Associations Between Sleep Architecture and Sleep-Disordered Breathing and Cognition in Older Community-Dwelling Men: The Osteoporotic Fractures in Men Sleep Study

Authors

  • Terri Blackwell MA,

    Corresponding author
    • Research Institute, California Pacific Medical Center, San Francisco, California
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  • Kristine Yaffe MD,

    1. Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, California
    2. San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Sonia Ancoli-Israel PhD,

    1. Department of Psychiatry, University of California at San Diego, La Jolla, California
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  • Susan Redline MD, MPH,

    1. Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Kristine E. Ensrud MD, MPH,

    1. Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
    2. Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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  • Marcia L. Stefanick PhD,

    1. Department of Medicine, Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, California
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  • Alison Laffan PhD,

    1. Research Institute, California Pacific Medical Center, San Francisco, California
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  • Katie L. Stone PhD,

    1. Research Institute, California Pacific Medical Center, San Francisco, California
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  • for the Osteoporotic Fractures in Men Study Group


Address correspondence to Terri Blackwell, MA, San Francisco Coordinating Center, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107. E-mail: tblackwell@sfcc-cpmc.net

Abstract

Objectives

To examine the association between sleep architecture, sleep-disordered breathing, and cognition in older men.

Design

Population-based cross-sectional study.

Setting

Six clinical sites in the United States.

Participants

Two thousand nine hundred nine community-dwelling men aged 67 and older who were not selected on the basis of sleep problems or cognitive impairment.

Measurements

Predictors were measured using in-home polysomnography: sleep architecture, nocturnal hypoxemia (any sleep time with arterial oxygen saturation <80%), apnea–hypopnea index (AHI), and arousal index. Cognitive outcomes were measured using the modified Mini-Mental State Examination (3MS), Trail-Making Test Part B (TMT-B), and the Digit Vigilance Test (DVT).

Results

Analyses adjusted for age, race, education, body mass index, lifestyle, comorbidities, and medication use showed that participants who spent less percentage of time in rapid eye movement (REM) sleep had lower levels of cognition; participants in the lowest quartile (<14.8%) took an average of 5.9 seconds longer on the TMT-B and 20.1 seconds longer on the DVT than those in the highest quartile (≥23.7%). Similarly, greater percentage of time spent in Stage 1 sleep was related to poorer cognitive function. Participants in the highest quartile of Stage 1 sleep (≥8.6%) had worse cognitive scores on average than those in the lowest quartile (<4.0%). Those with nocturnal hypoxemia took an average of 22.3 seconds longer to complete the DVT than those without, but no associations were found with 3MS or the TMT-B.

Conclusion

Spending less percentage of time in REM sleep and greater percentage of time in Stage 1 sleep and having higher levels of nocturnal hypoxemia were associated with poorer cognition in older men. Further studies are needed to clarify the direction of these associations and to explore potential mechanisms.

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