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
. 2025 May;21(5):e70280.
doi: 10.1002/alz.70280.

Sleep macro-architecture, nocturnal hypoxemia, and Alzheimer's disease-related MRI patterns among diverse older adults

Dillys Xiaodi Liu  1 , Meredith N Braskie  2 , Clémence Cavaillès  1 , Carrie Peltz  3 , Susan Redline  4 , Kristine Yaffe  5
Affiliations

Sleep macro-architecture, nocturnal hypoxemia, and Alzheimer's disease-related MRI patterns among diverse older adults

Dillys Xiaodi Liu et al. Alzheimers Dement. 2025 May.

Abstract

Introduction: Sleep patterns change with aging, yet their relationship with brain health, particularly Alzheimer's disease (AD)-related MRI patterns among diverse older adults is not clear.

Methods: We cross-sectionally studied community-dwelling Non-Hispanic White (NHW), Hispanic, and Black participants recruited from the Health and Aging Brain Study-Health Disparities (HABS-HD)-Dormir Study, who underwent WatchPAT and brain MRI.

Results: A total of 842 participants (34% male; 42% NHW, 33% Hispanic, and 25% Black; mean age 66.1 ± 8.6 years) were included. Greater light sleep percentage and longer rapid-eye movement (REM) sleep latency were independently associated with thinner cortex in AD-signature regions, while inverse pattern was observed for greater deep sleep percentage. Higher Apnea-Hypopnea Index (AHI) in REM sleep was independently associated with greater white matter hyperintensities volume. There were no ethnoracial interactions for these associations.

Discussion: Light and deep sleep percentage, REM sleep latency, and AHI in REM sleep were associated with AD-related MRI patterns.

Highlights: Greater light sleep percentage and longer rapid-eye movement sleep latency were associated with thinner cortex in the Alzheimer's Disease-siganture regions, while greater deep sleep percentage was associated with thicker cortex in those regions. Higher apnea hypoonea index in rapid eye movement sleep was associated with greater white matter hyperintensities volume. No moderation effects by race/ethnicity were observed among Non-Hispanic White/Hispanic/Black adults.

Keywords: Alzheimer's disease; dementia; magnetic resonance imaging; sleep; sleep apnea.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interests to report Author disclosures are available in the Supporting information

Figures

FIGURE 1
FIGURE 1
Scatterplot shows unadjusted associations between sleep macro‐architecture and Alzheimer's Disease‐signature cortical thickness. AD, Alzheimer's disease; REM, rapid eye movement.
FIGURE 2
FIGURE 2
Odds ratios of associations between sleep metrics and WMH volume. WMH volume was categorized into tertiles: the top tertile of WMH (largest WMH burden) to the lowest tertile of WMH (smallest WMH burden), using the lowest tertile as the reference group. Model 1 unadjusted. Model 2: model 1 plus further adjustment for age, sex, and race/ethnicity (in the model for overall sample). Model 3: model 2 plus further adjustment for education, body mass index, cognitive status, depressive status (history of depression or on anti‐depressant), smoking, alcohol consumption, time interval between WatchPAT and brain MRI, and MRI scanner. *FDR‐adjusted p < 0.05; **FDR‐adjusted p < 0.01; ***FDR‐adjusted p < 0.001. AHI, Apnea‐Hypopnea Index; CI, confidence interval; FDR, false discovery rate; MRI, magnetic resonance imaging; REM, rapid‐eye movement; WMH, white matter hyperintensities.
See this image and copyright information in PMC

References

    1. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta‐Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: developing Normative Sleep Values Across the Human Lifespan. Sleep. 2004;27(7):1255‐1273. doi:10.1093/sleep/27.7.1255 - DOI - PubMed
    1. Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A. The Effects of Age, Sex, Ethnicity, and Sleep‐Disordered Breathing on Sleep Architecture. Arch Intern Med. 2004;164(4):406‐418. doi:10.1001/archinte.164.4.406 - DOI - PubMed
    1. Cross NE, Memarian N, Duffy SL, et al. Structural brain correlates of obstructive sleep apnoea in older adults at risk for dementia. Eur Respir J. 2018;52(1):1800740. doi:10.1183/13993003.00740-2018 - DOI - PubMed
    1. Baril AA, Beiser AS, Mysliwiec V, et al. Slow‐Wave Sleep and MRI Markers of Brain Aging in a Community‐Based Sample. Neurology. 2021;96(10):e1462‐e1469. doi:10.1212/wnl.0000000000011377 - DOI - PMC - PubMed
    1. Zacharias HU, Weihs A, Habes M, et al. Association Between Obstructive Sleep Apnea and Brain White Matter Hyperintensities in a Population‐Based Cohort in Germany. JAMA Netw Open. 2021;4(10):e2128225. doi:10.1001/jamanetworkopen.2021.28225 - DOI - PMC - PubMed