Periodic Limb Movements in Sleep are Associated with Greater Cognitive Decline in Older Men without Dementia

Leng, Yue; Blackwell, Terri; Stone, Katie L.; Hoang, Tina; Redline, Susan; Yaffe, Kristine

doi:10.5665/sleep.6158

Cited by 37 publications

(25 citation statements)

References 25 publications

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“…Because of the decrease in symptom awareness in elderly people, ESS and BSQ scores might have limited use as indicators of sleep disorders [8,24]. Higher values of PLMI have been observed in elderly populations [25,26]; however, the median value of PLMI in our study group was 2.45, and there was no association between PLMI values and increased age.…”

Section: Discussioncontrasting

confidence: 54%

Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome

Balcan

Uğurlu

2017

Turk Thorac J

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OBJECTIVES:In this study, we evaluated data regarding the management of geriatric patients with symptoms of obstructive sleep apnea syndrome (age, >65 years) who were admitted to our sleep clinic. MATERIAL AND METHODS:Symptoms and sleep data of the patients were retrospectively evaluated, and the patients were reevaluated after treatment. RESULTS:A total of 85 patients with a median age of 69 years were included. Snoring and fatigue were the most common symptoms. Cardiovascular diseases were the most frequently listed comorbidity. The median Epworth sleepiness scale was 10, and based on Berlin sleep questionnaire findings, 63.5% of the participants were in the high-risk group. Eighty-seven percent were diagnosed with obstructive sleep apnea (2/3 of them were positional), and moderate-to-severe obstructive sleep apnea was observed more in women than in men. Only one patient was diagnosed with central sleep apnea. There were positive and linear correlations between increased age and the apnea-hypopnea index, arousal index, Epworth sleepiness scale, and being in a high-risk group according to the Berlin sleep scale; however, there was no correlation between increased age and the number of hypopnea and apnea events. There were also positive and linear correlations between the apnea-hypopnea index and the Epworth sleepiness scale, being in a high-risk group according to the Berlin sleep questionnaire, an increased number of known medical conditions, and increased body mass index. We were able to contact 72 of the 85 patients via phone calls. Patients who adjusted to treatment had positive feedbacks. CONCLUSION:Sleep disorders are observed more in the elderly, and an increasing age is an independent factor for sleep disorders. Besides the usual signs and symptoms of sleep disorders, it should be considered in elderly who have cognitive dysfunction and dementia. KEYWORDS: Elderly, polysomnography, obstructive sleep apnea INTRODUCTIONThe proportion of elderly people (age, >65 years) has been increasing, particularly in developing countries. The World Health Organization has estimated that the population of people aged >65 years will be 1.5 billion by 2050 [1]. Although some people age without having any serious illnesses, some elderly might have "pathological aging" with significant comorbidities that lead to functional impairment [2]. One way or another, the elderly may complain of changes in sleep habits such as difficulty falling asleep and maintaining sleep, with frequent nocturnal awakenings and early morning awakening; thus, sleep gets more fragmented and consequently lighter [3]. Because of the changes in sleep architecture or physiological and/or pathological changes owing to aging, elderly people may report increased daytime sleepiness and fatigue as well as concentration and memory problems [4]. These symptoms can also occur because of obstructive sleep apnea syndrome (OSAS), which is characterized by nocturnal episodes of upper airway obstruction, sleep fragmentations, and hypoxemia [5]. These symptoms might ...

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Section: Discussioncontrasting

confidence: 54%

Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome

Balcan

Uğurlu

2017

Turk Thorac J

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“…Some studies have suggested an association between PLMS and an increased risk of cardiovascular disorders. 2,14,15 Other studies have demonstrated a correlation between PLMI and affective symptoms and fatigue, 16 cognitive decline (particularly executive function) in older men without dementia, 17 and lower quality of life in children. 18 One study even suggested a possibility of higher mortality in those with PLMI >15/hour.…”

Section: Discussionmentioning

confidence: 98%

Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy

et al. 2020

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ObjectiveWe sought to assess the prevalence, correlates, and consequences of periodic limb movements of sleep (PLMS) in persons with obstructive sleep apnea (OSA) and the effect (worsening or improvement) of continuous positive airway pressure (CPAP) therapy on PLMS in a large prospective multicenter randomized controlled trial.MethodsWe performed retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study, a prospective multicenter randomized controlled trial. A total of 1,105 persons with OSA enrolled in this study underwent a polysomnographic investigation at baseline, another one for CPAP titration, and another study 6 months after randomization to either active CPAP or sham CPAP.ResultsOf all participants, 19.7% had PLM index (PLMI) ≥10/hour, 14.8% had PLMI ≥15/hour, 12.1% had PLMI ≥20/hour, 9.3% had PLMI ≥25/hour, and 7.5% had PLMI ≥30/hour. The odds of having a PLMI ≥10 were higher in older participants (odds ratio [OR] 1.03, p < 0.001), men (OR 1.63. p = 0.007), those using antidepressants (OR 1.48. p = 0.048), and those with higher caffeine use (OR 1.01, p = 0.04). After controlling for OSA and depression, PLMS were associated with increased sleep latency, reduced sleep efficiency, and reduced total sleep time. No significant relationships were noted between PLMS frequency and subjective sleepiness (Epworth Sleepiness Scale score) or objective sleepiness (Maintenance of Wakefulness Test). There was no differential effect of CPAP in comparison to sham CPAP on PLMS after 6 months of therapy.ConclusionsPLMS are common in patients with OSA and are associated with a significant reduction in sleep quality over and above that conferred by OSA. Treatment with CPAP does not affect the severity of PLMS.

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“…21 However, our observations should be considered preliminary given sample size limitations. Both apnea-hypopnea index and periodic limb movement index have been associated with decreased cognitive performance [22][23][24] and were also associated with higher BAI.…”

Section: Discussionmentioning

confidence: 99%

Association of Sleep Electroencephalography-Based Brain Age Index With Dementia

Sun

Leone

et al. 2020

JAMA Netw Open

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IMPORTANCE Dementia is an increasing cause of disability and loss of independence in the elderly population yet remains largely underdiagnosed. A biomarker for dementia that can identify individuals with or at risk for developing dementia may help close this diagnostic gap. OBJECTIVE To investigate the association between a sleep electroencephalography-based brain age index (BAI), the difference between chronological age and brain age estimated using the sleep electroencephalogram, and dementia. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cross-sectional study of 9834 polysomnograms, BAI was computed among individuals with previously determined dementia, mild cognitive impairment (MCI), or cognitive symptoms but no diagnosis of MCI or dementia, and among

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Periodic Limb Movements in Sleep are Associated with Greater Cognitive Decline in Older Men without Dementia

Cited by 37 publications

References 25 publications

Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome

Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome

Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy

Association of Sleep Electroencephalography-Based Brain Age Index With Dementia

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