Randomized Controlled Trial

. 2025 Feb 10;48(2):zsae204.

doi: 10.1093/sleep/zsae204.

Obstructive sleep apnea and cerebral small vessel disease in community-based older people: an aspirin in reducing events in the elderly imaging substudy

Stephanie A Ward^{1

2

3}, Elsdon Storey¹, Matthew T Naughton⁴, Rory Wolfe¹, Garun S Hamilton^{5

6}, Meng Law^{7

8}, Ryo Kawasaki⁹, Walter P Abhayaratna^{10

11}, Katherine L Webb¹, Fergal J O'Donoghue^{12

13}, Danijela Gasevic^{1

14}, Nigel P Stocks¹⁵, Ruth E Trevaks¹, Liubov D Robman^{1

16}, Scott Kolbe⁷, Sharyn M Fitzgerald¹, Suzanne G Orchard¹, Tien Y Wong^{17

18}, John J McNeil¹, Christopher M Reid^{1

19}, Ben Sinclair^{7

8}, Robyn L Woods¹

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, NSW, Australia.
³ Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia.
⁴ The Department of Respiratory Medicine, Alfred Hospital, and The Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁵ Department of Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, VIC, Australia.
⁶ School of Clinical Sciences, Monash University, Clayton VIC, Australia.
⁷ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁸ Department of Radiology, Alfred Health, Melbourne, VIC, Australia.
⁹ Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita-City, Japan.
¹⁰ College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
¹¹ Academic Unit of Internal Medicine, Canberra Hospital, Garran, ACT, Australia.
¹² Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.
¹³ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
¹⁴ Centre for Usher Institute, University of Edinburgh, Teviot Place, UK.
¹⁵ Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
¹⁶ Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC, Australia.
¹⁷ School of Clinical Medicine, Beijing Tsinghua Changgang Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China.
¹⁸ Singapore Eye Research Institute, Singapore National Eye Center, Singapore.
¹⁹ Curtin School of Population Health, Curtin University, Bentley, Perth, WA, Australia.

PMID: 39301859
PMCID: PMC11807880
DOI: 10.1093/sleep/zsae204

Randomized Controlled Trial

Obstructive sleep apnea and cerebral small vessel disease in community-based older people: an aspirin in reducing events in the elderly imaging substudy

Stephanie A Ward et al. Sleep. 2025.

. 2025 Feb 10;48(2):zsae204.

doi: 10.1093/sleep/zsae204.

Authors

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, NSW, Australia.
³ Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia.
⁴ The Department of Respiratory Medicine, Alfred Hospital, and The Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁵ Department of Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, VIC, Australia.
⁶ School of Clinical Sciences, Monash University, Clayton VIC, Australia.
⁷ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁸ Department of Radiology, Alfred Health, Melbourne, VIC, Australia.
⁹ Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita-City, Japan.
¹⁰ College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
¹¹ Academic Unit of Internal Medicine, Canberra Hospital, Garran, ACT, Australia.
¹² Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.
¹³ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
¹⁴ Centre for Usher Institute, University of Edinburgh, Teviot Place, UK.
¹⁵ Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
¹⁶ Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC, Australia.
¹⁷ School of Clinical Medicine, Beijing Tsinghua Changgang Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China.
¹⁸ Singapore Eye Research Institute, Singapore National Eye Center, Singapore.
¹⁹ Curtin School of Population Health, Curtin University, Bentley, Perth, WA, Australia.

PMID: 39301859
PMCID: PMC11807880
DOI: 10.1093/sleep/zsae204

Abstract

Study objectives: Obstructive sleep apnea (OSA) may increase the risk of dementia. A potential pathway for this risk is through cerebral small vessel disease (CSVD). In the context of an existing randomized trial of aspirin for primary prevention, we aimed to investigate OSA's impact on CSVD imaging measures and explore whether aspirin effects these measures over 3 years that differ in the presence or absence of OSA.

Methods: A substudy of the aspirin in reducing events in the elderly (ASPREE) randomized placebo-controlled trial of low-dose aspirin. Community-dwelling participants aged 70 years and above, without cognitive impairment, cardiovascular disease, or known OSA completed an unattended limited-channel sleep study that calculated the oxygen desaturation index and apnea-hypopnea index. At baseline and 3 years later, volumes of white matter hyperintensities (WMH) and silent brain infarctions (SBI) were measured on 1.5 Tesla brain magnetic resonance imaging, and retinal vessel calibers were calculated from retinal vascular imaging.

Results: Mild and moderate/severe OSA was detected in 48.9% and 29.9%, respectively, of the 311 participants, who had a mean age of 73.7 years (SD 3.4 years), 38.6% female. OSA of any severity was not associated with WMH volumes, SBI, nor retinal vessel calibers at baseline, nor with change in these measures in the 277 participants with repeated measures acquired after 3 years. OSA of any severity did not interact with aspirin on change in these measures over 3 years.

Conclusions: In healthy older adults undiagnosed OSA was not associated with retinal vascular calibers and neuroimaging measures of CSVD.

Clinical trial information: ASPREE trial has registration with the International Standard Randomized Controlled Trial Number (ISRCTN) www.isrctn.com, ISRCTN83772183 and with www.clinicaltrials.gov, NCT01038583. SNORE-ASA has registration with the Australian New Zealand Clinical Trials Registry (ANZCTR) at www.anzctr.org.au, ACTRN12612000891820.

Keywords: aging; cerebral small vessel disease; obstructive sleep apnea; sleep-disordered breathing; white matter hyperintensities.

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Figures

**Figure 1.**
Consort diagram showing participants in the SNORE-ASA Imaging Subset study. ASPREE, Aspirin in Reducing Events in the Elderly study; OSA, obstructive sleep apnea; CPAP, continuous positive airway pressure therapy; MRI, magnetic resonance imaging; RVI, retinal vascular imaging.

See this image and copyright information in PMC

References

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Obstructive sleep apnea and cerebral small vessel disease in community-based older people: an aspirin in reducing events in the elderly imaging substudy

Affiliations

Obstructive sleep apnea and cerebral small vessel disease in community-based older people: an aspirin in reducing events in the elderly imaging substudy

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical