Obstructive sleep apnea severity affects amyloid burden in cognitively normal elderly a longitudinal study

Recent evidence suggests that Obstructive Sleep Apnea (OSA) may be a risk factor for developing Mild Cognitive Impairment and Alzheimer’s disease. However, how sleep apnea affects longitudinal risk for Alzheimer’s disease is less well understood.Postprint (author's final draft

Injuries among Young Florida Athletes Playing Sports in Recreational Leagues

The purpose of this study was to identify the injury rates and mechanisms of sports injuries among 5-11-year-old athletes, and to provide preliminary guidance for decreasing injuries in this population. A total of 1511 athletes ages 5- 11 playing football, soccer, baseball and softball participated in our research. One certified athletic trainer (ATC) used Reporting Information Online (RIO) to collect the data on athletic exposure, injuries and injury mechanisms weekly during the 2016-2017 season in Hillsborough County, Florida. A total of 18 injuries occurred in practices or competitions. Football had the leading rate of injuries for both competitions and practices (1.18 and 0.68, per 1000 athlete-exposures respectively). Most injuries occurred during competition (66.7%) and the leading types of injuries were concussions (22.2%) and fractures (22.2%). The leading injury mechanisms were contact with another person (33.3%) and playing apparatus (33.3%). It is advantageous to have ATCs on site for initial injury evaluation and post injury management. Future studies should include additional study venues to provide more evidence on children’s sports injuries

Sleep oscillation-specific associations with Alzheimer’s disease CSF biomarkers : novel roles for sleep spindles and tau

Background: Based on associations between sleep spindles, cognition, and sleep-dependent memory processing, here we evaluated potential relationships between levels of CSF Aβ42, P-tau, and T-tau with sleep spindle density and other biophysical properties of sleep spindles in a sample of cognitively normal elderly individuals. Methods: One-night in-lab nocturnal polysomnography (NPSG) and morning to early afternoon CSF collection were performed to measure CSF Aβ42, P-tau and T-tau. Seven days of actigraphy were collected to assess habitual total sleep time. Results: Spindle density during NREM stage 2 (N2) sleep was negatively correlated with CSF Aβ42, P-tau and T-tau. From the three, CSF T-tau was the most significantly associated with spindle density, after adjusting for age, sex and ApoE4. Spindle duration, count and fast spindle density were also negatively correlated with T-tau levels. Sleep duration and other measures of sleep quality were not correlated with spindle characteristics and did not modify the associations between sleep spindle characteristics and the CSF biomarkers of AD. Conclusions: Reduced spindles during N2 sleep may represent an early dysfunction related to tau, possibly reflecting axonal damage or altered neuronal tau secretion, rendering it a potentially novel biomarker for early neuronal dysfunction. Given their putative role in memory consolidation and neuroplasticity, sleep spindles may represent a mechanism by which tau impairs memory consolidation, as well as a possible target for therapeutic interventions in cognitive decline

Obstructive Sleep Apnea Severity Affects Amyloid Burden in Cognitively Normal Elderly. A Longitudinal Study

Rationale: Recent evidence suggests that obstructive sleep apnea (OSA) may be a risk factor for developing mild cognitive impairment and Alzheimer’s disease. However, how sleep apnea affects longitudinal risk for Alzheimer’s disease is less well understood. Objectives: To test the hypothesis that there is an association between severity of OSA and longitudinal increase in amyloid burden in cognitively normal elderly. Methods: Data were derived from a 2-year prospective longitudinal study that sampled community-dwelling healthy cognitively normal elderly. Subjects were healthy volunteers between the ages of 55 and 90, were nondepressed, and had a consensus clinical diagnosis of cognitively normal. Cerebrospinal fluid amyloid β was measured using ELISA. Subjects received Pittsburgh compound B positron emission tomography scans following standardized procedures. Monitoring of OSA was completed using a home sleep recording device. Measurements and Main Results: We found that severity of OSA indices (AHIall [F1,88 = 4.26; P < 0.05] and AHI4% [F1,87 = 4.36; P < 0.05]) were associated with annual rate of change of cerebrospinal fluid amyloid β42 using linear regression after adjusting for age, sex, body mass index, and apolipoprotein E4 status. AHIall and AHI4% were not associated with increases in ADPiB-mask (Alzheimer’s disease vulnerable regions of interest Pittsburg compound B positron emission tomography mask) most likely because of the small sample size, although there was a trend for AHIall (F1,28 = 2.96, P = 0.09; and F1,28 = 2.32, not significant, respectively). Conclusions: In a sample of cognitively normal elderly, OSA was associated with markers of increased amyloid burden over the 2-year follow-up. Sleep fragmentation and/or intermittent hypoxia from OSA are likely candidate mechanisms. If confirmed, clinical interventions for OSA may be useful in preventing amyloid build-up in cognitively normal elderly

Obstructive sleep apnea severity affects amyloid burden in cognitively normal elderly a longitudinal study

Recent evidence suggests that Obstructive Sleep Apnea (OSA) may be a risk factor for developing Mild Cognitive Impairment and Alzheimer’s disease. However, how sleep apnea affects longitudinal risk for Alzheimer’s disease is less well understood

The Relationship between Obstructive Sleep Apnea and Alzheimer’s Disease

Obstructive sleep apnea (OSA) and Alzheimer’s disease (AD) are highly prevalent conditions with growing impact on our aging society. While the causes of OSA are now better characterized, the mechanisms underlying AD are still largely unknown, challenging the development of effective treatments. Cognitive impairment, especially affecting attention and executive functions, is a recognized clinical consequence of OSA. A deeper contribution of OSA to AD pathogenesis is now gaining support from several lines of research. OSA is intrinsically associated with disruptions of sleep architecture, intermittent hypoxia and oxidative stress, intrathoracic and hemodynamic changes as well as cardiovascular comorbidities. All of these could increase the risk for AD, rendering OSA as a potential modifiable target for AD prevention. Evidence supporting the relevance of each of these mechanisms for AD risk, as well as a possible effect of AD in OSA expression, will be explored in this review

Characterization of older, cognitively normal obstructive sleep apnea patients at risk of prospective cognitive decline using the NIA‐AA Research Framework

Background The association between Obstructive Sleep Apnea (OSA) and cognition in older‐adults is conflicting. We determined to characterize older OSA‐patients using the NIA‐AA Research Framework and test whether OSA accelerates cognitive decline in preclinical Alzheimer’s disease (AD) Method Community‐dwelling cognitively normal elderly participating on a study on memory, sleep and aging, with baseline AD biomarker data and both baseline and follow‐up neuropsychological data were included. OSA was defined using AHI4%. Data‐driven, clinically relevant thresholds for CSF‐Aβ42 (≤375pg/ml), and CSF P‐tau (≥53.7pg/ml) indicated OSA participants AT(N) status using the NIA‐AA Research Framework. Twenty‐four participants with non‐AD pathologic change defined as A‐T+ were excluded leaving 127 for the analysis. Main outcome was the annual rate‐of‐change in global cognition (calculated as an average composite Z‐score of episodic memory, language and executive function cognitive tests domains). Linear mixed‐effects models with random intercept and slope were used to assess associations between AT(N) characterized OSA subjects, and longitudinal changes in global cognition, controlling for age‐at‐baseline, sex, APOE4‐status, years‐of‐education, and their interactions with time. Result Of the 127 participants, 81 (63.8%) were women. The mean (SD) age was 69.6 (7.3) years and follow‐up time was 2.46 (0.64) years. Eight (6.3%) met biomarker criteria for AD (OSA+/A+/T+ [n=4] and OSA‐/A+/T+ [n=4]). Forty‐four participants (34.6%) were amyloid positive (OSA+/A+ [n=20] and OSA‐/A+ [n=24]). Sixteen (12.6%) were OSA+/A+/T‐, and 20 (15.7%) were OSA‐/A+/T‐. Eighty‐three (63.4%) had normal AD biomarkers (OSA+/A‐/T‐ [n=40] and OSA‐/A‐/T‐ [N=43]). Regardless of OSA status, relative to normal AD biomarkers, amyloid positive participants i.e. AD pathologic change, showed significant faster rate‐of‐decline in global cognition (β = −0.066, 95%CI, −0.088, −0.046; P < .001). However, OSA+/A+/T‐ participants showed even more significantly faster rate‐of‐decline in global cognition compared to OSA‐/A+/T‐ participants (β = −0.042, 95%CI, −0.063, −0.019; P < .001), suggesting an OSA/Aβ42 synergism independent of PTau. OSA+/A‐/T‐ or OSA‐/A‐/T‐ participants (normal AD biomarkers) did not show any significant cognitive change over time. Conclusion Among amyloid positive healthy‐elderly, OSA and Aβ demonstrate synergism related to cognitive decline that might be independent of tau deposition. Clinical trials in a population of elderly OSA cognitive‐normal individuals should target at minimum persons with Alzheimer’s pathologic change

Ambient Stimuli Perpetuate Nighttime Sleep Disturbances in Hospital Patients With TBI

Background and Objectives: The effect of the ambient environment, sound, light, and movement, on the nighttime rest-activity of patients hospitalized with moderate-severe traumatic brain injury (TBI) is poorly understood. The purpose of this study was to examine how sound, light, and movement in these patients' hospital rooms may contribute to nighttime awakenings. Methods: An observational design was used with 18 adult participants on a neuroscience step-down unit diagnosed with moderate-severe TBI. For up to five consecutive nights, actigraphy was used to capture nighttime awakenings while a custom-made multisensory device captured sound, light, and movement exposures in the participant's room. Results: Participants were awake for 24% (or about 3 hr) of the time during the designated nighttime period of 8 pm to 8 am. Average nighttime exposures of sound was 52 dB, light was nine lumens, and movement, measured as a proportion, was 0.28% or 28%. With each stimuli exposure set at its average, there was a 20% probability of participant nighttime awakenings. Clinically meaningful reductions of movement in and out the participant's room and elevated sound significantly decreases the participant's probability of nighttime awakenings (p < .05), but reductions in light did not. Conclusion: The ambient environment seems to impede restful sleep in immediate post-injury phase of patients with moderate-severe TBI

Injuries and concussions among young children, ages 5-11, playing sports in recreational leagues in Florida.

BackgroundThe specific research aims of this study included: 1) Conduct an epidemiologic analysis of recreational sports injuries among 1500 children, ages 5-11 in Florida: and 2) Utilize the computerized pediatric concussion tool from ImPACT Applications, Inc. for baseline and follow-up testing to better understand these injuries. This research followed a prospective surveillance design utilizing a large cohort of children, ages, 5-11, who play recreational football, soccer, and baseball/softball in Florida. The study venue was a large athletic facility in Hillsborough County, Florida. The sports observed were soccer (girls' and boys'), baseball, softball, and football. Internal and external advisory boards were consulted throughout the study.MethodsCertified Athletic Trainers (ATCs) were hired to use High School Reporting Information Online (RIO) for injuries and the Ipad-administered pediatric concussion tool developed by ImPACT Applications, Inc for baseline/follow-up concussion data.ResultsOver the course of the project, 26 RIO-reported injuries were reported. Football and soccer produced the greatest rate of injuries. There were 12 concussions which comprised nearly half of all the RIO injuries (46%). We conducted 882 baseline concussion tests and 13 follow-up tests over the 2 years.ConclusionsTo the best of our knowledge, this is the first time data have been collected and reported on sports injuries in the study population. Future studies built on these findings will allow for the development of targeted guidelines and interventions for coaches, players, and parents so sports injury-related morbidity and mortality decrease in our youngest athletes

Effect of APOE genotype on the Association between Sleep Disturbance and Cognition across Racial/Ethnic groups

Background APOE alleles are associated with cognitive‐decline and Alzheimer’s disease in Whites. We examined the effect of APOE‐genotype on the association between sleep disturbance (SD) and cognition across racial/ethnic groups. Method We conducted a cross‐sectional analysis of baseline data on 10,254 (i.e., 7900 non‐Hispanic Whites, 1428 Black/African‐Americans, 627 Hispanics and 299 Asians) cognitive‐normal subjects from the National Alzheimer’s Coordinating Center Uniform Dataset. We characterized SD using an item on the Neuropsychiatric Inventory‐Questionnaire. Generalized linear models examined SD‐group differences (i.e., SD vs. no SD) on psychometric tests performance between‐and‐within racial categories. The interactive associations of APOE genotype, SD, and race on psychometric tests performance was also examined. All models included age, sex, education, hypertension, and diabetes. Result Overall, the mean (sd) age was 71.1 (10.3) years and education was 15.7 (3.0) years. Prevalence of SD was 10% (Whites), 6.1% (Blacks), 18.2% (Hispanics), and 7.4% (Asians). SD subjects were at increased risk for worse psychometric scores in: executive, and language domains (p < 0.02 for all) among Whites; language domain (p = 0.001) among Blacks; memory, executive, and language domains (p ≤0.05 for all) among Hispanics; and visuospatial memory domain (p ≤0.001) among Asians. The interactive associations of APOE genotype, SD, and race on psychometric tests performance were significant (p ≤0.001 for all). Within racial groups, only Hispanic SD subjects with 1 or 2 APOE ε4 alleles were at increased risk for worse psychometric scores in memory, executive function, visuospatial, attention, processing speed and language domains (p ≤0.001 for all). Compared to Whites and Asians, Hispanic and Black SD subjects were at increased risk for worse psychometric scores across all domains (p ≤0.001 for all), regardless of APOE‐ε4 status. Conclusion In this sample of cognitive‐normal older‐adults, SD subjects were at increased risk for worse psychometric scores in specific cognitive domains that varied by race/ethnicity. Hispanic and Black SD subjects were at increased risk for worse psychometric scores regardless of APOE‐ε4 status. APOE‐ε4 effect on SD‐cognition association worsened psychometric scores and occurred only within Hispanics. These findings suggest that APOE‐ε4 interacts with sleep to effect varying cognitive domain outcomes within‐and‐between racial/ethnic groups