Obstructive Sleep Apnea and 15-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study
Open accessAbstract
Prospective data evaluating abnormal sleep quality and quantity with cognitive decline are limited because most studies used subjective data and/or had short follow-up. We hypothesized that, over 15 y of follow-up, participants with objectively measured obstructive sleep apnea (OSA) and other indices of poor sleep quantity and quality would experience greater decline in cognitive functioning than participants with normal sleep patterns. ARIC participants (n = 966; mean age 61 y, 55% women) with in-home polysomnography (1996–1998) and repeated cognitive testing were followed for 15 y. Three cognitive tests (Delayed Word Recall, Word Fluency, and Digit Symbol Substitution) were administered at two time points (1996–1998 and 2011–2013). Ten additional cognitive tests were administered at the 2011–2013 neurocognitive examination. OSA was modeled using established clinical OSA severity categories. Multivariable linear regression was used to explore associations of OSA and other sleep indices with change in cognitive tests between the two assessments. A median of 14.9 y (max: 17.3) passed between the two cognitive assessments. OSA category and additional indices of sleep (other measures of hypoxemia and disordered breathing, sleep fragmentation, sleep duration) were not associated with change in any cognitive test. Analyses of OSA severity categories and 10 cognitive tests administered only in 2011–2013 also showed little evidence of an association. Overall, abnormal sleep quality and quantity at midlife was not related to cognitive decline and later-life cognition. The effect of adverse sleep quality and quantity on cognitive decline among the elderly remains to be determined. Cognitive decline among older adults is a major public health concern, yet effective interventions to prevent cognitive decline are elusive. Intriguing research conducted largely in cross-sectional samples and animal models has suggested that obstructive sleep apnea (OSA) and other indices of poor sleep quantity and quality may result in cognitive decline. Counter to prior evidence, using observational data from nearly 1,000 individuals who were followed for about 15 years, there was no relation between sleep characteristics and cognitive decline. Although these results dampen enthusiasm about the role of sleep in cognitive decline, there are important methodological considerations—namely selection bias, statistical power, and the length of follow-up—that need to be taken into account when interpreting these findings.
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The Atherosclerosis Risk in Communities Study, a 15-year prospective cohort, found sleep apnea severity and nocturnal hypoxemia were not associated with cognitive decline.
“In contrast, the Atherosclerosis Risk in Communities Study, a 15-year prospective cohort study, found that sleep apnea severity and nocturnal hypoxemia were not associated with cognitive decline.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [839]
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Self-citation
- Authors
- Lutsey, P. L., Bengtson, L. G. S., Punjabi, N. M., Shahar, E., Mosley, T. H., Gottesman, R. F., Wruck, L. M., MacLehose, R. F., & Alonso, A.
- Affiliations
- University of Minnesota (US)
- Johns Hopkins University (US)
- University of Arizona (US)
- University of Mississippi Medical Center (US)
- University of North Carolina at Chapel Hill (US)
- University of Minnesota, Minneapolis, MN
- Corresponding author
- Lutsey, Pamela L.
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-02-01
- Volume
- 39
- Issue
- 2
- Pages
- 309-316
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC4712410
- OpenAlex
- W2281989231
- Semantic Scholar
- 3b53d9232807bd6353cdfe1753695db2aec215f5
- Cited by
- 86
- References
- 44
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 11 · 2023: 16 · 2022: 9 · 2021: 7 · 2020: 8 · 2019: 5 · 2018: 1 · 2017: 10 · 2016: 5
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01hl096899-08, 5u01hl053934-14, 5u01hl096902-08)
- National Heart, Lung, and Blood Institute (HL096814, U01 HL53934, U01HL064360, U01HL096814, U01-HL-096899, HL-096902, U01-HL-096902, HL-096899, U01HL096917, HL-096917, U01HL64360, U01HL096812)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- cognitive decline, sleep quality, sleep quantity, sleep fragmentation, hypoxemia, disordered breathing, sleep duration, midlife, older adults, Atherosclerosis Risk in Communities Study
- MeSH terms
- Cognition, Cognition Disorders, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Residence Characteristics, Risk, Sleep, Time Factors, Linear Models, Polysomnography, Sleep Apnea, Obstructive, Atherosclerosis
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