Poor objective sleep quality is associated with worse cognition cross‐sectionally and longitudinally in cognitively unimpaired adults
Bibliographic record
Abstract
Abstract Background Sleep disturbances are prevalent in Alzheimer’s disease (AD), with sleep quality being impaired already in the preclinical stages. Specifically, reduced sleep efficiency and sleep fragmentation have been cross‐sectionally associated with poor cognition in healthy older adults. However, there is limited knowledge of how objectively measured sleep features relate to cognitive change. We aimed to investigate the relationships of actigraphy‐measured sleep with both cross‐sectional and longitudinal cognition in a cohort of cognitively unimpaired (CU) adults at increased risk of AD. Method This study included 123 CU adults from the ALFASleep project (mean age 63.9 years, 60.2% females, 50.4% APOE‐ε4 carriers) without sleep medication use (Table 1). Correlates of sleep quality were measured using actigraphy (Actiwatch2®, Philips Respironics) for two weeks. We used separate multivariate linear regressions to assess the association between actigraphy‐derived sleep parameters: total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), and cognitive composite outcomes: Preclinical Alzheimer’s Cognitive Composite (PACC), and executive, memory and attention composites. We corrected all models for age, sex, APOE‐ε4, status, education and the time difference between cognitive and sleep assessments. Furthermore, we performed analyses on cognitive change from a previous visit (performed on average 3 years before) additionally adjusting by the time difference between two cognitive assessments. Results In cross‐sectional analyses, shorter TST was associated with lower PACC (p = 0.049) and executive composite (p = 0.039) scores. Also, lower sleep efficiency and higher WASO (indicating more nocturnal awakenings) were associated with lower performance on executive tasks (p = 0.015; p = 0.026) (Table 2). In longitudinal analyses, shorter TST was associated with poorer longitudinal performance in PACC and executive composite scores (p = 0.020). Conclusions Objectively measured indicators of poorer sleep quality are associated with poorer cognitive outcomes, both cross‐sectionally and longitudinally, in middle‐aged CU adults. Importantly, the executive function seems to be the most vulnerable to sleep impairment. Further research to unravel the underlying mechanisms using multi‐modal neuroimaging and CSF biomarkers of AD pathology is undergoing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".