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Associations Between Sleep-Disordered Breathing, Nocturnal Hypoxemia, and Subsequent Cognitive Decline in Older Community-Dwelling Men: The Osteoporotic Fractures in Men Sleep Study

Authors

  • Terri Blackwell MA,

    Corresponding author
    1. Research Institute, California Pacific Medical Center, San Francisco, California
    • Address correspondence to Terri Blackwell, San Francisco Coordinating Center, Mission Hall: Global Health and Clinical Sciences Building, 550 16th Street, 2nd Floor, San Francisco, CA 94158. E-mail: tblackwell@sfcc-cpmc.net

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  • Kristine Yaffe MD,

    1. Department of Psychiatry, University of California, San Francisco, California
    2. Department of Neurology, University of California, San Francisco, California
    3. Department of Epidemiology, University of California, San Francisco, California
    4. Veterans Affairs Medical Center, San Francisco, California
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  • Alison Laffan PhD,

    1. Research Institute, California Pacific Medical Center, San Francisco, California
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  • Susan Redline MD, MPH,

    1. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    2. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Sonia Ancoli-Israel PhD,

    1. Department of Psychiatry, University of California at San Diego, La Jolla, California
    2. Department of Medicine, University of California at San Diego, La Jolla, California
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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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  • Yeonsu Song 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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  • and for the Osteoporotic Fractures in Men Study Group


Abstract

Objectives

To determine whether sleep-disordered breathing (SDB), a group of disorders common in older adults characterized by breathing pauses during sleep often accompanied by hypoxemia, is associated with cognitive decline.

Design

Population-based longitudinal study.

Setting

Six centers in the United States.

Participants

Community-dwelling older men (N = 2,636; aged 76.0 ± 5.3) without probable mild cognitive impairment or dementia followed for 3.4 ± 0.5 years.

Measurements

SDB was measured using in-home polysomnography: nocturnal hypoxemia (≥1% of sleep time with oxygen saturation (SaO2) <90%, oxygen desaturation index (ODI: number of oxygen desaturations of ≥3% per hour of sleep)) and apnea–hypopnea index (AHI, number of apneas and hypopneas at ≥3% desaturation per hour of sleep). Cognitive decline was measured using the Modified Mini-Mental State Examination (3MS) and the Trail-Making Test Part B (Trails B) at baseline and two follow-up points. Associations between predictors and cognitive decline were examined using linear mixed models adjusted for multiple confounders. Models were further adjusted for potential mediators (sleep duration, sleep fragmentation, resting SaO2).

Results

Nocturnal hypoxemia was related to greater decline on the 3MS. Men with 1% or more of sleep time with SaO2 less than 90% had an adjusted annualized decline of 0.43 points, compared with 0.25 for men in the reference group (= .003). For each 5-point increase in ODI, there was an average annualized decline of 0.36 points (= .01). Results were robust to further adjustment for potential mediators. The association between AHI and cognitive decline did not reach significance. No associations were seen with SDB and decline on the Trails B.

Conclusion

In older community-dwelling men, there was a modest association between nocturnal hypoxemia and global cognitive decline, suggesting the importance of overnight oxygenation for cognitive function.

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