Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort.

STUDY OBJECTIVES: Clinical and epidemiological studies suggest a relation between bone mineral density (BMD) and self-assessment of sleep with an effect on bone formation and osteoporosis (OS) risk in short and long sleepers. This study explores this association in a large sample of older subjects. METHODS: We examined 500 participants without insomnia complaints aged 65.7 ± 0.8 y. Each participant had a full evaluation including anthropometric measurement, clinical examination and measurements of BMD at the lumbar spine and femoral sites by dual-energy X-ray absorptiometry. The daily energy expenditure (DEE) was measured by the Population Physical Activity Questionnaire. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index. The subjects were stratified into three groups according to sleep duration, i.e., short (< 6 h), normal (6-8 h), and long (≥ 8 h) sleepers. RESULTS: Osteopenia was found in 40% of the subjects at the femoral level and 43% at the vertebral level. The prevalence of OS was lower both at femoral (8%) and vertebral (12%) levels. Short, normal, and long sleepers accounted for 29%, 40%, and 31% of subjects, respectively. After adjustments for metabolic, anthropometric, and DEE, multinomial logistic regression analysis indicated that long sleepers were more likely to have femoral neck OS with a slight effect of DEE at vertebral spine. CONCLUSIONS: In a sample of older subjects, self-reported long sleep was the best predictor of OS risk at the femoral level. This finding suggests an association between OS and self-reported sleep duration in older subjects. CLINICAL TRIAL REGISTRATION: NCT 00759304 and NCT 00766584.

Risk factors of osteoporosis in healthy elderly with unrecognized obstructive sleep apnea: role of physical activity.

OBJECTIVE: Several studies suggest a relationship between bone mineral density (BMD) anthropometric and metabolic variables, and obstructive sleep apnea (OSA); all of these factors have an effect on osteoporosis (OS) risk. This cross-sectional study explores these associations in a large sample of older subjects with and without OSA. METHODS: Volunteers were recruited from the PROgnostic indicator OF cardiovascular and cerebrovascular events survey. A total of 461 subjects, aged 68.7 ± 0.8 years, were examined, blood samples were taken, and they were subjected to home polygraphy, assessment of daily energy expenditure (DEE), and dual-energy X-ray absorptiometry. RESULTS: Osteopenia (OP) was detected in 44% of subjects at the femoral and 39% at the vertebral level, while the prevalence of OS was lower at the femoral (4%) and vertebral (12%) levels. As expected, women had a higher prevalence of OP and OS. Subjects with OP and OS had a tendency to have lower DEE and values of obesity, apnea-hypopnea index (AHI), and indices of hypoxemia (ODI). At the correlation analyses, anthropometric factors and DEE were significantly related to BMD with a slight effect of indices of OSA severity. After adjustment for confounding variables, univariate and multivariate regression analyses showed a strong significant association between femoral and lumbar BMD and T-score and DEE without contribution of metabolic data and with a slight negative effect of respiratory factors. CONCLUSIONS: In this sample of the elderly, physical activity was the best predictor of OS with a slight effect of body mass index. The indices of OSA confirm their protective effect on bone mineral density.

Mood disorders in healthy elderly with obstructive sleep apnea: a gender effect.

OBJECTIVE: Previous studies have suggested an association between obstructive sleep apnea (OSA) and anxiety and depression, but it remains unclear as to whether this is due to OSA or other factors. The aim of this study was to evaluate this association in a large sample of healthy elderly with unrecognized OSA. METHODS: 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory home polygraphic study and completion of questionnaires related to depression, anxiety and sleepiness were examined. According to the apnea-hypopnea index (AHI), the subjects were stratified into no-OSA, mild-moderate and severe OSA cases. RESULTS: Anxiety was present in 38% of the sample and depression in 8%. Anxiolytic treatment was reported by 9% of the population and antidepressant treatment in 5%. Women had high scores for anxiety and depression and they were more frequently taking anxiolytic and antidepressant medications. No differences were found for anxiety and depression scores and medication intake in the three groups of subjects stratified according to the AHI. Regression analyses adjusted for age, gender, body mass index, hypertension (HT), AHI, and indices of hypoxemia revealed that females were 5.44 times more likely to have depression with a low contribution of the time with SaO2 < 90%. CONCLUSIONS: In a large sample of healthy elderly with OSA, neither the existence nor the severity of the OSA was associated with anxiety and depression score, with women having higher anxiety and depression scores. This finding supports the hypothesis that depressive symptoms originate from factors other than measures of OSA severity.

Hippocampus volume and subjective sleepiness in older people with sleep-disordered breathing: a preliminary report.

UNLABELLED: Sleep-disordered breathing (SDB) is associated with excessive daytime sleepiness (EDS) and explained by sleep fragmentation and hypoxaemia, both contributing to brain morphology abnormalities. Recent data on middle-aged SDB patients suggest a link between hippocampus volume (HV) and EDS. We tested this hypothesis in a group of SDB older subjects. A total of 232 healthy participants aged 75 ± 0.9 years were examined. Subjective EDS was assessed by the Epworth Sleep Questionnaire (ESS), with a mean score of 5.6 ± 3.5. Volumetric segmentation of the right (RHV) and left HV (LHV) were measured using FreeSurfer software. All subjects underwent extensive cognitive testing to exclude neurological disease, as well as ambulatory polygraphy to assess SDB status. Sleepy subjects showed a lower HV. In a correlation analysis, RHV (r = -0.162, P = 0.01) and LHV (r = -170, P = 0.05) were correlated negatively with ESS and not associated with respiratory data. Multiple regression analysis did not reveal any effect of age, gender, SDB severity and hypoxia. ESS was the only factor possibly explaining the lower RHV (P = -0.03) and LHV (P = -0.04). In older people with SDB, the subjective EDS was associated with lower HV. This morphological finding should be considered on the pathogenesis of sleepiness in SDB patients. CLINICAL TRIAL REGISTRATION: NCT 00759304 and NCT 00766584.

Association of body fat composition and obstructive sleep apnea in the elderly: A longitudinal study.

OBJECTIVE: Obesity and aging are considered risk factors for developing sleep apnea syndrome (OSA). The aim of this study was to determine the association between body fat composition and OSA in healthy elderly subjects examined in a 7-year longitudinal study. METHODS: A total of 209 elderly with unrecognized OSA aged 68.3 ± 0.8 years underwent a clinical, ambulatory nocturnal respiratory recording, and anthropometric as well as body fat composition assessment by dual-energy X-ray absorptiometry (DEXA) at baseline and follow-up. RESULTS: At study entry, 50.3% of the population showed an apnea+hypopnea index (AHI) <15 with a mean AHI of 16.8 ± 11. At follow-up, a reduction of OSA cases (42%) was evident with a mean AHI of 14.6 ± 10.2. The DEXA data demonstrated that body mass and total lean mass were reduced at follow-up, while central and peripheral fat mass showed a slight increase. Correlation analysis between the changes in DEXA measurements versus the changes in AHI and the indices of nocturnal hypoxemia showed an absence of a statistical correlation. CONCLUSIONS: The lack of correlation between the DEXA measurement changes and the changes in the AHI confirm our previous data on the absence of a central fat mass effect on OSA in the elderly.

Eight-year parallel change in baroreflex sensitivity and memory function in a sample of healthy older adults.

OBJECTIVES: To examine whether changes in the cardiac autonomic nervous system (ANS) over time, as expressed by baroreflex sensitivity (BRS), were associated with long-term changes in cognitive performance in elderly individuals without dementia. DESIGN: Community-based 8-year longitudinal study. SETTING: Clinical settings. PARTICIPANTS: Individuals aged 66.9 ± 0.9 (N = 425). MEASUREMENTS: At baseline and follow-up, subjects underwent a clinical interview, autonomic and vascular measurements, and a neuropsychological evaluation including attentional, executive, and memory tests using standardized Z-scores. BRS was defined as being normal, moderate, or severe alteration at each evaluation. On the basis of the longitudinal changes subjects were stratified as being stable, moderate or improved. RESULTS: Mean attentional, executive, and memory change Z-scores were -0.41 ± 0.9, -0.15 ± 0.7, and -0.14 ± 0.8, respectively. BRS of 56% of the subjects remained unchanged, of 20% decreased, and of 24% improved. After regression analysis, the worsened BRS group was 1.88 times as likely to have greater memory change as the group with stable BRS (P = .02). No significant association was found between longitudinal change in BRS and attentional and executive changes. CONCLUSION: In healthy elderly individuals, BRS decrease was associated with a weak but significant decrease in memory function. The long-term effect of BRS on memory changes may suggest a role of the ANS in cognitive decline.

Association of self-reported sleep and hypertension in non-insomniac elderly subjects.

OBJECTIVES: Sleep duration and sleep quality play important roles in the development of hypertension (HT) in middle-aged subjects, with controversial data in elderly. In this study, we investigated the link between HT and self-reported sleep in non-insomniac elderly subjects. METHODS: We examined 500 participants without insomnia complaints aged 72 ± 1 years. An extensive instrumental evaluation was carried out, including 24-h blood pressure (BP) monitoring and an assessment of nocturnal BP dipping. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI). The subjects were stratified into three groups according to sleep duration: short (< 6 h), normal (> 6h to < 8 h), and long (> 8 h) sleepers. A PSQI < 5 defined good sleepers (GS, n = 252), and a PSQI > 5 (n = 248) defined poor sleepers (PS). RESULTS: PS represented 50% of the subjects, more frequently females. Compared to GS, PS did not differ in terms of HT, BP, baroreflex sensitivity (BRS), and BP dipping. Short, normal, and long sleepers accounted for 28%, 42%, and 30% of subjects, with HT, BP values, BRS, and gender not differing between groups. No relationship was found between nocturnal BP values and self-reported sleep measures. Logistic regression analysis indicated that neither sleep duration nor sleep quality predicts the prevalence of HT, the body mass index being the only factor affecting this association. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifiers NCT00759304 and NCT00766584. CONCLUSIONS: In a sample of non-insomniac elderly subjects, neither sleep duration nor sleep quality affected the prevalence of HT. These data argue against a relationship between self-reported sleep duration and quality and HT in elderly without insomnia.

Baroreflex sensitivity, vascular risk factors, and cognitive function in a healthy elderly population: the PROOF cohort.

OBJECTIVES: To assess the role of the cardiac autonomic nervous system (ANS), as measured according to spontaneous cardiac baroreflex sensitivity (BRS), in the type and degree of cognitive performance in healthy young-elderly individuals, taking into account the presence of other vascular risk factors. DESIGN: Community-based cross-sectional study. SETTING: In-home and clinical settings. PARTICIPANTS: A subset of participants, aged 66.9±0.9, from a prospective study that aimed to assess the influence of ANS activity on cardiovascular and cerebrovascular morbidity and mortality (N=916). MEASUREMENTS: All subjects underwent a clinical interview, neuropsychological testing, and autonomic and vascular measurements. Three cognitive domains were defined: attentional (Trail-Making Test Part A, Stroop code and parts I & II), executive (Trail-Making Test Part B, Stroop part III, verbal fluency and similarity tests), and memory (Benton visual retention test, Grober and Buschké procedure). Subjects were stratified according to their scores into normal, low, and impaired performers. RESULTS: After adjustments to demographic and vascular data, participants with moderate autonomic dysregulation (36). CONCLUSION: In older individuals without dementia, autonomic dysregulation seems to have a direct, gradual, and independent effect on memory. Future studies are needed to evaluate the long-term effects of BRS and other markers of the ANS on cognitive decline.

Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population.

OBJECTIVES: The impact of sleep-related breathing disorders on the incidence of arterial hypertension (AHT) in the older adults is not well-established. The aim of our study was to test the link between severe obstructive sleep apnea (OSA) and the occurrence of hypertension in older subjects after 3 years. METHODS: 372 normotensive subjects with a mean age of 68.2 years were included in our longitudinal study. All participants had a ventilatory polygraphic recording and an ambulatory blood pressure (BP) monitoring at baseline and after 3 years. Severe OSA was defined by an apnea-hypopnea index (AHI) of ≥ P30 per hour. A new onset of hypertension was defined according to a mean 24-hour value >140mmHg for systolic BP and >85mmHg for diastolic BP or the use of antihypertensive medication. RESULTS: The baseline factors significantly associated with an increased risk for new-onset hypertension were male gender, obesity, diabetes mellitus (DM), dyslipidemia, and OSA. Multiple logistic regression analyses showed that an AHI ≥30 per hour was independently associated with incident hypertension after 3 years (P=.02; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8). CONCLUSIONS: The presence of severe OSA is associated with new-onset AHT in normotensive elderly (mean age, 68.2 y) subjects.

Does subjective sleep affect cognitive function in healthy elderly subjects? The Proof cohort.

OBJECTIVE: Some epidemiological data are available on the association between sleep duration and sleep quality, sleep complaints, and the aging related cognitive impairment in the elderly. In this study we examined a large sample of healthy elderly subjects to assess the relationship between sleep quality, subjective cognitive complaints, and neuropsychological performance. METHODS: A total of 272 elderly subjects (mean age 74.8 ± 1.1 years) were recruited from a population-based cross-sectional study on aging and cardiovascular morbidity. All subjects filled in self-assessment questionnaires evaluating cognitive function, anxiety, depression, sleep-related parameters, and the Pittsburgh Sleep Quality Index (PSQI). Ambulatory polygraphy and extensive neuropsychological tests were also performed. Based on the total PSQI score, subjects were classified as good sleepers (GS, PSQI<5, n=116) and poor sleepers (PS, PSQI≥5, n=156). RESULTS: Poor sleep did not affect the subjective cognitive function score, subjective cognitive impairment being mainly related to anxiety, depression, and sleep medication intake. No significant differences were seen between GS and PS in any of the objective cognitive function tests except for the Trail Making Test A (TMA-A), processing speed being longer in the PS group (p<0.001). Neither the presence of sleep-related breathing disorders nor gender affected cognitive performance. CONCLUSIONS: Our results suggest that in healthy elderly subjects, subjective sleep quality and duration did not significantly affect subjective and objective cognitive performances, except the attention level, for that the interference of sleep medication should be considered.