The Importance of Sleep Quality for Cognitive Health Throughout the Stages of Menopause

Galit L. Dunietz, PhD, MPH

At the 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina, Galit L. Dunietz, PhD, MPH, chaired the Sleep Matters for Women’s Health session, and presented a talk on the interplay between menopause, insomnia, and cognitive health. For years, clinicians have known that sleep is correlated with other late-life cognitive disorders, such as Alzheimer disease (AD), and are often some of the first presenting symptoms for these patients. Dunietz, an assistant professor in the Department of Neurology and Division of Sleep Medicine at the University of Michigan, has published several notable pieces in the field specifically looking at these associations.

She led a 2021 retrospective study that utilized Medicare claims data of 53,321 beneficiaries, aged 65 years and older with a diagnosis of obstructive sleep apnea (OSA), to assess the association between positive airway pressure (PAP) therapy, adherence, and incident diagnoses of AD, mild cognitive impairment, and dementia not otherwise specified (DNOS) in older adults. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD (odds ratio [OR], 0.78; 95% CI, 0.69-0.89) and DNOS (OR, 0.69; 95% CI, 0.55-0.85). Additionally, lower odds of MCI approaching a level of statistical significance were also observed among PAP users (OR, 0.82; 95% CI, 0.66-1.02).¹

NeurologyLive^® sat down with Dunietz at SLEEP 2022 to get insight on her talk and her previous research. She detailed the importance of continued longitudinal studies within this field, understanding the disparities in who may be more at-risk, as well as the knowns and unknowns about sleep and its association with late-life cognitive deficits.

NeurologyLive^®:Can you provide background on your presentation?

Galit Dunietz, MD: Our presentation is looking at the sleep of women along their lifespan. We’re focusing on the transitions aspect—when women transition reproductively from puberty to older adulthood, when they’re trying to conceive during their pregnancy, and also as they transition into menopause from the reproductive to postreproductive life. At every time point of that, we know sleep is vulnerable. These patients are at a higher risk for chronic comorbidities. In the symposium, we tried to cover those time periods and explain the metabolic and cognitive risks that women face as they transition through life.

Should neurologists be more involved with women during their stages of menopause?

As women transition into menopause, they are facing symptoms. They have hot flashes, they sweat, their sleep changes, and they experience mood disorders. All these symptoms have neurological origin. For women as they transition, in addition to seeing a gynecologist, they should also see a neurologist. It would be great if there was a subspecialty in neuro-gynecology.

Why were your findings regarding the association between PAP treatment and lower odds of incident AD so important to our community?

It’s important because our population is aging and there are going to be more adults in older phases of life. The burden of dementia is high. Currently, there’s no effective treatment for it. There’s a search for some life factors that could be modified. Sleep is a great candidate because sleep has a neurological origin. Dementia happens in the brain and there are some pathways that link sleep to cognitive impairment. If you have an underlying sleep disorder and you get treated for it, our paper shows that you’re able to reduce the risk. These are associations, but they are strong. It specifically focuses on obstructive sleep apnea, but there’s some evidence about insomnia that shows links with dementia and cognitive decline.

What do we know about the correlations between sleep and dementia? What is still left to be understood?

There are biological pathways between sleep and dementia, but we need to know more about the other dimensions of sleep, about the timing of sleep, the quality of sleep, variability of sleep, and how these patterns relate to dementia and cognitive decline. That’s the first thing we don’t know. The other thing is we need population-based studies, studies that require a long follow-up. It’s hard to follow [and] it’s expensive, but we need to try to think about how we can learn about sleep of adults as they age. We also need to retrospectively look at women and men, as well as racial and ethnic minorities. Most importantly to me, because my work is in women’s health, we need to look at the reproductive history of women and how it’s putting them at risk for sleep and later-life dementia. I think that sleep is a mediator, it mediates pathways between reproductive exposures and cognitive decline in women. Another thing we don’t know about men and reproductive aging. Men are going through aging as well, and are susceptible to dementia, but we don’t know how exactly reproductive aging in men contributes to the risk of dementia.

Can the odds of AD diagnosis differ among races and genders with obstructive sleep apnea?

We see that there are racial and ethnic disparities, as well as gender disparities in not only dementia, but in sleep. When you look at these associations and stratify them by race, you see that African American and Hispanic people are less likely to be treated if they’re diagnosed with obstructive sleep apnea and less likely to be adherent to treatment. At the same time, the disparities in dementia and cognitive health call for identification of some lifestyle factors that could help reduce the risk. We see about a 30% reduction in treatment among racial minorities in comparison to White [individuals]. Sleep is usually not a standalone, there’s a lot of comorbidities that come along with it. Some people are hit really hard and need to be taken care of.

What has stood out to you at this year’s SLEEP meeting?

There’s definitely more exposure to racial disparities and a focus on women’s health. I’m excited about both of those. There’s also an effort towards aging, [specifically,] how health aging is important and how sleep can help us age successfully.

Transcript was edited for clarity. Click here for more coverage of SLEEP 2022.

REFERENCES
1. Dunietz, GL, Chervin RD, Burke JF, Conceicao AS, Braley TJ. Obstructive sleep apnea treatment and dementia risk in older adults. Sleep. 2021;44(9):zsab076. doi:10.1093/sleep/zsab076