title: Sleep Apnea, Sleep Duration and Brain MRI Markers of Cerebral Vascular Disease and Alzheimer's Disease: The Atherosclerosis Risk in Communities Study (ARIC).
abstract: BACKGROUND
  A growing body of literature has suggested that obstructive sleep apnea (OSA) and habitual short sleep duration are linked to poor cognitive function. Neuroimaging studies may provide insight into this relation.
  
  
  OBJECTIVE
  We tested the hypotheses that OSA and habitual short sleep duration, measured at ages 54-73 years, would be associated with adverse brain morphology at ages 67-89 years.
  
  
  METHODS
  Included in this analysis are 312 ARIC study participants who underwent in-home overnight polysomnography in 1996-1998 and brain MRI scans about 15 years later (2012-2013). Sleep apnea was quantified by the apnea-hypopnea index and categorized as moderate/severe (≥15.0 events/hour), mild (5.0-14.9 events/hour), or normal (<5.0 events/hour). Habitual sleep duration was categorized, in hours, as <7, 7 to <8, ≥8. MRI outcomes included number of infarcts (total, subcortical, and cortical) and white matter hyperintensity (WMH) and Alzheimer's disease signature region volumes. Multivariable adjusted logistic and linear regression models were used. All models incorporated inverse probability weighting, to adjust for potential selection bias.
  
  
  RESULTS
  At the time of the sleep study participants were 61.7 (SD: 5.0) years old and 54% female; 19% had moderate/severe sleep apnea. MRI imaging took place 14.8 (SD: 1.0) years later, when participants were 76.5 (SD: 5.2) years old. In multivariable models which accounted for body mass index, neither OSA nor abnormal sleep duration were statistically significantly associated with odds of cerebral infarcts, WMH brain volumes or regional brain volumes.
  
  
  CONCLUSIONS
  In this community-based sample, mid-life OSA and habitually short sleep duration were not associated with later-life cerebral markers of vascular dementia and Alzheimer's disease. However, selection bias may have influenced our results and the modest sample size led to relatively imprecise associations.
authors.affiliation: University of Minnesota, Minneapolis, MN, United States of America.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: University of Minnesota, Minneapolis, MN, United States of America.
authors.forename: Faye L
authors.initials: FL
authors.lastname: Norby
authors.affiliation: Johns Hopkins University, Baltimore, MD, United States of America.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: University of Mississippi Medical Center, Jackson, MS, United States of America.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mosley
authors.affiliation: University of Minnesota, Minneapolis, MN, United States of America.
authors.forename: Richard F
authors.initials: RF
authors.lastname: MacLehose
authors.affiliation: Johns Hopkins University, Baltimore, MD, United States of America.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.affiliation: University of Arizona, Tucson, AZ, United States of America.
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.affiliation: Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Clifford R
authors.initials: CR
authors.lastname: Jack
authors.affiliation: Emory University, Atlanta, GA, United States of America.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D009929:Organ Size / Q000502:physiology; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology