Abstract MP085: Cognitive Impairment Mediates the Impact of Short Sleep Duration on Mortality in Individuals with Cardiovascular or Cerebrovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Fan He ◽  
Alexandros N Vgontzas ◽  
Duanping Liao ◽  
Edward O Bixler
Keyword(s):  
Cognitive Impairment ◽  
Sleep Duration ◽  
Processing Speed ◽  
Short Term Memory ◽  
Executive Attention ◽  
Short Term ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
History Of ◽  
The Impact

Background: Cardiovascular disease (CVD) and cerebrovascular disease (CBV) have been associated with short sleep duration and mortality. Furthermore, short sleep duration has been associated with impaired cognition. Most studies have been limited by using self-report measures and treating sleep duration as a sole, independent predictor, thus, its role in predicting mortality is still not well-established. Hypothesis: We hypothesized that 1) short sleep duration increases the impact of CVD and CBV on mortality and 2) cognitive impairment mediates the association of short sleep duration with mortality in those with CVD or CBV. Methods: We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1,741 men and women (48.7 ± 13.5 years) who were studied in the sleep laboratory and followed-up for 16.7 ± 4.6 years. CVD was defined by a history of heart disease, including hypertension or diabetes, and CBV by a history of stroke. Polysomnographic (PSG) total sleep time was classified as normal (≥ 6 hours) and short (< 6 hours) sleep duration based on the median of the cohort. All individuals underwent a comprehensive neuropsychological evaluation, including Symbol Digit Modalities Test, Trail Making Test, Benton Visual Retention Test, Thurstone Word Fluency Test, and Mini-Mental State Examination. We tested the interaction between CVD, CBV and PSG sleep duration on mortality using Cox proportional hazard models controlling for multiple potential confounders. Results: The hazard ratios (95%CI) of mortality associated with CVD and CBV were 0.9 (0.6-1.3) and 1.3 (0.5-3.1) for individuals with normal sleep duration and 1.8 (1.3-2.5) and 2.4 (1.3-4.4) for individuals with short sleep duration (P-interaction < .05). In individuals with CVD or CBV, short sleep duration was associated with impaired processing speed, executive attention, and short-term memory (all Ps < .05). Cognitive impairment significantly mediated the impact of short sleep duration on mortality in those with CVD or CBV [proportion of mediation effects were 6.5% (1.4%-18.6%), 4.5% (0.4%-14.2%), and 6.2% (1.0%-18.4%) for processing speed, executive attention and short-term memory, respectively]. Conclusions: The risk of mortality associated with CVD and CBV is significantly increased in those with short sleep duration. Although cognitive impairment significantly mediated this association, its modest effect suggests that future studies should examine other underlying mechanisms linking short sleep duration with mortality in individuals with CVD or CBV.

Clinical diagnosis of LGI1 antibody encephalitis in an 83-year-old woman

2021 ◽  
Vol 14 (1) ◽  
pp. e237398
Author(s):  
Jonathan E Attwood ◽  
Saniya Naseer ◽  
Sophia Michael ◽  
Josie Riley
Keyword(s):  
Cognitive Impairment ◽  
Clinical Diagnosis ◽  
Memory Impairment ◽  
Short Term Memory ◽  
Autoimmune Encephalitis ◽  
Short Term ◽  
Term Memory ◽  
Blood Tests ◽  
Abnormal Movements ◽  
History Of

An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.

scholarly journals 0355 Insomnia with Objective Short Sleep Duration is Associated with Cognitive Impairment: A Closer Look at Cardiometabolic Brain Health

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A145-A145
Author(s):  
Julio Fernandez-Mendoza ◽  
Fan He ◽  
Alexandros N Vgontzas ◽  
Susan L Calhoun ◽  
Duanping Liao ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sleep Duration ◽  
Brain Health ◽  
Short Sleep Duration ◽  
Short Sleep

scholarly journals 1030 History of Concussion In Student Athletes: A Risk Factor for Short Sleep Duration and Insomnia

SLEEP ◽  
2018 ◽  
Vol 41 (suppl_1) ◽  
pp. A382-A383
Author(s):  
V Bliznak ◽  
A Athey ◽  
W Killgore ◽  
J Gehrels ◽  
P Alfonso-Miller ◽  
...  
Keyword(s):  
Risk Factor ◽  
Sleep Duration ◽  
Student Athletes ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
History Of

scholarly journals 1130 Insomnia Short Sleep Phenotype is Associated With Frailty in Patients With Mild Cognitive Impairment (MCI)

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A430-A430
Author(s):  
M Basta ◽  
A Vgontzas ◽  
E Koutentaki ◽  
I Zaganas ◽  
J Fernandez-Mendoza ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sleep Duration ◽  
Large Population ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Sleep Time ◽  
Physical And Mental Health ◽  
Short Sleep Duration ◽  
Short Sleep

Abstract Introduction Insomnia short sleep phenotype is associated with cardiometabolic morbidity and mortality and neuropsychological impairment. In elderly untreated insomnia is associated with worse cognitive performance. The goal of the study was to examine the association between insomnia, objective sleep duration and physical and mental health in elderly patients with Mild Cognitive Impairment (MCI). Methods A sub-sample of 105 patients with MCI (mean age: 75.9 years, males 36%) were recruited from a large population-based cohort (Cretan Aging Cohort) in the island of Crete, Greece of 3,140 elders (≥ 60yrs). All participants underwent a complete medical history/ physical examination, extensive neuropsychiatric and neuropsychological evaluation and 3-day 24hr actigraphy. Insomnia was defined based on a question “do you have insomnia for more than a year”. Frailty was assessed with the Simple “Frail” Questionnaire Screening Tool. Comparisons between patients with insomnia and without insomnia were made using ANOVA controlling for age, gender and BMI. Results MCI patients with insomnia (n=23) compared to those without insomnia (n=82), had significantly shorter objective total sleep time (TST: 377 vs. 410 min, p=0.05) and significantly higher scores on the Geriatric Depression Scale and the Hospital Anxiety Scale (both p &lt;0.001). Furthermore, total frailty score, as well as scores in individual items, were significantly lower in MCI patients with insomnia (p&lt;0.01). This association remained significant after controlling for demographics, depression and anxiety. Finally, there was a statistical trend of association between insomnia and hypertension (p= 0.1). Conclusion In MCI patients, insomnia is associated with objective short sleep duration, and frailty. Improving insomnia and lengthening sleep duration may decrease frailty, a major problem associated with morbidity, disability and mortality in elders with cognitive decline. Support National Strategic Reference Framework (ESPA) 2007-2013, Program: THALES, University of Crete, title: “A multi-disciplinary network for the study of Alzheimer’s Disease” (Grant: MIS 377299).

Abstract MP94: Short Sleep Duration Modifies the Relationship Between Cognitive Impairment Associated with Cardiovascular Disease and All-cause Mortality

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Fan He ◽  
Alexandros N Vgontzas ◽  
Duanping Liao ◽  
Edward O Bixler
Keyword(s):  
Cognitive Impairment ◽  
Sleep Duration ◽  
Population Sample ◽  
Vascular Cognitive Impairment ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Penn State ◽  
The Relationship

Introduction: Short sleep duration has been associated with increased risk of cardiovascular and cerebrovascular disease (CVD), cognitive impairment (CI) and mortality. However, the role of sleep duration in predicting mortality in the context of CVD and CI is still not well-understood. Hypothesis: Short sleep duration is a key effect modifier of the relationship between CI associated with CVD and all-cause mortality. Methods: We addressed this hypothesis in the Penn State Adult Cohort, a random, general population sample of 1,741 middle-aged adults who were studied in the sleep lab and followed-up for 15y. An in-lab, 8-hour polysomnography was performed to ascertain sleep duration. CI associated with CVD was defined by the presence of hypertension, diabetes, heart disease and/or stroke with impaired higher-order, executive cognitive functioning, including slow processing speed. We tested the interaction between sleep duration and CI associated with CVD on all-cause mortality with multiple logistic regression while adjusting for sex, age, race, obesity, smoking, cholesterol, depression, insomnia, dementia, and sleep apnea. Results: The odds of mortality associated with CI-alone, CVD-alone, and CI associated with CVD were 1.3 (95% CI: 0.7-2.4), 1.7 (95% CI: 1.1-2.8), and 4.6 (95% CI: 2.8-7.7), respectively. As shown in Figure 1, the interaction between CI associated with CVD and sleep duration was significant (p < .01), indicating that the probability of mortality increased significantly as a function of shorter sleep duration in individuals with CI associated with CVD. Conclusion: We found that objective sleep duration modifies the relationship between CI associated with CVD and all-cause mortality in a dose-response manner. Short sleep duration in individuals with probable vascular cognitive impairment (VCI) may serve as a biomarker of the severity of central autonomic dysfunction. Future studies should examine whether improving sleep reduces the odds of mortality in individuals with VCI.

Abstract P072: Short Sleep Duration is Associated with Elevated Homocysteine Levels

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Megan E Petrov ◽  
Michael A Grandner ◽  
Carol M Baldwin ◽  
Matthew P Buman ◽  
Shawn D Youngstedt
Keyword(s):  
Cardiovascular Disease ◽  
Sleep Duration ◽  
Multinomial Logistic Regression ◽  
Menopausal Status ◽  
Short Sleep Duration ◽  
Dietary Folate ◽  
Short Sleep ◽  
Long Sleep ◽  
History Of ◽  
The Relationship

Introduction: Short and long sleep durations are associated with heightened risk for cardiovascular disease and vascular risk factors. Elevated homocysteine is also associated with greater risk for cardiovascular disease; however, studies have yet to investigate the relationship between sleep duration and homocysteine. Hypothesis: We hypothesized that short and long sleep duration would be associated with clinical levels of homocysteine. Methods: Adults (n=2,469; ≥20y) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were assessed for habitual sleep duration (coded as <5, 5, 6, 7, 8, 9, and ≥10hrs) and fasting plasma homocysteine levels (<10 [normative], 10 to <15 [pre-clinical] and ≥15 [clinical] μmol/L). Participants were excluded if pregnant, lactating, missing data on the primary variables, or if they had a history of cardiovascular disease, cancer, diabetes, kidney disease, or diagnosed sleep disorder. Population weighted, multinomial logistic regression analyses assessed the relationship between sleep duration and homocysteine after adjustment for age, sex, race/ethnicity, marital and menopausal status, shift work, dietary folate, alcohol intake, cotinine levels, reported physical activity, hypertension, and reported frequency of cessation of breathing at night. Results: Pre-clinical and clinical levels of homocysteine were present in 13.7% and 2.5% of the sample, respectively. The mean sleep duration was 6.9 ± 1.4 hours. In adjusted analyses, sleep duration was significantly related to homocysteine ( p < 0.001). See Table. Very short sleepers (<5hrs) were more likely to have clinical levels of homocysteine (OR: 3.01, 95%CI: 1.38, 6.57) compared to 7-hr sleepers. Conclusions: In a U.S. representative sample of adults without cardiovascular disease or other major conditions, short sleepers were at greater odds for clinical levels of homocysteine Findings suggest that homocysteine may be one mechanism linking short sleep duration to cardiovascular disease.

scholarly journals 1055 THE IMPACT OF SHORT SLEEP DURATION ON INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) AMONG STROKE SURVIVORS

SLEEP ◽  
2017 ◽  
Vol 40 (suppl_1) ◽  
pp. A392-A392
Author(s):  
D Chung ◽  
A Seixas ◽  
SL Richards ◽  
G Casimir ◽  
E Auguste ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Sleep Duration ◽  
Daily Living ◽  
Stroke Survivors ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Instrumental Activities ◽  
The Impact

scholarly journals Objective short sleep duration increases the risk of all-cause mortality associated with possible vascular cognitive impairment

Sleep Health ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Fan He ◽  
Susan L. Calhoun ◽  
Alexandros N. Vgontzas ◽  
Duanping Liao ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sleep Duration ◽  
Vascular Cognitive Impairment ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
All Cause Mortality

369 Insomnia with objective short sleep duration is associated with increased cortisol in patients with Mild Cognitive Impairment

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A147-A147
Author(s):  
Alexandros Vgontzas ◽  
Maria Basta ◽  
Yun Li ◽  
Julio Fernandez-Mendoza ◽  
Ioannis Zaganas ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sleep Duration ◽  
Plasma Cortisol ◽  
Neuropsychological Testing ◽  
Short Sleep Duration ◽  
Blood Draw ◽  
Short Sleep ◽  
Amnestic Mci ◽  
Cortisol Levels

Abstract Introduction Mild cognitive impairment (MCI) is frequent in the elderly and is in a continuum with dementia in a significant amount of people. Both insomnia and increased cortisol levels have been suggested as risk factors for MCI. The goal of this study was to examine whether activation of the hypothalamic-pituitary-adrenal (HPA) axis, as measured by plasma cortisol levels, is associated with the insomnia with short sleep duration (ISS) phenotype, as measured by actigraphy, in elderly with MCI. Methods A sub-sample of 109 subjects with MCI and 92 cognitively non-impaired controls 60 years or older (75.37±6.54y) was recruited from a population-based cohort residing on Crete, Greece. Subjects underwent medical history, physical examination, neuropsychiatric evaluation, neuropsychological testing, 3-day 24-h actigraphy, assessment of subjective insomnia symptoms (i.e., difficulties initiating and/or maintaining sleep), and a morning blood draw to assay for plasma cortisol levels. The ISS phenotype was defined by the presence of at least one insomnia symptom and an actigraphy-measured sleep efficiency below the median of the entire sample (i.e., ≤81%). Group differences in plasma cortisol levels between MCI subjects with and without the ISS phenotype were tested using ANCOVA adjusting for age, gender, BMI and depression. Results Subjects with MCI had higher cortisol levels compared to controls (105.34±9.34 vs. 70.3±10.02 nmol/L, p&lt;0.05). Subjects with MCI and the ISS phenotype (138.38±16.57 nmol/L) had significantly higher cortisol levels compared to those without insomnia (97.74±19.68 nmol/L) or those with insomnia and normal sleep duration (INS; 79.97±16.02 nmol/L, p=0.044). The association between the ISS phenotype and cortisol levels was modified by amnestic symptoms (p-interaction=0.079); commensurate, the ISS phenotype was associated with higher cortisol levels among the amnestic MCI subgroup (INS: 79.12±21.93 vs. ISS: 155.55±20.40 nmol/L, p=0.040), but not among the non-amnestic MCI subgroup (INS: 64.06±23.62 vs. ISS: 89.33±29.00 nmol/L, p=0.559). Conclusion The ISS phenotype is associated with increased cortisol levels in elderly with MCI, particularly those with amnestic type. Improving sleep quality, decreasing cortisol levels and lengthening sleep duration may slow down the progression of these individuals into dementia. Support (if any) National Strategic Reference Framework(NSRF), Program: THALES entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” Grant Cod:MIS 377299

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