Sleep Apnea and Cognition in Older Adults

Nearly a third of older adults experience difficulty initiating or maintaining sleep and nearly half have sleep apnea. However, current reliance on gold-standard in-lab polysomnography has been a barrier to detecting, quantifying, and measuring these sleep problems. Polysomnography is difficult for many older adults to tolerate, requires specialized technologists to obtain and analyze the recordings, is labour intensive and expensive, and not widely available in many jurisdictions, all of which impede use by primary care clinicians or end-users. Recent advances in wearable sensor development have led to a new generation of wearable sensors that have good potential to overcome these barriers.

Accumulating evidence suggests that poor sleep quality increases the risk of cognitive impairment and dementia, however studies in older adults linking objectively measured sleep function with comprehensive cognitive testing are lacking. The primary objective of this cross-sectional study is to examine the association of several objectively measured sleep parameters (e.g., sleep apnea) with cognitive performance.

The Advanced NeoNatal Epidermal (ANNE) Vital Sign System was created for the purposes of providing real-time vital signs monitoring in the paediatric intensive care unit. The ANNE Vital Sign System integrates simultaneous synchronized ambulatory measurement of electrocardiography, photoplethysmography with derived pulse oximetry, pulse arrival time with derived beat-to-beat blood pressure, triaxial accelerometry, respiratory rate, and temperature, to enable accurate measurement of sleep apnea. The characteristics that make the ANNE Vital Sign System ideal for use in children (non-invasive, flexible, ease of use, comfort, skin safety) also make it ideal for use in adults. Compelling in-laboratory preliminary data from our collaborator at Sunnybrook Research Institute (SRI) has demonstrated the capacity for ANNE to detect and characterize sleep apnea in older adults.

After the informed consent process, participants will complete a 1-hour battery of cognitive tests. If participants have completed the same set of cognitive tests in the past year at SRI no cognitive testing will take place.

Following testing, participants will be shown how to affix and remove the sensors to their chest and dominant index finger (or non-dominant if dominant is not available) according to manufacturer recommendations. Participants will be given the device to take home and asked to wear the sensors for a 24-hour period. They will also be provided with ANNE chest adhesive, ANNE limb adhesive, and a clinical waterproof 3M Tegaderm dressing. Participation in the study concludes after the device is worn for the 24-hour period.

Though there are no substantial benefits for participants, this study may lead to a better understanding of the association between sleep apnea and cognition in older adults. Given that poor sleep quality is a risk factor for dementia, there is a need to better characterize the relationship between objective sleep parameters and cognition.

Inclusion criteria

• Sufficient knowledge of English to understand and provide informed consent
• Competent to provide consent
• Aged 55-85, Male and Female
• ≥ 8 years of education
• Capable of cooperating for the duration of the study procedures and assessments
• No frank cognitive impairment or dementia
• Sufficient (corrected) vision to participate in cognitive testing
• Sufficient (corrected) hearing to participate in cognitive testing

Exclusion criteria

• Cannot read and comprehend English language instructions
• Major cardio- or cerebro-vascular event (heart attack, stroke, significant white matter changes)
• Unstable diseases (e.g., pulmonary, endocrine disorder)
• Active malignancy or infectious diseases
• History of significant learning disability
• Major psychiatric/neurologic/degenerative disorder, including a diagnosis of mild cognitive impairment or dementia
• History of significant head trauma or recurrent concussions requiring hospitalization followed by persistent neurologic defaults or known structural brain abnormalities
• Pain or sleep disorder that could interfere with cognitive testing
• Major medical concerns that might interfere with cognitive testing
• Recent history of substance/drug abuse
• Known nickel allergy
• Known cardiac implantable device
• Known arrhythmias
• Outside the included age range
• Pregnant or breast feeding
• Otherwise unable to use the ANNE sensors; for example, finger amputations.