title: Obstructive Sleep Apnea and 15-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Lindsay G S
authors.initials: LG
authors.lastname: Bengtson
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.affiliation: University of Arizona, Tucson, AZ.
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.affiliation: University of Mississippi Medical Center, Jackson, MS.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wruck
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Richard F
authors.initials: RF
authors.lastname: MacLehose
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
mesh_terms: D050197:Atherosclerosis / Q000150:complications*; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012111:Residence Characteristics; D012306:Risk; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors
keywords: Atherosclerosis Risk in Communities (ARIC) study; cognitive decline; epidemiology; obstructive sleep apnea