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- Title
Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood.
- Authors
Lee, Min-Hee; Lee, Seung Ku; Kim, Soriul; Kim, Regina E. Y.; Nam, Hye Ryeong; Siddiquee, Ali T.; Thomas, Robert J.; Hwang, Inha; Yoon, Jee-Eun; Yun, Chang-Ho; Shin, Chol
- Abstract
Key Points: Question: Is obstructive sleep apnea (OSA) associated with cognition and white matter (WM) integrity over time? Findings: In this cohort study of 1110 participants, OSA was associated with impaired cognition and WM integrity during 4 years of follow-up. Incident and persistent OSA were associated with accelerated attention, visual processing, and visual memory decline, which correlated with changes in fractional anisotropy of the relevant WM areas. Age and sex were associated with modifying the associations. Meaning: These findings suggest that timely evaluation and adequate intervention of OSA could aid in preserving brain health, improving cognition, and reducing the risk of cognitive impairment. This cohort study assess the associations of obstructive sleep apnea with 4-year changes in cognitive function and white matter integrity among middle-aged and older adults. Importance: Obstructive sleep apnea (OSA) is associated with cognitive impairment and brain structural alterations, but longitudinal outcomes are understudied. Objective: To examine the associations of OSA with cognition and white matter (WM) integrity over a 4-year period. Design, Setting, and Participants: This prospective cohort study was conducted in a community-based adult population among participants who had both baseline (2011-2014) and 4-year follow-up (2015-2018) polysomnography, diffusion tensor imaging, and cognitive assessment data. Participants with neurological disorders, anomalous findings on brain magnetic resonance imaging, or inadequate quality of the evaluations were excluded. Data were analyzed from March to November 2021. Exposures: Participants were categorized depending on the presence vs absence of OSA at baseline and follow-up polysomnographic analysis. Main Outcomes and Measures: The main outcomes were proportional changes over a 4-year period in neuropsychological performance and WM integrity. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol–coding, Trail Making Test–A, and Stroop Test. WM integrity was assessed by fractional anisotropy, axial, and radial diffusivity. To examine interactions with age and sex, participants were subgrouped by age older than 60 years vs 60 years or younger and men vs women. Results: A total of 1998 individuals were assessed for eligibility, and 888 were excluded based on exclusion criteria, leaving 1110 participants (mean [SD] age, 58.0 [6.0] years; 517 [46.6%] men) for analysis, including 458 participants grouped as OSA-free, 72 participants with resolved OSA, 163 participants with incident OSA, and 417 participants with persistent OSA. Incident OSA was associated with altered WM integrity and with concomitant changes in sustained attention compared with participants without OSA (eg, change in Digit Symbol–coding test score, –3.2% [95% CI, –5.2% to –1.2%]). Participants with resolved OSA showed better visual recall at the follow-up (change in Visual Reproduction–immediate recall test, 17.5% [95% CI, 8.9% to 26.1%]; change in Visual Reproduction–delayed recall test, 33.1% [95% CI, 11.3% to 54.9%]), with concordant changes in diffusion parameters at the relevant anatomic areas. In the older group only (age >60 years), persistent OSA was associated with altered WM integrity and cognition (eg, Visual Reproduction–recognition test: β = −24.2 [95% CI, −40.7 to −7.7]). Sex also was associated with modifying the association of OSA with WM integrity of the left posterior internal capsule, the left genu of corpus callosum, and the right middle cerebellar peduncle only in men and with cognition only in women (eg, Visual Reproduction–immediate recall test: β = 33.4 [95% CI, 19.1 to 47.7]). Conclusions and Relevance: These findings suggest that dynamic changes in OSA status were significantly associated with WM integrity and cognition, which varied by age and sex. It is possible that adequate interventions for OSA could better preserve brain health in middle to late adulthood.
- Subjects
PATIENT aftercare; CONFIDENCE intervals; COMMUNITY health services; MAGNETIC resonance imaging; WHITE matter (Nerve tissue); SLEEP apnea syndromes; DESCRIPTIVE statistics; RESEARCH funding; COGNITIVE testing; LONGITUDINAL method
- Publication
JAMA Network Open, 2022, Vol 5, Issue 7, pe2222999
- ISSN
2574-3805
- Publication type
Academic Journal
- DOI
10.1001/jamanetworkopen.2022.22999