Cheng-Yu Tsai1, Wen-Hua Hsu2, Yin-Tzu Lin3, Yi-Shin Liu2, Kang Lo4, Shang-Yang Lin2, Arnab Majumdar1, Wun-Hao Cheng5, Kang-Yun Lee6,7, Dean Wu4,8,9,10,11, Hsin-Chien Lee12, Shin-Mei Hsu4, Shu-Chuan Ho2, Feng-Ching Lin13, Wen-Te Liu2,4,6, Yi-Chun Kuan4,8,9,10,11,14. 1. Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom. 2. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan. 3. Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 4. Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 5. Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan. 6. Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 7. Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 8. Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 9. Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 10. Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan. 11. Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 12. Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan. 13. Division of Integrated Diagnostic and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan. 14. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Abstract
STUDY OBJECTIVES: Dementia is associated with sleep disorders. However, the relationship between dementia and sleep arousal remains unclear. This study explored the associations among sleep parameters, arousal responses, and risk of mild cognitive impairment (MCI). METHODS: Participants with the chief complaints of memory problems and sleep disorders, from the sleep center database of Taipei Medical University Shuang-Ho Hospital, were screened, and the parameters related to the Cognitive Abilities Screening Instrument, Clinical Dementia Rating, and polysomnography were determined. All examinations were conducted within 6 months and without a particular order. The participants were divided into those without cognitive impairment (Clinical Dementia Rating = 0) and those with MCI (Clinical Dementia Rating = 0.5). Mean comparison, linear regression models, and logistic regression models were employed to investigate the associations among obtained variables. RESULTS: This study included 31 participants without MCI and 37 with MCI (17 with amnestic MCI, 20 with multidomain MCI). Patients with MCI had significantly higher mean values of the spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage than those without MCI. An increased risk of MCI was significantly associated with increased spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage with various adjustments. Significant associations between the Cognitive Abilities Screening Instrument scores and the oximetry parameters and sleep disorder indexes were observed. CONCLUSIONS: Repetitive respiratory events with hypoxia were associated with cognitive dysfunction. Spontaneous arousal, especially in non-rapid eye movement sleep, was related to the risk of MCI. However, additional longitudinal studies are required to confirm their causality. CITATION: Tsai C-Y, Hsu W-H, Lin Y-T, et al. Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population. J Clin Sleep Med. 2022;18(4): 1003-1012.
STUDY OBJECTIVES: Dementia is associated with sleep disorders. However, the relationship between dementia and sleep arousal remains unclear. This study explored the associations among sleep parameters, arousal responses, and risk of mild cognitive impairment (MCI). METHODS: Participants with the chief complaints of memory problems and sleep disorders, from the sleep center database of Taipei Medical University Shuang-Ho Hospital, were screened, and the parameters related to the Cognitive Abilities Screening Instrument, Clinical Dementia Rating, and polysomnography were determined. All examinations were conducted within 6 months and without a particular order. The participants were divided into those without cognitive impairment (Clinical Dementia Rating = 0) and those with MCI (Clinical Dementia Rating = 0.5). Mean comparison, linear regression models, and logistic regression models were employed to investigate the associations among obtained variables. RESULTS: This study included 31 participants without MCI and 37 with MCI (17 with amnestic MCI, 20 with multidomain MCI). Patients with MCI had significantly higher mean values of the spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage than those without MCI. An increased risk of MCI was significantly associated with increased spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage with various adjustments. Significant associations between the Cognitive Abilities Screening Instrument scores and the oximetry parameters and sleep disorder indexes were observed. CONCLUSIONS: Repetitive respiratory events with hypoxia were associated with cognitive dysfunction. Spontaneous arousal, especially in non-rapid eye movement sleep, was related to the risk of MCI. However, additional longitudinal studies are required to confirm their causality. CITATION: Tsai C-Y, Hsu W-H, Lin Y-T, et al. Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population. J Clin Sleep Med. 2022;18(4): 1003-1012.
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