title: Sleep-disordered breathing advances cognitive decline in the elderly.
abstract: OBJECTIVE
  To examine whether the presence of sleep-disordered breathing (SDB) is associated with an earlier age at mild cognitive impairment (MCI) or Alzheimer disease (AD)-dementia onset in participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. We also examined whether continuous positive airway pressure (CPAP) use is associated with delayed onset of cognitive decline.
  
  
  METHODS
  From the ADNI cohort, 3 subsets with progressively stringent criteria were created in a step-wise manner. Age at MCI or AD-dementia onset was the main outcome variable. Analyses were performed separately for each subset in untreated SDB+ vs SDB- and untreated SDB+ vs CPAP+ groups. Chi-square and t tests were performed to examine between-group differences. Survival analyses were performed using the Kaplan-Meier method, compared by the log-rank test, and assessed by multivariate Cox regression adjusting for potential confounders.
  
  
  RESULTS
  SDB+ patients had a younger age at MCI onset in all subsets (MC1: 72.63 vs 83.67; MC2: 72.15 vs 83.45; MC3: 77.40 vs 89.89; p < 0.01). SDB+ patients had a younger age at AD-dementia onset only in our most conservative subset (AC3: 83.46 vs 88.13; p < 0.05). In a combined outcome analysis, SDB+ patients had a younger age at onset to MCI or AD-dementia in all subsets. In subsets 1 and 2, CPAP use delayed the age at MCI onset (CMC1: 72.63 vs 82.10; CMC2: 72.11 vs 82.10; p < 0.01).
  
  
  CONCLUSIONS
  Consistent with our hypothesis, the presence of SDB was associated with an earlier age at cognitive decline. Our findings in CPAP+ participants suggest that CPAP treatment of SDB may delay progression of cognitive impairment.
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ. ricardo.osorio@nyumc.org.
authors: Ricardo S
authors: RS
authors: Osorio
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Tyler
authors: T
authors: Gumb
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Elizabeth
authors: E
authors: Pirraglia
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Andrew W
authors: AW
authors: Varga
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Shou-En
authors: SE
authors: Lu
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Jason
authors: J
authors: Lim
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Margaret E
authors: ME
authors: Wohlleber
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Emma L
authors: EL
authors: Ducca
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Viachaslau
authors: V
authors: Koushyk
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Lidia
authors: L
authors: Glodzik
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Lisa
authors: L
authors: Mosconi
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Indu
authors: I
authors: Ayappa
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: David M
authors: DM
authors: Rapoport
authors: From the Center for Brain Health (R.S.O., T.G., E.P., M.E.W., L.G., L.M., M.J.d.L.) and Division of Pulmonary, Critical Care, and Sleep Medicine (A.W.V., J.L., E.L.D., V.K., I.A., D.M.R.), NYU School of Medicine, New York, NY; and Department of Biostatistics (S.-e.L.), Rutgers School of Public Health, Piscataway, NJ.
authors: Mony J
authors: MJ
authors: de Leon
mesh_terms: D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D015984:Causality; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States