BREATHING DISORDERS DURING SLEEP AND COGNITIVE PERFORMANCE IN AN OLDER COMMUNITY SAMPLE - THE EVA STUDY

OBJECTIVES: To determine whether poor cognitive performance was associ ated with symptoms related to the sleep apnea syndrome, snoring, and b reathing stoppage during sleep. DESIGN: Cross-sectional analysis of da ta collected at baseline in the EVA Study, a 4-year cohort study. SETT ING: The city of Nantes in western France. SAMPLE: A total of 1389 per sons, aged 60 to 70 years, recruited from the electoral rolls of the c ity of Nantes. MEASUREMENTS: Demographic characteristics and data on d rug use and tobacco and alcohol consumption were collected using a sta ndardized questionnaire. Weight and height were measured. Individuals completed a previously validated sleep questionnaire about nocturnal s leep characteristics, snoring, breathing stoppage during sleep, and da ytime sleepiness. Trained psychologists administered eight neuropsycho logical tests: The Mini-Mental State Examination, Trail Making Test, D igit Symbol Substitution Test of the WAIS-Revised, Benton Visual Reten tion Test, Paced Auditory Serial-Addition Task, Auditory Verbal Learni ng Test, Raven Progressive Matrices, and Word Fluency Test. Depressive symptomatology was assessed by the Center for Epidemiologic Studies-D epression scale. MAIN RESULTS: In this older sample, 49.5% of subjects reported snoring, and 10.8% reported breathing stoppage during sleep. Both respiratory disorders were associated significantly with male ge nder and high body mass index. In men, prevalence of snoring was incre ased significantly in those with alcohol consumption greater than 40 m t per day. Breathing stoppage during sleep was associated with depress ive symptoms in women. Logistic regression models adjusted for age, ge nder, educational level, tobacco status and alcohol consumption, depre ssive symptomatology, and number of medications found that both snorin g and breathing stoppage were associated with low scores (less than or equal to 10th percentile) in tests requiring visual attention skills, the Trail Making Test (OR=2.14, 95% CI=1.24-3.69 and OR=1.88, 95% CI= 1.04-3.39, respectively), and the Digit Symbol Substitution Test (OR=1 .80, 95% CI=1.09-2.99 and OR=1.58, 95% CI=.87-2.89, respectively). The se relationships were significant only when either snoring or breathin g stoppage was associated with daytime sleepiness. CONCLUSIONS: This c ross-sectional analysis suggested that in community-dwelling individua ls 60 to 70 years of age, snoring and breathing stoppage during sleep associated with daytime sleepiness were risk factors for low cognitive performance in tests requiring visual attention skills.