This study was presented as a poster at the 20th meeting of the American Association for Geriatric Psychiatry, March 2007, New Orleans, Louisiana.
Sleep-Disordered Breathing and Cognition in Older Women
Article first published online: 28 NOV 2007
Journal of the American Geriatrics Society
Volume 56, Issue 1, pages 45–50, January 2008
How to Cite
Spira, A. P., Blackwell, T., Stone, K. L., Redline, S., Cauley, J. A., Ancoli-Israel, S. and Yaffe, K. (2008), Sleep-Disordered Breathing and Cognition in Older Women. Journal of the American Geriatrics Society, 56: 45–50. doi: 10.1111/j.1532-5415.2007.01506.x
- Issue published online: 28 NOV 2007
- Article first published online: 28 NOV 2007
- sleep apnea;
- older adults;
OBJECTIVES: To investigate the association between objectively measured sleep-disordered breathing (SDB) and cognitive impairment in community-dwelling older women and to determine whether the apolipoprotein E (APOE) ɛ4 allele modifies this association.
SETTING: Participants' homes and two sites of the Study of Osteoporotic Fractures (SOF).
PARTICIPANTS: Four hundred forty-eight women with a mean age±standard deviation (SD) of 82.8±3.4.
MEASUREMENTS: Participants completed the Mini-Mental State Examination (MMSE), Trail Making Test Part B (Trails B), and polysomnography (PSG). SDB indices were the apnea–hypopnea index (AHI), the central apnea index (CAI), and oxygen saturation (SaO2) nadir less than 80%. APOE ɛ4 was determined for a subset of 242 women. Cognitive impairment was defined as 1.5 SDs or more from the sample mean on either cognitive test (MMSE or Trails B).
RESULTS: All SDB indices were associated with cognitive impairment according to the MMSE (AHI (per SD, odds ratio (OR)=1.4, 95% confidence interval (CI)=1.03–1.9), AHI of ≥30 (OR=3.4, 95% CI=1.4–8.1), SaO2 nadir <80% (OR=2.7, 95% CI=1.1–6.6), and CAI (per SD, OR=1.4, 95% CI=1.1–1.7)). Weaker, nonsignificant associations emerged between SDB and Trails B. In women who completed genotyping, each SD increase in AHI was associated with 70% greater odds of cognitive impairment according to the MMSE (OR=1.7, 95% CI=1.2–2.6). Women with the ɛ4 allele had a nearly five times greater odds of impairment (per SD, OR=4.6, 95% CI-1.0–20.7); the association was smaller and nonsignificant in women without the ɛ4 allele (per SD, OR=1.5, 95% CI-0.9–2.4; P for interaction=.08).
CONCLUSION: SDB is an important risk factor for cognitive impairment in older women, especially those with the APOE ɛ4 allele. Mechanisms linking these disorders need to be identified.