Obstructive Sleep Apnea and Cerebral Small Vessel disease in Community-based Older People: An ASPREE Imaging Substudy

Stephanie A Ward; Elsdon Storey; Matthew T Naughton; Rory Wolfe; Garun S Hamilton; Meng Law; Ryo Kawasaki; Walter P Abhayaratna; Katherine L Webb; Fergal J O'Donoghue; Danijela Gasevic; Nigel P Stocks; Ruth E Trevaks; Liubov D Robman; Scott Kolbe; Sharyn M Fitzgerald; Suzanne G Orchard; Tien Wong; John McNeil; Christopher M Reid; Ben Sinclair; Robyn L Woods

doi:10.1093/sleep/zsae204

Obstructive Sleep Apnea and Cerebral Small Vessel disease in Community-based Older People: An ASPREE Imaging Substudy

Sleep. 2024 Sep 20:zsae204. doi: 10.1093/sleep/zsae204. Online ahead of print.

Authors

Stephanie A Ward^{1

2

3}, Elsdon Storey¹, Matthew T Naughton⁴, Rory Wolfe¹, Garun S Hamilton^{5

6}, Meng Law^{7

8}, Ryo Kawasaki⁹, Walter P Abhayaratna^{10

11}, Katherine L Webb¹, Fergal J O'Donoghue^{12

13}, Danijela Gasevic^{1

14}, Nigel P Stocks¹⁵, Ruth E Trevaks¹, Liubov D Robman^{1

16}, Scott Kolbe⁷, Sharyn M Fitzgerald¹, Suzanne G Orchard¹, Tien Wong^{17

18}, John McNeil¹, Christopher M Reid^{1

19}, Ben Sinclair^{7

8}, Robyn L Woods¹

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
² Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, New South Wales, 2033, Australia.
³ Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales, 2031, Australia.
⁴ The Department of Respiratory Medicine, Alfred Hospital, and The Central Clinical School, Monash University, Melbourne, Victoria, 3004 , Australia.
⁵ Department of Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria.
⁶ School of Clinical Sciences, Monash University, Clayton Victoria, 3168, Australia.
⁷ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia.
⁸ Department of Radiology, Alfred Health, Melbourne, Victoria, 3004, Australia.
⁹ Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita-city, Osaka, 565-0871, Japan.
¹⁰ College of Health and Medicine, Australian National University, Australian Capital Territory, 0200, Australia.
¹¹ Academic Unit of Internal Medicine, Canberra Hospital, Garran Australian Capital Territory, 2605, Australia.
¹² Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia.
¹³ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
¹⁴ Centre for Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
¹⁵ Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5005, Australia.
¹⁶ Centre for Eye Research Australia, The University of Melbourne, East Melbourne, Victoria, 3002, Australia.
¹⁷ Tsinghua Medicine, Tsinghua University, Beijing, China.
¹⁸ Singapore National Eye Center, Singapore.
¹⁹ Curtin School of Population Health, Curtin University, Bentley Perth Western Australia 6102, Australia.

PMID: 39301859
DOI: 10.1093/sleep/zsae204

Abstract

Study objectives: Obstructive sleep apnea (OSA) may increase risk of dementia. A potential pathway for this risk is through cerebral small vessel disease (CSVD). In the context of an existing randomized trial of aspirin for primary prevention, we aimed to investigate OSA's impact on CSVD imaging measures and explore whether aspirin effects these measures over 3 years that differ in the presence or absence of OSA.

Methods: A sub-study of the ASPirin in Reducing Events in the Elderly randomized placebo-controlled trial of low-dose aspirin. Community-dwelling participants aged 70 years and above, without cognitive impairment, cardiovascular disease or known OSA completed an unattended limited-channel sleep study that calculated the oxygen desaturation index and apnea-hypopnea index. At baseline and 3 years later, volumes of white matter hyperintensities (WMH) and silent brain infarctions (SBI) were measured on 1.5 Tesla brain magnetic resonance imaging, and retinal vessel calibers were calculated from retinal vascular imaging.

Results: Mild and moderate/severe OSA was detected in 48.9% and 29.9%, respectively, of the 311 participants, who had a mean age of 73.7 years (SD 3.4 years), 38.6% female. OSA of any severity did not associate with WMH volumes, SBI, nor with retinal vessel calibers at baseline, nor with change in these measures in the 277 participants with repeated measures acquired after 3 years. OSA of any severity did not interact with aspirin on change in these measures over 3 years.

Conclusion: In healthy older adults undiagnosed OSA was not associated with retinal vascular calibers and neuroimaging measures of CSVD.

Keywords: Aging; Cerebral Small Vessel Disease; Obstructive Sleep Apnea; Sleep Disordered breathing; White Matter Hyperintensities.