Longitudinal trajectories of sleep apnea parameters and cognitive decline: An 8-year follow-up study in a community-based cohort

초록

Background and aims: Sleep-disordered breathing, including obstructive sleep apnea (OSA), has been linked to cognitive impairment. However, few studies have examined how changes in OSA severity over time relate to the development of mild cognitive impairment (MCI) in community populations. Methods: We analyzed data from 1,592 participants in a prospective community-based cohort who underwent two home-based polysomnography (PSG) assessments approximately 8 years apart. Cognitive function at follow-up was evaluated using the Seoul Neuropsychological Screening Battery, 2nd edition (SNSB-II). Group-based trajectory modeling and linear mixed-effects models were used to compare longitudinal changes in sleep apnea metrics such as apnea-hypopnea index (AHI) between the MCI (n = 445, mean 65.35 ± 5.51 years, male: 52.8 %) and cognitively normal groups (n = 1146, mean 65.60 ± 5.41 years, male: 46.64 %). Results: Participants who developed MCI exhibited a significantly steeper increase in AHI and RDI over the 8-year period compared to those who remained cognitively normal (p < 0.01). In particular, increases in REM-specific AHI and positional AHI were more pronounced in the women's MCI group, even after adjusting for baseline demographics, BMI, and comorbidities. Conclusions: While OSA is more common in men, longitudinal worsening of sleep apnea is linked to elevated MCI risk, with a more substantial effect in female participants. These results highlight the importance of considering sex-specific vulnerability when screening and managing sleep-disordered breathing in aging populations. Acknowledgement: This study was supported by grants from the NRF funded by MSIT (RS-2024-00359247 to HJ Kim), and KDCA (2011-E71004-00 ~ 2021-E0602-01 to C Shin).