Sleep-Disordered Breathing Risk with Comorbid Insomnia Is Associated with Mild Cognitive Impairment

Christian Agudelo,Douglas Wallace,Xiaoyan Sun,Alberto Ramos,Josefina Kather,Sonya Kaur,Dylan Del Papa

doi:10.3390/app12052414

Abstract

Introduction: Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). To test the hypothesis that SDB with comorbid insomnia is associated with greater odds of MCI than either sleep disorder independently, we used ADNI data to evaluate cross-sectional associations between SDB risk with comorbid insomnia status and MCI. Methods: Participants with normal cognition or MCI were included. Insomnia was defined by self-report. SDB risk was assessed by modified STOP-BANG. Logistic regression models evaluated associations between four sleep disorder subgroups (low risk for SDB alone, low risk for SDB with insomnia, high risk for SDB alone, and high risk for SDB with insomnia) and MCI. Models adjusted for age, sex, BMI, APOE4 genotype, race, ethnicity, education, marital status, hypertension, cardiovascular disease, stroke, alcohol abuse, and smoking. Results: The sample (n = 1391) had a mean age of 73.5 ± 7.0 years, 44.9% were female, 72.0% were at low risk for SDB alone, 13.8% at low risk for SDB with insomnia, 10.1% at high risk for SDB alone, and 4.1% at high risk for SDB with insomnia. Only high risk for SDB with comorbid insomnia was associated with higher odds of MCI (OR 3.22, 95% CI 1.57–6.60). Conclusion: Studies are needed to evaluate SDB with comorbid insomnia as a modifiable risk factor for MCI.

Highlights

Few studies have evaluated the combined association between sleep-disordered breathing (SDB) with comorbid insomnia and mild cognitive impairment (MCI)
The sample had a mean age of 73.5 ± 7.0 years, was 44.8% female, had a mean BMI of 27 ± 5 mg/kg2, 57.8% lacked APOE4 alleles, 92.5% were white, 96.2% were non-Hispanic, and 62.7% had MCI
72.0% were at low risk for SDB alone, 13.7% were at low risk for SDB with insomnia, 10.1% were at high risk for SDB alone, and 4.1% were at high risk for SDB with insomnia

Summary

Introduction

Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). Logistic regression models evaluated associations between four sleep disorder subgroups (low risk for SDB alone, low risk for SDB with insomnia, high risk for SDB alone, and high risk for SDB with insomnia) and MCI. High risk for SDB with comorbid insomnia was associated with higher odds of MCI (OR 3.22, 95% CI 1.57–6.60). Conclusion: Studies are needed to evaluate SDB with comorbid insomnia as a modifiable risk factor for MCI. Individual sleep disturbances, including sleep-disordered breathing (SDB) and insomnia, have each been associated with dementia [2]. Few studies have explored the combined association between SDB with comorbid insomnia and cognitive impairment, which, together, may convey more severe cognitive consequences. In a meta-analysis of 18 prospective studies examining sleep disturbances (i.e., insomnia, SDB, and other sleep problems) and the risk of dementia [2], only three studies assessed both SDB and insomnia, yet none of their analyses accounted for SDB with comorbid insomnia [4,5,6]

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