Obstructive sleep apnoea and 5-year cognitive decline in the elderly

Nicola Andrea Marchi; Geoffroy Solelhac; Mathieu Berger; José Haba-Rubio; Nadia Gosselin; Peter Vollenweider; Pedro Marques-Vidal; Julius Popp; Armin von Gunten; Martin Preisig; Bogdan Draganski; Raphael Heinzer

doi:10.1183/13993003.01621-2022

Obstructive sleep apnoea and 5-year cognitive decline in the elderly

Eur Respir J. 2023 Apr 27;61(4):2201621. doi: 10.1183/13993003.01621-2022. Print 2023 Apr.

Authors

Nicola Andrea Marchi^{1

2

3

4}, Geoffroy Solelhac⁵, Mathieu Berger⁵, José Haba-Rubio⁵, Nadia Gosselin^{3

4}, Peter Vollenweider⁶, Pedro Marques-Vidal⁶, Julius Popp^{7

8}, Armin von Gunten⁷, Martin Preisig⁹, Bogdan Draganski^{2

10

11}, Raphael Heinzer^{5

11}

Affiliations

¹ Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland nicola.marchi@unil.ch.
² Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur-de-Montréal, Montréal, QC, Canada.
⁴ Department of Psychology, Université de Montréal, Montréal, QC, Canada.
⁵ Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁶ Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁷ Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁸ Department of Geriatric Psychiatry, University Hospital of Psychiatry Zürich and University of Zürich, Zürich, Switzerland.
⁹ Center for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁰ Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
¹¹ Equal contribution as senior author.

Abstract

Background: The relationship between obstructive sleep apnoea (OSA) and cognitive decline remains controversial, especially in the elderly population. We used data from the HypnoLaus study to assess associations between OSA and longitudinal cognitive changes in a sample of community-dwelling elderly individuals.

Methods: We studied associations between polysomnographic OSA parameters (of breathing/hypoxaemia and sleep fragmentation) and cognitive changes over a 5-year period, after adjustment for potential confounders. The primary outcome was the annual change in cognitive scores. The moderating effects of age, sex and apolipoprotein E4 (ApoE4) status were also examined.

Results: 358 elderly individuals without dementia were included (mean±sd age 71.0±4.2 years; 42.5% males). A lower mean peripheral oxygen saturation (S _pO₂ ) during sleep was associated with a steeper decline in Mini-Mental State Examination (B= -0.12, p=0.004), Stroop test condition 1 (B=0.53, p=0.002) and Free and Cued Selective Reminding Test delayed free recall (B= -0.05, p=0.008). A longer time spent asleep with S _pO₂ <90% was associated with a steeper decline in Stroop test condition 1 (B=0.47, p=0.006). Moderation analysis showed that apnoea-hypopnoea index and oxygen desaturation index were associated with a steeper decline in global cognitive function, processing speed and executive function only in older participants, men and ApoE4 carriers.

Conclusions: Our results provide evidence of the contribution of OSA and nocturnal hypoxaemia to cognitive decline in the elderly population.

MeSH terms

Aged
Apolipoprotein E4 / genetics
Cognitive Dysfunction* / complications
Female
Humans
Hypoxia / complications
Male
Sleep
Sleep Apnea, Obstructive*

Substances

Apolipoprotein E4