Absence of Sleep Apnea Associated with Better Cognition Over 5-Year Follow-Up


The findings showed that interventions to improve sleep could be key to maintaining cognitive function, with investigators calling for further studies.

Sleep consolidation and the absence of obstructive sleep apnea (OSA) have been associated with better cognition in a 5-year follow-up, according to results of a study published in JAMA Network Open.

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The findings showed that interventions to improve sleep could be key to maintaining cognitive function, with investigators calling for further studies. Investigators aimed to determine whether there was an association between sleep, OSA, and cognitive function, using the Sleep and Dementia Consortium.

The Sleep and Dementia Consortium included data from 5 population-based cohorts in the United States, including data from home-based type 2 polysomnography (PSG) and neuropsychological assessments over 5 years of follow up. The studies included the Atherosclerosis Risk in Communities study (NCT00005131), the Cardiovascular Health Study (NCT00005133), the Framingham Heart Study (NCT00005121), the Osteoporotic Fractures in Men Study, and the Study of Osteoporotic Fractures.

Investigators adjusted the results for demographic variables, the time between PSG, the neuropsychological assessment from 0 to 5 years, body mass index, antidepressant use, and sedative use.

There were 5946 individuals included in the analysis who did not have stroke or dementia, and data were analyzed from March 2020 to June 2023.

Investigators found that the median wake after sleep onset time ranged from 44 to 101 minutes. The prevalence of moderate to severe OSA ranged from 16.9% to 28.9%.

Additionally, the results showed that “higher sleep maintenance efficiency and lower wake after sleep onset were associated with better global cognition,” according to the investigators.

Mild to severe OSA were associated with poorer global cognition with an apnea-hypopnea index of 5 or greater compared to an apnea-hypopnea index of less than 5.

Similar results were found for moderate to severe OSA, although the differences in sleep stages were not found to be associated with cognition.

Furthermore, investigators found that short total sleep times, at less than 6 hours, were associated with poorer attention and processing speeds compared to 6 or more hours of sleep. There were no overall associations between sleep and learning, memory, or visuospatial abilities, according to investigators.

OSA was also associated with poorer global cognition in individuals with excessive daytime sleepiness, but not observed in those without. Rapid eye movement sleep percentage and global cognition were positively associated for women, but there was no association observed in men.

However, investigators did say that there is little evidence that sex, the APOE ε4 gene, or excessive daytime sleepiness interacted with these associations.

Investigators said that further analysis of the Sleep and Dementia Consortium should be done to build on these findings.

Limitations of the study included sleep and cognition being assessed at 1 time. A longer duration may be required to develop the associations between poor sleep and cognitive impairment because the affects could be greater over time. The investigators plan on addressing the limitations in further analyses of PSG at 2 times and with an incidence of dementia follow-up.


Pase MP, Harrison S, Misialek JR, Kline CE, et al. Sleep architecture, obstructive sleep apnea, and cognitive function in adults. JAMA Netw Open. 2023;6(7):e2325152. doi:10.1001/jamanetworkopen.2023.25152

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