title: Poor sleep quality and silent markers of cerebral small vessel disease: a population-based study in community-dwelling older adults (The Atahualpa Project).
abstract: OBJECTIVE
  Evidence of a relationship between non-breathing-related sleep symptoms and silent markers of cerebral small vessel disease (SVD) is scarce. The present study aimed to evaluate this association in older people living in rural Ecuador, where the burden of stroke is on the rise.
  
  
  METHODS
  A group of Atahualpa residents, aged ≥60 years, were interviewed with a validated Spanish version of the Pittsburgh Sleep Quality Index, and underwent magnetic resonance imaging (MRI) for identification of silent markers of SVD. Using multinomial logistic regression analysis, after adjusting for demographics and cardiovascular health status, it was evaluated whether sleep quality is associated with the severity of white matter hyperintensity (WMH), lacunar infarcts, and deep microbleeds.
  
  
  RESULTS
  Out of 311 people aged ≥60 years, 237 (76%) were enrolled into the study. Mean age was 70 ± 8 years, 59% were women, 83% had primary school education only, and 73% had a poor cardiovascular health status. Seventy-eight (33%) had poor sleep quality. The MRI showed: WMH in 154 (65%) participants (moderate-to-severe in 52); silent lacunar infarcts in 28 (12%); and deep microbleeds in 17 (7%). Poor sleep quality was associated with WMH presence (OR 2.44, 95% CI 1.26 to 4.71, p = 0.008) and severity (β coefficient 0.77, SE 0.37, p = 0.037), but not with silent lacunar infarcts or deep microbleeds.
  
  
  CONCLUSIONS
  The present study showed an association between poor sleep quality and WMH severity. Further longitudinal studies would help to elucidate the cause and effect of this relationship.
authors: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador. Electronic address: oscardelbrutto@hotmail.com.
authors: Oscar H
authors: OH
authors: Del Brutto
authors: Gastroenterology Department, Vanderbilt University, Nashville, TN, United States.
authors: Robertino M
authors: RM
authors: Mera
authors: Community Center, The Atahualpa Project, Atahualpa, Ecuador.
authors: Mauricio
authors: M
authors: Zambrano
authors: Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
authors: Julio
authors: J
authors: Lama
authors: Community Center, The Atahualpa Project, Atahualpa, Ecuador.
authors: Victor J
authors: VJ
authors: Del Brutto
authors: Mayo Clinic College of Medicine, Jacksonville, FL, United States.
authors: Pablo R
authors: PR
authors: Castillo
mesh_terms: D000368:Aged; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000208:ethnology* / Q000473:pathology*; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006801:Humans; D007197:Indians, Central American / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012893:Sleep Wake Disorders / Q000150:complications* / Q000208:ethnology* / Q000473:pathology
keywords: Cerebral small vessel disease; Deep microbleeds; Population-based study; Silent stroke; Sleep quality; White matter hyperintensity