Sex-specific dementia risk in known or suspected obstructive sleep apnea: a 10-year longitudinal population-based study

Tiffany J Braley; Xiru Lyu; Galit Levi Dunietz; Paul C Schulz; Riley Bove; Ronald D Chervin; Henry L Paulson; Kerby Shedden

doi:10.1093/sleepadvances/zpae077

Sex-specific dementia risk in known or suspected obstructive sleep apnea: a 10-year longitudinal population-based study

Sleep Adv. 2024 Oct 22;5(1):zpae077. doi: 10.1093/sleepadvances/zpae077. eCollection 2024.

Authors

Tiffany J Braley^{1

2}, Xiru Lyu³, Galit Levi Dunietz¹, Paul C Schulz⁴, Riley Bove⁵, Ronald D Chervin¹, Henry L Paulson⁶, Kerby Shedden^{3

7}

Affiliations

¹ Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
² Division of Neuroimmunology, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
³ Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, USA.
⁴ Population Studies Center, Center for Social Research, University of Michigan, Ann Arbor, MI, USA.
⁵ Division of Neuroimmunology, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
⁶ Division of Cognitive Disorders, Department of Neurology, University of Michigan, Ann Arbor, MI, Michigan Alzheimer's Disease Center, Ann Arbor, MI, USA.
⁷ Department of Statistics, University of Michigan, Ann Arbor, MI, USA.

Abstract

Study objectives: To evaluate sex-specific associations between known or suspected obstructive sleep apnea (OSA) and dementia risk over 10 years among older women and men.

Methods: This study included 18 815 women and men age 50+ years (dementia-free at baseline) who participated in the Health and Retirement Study (HRS), a nationally representative cohort of US adults. Presence of OSA was defined by self-reported diagnosis or key HRS items that correspond to elements of a validated OSA screening tool (STOP-Bang). Incident dementia cases were identified using a validated, HRS-based algorithm derived from objective cognitive assessments. Survey-weighted regression models based on pseudo-values were utilized to estimate sex- and age-specific differences in cumulative incidence of dementia by OSA status.

Results: Data from 18 815 adults were analyzed, of which 9% of women and 8% of men (weighted proportions) met criteria for incident dementia. Known/suspected OSA was more prevalent in men than in women (weighted proportions 68% vs. 31%). Unadjusted sex-stratified analyses showed that known/suspected OSA was associated with higher cumulative incidence of dementia across ages 60-84 years for women and men. By age 80, relative to adults without known/suspected OSA, the cumulative incidence of dementia was 4.7% higher (CI 2.8%, 6.7%) for women with known/suspected OSA, and 2.5% (CI 0.5%, 4.5%) for men with known/suspected OSA, respectively. Adjusted associations between age-specific OSA and cumulative incidence of dementia attenuated for both women and men but remained statistically significant.

Conclusions: OSA contributes to dementia risk in older adults, particularly women. This study illuminates the impact of a potentially modifiable yet frequently overlooked risk factor for dementia onset.

Keywords: OSA; cognitive function; dementia; neurodegenerative disorders; neurological disorders; women’s health.