Jean Claude Barthélémy

Does subjective sleep affect cognitive function in healthy elderly subjects? The Proof cohort

OBJECTIVE Some epidemiological data are available on the association between sleep duration and sleep quality, sleep complaints, and the aging related cognitive impairment in the elderly. In this study we examined a large sample of healthy elderly subjects to assess the relationship between sleep quality, subjective cognitive complaints, and neuropsychological performance. METHODS A total of 272 elderly subjects (mean age 74.8 ± 1.1 years) were recruited from a population-based cross-sectional study on aging and cardiovascular morbidity. All subjects filled in self-assessment questionnaires evaluating cognitive function, anxiety, depression, sleep-related parameters, and the Pittsburgh Sleep Quality Index (PSQI). Ambulatory polygraphy and extensive neuropsychological tests were also performed. Based on the total PSQI score, subjects were classified as good sleepers (GS, PSQI<5, n=116) and poor sleepers (PS, PSQI≥5, n=156). RESULTS Poor sleep did not affect the subjective cognitive function score, subjective cognitive impairment being mainly related to anxiety, depression, and sleep medication intake. No significant differences were seen between GS and PS in any of the objective cognitive function tests except for the Trail Making Test A (TMA-A), processing speed being longer in the PS group (p<0.001). Neither the presence of sleep-related breathing disorders nor gender affected cognitive performance. CONCLUSIONS Our results suggest that in healthy elderly subjects, subjective sleep quality and duration did not significantly affect subjective and objective cognitive performances, except the attention level, for that the interference of sleep medication should be considered.

Sleep breathing disorders and cognitive function in the elderly: an 8-year follow-up study. the proof-synapse cohort.

STUDY OBJECTIVES Sleep breathing disorder (SBD) may be an important factor in age-related cognitive decline. In a cohort of healthy elderly subjects, we performed an 8-y longitudinal study to assess whether changes in cognitive function occur in untreated elderly patients with SBD and without dementia and the factors implicated in these changes. DESIGN A population-based longitudinal study. SETTING Clinical research settings. PARTICIPANTS A total of 559 participants of the PROOF study aged 67 y at the study entry and free from neurological disorders were examined. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Abnormal breathing events were defined by an apnea-hypopnea index (AHI) > 15. The raw cognitive data and averaged Z-scores for the attentional, executive, and memory functions were collected at the baseline and follow-up. At baseline, AHI > 15 was found in 54% of subjects with 18% having an AHI > 30. At follow-up, the presence of abnormal breathing events was associated with a slight but significant decline in the attentional domain (P = 0.01), which was more evident in the subjects with an AHI > 30 (P = 0.004). No significant changes over time were observed in the executive and memory functions. Several indices of chronic hypoxemia, defined either as a cumulative peripheral oxygen saturation (SpO2) < 90% or a minimal SpO2, accounted for portions of the variance in the decline in attention. All observed effects were small, accounting for 4-7% of variance in multivariate models. CONCLUSION In healthy elderly subjects, various components of sleep breathing disorder at baseline were associated with small changes in selected cognitive functions specific to the attention domain after controlling for multiple comorbidities, such as sleepiness, hypertension, diabetes, anxiety, and depression. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifiers NCT 00759304 and NCT 00766584.

A 3-year longitudinal study of sleep disordered breathing in the elderly

Limited and controversial data exist on the natural evolution of sleep disordered breathing (SDB) in untreated individuals. This study examines the evolution of SDB over a 3-yr period in a community-based sample of elderly subjects. From the initial cohort of 854 healthy subjects aged mean±sd 68.4±0.8 yrs, 519 untreated subjects accepted clinical and instrumental follow-up 3.6±1.6 yrs later. SDB was defined as a respiratory disturbance index (RDI) >15 events·h−1. At baseline, 202 (39%) subjects had an RDI ≤15 events·h−1 and 317 (61%) had an RDI >15 events·h−1. 3 yrs later, 280 (54%) subjects were non-SDB and 239 (46%) had SDB. Between evaluations, the RDI decreased from 22.3±16.2 to 16.4±13.0 events·h−1, with a greater decrease in the number of cases with an RDI >30 events·h−1 that in those with RDI ≥30 events·h−1. In the non-SDB group, 81% had a stable RDI and 19% increased their RDI by a mean of 13.7 events·h−1. In the SDB group, the RDI decreased to values ≤15 events·h−1 in 36.6% of cases, 63.4% still having SDB. The RDI changes did not depend on weight changes. In healthy elderly subjects, the prevalence and severity of SDB did not show a tendency toward natural worsening, some cases having improvement or a remission independent of weight changes. These findings also suggest that in the elderly, natural SDB progression is still hypothetical.

At 68 years, unrecognised sleep apnoea is associated with elevated ambulatory blood pressure

After the age of 65 yrs the specific impact of unrecognised sleep-related breathing disorders (SRBD) on 24-h blood pressure (BP) levels remains under debate. We tested the cross-sectional relationship between the severity of obstructive sleep apnoea/hypopnoea (OSAH) and the increase of BP using ambulatory BP monitoring (ABPM) in the PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events study)-SYNAPSE (Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea study) cohort. 470 subjects (aged 68 yrs) neither treated for hypertension nor diagnosed for SRBD were included. All subjects underwent ABPM, and unattended at-home polygraphic studies. OSAH was defined by an apnoea/hypopnoea index (AHI) >15·h−1. The severity of the sleep apnoea was also quantified as the index of dips in oxyhaemoglobin saturation >3% (ODI). Results are expressed in per protocol analysis. Severe OSAH (AHI >30·h−1, 17% of subjects) was associated with a significant 5 mmHg increase in both diurnal and nocturnal systolic BP (SBP), and with a nocturnal 3 mmHg increase in diastolic BP (DBP). Systolic (mean SBP >135 mmHg) or diastolic (mean DBP >80 mmHg) hypertension were more frequently encountered in subjects suffering from moderate (AHI 15–30) or severe OSAH. After adjustment, the independent association between severe OSAH and 24-h systolic hypertension remained significant (OR 2.42, 95% CI 1.1–5.4). The relationship was further reinforced when SRBD severity was expressed using ODI >10·h−1. The impact of unrecognised SRBD on BP levels also exists at the age of 68 yrs. The hypoxaemic load appears to be the pathophysiological cornerstone for such a relationship.

Mood disorders in healthy elderly with obstructive sleep apnea: a gender effect

OBJECTIVE Previous studies have suggested an association between obstructive sleep apnea (OSA) and anxiety and depression, but it remains unclear as to whether this is due to OSA or other factors. The aim of this study was to evaluate this association in a large sample of healthy elderly with unrecognized OSA. METHODS 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory home polygraphic study and completion of questionnaires related to depression, anxiety and sleepiness were examined. According to the apnea-hypopnea index (AHI), the subjects were stratified into no-OSA, mild-moderate and severe OSA cases. RESULTS Anxiety was present in 38% of the sample and depression in 8%. Anxiolytic treatment was reported by 9% of the population and antidepressant treatment in 5%. Women had high scores for anxiety and depression and they were more frequently taking anxiolytic and antidepressant medications. No differences were found for anxiety and depression scores and medication intake in the three groups of subjects stratified according to the AHI. Regression analyses adjusted for age, gender, body mass index, hypertension (HT), AHI, and indices of hypoxemia revealed that females were 5.44 times more likely to have depression with a low contribution of the time with SaO2 < 90%. CONCLUSIONS In a large sample of healthy elderly with OSA, neither the existence nor the severity of the OSA was associated with anxiety and depression score, with women having higher anxiety and depression scores. This finding supports the hypothesis that depressive symptoms originate from factors other than measures of OSA severity.

Association of body fat composition and obstructive sleep apnea in the elderly: A longitudinal study

Obesity and aging are considered risk factors for developing sleep apnea syndrome (OSA). The aim of this study was to determine the association between body fat composition and OSA in healthy elderly subjects examined in a 7‐year longitudinal study.

Long-lasting active lifestyle and successful cognitive aging in a healthy elderly population: The PROOF cohort

OBJECTIVES The aim of this study was to determine whether cognitive reserve in the elderly affects the evolution of cognitive performance and what its relationship is with active lifestyles in later life. METHODS Cognitive performance was evaluated at baseline and 8 years later in 543 participants of the PROOF cohort, initially aged 67 years. Subjects were categorized as Cognitively Elite (CE), Cognitively Normal (CN) or Cognitively Impaired (CI) at each evaluation. At follow-up, demographic data and lifestyle, including social, intellectual and physical behaviors, were collected by questionnaires. RESULTS As much as 69% (n=375) remained unchanged, while 25.5% (n=138) decreased and 5.5% (n=30) improved. When present, the reduction in cognitive status was most often limited to one level, but was dependent on the initial level, affecting up to 73% of the initially CN, but only 58% of the initially CE. Cognitive stability was significantly associated with the degree of social engagement at follow-up (CE: P=0.009; CN: P=0.025). CONCLUSION In the healthy elderly, high cognitive ability predicts both cognitive ability and social involvement in later life. Cognitive decline by only one level may also extend the time to reach impairment, underlining the importance of the so-called cognitive reserve.

Is there an association between altered baroreceptor sensitivity and obstructive sleep apnoea in the healthy elderly

Obstructive sleep apnoea (OSA) is associated with a rise in cardiovascular risk in which increased sympathetic activity and depressed baroreceptor reflex sensitivity (BRS) have been proposed. We examined this association in a sample of healthy elderly subjects with unrecognised OSA. 801 healthy elderly (aged ≥65 years) subjects undergoing clinical, respiratory polygraphy and vascular assessment were examined. According to the apnoea–hypopnoea index (AHI), the subjects were stratified into no OSA, mild–moderate OSA and severe OSA cases. OSA was present in 62% of the sample, 62% being mild–moderate and 38% severe. No differences were found for BRS value according to sex and OSA severity. 54% of the group had normal BRS value, 36% mild impairment and 10% severe dysfunction. BRS was negatively associated with body mass index (p=0.006), 24-h systolic (p=0.001) and diastolic pressure (p=0.001), and oxygen desaturation index (ODI) (p=0.03). Regression analyses revealed that subjects with lower BRS were those with hypertension (OR 0.41, 95% CI 0.24–0.81; p=0.002) and overweight (OR 0.42, 95% CI 0.25–0.81; p=0.008), without the effect of AHI and ODI. In the healthy elderly, the presence of a severe BRS dysfunction affects a small amount of severe cases without effect on snorers and mild OSA. Hypertension and obesity seem to play a great role in BRS impairment. In the healthy elderly with unrecognised OSA, the risk of blunted baroreceptor sensitivity was low http://ow.ly/kofu302IZWS

P3-31 Le maintien des capacités cognitives à 65 ans peut-il prédire un vieillissement réussi 6 ans plus tard ? Etude PROOF

Introduction Notre enquete a porte sur une cohorte de personnes âgees suivies depuis 2001 pour determiner si le maintien des capacites cognitives chez de jeunes retraites vivant a domicile pouvait predire un vieillissement reussi quelques annees plus tard. Methodes 988 questionnaires ont ete envoyes aux sujets de la cohorte PROOF. Le vieillissement reussi a ete defini selon la notion de bien-etre a travers un score global d’etat de sante percu (“Comment percevez-vous votre etat de sante?”) et un score global de satisfaction (“Etes-vous en general satisfait de votre vie actuelle ?), mesures par des Echelles Visuelles Analogiques (EVA) graduees de 0 a 10. Les capacites cognitives avaient ete evaluees 6 ans plus tot selon une approche objective (epreuve de rappel libre/rappel indice (RL/RI) a 16 items, test de Benton et test des similitudes de la WAIS-3) et une approche subjective (EVA pour evaluer la plainte mnesique, echelle d’anxiete de Goldberg et echelle de Mac Nair). Resultats 686 questionnaires ont pu etre analyses. La moyenne d’âge des sujets etait de 72.9 ans +/-1,2 et on retrouvait 59.2% de femmes. 99% des personnes vivaient a domicile ; 24.5% vivaient seules. Parmi ceux qui avaient travaille, le nombre moyen d’annees de retraite etait de 13.7 ans +/- 4.1. Les personnes âgees vivant seules avaient un plus mauvais score d’etat de sante percu (p=0.0254) et de satisfaction (p Conclusion Le maintien des capacites cognitives chez de jeunes retraites vivant a domicile est un facteur predictif de vieillissement reussi autopercu 6 ans plus tard.

P3-35 L’activité physique mesurée à l’âge de 65 ans, un facteur prédictif du bien vieillir 7 ans plus tard. Etude PROOF

Introduction L’activite physique a un effet pleiotrope et est un des principaux facteurs contribuant au bien vieillir. Cependant son effet sur l’auto perception de la sante et la satisfaction de vie est peu documente. Il parait donc interessant de verifier quel impact a l’activite physique, mesuree sur une cohorte âgee de 65 ans, sur le niveau de bien etre evalue sept ans plus tard. Materiels et Methodes 988 questionnaires ont ete envoyes a une population representative de retraites en bonne sante (Proof cohort, Neuroepidemiology 2007). La perception du bien etre et de l’etat de sante ont ete mesurees par deux echelles analogiques (graduees de 0 a 10), repondant aux deux questions suivantes : Etes-vous satisfait de votre vie actuelle ? Comment estimez-vous votre etat de sante ? Le niveau d’activite physique a ete evalue par le questionnaire POPAQ (Garet et al. Eur J Heart Failure. 2004) en 2001, permettant d’estimer : 1) la Depense d’energie quotidienne (DEE), 2) la Depense d’energie en activite physique (PAEE), 3) la DEE superieure a 5 MET (DEQ isa), 4) l’Indice d’activite (PAEE/DEE), 5) la VO2 pic. Resultats 686 questionnaires ont ete analyses dont 279 hommes (40.7%) et 407 femmes (59.3%). La moyenne d’âge etait de 72.9 +/- 1.2 ans et 98% (n=672) des personnes interrogees vivaient a leur domicile dont 24.7% (n=168) seul. La DEE moyenne etait de 10365+/-1964 kj/24h, la PAEE moyenne etait de 4479+/-1170 kj/24h, l’indice d’activite moyen etait de 0.42+/-0.05 et la VO2 pic moyenne de 22.5+/-1.6 mL/min/kg. Les individus presentant une depense superieure a 5MET, soit une activite physique soutenue, representaient 57.6% (n=395). L’index d’activite physique et la VO2 pic etaient les variables les plus significativement correlees a la perception de l’etat de sante (p=0.0032 et p=0.0011) et a la perception du bien etre (p= 0.0117 et p= 0.0053). Conclusion L’indice d’activite physique et la VO2 pic estimes a partir de la DEE, mesures a l’âge de 65 ans, sont de puissants facteurs predictifs du bien vieillir, sept ans plus tard.