Purpose. Mild cognitive impairment (MCI) is considered an “at risk” state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA) is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI), a patient self-report survey, to assess OSA in MCI. Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG). Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI). Receiver-operating characteristics (ROC) curve analyses were performed using various cut-off scores for apnoea severity. Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI: , ). However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC) in the MCI sample compared to the controls across all AHI severity cut-off scores. Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI. 1. Introduction Mild cognitive impairment (MCI) is a syndrome defining a transitional stage between normal ageing and dementia. Clinically, it is defined as cognitive decline greater than expected for an individual’s age and education, but with preservation of daily functioning [1]. Since there is a conversion rate to dementia of around 50% in five years, MCI is often considered an “at risk” state. Importantly, in this critical period, there is opportunity to implement secondary prevention strategies targeting modifiable risk factors. Research to date has identified that a range of cardiovascular, psychological, and lifestyle factors are associated with an increased conversion to dementia. However, there has been a paucity of research addressing sleep. This is despite the fact that sleep disturbance is a common symptom of dementia [2], associated with decreased cognitive and daily functioning, reduced quality of life, and increased carer burden [3]. Sleep disturbance in older people is multifaceted and includes age-related changes to sleep macro- and microarchitecture, medical comorbidity, mood disturbance, and alterations in circadian rhythm [3, 4]. In addition, the prevalence of nocturnal respiratory disturbance increases with age, and, in particular, obstructive sleep apnoea (OSA)
References
[1]
S. Gauthier, B. Reisberg, M. Zaudig et al., “Mild cognitive impairment,” The Lancet, vol. 367, no. 9518, pp. 1262–1270, 2006.
[2]
J.-M. Yu, I.-J. Tseng, R.-Y. Yuan, J.-J. Sheu, H.-C. Liu, and C.-J. Hu, “Low sleep efficiency in patients with cognitive impairment,” Acta Neurologica Taiwanica, vol. 18, no. 2, pp. 91–97, 2009.
[3]
S. L. Naismith, S. J. Lewis, and N. L. Rogers, “Sleep-wake changes and cognition in neurodegenerative disease,” Progress in Brain Research, vol. 190, pp. 21–52, 2011.
[4]
N. Wolkove, O. Elkholy, M. Baltzan, and M. Palayew, “Sleep and aging: 1. Sleep disorders commonly found in older people,” Canadian Medical Association Journal, vol. 176, no. 9, pp. 1299–1304, 2007.
[5]
S. Ancoli-Israel, D. F. Kripke, M. R. Klauber, W. J. Mason, R. Fell, and O. Kaplan, “Sleep-disordered breathing in community-dwelling elderly,” Sleep, vol. 14, no. 6, pp. 486–495, 1991.
[6]
N. M. Punjabi, “The epidemiology of adult obstructive sleep apnea,” Proceedings of the American Thoracic Society, vol. 5, no. 2, pp. 136–143, 2008.
[7]
J. R. Cooke, L. Ayalon, B. W. Palmer et al., “Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer's disease and obstructive sleep apnea: a preliminary study,” Journal of Clinical Sleep Medicine, vol. 5, no. 4, pp. 305–309, 2009.
[8]
S. J. Kim, J. H. Lee, D. Y. Lee, J. H. Jhoo, and J. I. Woo, “Neurocognitive dysfunction associated with sleep quality and sleep apnea in patients with mild cognitive impairment,” American Journal of Geriatric Psychiatry, vol. 19, no. 4, pp. 374–381, 2011.
[9]
S. Naismith, V. Winter, H. Gotsopoulos, I. Hickie, and P. Cistulli, “Neurobehavioral functioning in obstructive sleep apnea: differential effects of sleep quality, hypoxemia and subjective sleepiness,” Journal of Clinical and Experimental Neuropsychology, vol. 26, no. 1, pp. 43–54, 2004.
[10]
N. Canessa and L. Ferini-Strambi, “Sleep-disordered breathing and cognitive decline in older adults,” The Journal of the American Medical Association, vol. 306, no. 6, pp. 654–655, 2011.
[11]
K. Yaffe, A. M. Laffan, S. L. Harrison et al., “Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women,” The Journal of the American Medical Association, vol. 306, no. 6, pp. 613–619, 2011.
[12]
K. Jones and Y. Harrison, “Frontal lobe function, sleep loss and fragmented sleep,” Sleep Medicine Reviews, vol. 5, no. 6, pp. 463–475, 2001.
[13]
J. G. McCoy and R. E. Strecker, “The cognitive cost of sleep lost,” Neurobiology of Learning and Memory, vol. 96, no. 4, pp. 564–582, 2011.
[14]
J. R. Cooke, S. Ancoli-Israel, L. Liu et al., “Continuous positive airway pressure deepens sleep in patients with Alzheimer's disease and obstructive sleep apnea,” Sleep Medicine, vol. 10, no. 10, pp. 1101–1106, 2009.
[15]
C. A. Kushida, D. A. Nichols, T. H. Holmes, et al., “Effects of continuous positive airway pressure on neurocognitive function in obstructive apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES),” Sleep, vol. 35, no. 12, pp. 1593–1602, 2012.
[16]
A. Wauquier, B. Van Sweden, G. A. Kerkhof, and H. A. C. Kamphuisen, “Ambulatory first night sleep effect recording in the elderly,” Behavioural Brain Research, vol. 42, no. 1, pp. 7–11, 1991.
[17]
G. Maislin, A. I. Pack, N. B. Kribbs et al., “A survey screen for prediction of apnea,” Sleep, vol. 18, no. 3, pp. 158–166, 1995.
[18]
K. K. H. Wong, M. P. Jones, G. Marks, N. Zwar, and R. R. Grunstein, “Development of a diagnostic model for sleep apnea in primary care,” Poster session presented at: World Sleep, 2011.
[19]
G. Maislin, I. Gurubhagavatula, R. Hachadoorian et al., “Operating characteristics of the multivariable apnea prediction index in non-clinic populations,” Sleep, vol. 26, 2003, abstract A247.
[20]
I. Gurubhagavatula, G. Maislin, and A. I. Pack, “An algorithm to stratify sleep apnea risk in a sleep disorders clinic population,” American Journal of Respiratory and Critical Care Medicine, vol. 164, no. 10 I, pp. 1904–1909, 2001.
[21]
R. C. Petersen and J. C. Morris, “Mild cognitive impairment as a clinical entity and treatment target,” Archives of Neurology, vol. 62, no. 7, pp. 1160–1163, 2005.
[22]
B. S. Linn, M. W. Linn, and L. Gurel, “Cumulative illness rating scale,” Journal of the American Geriatrics Society, vol. 16, no. 5, pp. 622–626, 1968.
[23]
M. F. Folstein, S. E. Folstein, and P. R. McHugh, “‘Mini mental state’. A practical method for grading the cognitive state of patients for the clinician,” Journal of Psychiatric Research, vol. 12, no. 3, pp. 189–198, 1975.
[24]
S. L. Naismith, N. L. Rogers, I. B. Hickie, J. MacKenzie, L. M. Norrie, and S. J. G. Lewis, “Sleep well, think well: sleep-wake disturbance in mild cognitive impairment,” Journal of Geriatric Psychiatry and Neurology, vol. 23, no. 2, pp. 123–130, 2010.
[25]
B. Winblad, K. Palmer, M. Kivipelto et al., “Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment,” Journal of Internal Medicine, vol. 256, no. 3, pp. 240–246, 2004.
[26]
K. Rechtschaffen, A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects, vol. 204, National Institutes of Health, U. S. National Institute of Neurological Diseases and Blindness, Neurological Information Network, Bethesda, Md, USA, 1968, Edited by: A. Rechtschaffen and A. Kales, http://catalogue.nla.gov.au/Record/823711.
[27]
W. B. Webb and L. M. Dreblow, “A modified method for scoring slow wave sleep of older subjects,” Sleep, vol. 5, no. 2, pp. 195–199, 1982.
[28]
W. W. Flemons, D. Buysse, S. Redline et al., “Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of American Academy of Sleep Medicine Task Force,” Sleep, vol. 22, no. 5, pp. 667–689, 1999.
[29]
D. J. Buysse, C. F. Reynolds III, T. H. Monk, S. R. Berman, and D. J. Kupfer, “The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research,” Psychiatry Research, vol. 28, no. 2, pp. 193–213, 1989.
[30]
D. J. Eckert, A. S. Jordan, P. Merchia, and A. Malhotra, “Central sleep apnea: pathophysiology and treatment,” Chest, vol. 131, no. 2, pp. 595–607, 2007.
[31]
E. M. Weaver, V. Kapur, and B. Yueh, “Polysomnography vs self-reported measures in patients with sleep apnea,” Archives of Otolaryngology—Head and Neck Surgery, vol. 130, no. 4, pp. 453–458, 2004.
[32]
L. M. Rofail, K. K. H. Wong, G. Unger, G. B. Marks, and R. R. Grunstein, “The utility of single-channel nasal airflow pressure transducer in the diagnosis of OSA at home,” Sleep, vol. 33, no. 8, pp. 1097–1105, 2010.
[33]
L. M. Rofail, K. K. H. Wong, G. Unger, G. B. Marks, and R. R. Grunstein, “Comparison between a single-channel nasal airflow device and oximetry for the diagnosis of obstructive sleep apnea,” Sleep, vol. 33, no. 8, pp. 1106–1114, 2010.
