Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 27;61(4):2201621.
doi: 10.1183/13993003.01621-2022. Print 2023 Apr.

Obstructive sleep apnoea and 5-year cognitive decline in the elderly

Nicola Andrea Marchi  1   2   3   4 , Geoffroy Solelhac  5 , Mathieu Berger  5 , José Haba-Rubio  5 , Nadia Gosselin  3   4 , Peter Vollenweider  6 , Pedro Marques-Vidal  6 , Julius Popp  7   8 , Armin von Gunten  7 , Martin Preisig  9 , Bogdan Draganski  2   10   11 , Raphael Heinzer  5   11
Affiliations

Obstructive sleep apnoea and 5-year cognitive decline in the elderly

Nicola Andrea Marchi et al. Eur Respir J. .

Abstract

Background: The relationship between obstructive sleep apnoea (OSA) and cognitive decline remains controversial, especially in the elderly population. We used data from the HypnoLaus study to assess associations between OSA and longitudinal cognitive changes in a sample of community-dwelling elderly individuals.

Methods: We studied associations between polysomnographic OSA parameters (of breathing/hypoxaemia and sleep fragmentation) and cognitive changes over a 5-year period, after adjustment for potential confounders. The primary outcome was the annual change in cognitive scores. The moderating effects of age, sex and apolipoprotein E4 (ApoE4) status were also examined.

Results: 358 elderly individuals without dementia were included (mean±sd age 71.0±4.2 years; 42.5% males). A lower mean peripheral oxygen saturation (S pO2 ) during sleep was associated with a steeper decline in Mini-Mental State Examination (B= -0.12, p=0.004), Stroop test condition 1 (B=0.53, p=0.002) and Free and Cued Selective Reminding Test delayed free recall (B= -0.05, p=0.008). A longer time spent asleep with S pO2 <90% was associated with a steeper decline in Stroop test condition 1 (B=0.47, p=0.006). Moderation analysis showed that apnoea-hypopnoea index and oxygen desaturation index were associated with a steeper decline in global cognitive function, processing speed and executive function only in older participants, men and ApoE4 carriers.

Conclusions: Our results provide evidence of the contribution of OSA and nocturnal hypoxaemia to cognitive decline in the elderly population.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: R. Heinzer is member of the medical advisory board of Dreem and Nightbalance (Philips), and received speaker's fees or honorarium from ResMed, Philips, Jazz and Inspire. The remaining authors have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Conditional effects of obstructive sleep apnoea (OSA) parameters at moderator values. Data were analysed by Hayes' SPSS Process macro version 4.1 [37] for moderation analysis using annual change in cognitive score as dependent variable, OSA parameter as independent variable and a, b) age, c, d) sex or e, f) apolipoprotein E4 (ApoE4) status as moderator. Asterisks indicate significant difference between apnoea–hypopnoea index (AHI; events·h−1) or oxygen desaturation index (ODI; events·h−1) groups: *: p<0.05; **; p<0.01. Models were corrected for age (continuous), sex (male, female), education (≥high school, <high school), ApoE4 (carriers, non-carriers), body mass index (continuous), diabetes (presence, absence), hypertension (presence, absence), smoking (current or ex-smoker, never-smoker), alcohol consumption (≥14, <14 units per week), psychotropic drugs (presence, absence), depression (presence, absence), Epworth Sleepiness Scale score (continuous), continuous positive airway pressure (yes, no) and COPD (yes, no). MMSE: Mini-Mental State Examination.
FIGURE 2
FIGURE 2
Overview of the results. The thickness of the arrows indicates the strength of the associations. Mean peripheral oxygen saturation during sleep (mean SpO2) and sleep time with SpO2 <90% (TST90) were the parameters most consistently associated with cognitive decline. Apnoea–hypopnoea index (AHI), oxygen desaturation index (ODI) and hypoxic burden were less consistently associated with cognitive decline, and their associations were partly moderated by age, sex and apolipoprotein E4 (ApoE4) status. OSA: obstructive sleep apnoea.
See this image and copyright information in PMC

Comment in

References

    1. Heinzer R, Vat S, Marques-Vidal P, et al. . Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3: 310–318. doi:10.1016/S2213-2600(15)00043-0 - DOI - PMC - PubMed
    1. Bubu OM, Andrade AG, Umasabor-Bubu OQ, et al. . Obstructive sleep apnea, cognition and Alzheimer's disease: a systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 2020; 50: 101250. doi:10.1016/j.smrv.2019.101250 - DOI - PMC - PubMed
    1. Cross N, Lampit A, Pye J, et al. . is obstructive sleep apnoea related to neuropsychological function in healthy older adults? A systematic review and meta-analysis. Neuropsychol Rev 2017; 27: 389–402. doi:10.1007/s11065-017-9344-6 - DOI - PubMed
    1. Gosselin N, Baril AA, Osorio RS, et al. . Obstructive sleep apnea and the risk of cognitive decline in older adults. Am J Respir Crit Care Med 2019; 199: 142–148. doi:10.1164/rccm.201801-0204PP - DOI - PMC - PubMed
    1. Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2022; 59: 2101649. doi:10.1183/13993003.01649-2021 - DOI - PMC - PubMed

Substances