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Structural brain correlates of obstructive sleep apnoea in older adults at risk for dementia

Nathan E. Cross, Negar Memarian, Shantel L. Duffy, Casey Paquola, Haley LaMonica, Angela D'Rozario, Simon J.G. Lewis, Ian B. Hickie, Ronald R. Grunstein, Sharon L. Naismith
European Respiratory Journal 2018 52: 1800740; DOI: 10.1183/13993003.00740-2018
Nathan E. Cross
1School of Psychology, The University of Sydney, Camperdown, Australia
2Woolcock Institute of Medical Research, The University of Sydney, Camperdown, Australia
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
5Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Negar Memarian
2Woolcock Institute of Medical Research, The University of Sydney, Camperdown, Australia
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
5Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Shantel L. Duffy
2Woolcock Institute of Medical Research, The University of Sydney, Camperdown, Australia
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
5Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Casey Paquola
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
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Haley LaMonica
1School of Psychology, The University of Sydney, Camperdown, Australia
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
5Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Angela D'Rozario
1School of Psychology, The University of Sydney, Camperdown, Australia
2Woolcock Institute of Medical Research, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
5Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Simon J.G. Lewis
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
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Ian B. Hickie
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
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Ronald R. Grunstein
2Woolcock Institute of Medical Research, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
6Sydney Health Partners, The University of Sydney, Camperdown, Australia
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Sharon L. Naismith
1School of Psychology, The University of Sydney, Camperdown, Australia
3Brain and Mind Centre, The University of Sydney, Camperdown, Australia
4Neurosleep, NHMRC Centre of Research Excellence, The University of Sydney, Camperdown, Australia
5Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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  • FIGURE 1
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    FIGURE 1

    Significant atrophy in the left temporal pole (LTP) and right fusiform gyrus (RFG) related to “oxygen desaturation” in older “at-risk” patients; displayed on Qdec's (query, design, estimate, contrast) semi-inflated cortical surfaces. a) Left lateral and left medial; b) right lateral and right medial; c) anterior and posterior; d) inferior and superior views. Results were obtained using Monte Carlo simulation, with a threshold of p<0.05, to provide cluster-wise correction for multiple comparisons. Clusters are labelled based on the location of the vertex with the greatest association as defined by Qdec.

  • FIGURE 2
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    FIGURE 2

    Significant hypertrophy in the postcentral gyrus (PCG), pars opercularis (PO) and pericalcarine (PA) related to “sleep disturbance” in older “at-risk” patients; displayed on Qdec's (query, design, estimate, contrast) semi-inflated cortical surfaces. a) Left lateral and left medial; b) right lateral and right medial; c) anterior and posterior; d) inferior and superior views. Results were obtained using Monte Carlo simulation, with a threshold of p<0.05, to provide cluster-wise correction for multiple comparisons. Clusters are labelled based on the location of the vertex with the greatest association as defined by Qdec.

  • FIGURE 3
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    FIGURE 3

    Significant linear regressions between “sleep disturbance” in older “at-risk” patients and grey matter volume of a) hippocampal and b) amygdala subcortical regions. Volume was calculated using FreeSurfer automated segmentation. Analysis was conducted accounting for age and intracranial volume.

Tables

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  • TABLE 1

    Demographic and clinical statistics of the sample

    Age years51.1–88.567.4±7.5
    Education years4.0–23.013.3±3.2
    Body mass index kg·m−215.7–64.427.8±6.8
    Mini-Mental State Examination total score24.0–30.028.6±1.6
    Geriatric Depression Scale total score0.0–15.04.1±3.6
    Cumulative Illness Rating Scale total score0.0–17.04.8±3.8
    Alcohol consumption drinks per week0.0–35.04.7±6.8
    Epworth Sleepiness Scale total score0.0–19.07.6±4.4
    Apnoea–hypopnoea index events·h−10.0–111.018.7±20.2
    Oxygen desaturation index events·h−10.0–109.715.1±19.1
    Lowest oxygen saturation %71.0–97.085.6±6.1
    Oxygen saturation <90% %TST0.0–46.14.4±8.2
    Sleep efficiency %37.4–96.075.7±12.1
    Awakening index events·h−11.8–49.46.6±6.8
    Arousal index events·h−15.4–78.919.8±14.7

    Data are presented as range or mean±sd. n=83. %TST: percentage of total sleep time.

    • TABLE 2

      Rotated component matrix of the principal components analysis of obstructive sleep apnoea severity metrics

      Component
      “Oxygen desaturation”“Sleep disturbance”
      Apnoea–hypopnoea index0.7740.489
      Oxygen desaturation index0.8560.311
      %TST saturation oxygen <90%0.8420.154
      Lowest oxygen saturation (inverted)0.855−0.115
      Sleep efficiency (inverted)0.0010.768
      Awakening index events·h−10.1150.780
      Arousal index events·h−10.4540.734
      Variance explained %42.830.1

      Extraction method: principal component analysis; rotation method: varimax with Kaiser normalisation. Variables with a loading >0.5 on each component are presented in bold. %TST: percentage of total sleep time.

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        Supplementary tables ERJ-00740-2018_Supplement

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      Structural brain correlates of obstructive sleep apnoea in older adults at risk for dementia
      Nathan E. Cross, Negar Memarian, Shantel L. Duffy, Casey Paquola, Haley LaMonica, Angela D'Rozario, Simon J.G. Lewis, Ian B. Hickie, Ronald R. Grunstein, Sharon L. Naismith
      European Respiratory Journal Jul 2018, 52 (1) 1800740; DOI: 10.1183/13993003.00740-2018

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      Structural brain correlates of obstructive sleep apnoea in older adults at risk for dementia
      Nathan E. Cross, Negar Memarian, Shantel L. Duffy, Casey Paquola, Haley LaMonica, Angela D'Rozario, Simon J.G. Lewis, Ian B. Hickie, Ronald R. Grunstein, Sharon L. Naismith
      European Respiratory Journal Jul 2018, 52 (1) 1800740; DOI: 10.1183/13993003.00740-2018
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