Daytime Sleepiness Is Associated with Lower Cognitive Scores: The Look AHEAD Study

K M Hayden; A Anderson; A P Spira; M-P St-Onge; J Ding; M Culkin; D Molina-Henry; A H Sanderlin; D Reboussin; J Bahnson; M A Espeland

doi:10.14283/jarlife.2023.9

Daytime Sleepiness Is Associated with Lower Cognitive Scores: The Look AHEAD Study

JAR Life. 2023 Jun 26:12:46-55. doi: 10.14283/jarlife.2023.9. eCollection 2023.

Authors

K M Hayden¹, A Anderson², A P Spira^{3

4

5}, M-P St-Onge⁶, J Ding⁷, M Culkin¹, D Molina-Henry^{8

9}, A H Sanderlin^{7

10}, D Reboussin², J Bahnson², M A Espeland^{2

7}

Affiliations

¹ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
² Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
³ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁵ Johns Hopkins Center on Aging and Health, Baltimore, MD, USA.
⁶ Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
⁷ Department of Internal Medicine, Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁸ Winston-Salem State University, Winston-Salem, NC, USA.
⁹ University of Southern California, Alzheimer's Therapeutic Research Institute, San Diego, CA, USA.
¹⁰ Department of Biology, North Carolina Agricultural and Technical State University, Greensboro, NC, USA.

Abstract

Background: Daytime sleepiness is common in older adults and may result from poor nighttime sleep due to sleep disordered breathing, fragmented sleep, or other sleep disorders. Daytime sleepiness may be associated with cognition in older adults.

Objectives: We investigated the association between self-reported daytime sleepiness and cognitive function in the Look AHEAD clinical trial.

Design: Observational follow-up of a randomized clinical trial of an intensive lifestyle intervention.

Setting: Clinic.

Participants: Participants (n=1,778) aged 45-76 years at baseline with type 2 diabetes and overweight or obesity.

Interventions: Participants were randomized to an intensive lifestyle intervention for weight loss or a control condition of diabetes support and education.

Measurements: Participants provided self-reported levels of daytime sleepiness at baseline and years 12-13. Cognitive function was assessed with a neurocognitive battery at years 12-13 and 18-20.

Results: Participants who reported having frequent daytime sleepiness (often or always) performed significantly worse than others on the cognitive composite (-0.35; p-value=0.014) after controlling for covariates. When stratified by intervention arm, participants assigned to the intensive lifestyle intervention who reported often/always having daytime sleepiness performed worse on Digit Symbol Coding (-0.63; p-value=0.05) and Trail Making Part-B (-0.56; p-value=0.02) after controlling for covariates. Statistical interactions revealed associations between daytime sleepiness and the following covariates: race and ethnicity, APOE ε4 carrier status, baseline history of cardiovascular disease, and depression.

Conclusions: Daytime sleepiness over ~13 years predicted poorer cognitive performance in older individuals who, by virtue of having diabetes and overweight/obesity, are at high risk for sleep disorders and cognitive impairment.

Keywords: Sleep disorders; aging; cognition disorders; diabetes mellitus; obesity; overweight; type 2.

Grants and funding

Funding: Look AHEAD was funded by the National Institutes of Health through cooperative agreements with the National Institute on Aging and National Institute of Diabetes and Digestive and Kidney Diseases: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. Additional funding was provided by the National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; NIH Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service (I.H.S.) provided personnel, medical oversight, and use of facilities. The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the I.H.S. or other funding sources. Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center (M01RR01066); the Harvard Clinical and Translational Science Center (RR025758-04); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (GCRC) (M01RR000056), the Clinical Translational Research Center (CTRC) funded by the Clinical & Translational Science Award (UL1 RR 024153) and NIH grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The National Institute of Aging provided funding for the Look AHEAD Mind ancillary study (R01AG058571) and the Look AHEAD Sleep ancillary (R01AG074562). MSPO was funded from R35HL155670. The following organizations have committed to make major contributions to Look AHEAD: FedEx Corporation; Health Management Resources; LifeScan, Inc., a Johnson & Johnson Company; OPTIFAST® of Nestle HealthCare Nutrition, Inc.; Hoffmann-La Roche Inc.; Abbott Nutrition; and Slim-Fast Brand of Unilever North America. Some of the information contained herein was derived from data provided by the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene.