From the Normandie Univ (C.A., E.K., S.R., V.O., S.D.-S., C.P., F.F., P.C., S.D., D.V., G.C., R.F., G.R.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, France; Normandie Univ (C.A., S.R., V.O., P.C., V.L.S.), UNICAEN, PSL Université, EPHE, INSERM, CHU de Caen, GIP Cyceron, NIMH, France; Penn Image Computing and Science Laboratory (PICSL) (P.Y.), University of Pennsylvania, Philadelphia; Département de Recherche Clinique (D.V.), CHU Caen-Normandie, France; and Service de Neurologie (V.L.S.), CHU de Caen, France.
Neurology. 2023 Jul 25;101(4):e370-e385. doi: 10.1212/WNL.0000000000207421. Epub 2023 May 31.
Sleep disordered breathing (SDB) has been related to amyloid deposition and an increased dementia risk. However, how SDB relates to medial temporal lobe neurodegeneration and subsequent episodic memory impairment is unclear. Our objective was to investigate the impact of amyloid positivity on the associations between SDB severity, medial temporal lobe subregions, and episodic memory performance in cognitively unimpaired older adults.
Data were acquired between 2016 and 2020 in the context of the Age-Well randomized controlled trial of the Medit-Aging European project. Participants older than 65 years who were free of neurologic, psychiatric, or chronic medical diseases were recruited from the community. They completed a neuropsychological evaluation, in-home polysomnography, a Florbetapir PET, and an MRI, including a specific high-resolution assessment of the medial temporal lobe and hippocampal subfields. Multiple linear regressions were conducted to test interactions between amyloid status and SDB severity on the volume of MTL subregions, controlling for age, sex, education, and the ApoE4 status. Secondary analyses aimed at investigating the links between SDB, MTL subregional atrophy, and episodic memory performance at baseline and at a mean follow-up of 20.66 months in the whole cohort and in subgroups stratified according to amyloid status.
We included 122 cognitively intact community-dwelling older adults (mean age ± SD: 69.40 ± 3.85 years, 77 women, 26 Aβ+ individuals) in baseline analyses and 111 at follow-up. The apnea-hypopnea index interacted with entorhinal (β = -0.81, < 0.001, pη = 0.19), whole hippocampal (β = -0.61, < 0.001, pη = 0.10), subiculum (β = -0.56, = 0.002, pη = 0.08), CA1 (β = -0.55, = 0.002, pη = 0.08), and DG (β = -0.53, = 0.003, pη = 0.08) volumes such that a higher sleep apnea severity was related to lower MTL subregion volumes in amyloid-positive individuals, but not in those who were amyloid negative. In the whole cohort, lower whole hippocampal ( = 0.27, = 0.005) and CA1 ( = 0.28, = 0.003) volumes at baseline were associated with worse episodic memory performance at follow-up.
Overall, we showed that SDB was associated with MTL atrophy in cognitively asymptomatic older adults engaged in the Alzheimer continuum, which may increase the risk of developing memory impairment over time.
ClinicalTrials.gov Identifier: NCT02977819.
睡眠呼吸障碍（SDB）与淀粉样蛋白沉积和痴呆风险增加有关。然而，SDB 与内侧颞叶神经退行性变以及随后的情景记忆障碍之间的关系尚不清楚。我们的目的是研究淀粉样蛋白阳性对认知正常的老年人中 SDB 严重程度、内侧颞叶亚区和情景记忆表现之间关联的影响。
数据采集于 2016 年至 2020 年期间，作为 Medit-Aging 欧洲项目 Age-Well 随机对照试验的一部分。从社区招募年龄在 65 岁以上、无神经、精神或慢性疾病的参与者。他们完成了神经心理学评估、家庭多导睡眠图、Florbetapir PET 和 MRI，包括内侧颞叶和海马亚区的特定高分辨率评估。进行了多次线性回归，以测试淀粉样蛋白状态与 SDB 严重程度之间的相互作用对 MTL 亚区体积的影响，同时控制年龄、性别、教育和 ApoE4 状态。次要分析旨在调查 SDB、MTL 亚区萎缩与整个队列以及根据淀粉样蛋白状态分层的亚组中基线和平均 20.66 个月随访时情景记忆表现之间的联系。
我们纳入了 122 名认知正常的社区居住老年人（平均年龄±标准差：69.40±3.85 岁，77 名女性，26 名 Aβ+个体）进行基线分析，111 名在随访时进行分析。呼吸暂停低通气指数与内嗅皮质（β=-0.81， < 0.001，pη=0.19）、整个海马（β=-0.61， < 0.001，pη=0.10）、下托（β=-0.56， = 0.002，pη=0.08）、CA1（β=-0.55， = 0.002，pη=0.08）和 DG（β=-0.53， = 0.003，pη=0.08）体积之间存在交互作用，表明睡眠呼吸暂停严重程度越高，淀粉样蛋白阳性个体的 MTL 亚区体积越低，但在淀粉样蛋白阴性个体中则不然。在整个队列中，基线时整个海马（ = 0.27， = 0.005）和 CA1（ = 0.28， = 0.003）体积较低与随访时情景记忆表现较差相关。
总的来说，我们发现 SDB 与处于阿尔茨海默病连续体中的认知无症状老年人的内侧颞叶萎缩有关，这可能会随着时间的推移增加记忆障碍的风险。
ClinicalTrials.gov 标识符：NCT02977819。
