Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos

Stephen F Smagula; Gehui Zhang; Robert T Krafty; Alberto Ramos; Daniela Sotres-Alvarez; Juleen Rodakowski; Linda C Gallo; Melissa Lamar; Swathi Gujral; Dorothee Fischer; Wassim Tarraf; Yasmin Mossavar-Rahmani; Susan Redline; Katie L Stone; Hector M Gonzalez; Sanjay R Patel

doi:10.1016/j.sleh.2024.02.002

Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos

Sleep Health. 2024 Apr 30:S2352-7218(24)00027-5. doi: 10.1016/j.sleh.2024.02.002. Online ahead of print.

Authors

Stephen F Smagula¹, Gehui Zhang², Robert T Krafty³, Alberto Ramos⁴, Daniela Sotres-Alvarez⁵, Juleen Rodakowski⁶, Linda C Gallo⁷, Melissa Lamar⁸, Swathi Gujral⁹, Dorothee Fischer¹⁰, Wassim Tarraf¹¹, Yasmin Mossavar-Rahmani¹², Susan Redline¹³, Katie L Stone¹⁴, Hector M Gonzalez¹⁵, Sanjay R Patel¹⁶

Affiliations

¹ Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. Electronic address: smagulasf@upmc.edu.
² Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
⁴ Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida, USA.
⁵ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁷ Department of Psychology, University of California San Diego, San Diego, California, USA.
⁸ Institute of Minority Health Research, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.
⁹ Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁰ Department of Sleep and Human Factors Research, Institute for Aerospace Medicine, German Aerospace Center, Cologne, Germany.
¹¹ Institute of Gerontology, Wayne State University, Detroit, Michigan, USA.
¹² Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York, USA.
¹³ Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
¹⁴ California Pacific Medical Center Research Institute, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
¹⁵ Department of Neurosciences and the Shiley-Marcos Alzheimer's Disease Research Center, UC San Diego, San Diego, California, USA.
¹⁶ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

PMID: 38693044
DOI: 10.1016/j.sleh.2024.02.002

Abstract

Objectives: Many sleep-wake behaviors have been associated with cognition. We examined a panel of sleep-wake/activity characteristics to determine which are most robustly related to having low cognitive performance in midlife. Secondarily, we evaluate the predictive utility of sleep-wake measures to screen for low cognitive performance.

Methods: The outcome was low cognitive performance defined as being >1 standard deviation below average age/sex/education internally normalized composite cognitive performance levels assessed in the Hispanic Community Health Study/Study of Latinos. Analyses included 1006 individuals who had sufficient sleep-wake measurements about 2years later (mean age=54.9, standard deviation= 5.1; 68.82% female). We evaluated associations of 31 sleep-wake variables with low cognitive performance using separate logistic regressions.

Results: In individual models, the strongest sleep-wake correlates of low cognitive performance were measures of weaker and unstable 24-hour rhythms; greater 24-hour fragmentation; longer time-in-bed; and lower rhythm amplitude. One standard deviation worse on these sleep-wake factors was associated with ∼20%-30% greater odds of having low cognitive performance. In an internally cross-validated prediction model, the independent correlates of low cognitive performance were: lower Sleep Regularity Index scores; lower pseudo-F statistics (modellability of 24-hour rhythms); lower activity rhythm amplitude; and greater time in bed. Area under the curve was low/moderate (64%) indicating poor predictive utility.

Conclusion: The strongest sleep-wake behavioral correlates of low cognitive performance were measures of longer time-in-bed and irregular/weak rhythms. These sleep-wake assessments were not useful to identify previous low cognitive performance. Given their potential modifiability, experimental trials could test if targeting midlife time-in-bed and/or irregular rhythms influences cognition.

Keywords: Cognitive aging; Cognitive performance; Hispanic/Latino; Sleep; Sleep-wake rhythms.

Abstract

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