Auditory Verbal Learning Test, immediate recall, p=0.040), and executive functioning (Animal Fluency test, p=0.011; Mental Alternation test, p=0.006; Stroop Test, inhibition condition, p=0.047; low‐interference index, p=0.027 and high‐interference index, p=0.022) compared to those at low‐risk of OSA. These associations were not found in women aged ≥60 and in men of all age groups. The association between OSA risk and cognition was not moderated by education nor consistently moderated or mediated by the level of hs‐CRP. Conclusion These findings suggest that OSA might represent a modifiable risk factor of early cognitive impairment in women aged 45‐59. We suggest clinicians systematically screen for cognitive impairment when patients of this group present suspected or diagnosed OSA. Furthermore, it is important to track changes in cognitive profile of women aged 45‐59 in the CLSA cohort to identify those at risk of long‐term cognitive decline.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v17.S6
    DOI: 10.1002/alz.051503
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 9
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    Associations between REM‐sleep EEG spectral power, the cholinergic basal forebrain volume and episodic memory in ageing
    Wiley ; 2021
    In:  Alzheimer's & Dementia Vol. 17, No. S6 ( 2021-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S6 ( 2021-12)
    Abstract: Our research team has demonstrated that quantitative electroencephalography (qEEG) slowing during rapid‐eye movement (REM) sleep is a more powerful tool to discriminate patients with mild cognitive impairment (MCI) or Alzheimer Disease (AD) from healthy controls than waking EEG. Cortical activation during REM sleep highly depends on the cholinergic basal forebrain system (BFCS) neurons, while other neuronal systems are less active compared to wakefulness. However, the BFCS degenerates early in AD. Here, we tested the hypothesis that REM sleep EEG activity could be strongly associated with neurodegeneration of the BFCS, before the onset of dementia. Method 134 participants (mean age 68.45 ± 7.8 years; 52 women; 61 with MCI) underwent a polysomnography, structural magnetic resonance imaging, and a neuropsychological evaluation. T1‐weighted images were preprocessed using CAT12 and the DARTEL algorithm, and the JuBrain Anatomy Toolbox was used to extract bilateral BFCS volumes (i.e., Ch1‐2‐3, Ch4 and total volume). Based on prior evidence, theta (4‐8Hz) and alpha (8‐13Hz) absolute EEG power during REM sleep were computed on temporal electrodes (T3‐T4‐T5‐T6). A composite episodic memory score was calculated as the mean of Z‐scores obtained on the Rey Auditory Verbal Learning Test immediate and delayed free recalls. Multiple regressions were performed between (i) spectral power values or (ii) episodic memory performance, and basal forebrain volumes controlling for age, sex, the apnea‐hypopnea index, and the total intracranial volume. Complementary analyses were performed by stratifying the cohort by sex. Result Both Ch4 (r=0.24, p=0.006) and total BFCS (r=0.25, p=0.005) volumes were positively associated with episodic memory performance. Ch4 (r=‐0.21; p=0.025) and total BFCS (r=‐0.22; p=0.02) volumes were negatively associated with temporal theta power. Moreover, total BFCS (r=‐0.22; p=0.023) volumes were negatively associated with temporal alpha power. Sex‐stratified analyses revealed that the associations between BFCS volumes, REM‐sleep spectral power and episodic memory were significant in women, but not in men. Conclusion These results confirmed that cortical activation during REM sleep is sensitive to volume loss in the BFCS, a cholinergic region known to degenerate early in AD. Why this association was only observed in women is intriguing and will need further investigation.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v17.S6
    DOI: 10.1002/alz.057683
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 10
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    Longitudinal medial temporal lobe gray matter volume and cognitive changes in late middle‐aged and older adults with treated and non‐treated obstructive sleep apnea
    Wiley ; 2022
    In:  Alzheimer's & Dementia Vol. 18, No. S7 ( 2022-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 18, No. S7 ( 2022-12)
    Abstract: Neuroimaging studies in obstructive sleep apnea (OSA) have found both gray matter atrophy and hypertrophy in medial temporal lobe subregions, the latter probably reflecting edema. Whether and how these changes progress over time when OSA is treated or untreated remains unclear. Here, we investigated gray matter volume changes in medial temporal lobe subregions in treated OSA, untreated OSA and control participants aged 〉 55 years. We also explored whether the medial temporal lobe volume at baseline could predict cognitive decline. Method Twenty‐three non‐treated OSA participants (65.8 ±5.4 years) and twenty controls (64.0 ±6.4 years) were evaluated with overnight polysomnography, MRI session and neuropsychological assessment. Twelve OSA participants then started continuous positive airway pressure (CPAP) therapy and used it at least 4 hours per night, 4 nights per week. Eleven participants refused treatment. Participants were evaluated again with MRI and neuropsychology after 18 months. We extracted the entorhinal, hippocampal and parahippocampal volumes using FreeSurfer 7.1. We performed repeated‐measure ANOVAs with Group (treated OSA, untreated OSA and controls) and Time (baseline and follow‐up) on bilateral volumes. We also performed partial correlations between bilateral medial temporal volumes at baseline and changes in cognition (Montreal Cognitive Assessment, score at follow‐up – baseline) in each group separately. Analyses were corrected for age, sex, and total intracranial volume. Result We found a significant Group X Time interaction for bilateral parahippocampal volumes (F = 7.2; p = 0.002) where treated OSA participants showed a decreased volume over time (p tukey 〈 0.001), while no changes occurred in the two other groups. Regarding the predictive value of medial temporal lobe volume, in untreated participants, higher bilateral hippocampal volume at baseline was associated with more severe cognitive decline over time (r = ‐0.77; p = 0.01). In treated participants, higher bilateral entorhinal cortex volume at baseline was associated with more cognitive decline (r = ‐0.74; p = 0.035). No associations were found in controls. Conclusion These preliminary results showed that presenting hypertrophy of the medial temporal lobe subregions at baseline is associated with worse cognitive outcome at 18‐month follow‐up in OSA participants. In the CPAP group, the decrease in parahippocampal volume might represent a reduction in hypertrophy, possibly by limiting edema.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v18.S7
    DOI: 10.1002/alz.064745
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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