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Aging News & Information

Older Women with Sleep-Disordered Breathing at Risk of Cognitive Decline, Dementia

Findings suggest potential role for supplemental oxygen for sleep-disordered breathing in elderly

Aug. 9, 2011 - Older women with sleep-disordered breathing, as indicated by measures of oxygen deficiency (hypoxia), were more likely to develop cognitive impairment or dementia than women without this disorder, according to a study in the August 10 issue of the Journal of the American Medical Association (JAMA). This is a common condition among senior citizens, affecting up to 60 percent.

Sleep-disordered breathing is a disorder characterized by recurrent arousals from sleep and intermittent hypoxemia.

A number of adverse health outcomes including hypertension, cardiovascular disease, and diabetes have been associated with sleep-disordered breathing," according to background information in the article.

 

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Cognitive impairment also has been linked to sleep-disordered breathing in some studies, but the design of most of these studies has limited the ability to draw conclusions regarding this association.

"Given the high prevalence and significant morbidity associated with both sleep-disordered breathing and cognitive impairment in older populations, establishing whether a prospective association exists between sleep-disordered breathing and cognition is important,” the researchers said in explaining why they began the study.

“This is especially important because effective treatments for sleep-disordered breathing exist," they added.

The association between prevalent sleep-disordered breathing as measured with polysomnography (monitoring of physiological activity during sleep) and subsequent diagnoses of mild cognitive impairment and dementia, was examined by Kristine Yaffe, M.D., of the University of California, San Francisco, and colleagues.

The study included 298 women without dementia at the beginning of the study (average age, 82.3 years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures.

Sleep-disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. The apnea-hypopnea index is the number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep.

Cognitive status (normal, dementia, or mild cognitive impairment) was based on data collected between November 2006 and September 2008.

Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for any association between sleep-disordered breathing and cognitive impairment.

Among the 298 women, 35.2 percent met criteria for sleep-disordered breathing.

After an average of 4.7 years of follow-up, 35.9 percent of the women developed mild cognitive impairment or dementia (mild cognitive impairment: 20.1 percent; dementia: 15.8 percent).

Forty-seven women (44.8 percent) with prevalent sleep-disordered breathing developed mild cognitive impairment or dementia compared with 31.1 percent of those without sleep-disordered breathing.

Analysis of the data indicated that the presence of sleep-disordered breathing was associated with an increased risk of subsequent mild cognitive impairment or dementia.

The researchers also found, after adjusting for various demographic risk factors, that two measures of hypoxia (an oxygen desaturation index of 15 or greater and a high percentage of total sleep time - greater than 7 percent - in apnea or hypopnea) were associated with higher incidence of mild cognitive impairment or dementia.

"Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment."

The authors add that their finding that sleep-disordered breathing was associated with an increased risk of cognitive impairment seems to be related primarily to measures of hypoxia.

"Given the high prevalence of both sleep-disordered breathing and cognitive impairment among older adults, the possibility of an association between the 2 conditions, even a modest one, has the potential for a large public health impact.

“Furthermore, the finding that hypoxia, and not sleep fragmentation or duration, seems to be associated with risk of mild cognitive impairment or dementia provides clues to the mechanisms through which sleep-disordered breathing might promote cognitive impairment.

“The increased risk for cognitive impairment associated with sleep-disordered breathing opens a new avenue for additional research on the risk for development of mild cognitive impairment or dementia and exploration of preventive strategies that target sleep quality including sleep-disordered breathing," the researchers write.

They add that to fully evaluate the impact of treatment for sleep-disordered breathing in elderly populations, additional trials with larger sample sizes, longer treatment periods, and more diverse populations are required.

"Of interest, our findings suggest a potential role for supplemental oxygen therapy for sleep-disordered breathing in elderly individuals; however, its role requires critical evaluation in intervention studies."

Editorial: More Trials Needed of Sleep-Disordered Breathing

An editorial in the same issue of JAMA supports the conclusion that “large trials with continuous positive air pressure (CPAP) treatment in elderly participants with sleep-disordered breathing should be performed."

"Moreover, in trials evaluating the effects of pharmacological and nonpharmacological (e.g., cognitive training and rehabilitation) interventions on cognitive function in patients with mild cognitive impairment or dementia, the possible coexistence of sleep-disordered breathing should be considered,” wrote Nicola Canessa, Ph.D., of the Center for Cognitive Neuroscience, and Luigi Ferini-Strambi, M.D., of the Universita Vita-Salute San Raffaele, Milan, Italy.

“Finally, physicians of patients with mild cognitive impairment and sleep-disordered breathing for whom treatment with CPAP may be indicated should consider these results, and future guidelines to formalize the clinical management of patients with mild cognitive impairment should consider the implications of this study and related research."

It was specifically emotional abuse - rather than physical abuse or emotional neglect - that was tied to trouble in getting a good night’s sleep.

“A negative early attachment continues to exert an influence on our well being decades later through an accumulation of stressful interpersonal experiences across our lives,” said Cecilia Y. M. Poon, MA, the study’s lead author. “The impact of abuse stays in the system. Emotional trauma may limit a person’s ability to fend for themselves emotionally and successfully navigate the social world”

The data was taken from the National Survey of Midlife Development in the United States. In 1995, approximately 3,500 adults responded to questions about their childhood. A decade later, they were asked follow-up questions about sleep, relationships, and emotional distress. Poon's study looked at the answers from those age 60 and above.

During the second round of interviews, the participants were asked how often within the previous 30 day they had
   ● trouble falling asleep,
   ● woke up during the night and had difficulty going back to sleep,
   ● woke up too early in the morning and were unable to get back to sleep, and
   ● felt unrested during the day no matter how many hours of sleep they had.

Emotional abuse was assessed by asking participants how often their mother and father insulted or swore at them, sulked or refused to talk to them, stomped out of the room, did or said something to spite them, threatened to hit them, or smashed or knocked something in anger.

The same survey found that emotional abuse during childhood also was associated with poorer relationships in adulthood. Poon speculated that this lack of support, associated with stress, likely influences sleep quality.

The Journals of Gerontology Series B: Psychological and Social Sciences is a refereed publication of The Gerontological Society of America (GSA), the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,400+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society, and an educational branch, the Association for Gerontology in Higher Education.


Senior Citizens and Sleep Problems

Older adults need about the same amount of sleep as younger adults (7 to 9 hours nightly), according to Mayo Clinic sleep specialist Timothy Morgenthaler, M.D.

Although, a study published in the February, 2010, issue of the journal SLEEP, reported older adults sleep about 20 minutes less than middle-aged adults, who sleep 23 minutes less than young adults.

“As you get older, however, your sleeping patterns may change. Older adults tend to sleep more lightly and awaken more frequently during the night than do younger adults. This may create a need for or tendency toward daytime napping,” Dr. Morgenthaler writes in a Mayo Clinic Q&A.

“If your sleep is frequently interrupted or cut short, you're not getting quality sleep — and the quality of your sleep is just as important as the quantity,” he adds.

Dr. Morgenthaler points out that lack of sleep can affect your immune system.

“Studies show that people who don't get a good night's sleep or who don't get enough sleep are more likely to get sick after being exposed to a virus, such as the common cold. Lack of sleep can also affect how fast you recover if you do get sick,” he says.

“During sleep, your immune system releases proteins called cytokines. These substances increase in the presence of an infection, inflammation and stress. Increased cytokines are necessary in fighting infection and regulating deeper sleep. In addition, other infection-fighting cells are reduced during periods of sleep deprivation. So, your body needs sleep to fight infectious diseases.

“How much sleep do you need to bolster your immune system? The optimal amount of sleep for most adults is seven to eight hours a night. School-aged children and adolescents need nine or more hours of sleep a night.

“But be careful; more sleep is not always better. For adults, sleeping more than nine to 10 hours a night has been associated with weight gain, heart problems, stroke, sleep disorders, depression and other health concerns.”

>> More at the Mayo Clinic’s Website on Insomnia.


More links to news about sleep and senior citizens

Sleep Apnea Connection to Stroke and Death Explained by New Study

One in 10 senior citizens suffer with sleep apnea that is more common as people age

Jan. 6, 2009


Sleeping Less than 7.5 Hours Daily May Cause Heart Disease for Elderly with Hypertension

Particularly when it occurs with elevated nighttime blood pressure; sleep patterns should be checked for those with high blood pressure

Nov. 12, 2008


Elderly Women Increase Their Risk of Falling with Less Than Five Hours Sleep

About one-third of adults older than age 65 experience falls each year

Sept. 8, 2008


Study Indicates Older People Just Need Less Sleep than Young Adults

With the same time in bed, older people take longer to fall asleep and sleep for less time than younger people do

July 25, 2008


Older Women Who Nap Less, Go Back to Sleep Easily Achieve Healthy Aging

Study of  2,226 senior women, sixty and older, finds 20.8% are “successful agers”.

June 11, 2008


Graphic Brain Scans Shows Memory Loss from Sleep Apnea

Scans reveal dwindling of brain structures that store memory

June 11, 2008


Sleep Disruption Linked to Increased Cardiovascular Risk

Certain sleep disruptions such as obstructive sleep apnea known to convey extensive cardiovascular risk

March 30, 2007


Older Men Living at Home Survive Longer with Undisturbed Sleep and 'Robust Rhythms'

Regular sleep routine – to bed and up at regular times – means good health for senior men

June 11, 2008


Snoring Linked to Cardiovascular Disease, Hypertension and Stroke

Study says odds of heart attack are 34% higher, hypertension up 40%, stroke 60%

March 3, 2008


Harvard Wants America to Sleep Better and Contributes New Interactive Website

‘Health Sleep’ aimed at helping people better understand sleep

Feb. 27, 2008


Three New Studies Focus on Problems in Sleeping for Senior Citizens

Respiratory disturbances, periodic leg movement with cognitive impairment, and benefits of daytime nap are explored

Feb. 1, 2008


Reducing or Increasing Sleep Leads to More Deaths from Different Causes

Sleep Medicine group offers tips on how to get a good night’s sleep - Dec. 3, 2007


Risk of Death Doubles from Too Little or Too Much Sleep Says British Study

NIH says senior citizens should know sleep problems not a normal part of aging - Sept. 24, 2007


Ohio Scientists Pushing Blue-Blocking Glasses, Lights to Improve Sleep

Website says if glasses don't improve sleep, return them within 30 days and money will be refunded

By Tucker Sutherland, editor - Nov. 13, 2007


Senior Citizens Toss and Turn with Many Sleep Problems that Come with Aging

Many older people may not be getting enough sleep for healthy aging - Aug. 14, 2007


Geriatric Conditions May Hinder Half of All Senior Citizens in Daily Activities

Same level of dependency as older patients with chronic diseases - Aug. 8, 2007


Kicking Spouse in Bed at Night Can Now Be Blamed on Your Genes


Gene found responsible for Restless Legs Syndrome affecting 10% of senior citizens - July 19, 2007

Sleep Problems Among the Elderly Linked to Suicide Risk

Many older adults get less sleep than needed due to trouble falling asleep - June 14, 2007


Sleep Disruption Linked to Increased Cardiovascular Risk

Certain sleep disruptions such as obstructive sleep apnea known to convey extensive cardiovascular risk - March 30, 2007


Mistake for Doctors to Neglect Insomnia Treatment in Older Patients

Excessive daytime sleepiness is best predictor of poor health

January 3, 2007


Tips for Senior Citizens to Get a Good Nights Sleep Offered by Longevity Center

New report issued: The Role of Sleep In Healthy Aging

December 7, 2006


Sleep Studies of Older People Find Behavioral Treatment Helps Insomnia; Women Endangered by Restless Legs

October 2, 2006


Sleep Evaluation Should be Routine Medical Care Says Editorial

September 18, 2006


Advice for Senior Citizens on Finding a Good Night's Sleep

Research finds that sleep problems grow with the accumulation of illnesses, not years.

September 18, 2006

 

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