Study Objectives: Growing evidence suggests that sleep disturbances is common in vascular dementia (VaD). The goal of the current study is to assess the disturbance in sleep pattern in patients with VaD, and compare it to healthy normally cognitive elderly individuals. We next studied whether there are meaningful differences in the Subjective sleep assessment: Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and sleep measurements by polysomnography (PSG) in VaD patients. Study design: Case control study. Subject and methods: Overnight PSG recordings and self-reported sleep measures were obtained from 20 healthy elderly subjects and 20 VaD patients at the sleep laboratory. Results: This study showed abnormal subjective sleep quality in all patients and revealed that the most common sleep complaints among VaD patients were: excessive daytime sleepiness (EDS), sleep disordered breathing (SDB), insomnia, restless leg syndrome (RLS), periodic limb movements (PLMS) and REM behavioral disordered (RBD) respectively. Moreover, patients spent more time in stage I sleep, but less time in slow wave sleep (SWS) and REM sleep compared to control populations, with delayed REML and less 1st REML. Also, increased sleep fragmentation; wakefulness after sleep onset (WASO) & sleep fragmentation index (SFI), increased arousal index (AI) & PLMS index were detected in VaD patients. Finally, VaD patients had significant high Apnea, Hypopnea and Respiratory Distress Index (RDI) score with high average SpO2 Desaturation. Conclusions: Sleep is significantly impaired in patients with VaD at both the objective and subjective level, which may be used as a diagnostic marker of VaD. SDB is a common feature of VaD and leads to fragmented sleep, increased nocturnal confusion, and excessive daytime sleepiness. Subjective sleep assessment questionnaire (ESS and PSQI) can be used in VaD patients when objective sleep assessment by PSG recordings is difficult to be done. The PSG study of sleep continuity, sleep architecture, and REM sleep may help in the prevention of progression of VaD.
References
[1]
Helman, A.M. and Murphy, P.M. (2016) Vascular Cognitive Impairment: Modeling a Critical Neurologic Disease in Vitro and in Vivo. Biochimica et Biophysica Acta (BBA)—Molecular Basis of Disease, 1862, 975-982.
https://doi.org/10.1016/j.bbadis.2015.12.009
[2]
Ganguli, M. (2011) Epidemiology of Dementia. In: Abou-Saleh, M.T., Katona, C. and Kumar, A., Eds., Principles and Practice of Geriatric Psychiatry, 3rd Edition, Wiley, Hoboken, NJ, 207-212. https://doi.org/10.1002/9780470669600.ch38
[3]
Azarpazhooh, M.R., Avan, A., Cipriano, L.E., Munoz, D.G., Sposatoa, L.A. and Hachinski, V. (2018) Concomitant Vascular and Neurodegenerative Pathologies Double the Risk of Dementia. Alzheimer’s & Dementia, 14, 148-156.
https://doi.org/10.1016/j.jalz.2017.07.755
[4]
Elshahidi, M.H., Elhadidi, M.A., Sharaqi, A., Mostafa, A. and Elzhery, M.A. (2017) Prevalence of Dementia in Egypt: A Systematic Review. Neuropsychiatric Disease and Treatment, 13, 715-720. https://doi.org/10.2147/NDT.S127605
[5]
Hu, G.C. and Chen, M.Y. (2017) Post-Stroke Dementia: Epidemiology, Mechanisms and Management. International Journal of Gerontology, 11, 210-214.
https://doi.org/10.1016/j.ijge.2017.07.004
[6]
Gehrman, P., Gooneratne, N.S., Brewster, G.S., et al. (2017) Impact of Alzheimer Disease Patients’ Sleep Disturbances on Their Caregivers. Geriatric Nursing, 39, 60-65. https://doi.org/10.1016/j.gerinurse.2017.06.003
[7]
Chiu, P.Y., Liu, C.-H. and Tsai, C.-H. (2007) Neuropsychiatric Manifestations in Vascular Cognitive Impairment Patients with and without Dementia. Acta Neurologica Taiwanica, 16, 86-91.
[8]
Biessels, G.J. (2016) Diagnosis and Treatment of Vascular Damage in Dementia. Biochimica et Biophysica Acta, 1862, 869-877.
https://doi.org/10.1016/j.bbadis.2015.11.009
[9]
Jiang, B., Ding, C.-Y., Yao, G., Yao, C.-S., Zhang, Y.-Y., Ge, J.-L., et al. (2013) Polysomnographic Abnormalities in Patients with Vascular Cognitive Impairment-No dementia. Sleep Medicine, 14, 1071-1075.
https://doi.org/10.1016/j.sleep.2013.07.003
[10]
Rakesh, G., Szabo, S.T., Alexopoulos, G.S. and Zannas, A.S. (2017) Strategies for Dementia Prevention: Latest Evidence and Implications. Therapeutic Advances in Chronic Disease, 8, 121-136. https://doi.org/10.1177/2040622317712442
[11]
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, American Psychiatric Association, Washington DC.
https://doi.org/10.1176/appi.books.9780890425596
[12]
Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology, 43, 2412-2414.
https://doi.org/10.1212/WNL.43.11.2412-a
[13]
Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
[14]
Alexopoulos, G.S., Abrams, R.C., Young, R.C. and Shamoian, C.A. (1988) Use of the Cornell Scale in Nondemented Patients. Journal of the American Geriatrics Society, 36, 230-236. https://doi.org/10.1111/j.1532-5415.1988.tb01806.x
[15]
Taylor, J.A. (1953) A Personality Scale of Manifest Anxiety. The Journal of Abnormal and Social Psychology, 48, 285-290. https://doi.org/10.1037/h0056264
[16]
Assad, T. and Kahla, O. (2001) Psychometric Sleep Assessment Instruments: An Arabic Version for Sleep Evaluation. Elnahda, El-Fagala, Egypt, 26-47.
[17]
Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R. and Kupfer, D.J. (1989) The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28, 193-213.
https://doi.org/10.1016/0165-1781(89)90047-4
[18]
Johns, M.W. (1991) A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545. https://doi.org/10.1093/sleep/14.6.540
[19]
Mellman, T.A., Bustamante, V., Fins, A.I., Pigeon, W.R. and Nolan, B. (2002) REM Sleep and the Early Development of Posttraumatic Stress Disorder. The American Journal of Psychiatry, 159, 1696-1701. https://doi.org/10.1176/appi.ajp.159.10.1696
[20]
Hori, T., Yoshio, S., Einosuke, K., et al. (2001) A Proposed Supplements and Amendments to “A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects”, the Rechtschaffen & Kales (1968) Standard. Psychiatry and Clinical Neurosciences, 55, 305-310.
https://doi.org/10.1046/j.1440-1819.2001.00810.x
[21]
Bliwise, D.L., Mercaldo, N.D., Avidan, A.Y., Boeve, B.F., Greer, S.A. and Kukull, W.A. (2011) Sleep Disturbance in Dementia with Lewy Bodies and Alzheimer’s Disease: A Multicenter Analysis. Dementia and Geriatric Cognitive Disorders, 31, 239-246. https://doi.org/10.1159/000326238
[22]
Hébert, R., Lindsay, J., Verreault, R., Rockwood, K., Hill, G. and Dubois, M.F. (2000) Vascular Dementia Incidence and Risk Factors in the Canadian Study of Health and Aging. Stroke, 31, 1487-1493. https://doi.org/10.1161/01.STR.31.7.1487
[23]
Ramirez-Santos, R., Acosta-Castillo, G. and Sosa-Ortiz, A. (2015) Sleep Disorders Prevalence among Patients with Mild Cognitive Impairment and Dementia Subtypes. Alzheimer’s & Dementia, 11, 394. https://doi.org/10.1016/j.jalz.2015.06.334
[24]
Guarnieri, B., Adorni, F., Musicco, M., Appollonio, I., Bonanni, E., Caffarra, P., et al. (2012) Prevalence of Sleep Disturbances in Mild Cognitive Impairment and Dementing Disorders: A Multicenter Italian Clinical Cross-Sectional Study on 431 Patients. Dementia and Geriatric Cognitive Disorders, 33, 50-58.
https://doi.org/10.1159/000335363
[25]
Hermann, D.M. and Bassetti, C.L. (2009) Sleep-Related Breathing and Sleep-Wake Disturbances in Ischemic Stroke. Neurology, 73, 1313-1322.
https://doi.org/10.1212/WNL.0b013e3181bd137c
[26]
Mondal, P., Gjevre, J.A., Taylor-Gjevre, R. and Lim, H.J. (2013) Relationship between the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in a Sleep Laboratory Referral Population. Nature and Science of Sleep, 5, 15-21.
https://doi.org/10.2147/NSS.S40608
[27]
Miu, D.K. and Szeto, S.S. (2012) Sleep Disturbances among a Group of Dementia Participants. Journal of Clinical Gerontology and Geriatrics, 3, 105-109.
https://doi.org/10.1016/j.jcgg.2012.04.008
[28]
Merlino, G., Piani, A., Gigli, G.L., Cancelli, I., Rinaldi, A., Baroselli, A., Serafini, A., Zanchettin, B. and Valente, M. (2010) Daytime Sleepiness Is Associated with Dementia and Cognitive Decline in Older Italian Adults: A Population-Based Study. Sleep Medicine, 11, 372-377. https://doi.org/10.1016/j.sleep.2009.07.018
[29]
Gent, T., Bassetti, C.L. and Adamantidis, A.R. (2018) Sleep-Wake Control and the Thalamus. Current Opinion in Neurobiology, 52, 188-197.
https://doi.org/10.1016/j.conb.2018.08.002
[30]
Lyons, O.D. and Ryan, C.M. (2015) Sleep Apnea and Stroke. Canadian Journal of Cardiology, 31, 918-927. https://doi.org/10.1016/j.cjca.2015.03.014
[31]
Weiner, O.M. and Dang-Vu, T.T. (2016) Spindle Oscillations in Sleep Disorders: A Systematic Review. Neural Plasticity, 2016, Article ID: 7328725.
https://doi.org/10.1155/2016/7328725
[32]
Pase, M.P., Himali, J.J., Grima, N.A., Beiser, A.S., Satizabal, C.L., et al. (2017) Sleep Architecture and the Risk of Incident Dementia in the Community. Neurology, 89, 1244-1250. https://doi.org/10.1212/WNL.0000000000004373
[33]
Bassetti, C.L. and Hermann, D.M. (2011) Chapter 62: Sleep and Stroke. Handbook of Clinical Neurology, 99, 1051-1072.
https://doi.org/10.1016/B978-0-444-52007-4.00021-7
[34]
Assad, T., Sweed, H., Alloush, A., Shaheen, A. and Hamdy, M. (2017) Sleep Profile in Patients with Alzheimer’s Disease: A Polysomnographic Evaluation in an Egyptian Sample. Sleep Medicine, 40, e19. https://doi.org/10.1016/j.sleep.2017.11.048
[35]
Rauchs, G., Schabus, M., Parapatics, S., et al. (2008) Is There a Link between Sleep Changes and Memory in Alzheimer’s Disease? Neuroreport, 19, 1159-1162.
https://doi.org/10.1097/WNR.0b013e32830867c4
[36]
Bassetti, C.L., Milanova, M. and Gugger, M. (2006) Sleep-Disordered Breathing and Acute Ischemic Stroke: Diagnosis, Risk Factors, Treatment, Evolution, and Long-Term Clinical Outcome. Stroke, 37, 967-972.
https://doi.org/10.1161/01.STR.0000208215.49243.c3
[37]
Erkinjuntti, T., Partinen, M., Sulkava, R., Telakivi, T., Salmi, T. and Tilvis, R. (1987) Sleep Apnea in Multi-Infarct Dementia and Alzheimer’s Disease. Sleep, 10, 419-425.
https://doi.org/10.1093/sleep/10.5.419
[38]
Karaca, B. (2016) Factors Affecting Poststroke Sleep Disorders. Journal of Stroke and Cerebrovascular Diseases, 25, 727-732.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.015
[39]
Sullivan, S.C. and Richards, K.C. (2004) Predictors of Circadian Sleep-Wake Rhythm Maintenance in Elders with Dementia. Aging & Mental Health, 8, 143-152.
https://doi.org/10.1080/13607860410001649608
[40]
Siccoli, M., Valko, P.O., Hermann, D.M. and Bassetti, C.L. (2008) Central Periodic Breathing in 74 Patients with Acute Ischemic Stroke—Neurogenic and Cardiogenic Factors. Journal of Neurology, 255, 1687-1692.
https://doi.org/10.1007/s00415-008-0981-9
[41]
Vock, J., Achermann, P., Bischof, M., Milanova, M., Muller, C., Nirkko, A., Roth, C. and Bassetti, C.L. (2002) Evolution of Sleep and Sleep EEG after Hemispheric Stroke. Journal of Sleep Research, 11, 331-338.
https://doi.org/10.1046/j.1365-2869.2002.00316.x
[42]
Cheng, C.Y., Tsai, C.-F., Wang, S.-J., Hsu, C.-Y. and Fuh, J.-L. (2013) Sleep Disturbance Correlates with White Matter Hyperintensity in Patients with Subcortical Ischemic Vascular Dementia. Journal of Geriatric Psychiatry and Neurology, 26, 158-164. https://doi.org/10.1177/0891988713493503
[43]
Baillet, M., Dilharreguy, B., Pérès, K., Dartigues, J.-F., Mayo, W. and Catheline, G. (2017) Activity/Rest Cycle and Disturbances of Structural Backbone of Cerebral Networks in Aging. NeuroImage, 146, 814-820.
https://doi.org/10.1016/j.neuroimage.2016.09.051
[44]
Lim, A.S., Yu, L., Schneider, J.A., Bennett, D.A. and Buchman, A.S. (2016) Sleep Fragmentation, Cerebral Arteriolosclerosis, and Brain Infarct Pathology in Community-Dwelling Older People. Stroke, 47, 516-518.
https://doi.org/10.1161/STROKEAHA.115.011608
[45]
Bassetti, C.L. (2017) Sleep and stroke. In: Kryger, M., Roth, T. and Dement, W., Eds., Neurologic Disorders, 6th Edition, Elsevier, Amsterdam, 903-915.
https://doi.org/10.1016/B978-0-323-24288-2.00093-3
[46]
Sharma, S. and Culebras, A. (2016) Sleep Apnea and Stroke. Stroke and Vascular Neurology, 1, 1-7. https://doi.org/10.1136/svn-2016-000038
[47]
Ferre, A., Ribo, M., Rodriguez-Luna, D., Romero, O., Sampol, G., Molina, C. and álvarez-Sabin, J. (2013) Strokes and Their Relationship with Sleep and Sleep Disorders. Neurologia, 28, 103-118. https://doi.org/10.1016/j.nrl.2010.09.016
[48]
Nogués, M.A. and Benarroch, E. (2008) Abnormalities of Respiratory Control and the Respiratory Motor Unit. The Neurologist, 14, 273-288.
https://doi.org/10.1097/NRL.0b013e318173e830
[49]
Kim, H., Yun, C.H., Thomas, R.J., et al. (2013) Obstructive Sleep Apnea as a Risk Factor for Cerebral White Matter in a Middle-Aged and Older General Population. Sleep, 36, 709-715. https://doi.org/10.5665/sleep.2632
[50]
Liguori, C., Mercuri, N.B., Izzi, F., Romigi, A., Cordella, A., Sancesario, G. and Placidi, F. (2017) Obstructive Sleep Apnea Is Associated with Early but Possibly Modifiable Alzheimer’s Disease Biomarkers Changes. Sleep, 40, zsx011.
https://doi.org/10.1093/sleep/zsx011
[51]
Lee, E., Wub, Y.S., Juna, J.Y., Kuka, K.S. and Honga, C.K. (2019) Sleep-Disordered Breathing and Alzheimer’s Disease: A Nationwide Cohort Study. Psychiatry Research, 273, 624-630. https://doi.org/10.1016/j.psychres.2019.01.086
[52]
McCarter, S.J., St. Louis, E.K. and Boeve, B.F. (2015) Sleep, Cognitive Dysfunction, and Dementia. In: Chokroverty, S. and Billiard, M., Eds., Sleep Medicine, Springer, New York. https://doi.org/10.1007/978-1-4939-2089-1_33
[53]
Ooms, S. and Ju, Y. (2016) Treatment of Sleep Disorders in Dementia. Current Treatment Options in Neurology, 18, 40.
https://doi.org/10.1007/s11940-016-0424-3
[54]
Bonnin-Vilaplana, M., Arboix, A., Parra, O., García-Eroles, L., Montserrat, J.M., Massons, J.M. and Massons, J. (2009) Sleep-Related Breathing Disorders in Acute Lacunar Stroke. Journal of Neurology, 256, 2036.
https://doi.org/10.1007/s00415-009-5236-x
[55]
Lee, S.J., Kim, J.S., Song, I.U., An, J.-Y., Kim, Y.-I. and Lee, K.-S. (2008) Poststroke Restless Legs Syndrome and Lesion Location: Anatomical Considerations. Movement Disorders, 24, 77-84. https://doi.org/10.1002/mds.22303
[56]
Woo, H.G., Lee, D., Hwang, K.J. and Ahn, T.-B. (2017) Post-Stroke Restless Leg Syndrome and Periodic Limb Movements in Sleep. Acta Neurologica Scandinavica, 135, 204-210. https://doi.org/10.1111/ane.12582
[57]
Manconi, M., Fanfulla, F., Ferri, R., Miano, S., et al. (2018) Periodic Limb Movements during Sleep in Stroke/TIA Prevalence, Course, and Cardiovascular Burden. Neurology, 90, e1663-e1674. https://doi.org/10.1212/WNL.0000000000005471
[58]
Bliwise, D.L., Trotti, L.M., Yesavage, J.A. and Rye, D.B. (2012) Periodic Leg Movements in Sleep in Elderly Patients with Parkinsonism and Alzheimer’s Disease. European Journal of Neurology, 19, 918-923.
https://doi.org/10.1111/j.1468-1331.2012.03673.x
[59]
Kimura, K., Tachibana, N., Kohyama, J., Otsuka, Y., Fukazawa, S. and Waki, R. (2000) A Discrete Pontine Ischemic Lesion Could Cause REM Sleep Behavior Disorder. Neurology, 55, 894-895. https://doi.org/10.1212/WNL.55.6.894
[60]
Bassetti, C.L. (2005) Sleep and Stroke. Seminars in Neurology, 25, 19-32.
https://doi.org/10.1055/s-2005-867073
[61]
Dichgans, M. and Leys, D. (2017) Vascular Cognitive Impairment. Circulation Research, 120, 573-591. https://doi.org/10.1161/CIRCRESAHA.116.308426
[62]
Lutsey, P., Norby, F., Gottesman, R., Mosley, T. and MacLehose, R. (2016) Sleep Apnea, Sleep Duration and Brain MRI Markers of Cerebral Vascular Disease and Alzheimer’s Disease: The Atherosclerosis Risk in Communities Study (ARIC). PLoS ONE, 11, e0158758. https://doi.org/10.1371/journal.pone.0158758
[63]
Korner, E., Flooh, E., Reinhart, B., Wolf, R., Ott, E., Krenn, W. and Lechner, H. (1986) Sleep Alterations in Ischemic Stroke. European Neurology, 25, 104-110.
https://doi.org/10.1159/000116090
[64]
Pasic, Z., Smajlovic, D., Dostovic, Z., Kojic, B. and Selmanovic, S. (2011) Incidence and Types of Sleep Disorders in Patients with Stroke. Medical Archives, 65, 225-227. https://doi.org/10.5455/medarh.2011.65.225-227
[65]
Da Rocha, P.C., Barroso, M.T., Dantas, A.A.T.S.G., Melo, L.P. and Campos, T.F. (2013) Predictive Factors of Subjective Sleep Quality and Insomnia Complaint in Patients with Stroke: Implications for Clinical Practice. Anais da Academia Brasileira de Ciências, 85, 1197-1206. https://doi.org/10.1590/S0001-37652013005000053
[66]
Wu, W., Cui, L., Fu, Y., Tian, Q., Liu, L. and Zhang, X. (2016) Sleep and Cognitive Abnormalities in Acute Minor Thalamic Infarction. Neuroscience Bulletin, 32, 341-348. https://doi.org/10.1007/s12264-016-0036-7
[67]
Sindi, S., Kareholt, I., Johansson, L., et al. (2018) Sleep Disturbances and Dementia Risk: A Multicenter Study Alzheimer’s & Dementia, 14, 1235-1242.
https://doi.org/10.1016/j.jalz.2018.05.012
[68]
Culebras, A. and Anwar, S. (2018) Sleep Apnea Is a Risk Factor for Stroke and Vascular Dementia. Current Neurology and Neuroscience Reports, 18, 53.
https://doi.org/10.1007/s11910-018-0855-1
